Oklahoma § 74-1306.2 - Information regarding utilization review - Submission

§ 74-1306.2. Information regarding utilization review - Submission

to Commissioner.

A. The Oklahoma Health Care Authority shall submit to the

Insurance Commissioner the following information regarding

utilization review performed by employees of the Authority:

1. A utilization review plan that includes:

a.

an adequate summary description of review standards,

protocol and procedures to be used in evaluating

proposed or delivered hospital and medical care,

b.

assurances that the standards and criteria to be

applied in review determinations are established with

input from health care providers representing major

Oklahoma Statutes - Title 74. State Government

areas of specialty and certified by the boards of the

various American medical specialties, and

c.

the provisions by which patients or health care

providers may seek reconsideration or appeal of

adverse decisions concerning requests for medical

evaluation, treatment or procedures;

2. The type and qualifications of the personnel either employed

or under contract to perform the utilization review;

3. The procedures and policies to ensure that an employee of

the Authority is reasonably accessible to patients and health care

providers five (5) days a week during normal business hours, such

procedures and policies to include as a requirement a toll-free

telephone number to be available during such business hours;

4. The policies and procedures to ensure that all applicable

state and federal laws to protect the confidentiality of individual

medical records are followed;

5. The policies and procedures to verify the identity and

authority of personnel performing utilization review by telephone;

6. A copy of the materials designed to inform applicable

patients and health care providers of the requirements of the

utilization review plan;

7. The procedures for receiving and handling complaints by

patients, hospitals and health care providers concerning utilization

review; and

8. Procedures to ensure that after a request for medical

evaluation, treatment, or procedures has been rejected in whole or

in part and in the event a copy of the report on such rejection is

requested, a copy of the report of the personnel performing

utilization review concerning the rejection shall be mailed by the

insurer, postage prepaid, to the ill or injured person, the treating

health care provider, hospital or to the person financially

responsible for the patient’s bill within fifteen (15) days after

receipt of the request for the report.

B. The Authority shall pay an annual fee to the Insurance

Commissioner of Five Hundred Dollars ($500.00).

Added by Laws 1991, c. 294, § 17, eff. Nov. 1, 1991. Amended by

Laws 2012, c. 304, § 938; Laws 2024, c. 123, § 2, eff. July 1, 2024.