Oklahoma § 63-5011.1 - State-purchased health care benefits – Optometrists to

§ 63-5011.1. State-purchased health care benefits – Optometrists to

be permitted to provide vision care or medical diagnosis and

treatment of the eye.

A. All state-purchased and state-subsidized health care benefit

plans, including but not limited to Medicaid, which offer services

for vision care or medical diagnosis and treatment for the eye shall

allow optometrists to be providers of those services. Such statepurchased and state-subsidized health care benefit plans shall also

require equal payment for the same services provided by an

optometrist if the services are within the scope of practice of

optometry.

B. With respect to optometric services, any state-purchased and

state-subsidized health care benefit plan, including but not limited

to Medicaid, which uses a gatekeeper or equivalent for referrals for

services for vision care or for medical diagnosis and treatment of

the eye, shall require such covered services be provided on a

referral basis within the medical group or network at the request of

an enrollee who has a condition requiring vision care or medical

diagnosis and treatment of the eye if:

1. A referral is necessitated in the judgment of the primary

care physician; and

2. Treatment for the condition falls within the licensed scope

of practice of an optometrist.

C. All state-purchased and state-subsidized health care benefit

plans shall have a defined set of standards and procedures for

selecting providers, including specialists, to serve enrollees. The

standards and procedures shall be drafted in such a manner that they

are applicable to all categories of providers and shall be utilized

by the health plan in a manner that is without bias for or

discrimination against a particular category or categories of

providers.

D. No health care benefit plan specified by this section shall

require a provider to have hospital privileges if hospital

privileges are not usual and customary for the services the provider

provides.

Oklahoma Statutes - Title 63. Public Health and Safety

E. Nothing in this section shall be construed to:

1. Prohibit any state-purchased and state-subsidized health

care benefit plan which offers services for vision care or medical

diagnosis and treatment for the eye from determining the adequacy of

the size of its network;

2. Prohibit an optometrist from agreeing to a fee schedule;

3. Limit, expand, or otherwise affect the scope of practice of

optometry; or

4. Alter, repeal, modify or affect the laws of this state

except where such laws are in conflict or are inconsistent with the

express provisions of this section.

F. Existing state-purchased and state-subsidized health care

benefit plans shall comply with the requirements of this section

upon issuance or renewal on or after the effective date of this act.

Added by Laws 2000, c. 54, § 3, eff. Nov. 1, 2000.