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0 chapters · 1,670 sections in this title.
36 O.S. § 6563 Liability - Construction of act
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Nothing in the Hospital and Medical Services Utilization Review Act shall be deemed to reduce or expand the liability of any person or entity for any actions or activities with respect to utilization review. Added by Laws 1991, c. 294, § 13, eff. Nov. 1, 1991.
36 O.S. § 6564 Examination of affairs of private review agent
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Whenever the Insurance Commissioner deems it to be prudent for the benefit of the insureds, health care providers, or insurers, the Commissioner or any person designated by the Commissioner may visit and examine the affairs of any private review agent to determine if the agent is…
36 O.S. § 6565 Civil fines
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For any violation of the provisions of the Hospital and Medical Services Utilization Review Act or any rule adopted pursuant thereto, the Insurance Commissioner may, upon notice and hearing, subject a person or entity to a civil fine of not less than One Hundred Dollars ($100.00)…
36 O.S. § 6570.1 Definitions
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As used in this act: 1. "Adverse determination" means a determination by a health carrier or its designee utilization review entity that an admission, availability of care, continued stay, or other health care service that is a covered benefit has been reviewed and, based upon th…
36 O.S. § 6570.10 Prior authorization granted under former health plan —
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Time frame to honor — Review. A. On receipt of information documenting a prior authorization from the enrollee or from the enrollee's health care provider, a utilization review entity shall honor a prior authorization granted to an enrollee from a previous utilization review enti…
36 O.S. § 6570.11 Severability
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If any provision of this act or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of the act which can be given effect without the invalid provision or application, and to this end, the provisi…
36 O.S. § 6570.2 Utilization review entities — Duties
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A utilization review entity shall make any current prior authorization requirements and restrictions, including written clinical criteria, readily accessible on its website to enrollees and health care providers. Prior authorization requirements shall be described in detail but a…
36 O.S. § 6570.3 Adverse determinations to be made by physician or
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licensed mental health professional. A utilization review entity shall ensure that all adverse determinations are made by a physician or licensed mental health professional. The physician or licensed mental health professional shall: 1. Possess a current and valid nonrestricted l…
36 O.S. § 6570.4 Appeals to be reviewed by physician or licensed mental
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health professional. A utilization review entity shall ensure that all appeals are reviewed by a physician or licensed mental health professional. The physician or licensed mental health professional shall: 1. Possess a current and valid unrestricted license in any United States …
36 O.S. § 6570.5 Prior Authorization Application Programming Interface
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requirement. A. For plan years beginning on or after January 1, 2027, a health benefit plan must implement and maintain a Prior Authorization Application Programming Interface (API), as described in 45 C.F.R. Part 156. B. By July 1, 2027, health care providers must have electroni…
36 O.S. § 6570.50 Definitions
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As used in this act: 1. "Adverse determination" means a determination by a health carrier, pharmacy benefits manager (PBM), or its designee utilization review entity that a prescription drug that is a covered benefit has been reviewed and, based upon the information provided, doe…
36 O.S. § 6570.51 Online accessibility for prescription drug prior
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authorization requirements, restrictions, and formularies. A utilization review entity shall make any current prescription drug prior authorization requirements and restrictions, including written clinical criteria, readily accessible on its website to enrollees and health care p…
36 O.S. § 6570.52 Adverse determinations to include alternative
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prescription drugs — Qualifications of reviewers. A utilization review entity shall ensure that all adverse determinations include alternative prescription drugs covered by the health plan's formulary and are made by a physician, pharmacist, or licensed mental health professional…
36 O.S. § 6570.53 Review of appeals — Qualifications of reviewers
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A utilization review entity shall ensure that all appeals are reviewed by a physician, pharmacist, or licensed mental health professional. The physician, pharmacist, or licensed mental health professional shall: 1. Possess a current and valid unrestricted license in any United St…
36 O.S. § 6570.54 Timeframes for prior authorizations
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A. If a utilization review entity requires prior authorization of a prescription drug, the utilization review entity shall make a prior authorization or adverse determination and notify the enrollee and the enrollee's health care provider of the prior authorization or adverse det…
36 O.S. § 6570.55 Prior authorization not required for emergency
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services. A utilization review entity shall not require prior authorization for prescription drugs administered as a part of the provision of emergency health care services. Added by Laws 2025, c. 447, § 7, eff. Nov. 1, 2025.
36 O.S. § 6570.56 Timeframe for validity of prior authorizations for
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chronic conditions. A. If a prior authorization is required for a prescription drug for the treatment of a chronic condition of an enrollee, and the enrollee remains on the same health plan, then the prior authorization shall remain valid for three (3) years from the date the hea…
36 O.S. § 6570.57 Continuity of prior authorizations during health plan
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changes. A. On receipt of information documenting a prior authorization from the enrollee or from the enrollee's health care provider, a utilization review entity shall honor a prior authorization granted to an enrollee from a previous utilization review entity for at least the i…
36 O.S. § 6570.58 Violations — Penalties
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A. 1. The Insurance Commissioner may, if the Commissioner finds that any person or organization has violated the provisions of this act, impose a penalty of not more than Five Thousand Dollars ($5,000.00) for each such violation. Such penalties may be in addition to any other pen…
36 O.S. § 6570.59 Application to Oklahoma Medicaid State Plan
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This act shall apply to the Oklahoma Medicaid State Plan. Added by Laws 2025, c. 447, § 11, eff. Nov. 1, 2025.
36 O.S. § 6570.6 Time frame to make prior authorization or adverse
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determination. A. If a utilization review entity requires prior authorization of a health care service, the utilization review entity must make a prior authorization or adverse determination and notify the enrollee and the enrollee's health care provider of the prior authorizatio…
36 O.S. § 6570.7 Services not requiring prior authorization — Time frame
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to notify utilization review entity of such services. A. A utilization review entity shall not require prior authorization for pre-hospital transportation, for the provision of emergency health care services, or for transfers between facilities as required by the Emergency Medica…
36 O.S. § 6570.8 Time frame in which prior authorization may not be
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altered — Contracted payment rate requirement and exceptions. A. A health benefit plan may not revoke, limit, condition, or restrict a prior authorization if care is provided within forty-five (45) business days from the date the health care provider received the prior authorizat…
36 O.S. § 6570.9 Treatment of chronic conditions — Validity period for
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prior authorization of inpatient and non-inpatient care. A. If a prior authorization is required for a health care service, other than for inpatient care, for the treatment of a chronic condition of an enrollee, then the prior authorization shall remain valid for at least six (6)…
36 O.S. § 6571 Determination of average area or customary and reasonable
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charges - Disclosure to health care provider of information used. A. As used in this section: 1. "Health care provider" means any person, firm, corporation or other legal entity that is licensed, certified or otherwise authorized by the laws of this state to provide health care s…
36 O.S. § 6581 Uniform health claim forms - Uniform billing forms -
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Rules. A. On or before January 1, 1994, the Insurance Commissioner shall develop and adopt: 1. Uniform health care claim forms for use by all health care providers and carriers in the state; and 2. Uniform standards and procedures for processing such claim forms in electronic and…
36 O.S. § 6591 Short title - Declaration of necessity
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A. Sections 1 through 6 of this act shall be known and may be cited as the "Managed Health Care Reform and Accountability Act". B. The Legislature hereby declares that the public good and the general welfare of the citizens of this state require the enactment of this measure unde…
36 O.S. § 6592 Definitions
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For purposes of this act: 1. "Enrollee" means an individual who is enrolled in a health care plan, including covered dependents; 2. "Health care plan" means any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the costs of any h…
36 O.S. § 6593 Duty of health care entity to exercise ordinary care -
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Liability for damages - Application of act. A. A health insurance carrier, health maintenance organization, or other managed care entity for a health care plan has the duty to exercise ordinary care when making health care treatment decisions and shall be liable for damages for h…
36 O.S. § 6594 Prerequisites to maintaining cause of action - Exhaustion
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of appeal and review process and all applicable remedies - Notice. A. A person may not maintain a cause of action under this act against a health insurance carrier, health maintenance organization, or other managed care entity unless the affected enrollee or the representative of…
36 O.S. § 6595 Class action
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No cause of action brought pursuant to this act shall be certified as a class action. Added by Laws 2000, c. 163, § 5, eff. July 1, 2000.
36 O.S. § 6596 Application of Section 9.1 of Title 23 to cause of action
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brought under act. Subparagraph c of paragraph 2 of subsection C of Section 9.1 of Title 23 of the Oklahoma Statutes shall not apply to any cause of action brought under the Managed Health Care Reform and Accountability Act. Added by Laws 2000, c. 163, § 6, eff. July 1, 2000.
36 O.S. § 660.1 Definitions
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As used in this act, unless the context otherwise requires: 1. "Board" means the board of directors of a converting mutual insurer; 2. "Conversion" means a process by which a domestic mutual insurer is converted to a domestic stock insurer as part of a reorganization; 3. "Convert…
36 O.S. § 660.10 Organization of mutual holding company — Requirements
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A mutual holding company that results from the reorganization of a domestic mutual insurance company organized under this act must be organized in accordance with Title 18 of the Oklahoma Statutes. The articles of incorporation, and any amendments to those articles, of the mutual…
36 O.S. § 660.11 Policyholder membership interests
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A. The membership interests of the policyholders of the resulting company become membership interests in the mutual holding company. Eligible members of the converting company become members of the mutual holding company in accordance with the articles of incorporation and bylaws…
36 O.S. § 660.12 Initial shares — Majority of voting shares
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A. As used in this section: 1. "Intermediate holding company" means a holding company that: a. is a subsidiary of a mutual holding company formed to reorganize a mutual insurance company, and b. directly or through a subsidiary intermediate holding company, owns the resulting com…
36 O.S. § 660.13 Foreign mutual insurance company — Reorganization
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requirements. A. On the approval of the Oklahoma Insurance Commissioner, a foreign mutual insurance company may reorganize in compliance with the requirements of any law or regulation applicable to the foreign mutual insurance company by: 1. Transferring its members' membership i…
36 O.S. § 660.2 Effect of conversion
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A. On the effective date of a plan of reorganization, all of the following occur: 1. The converting mutual insurer becomes a converted stock insurer. The amended or restated articles of incorporation and bylaws of the converting mutual insurer shall be filed with the Oklahoma Ins…
36 O.S. § 660.3 Reorganization — Filing of documents — Approval by
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Commissioner. A. A domestic mutual insurer may engage in a conversion as part of a reorganization as a mutual holding company, only if the board passes a resolution that the reorganization is fair and equitable to the policyholders and adopts a plan that meets the requirements of…
36 O.S. § 660.4 Reorganization plan — requirements
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A plan of reorganization of a domestic mutual insurer shall include all of the following: 1. A statement of the reasons for the proposed action; 2. A description of how the plan will be carried out, including any transaction included within the plan and a description of any mutua…
36 O.S. § 660.5 Commissioner review
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A. The Oklahoma Insurance Commissioner shall review a plan of reorganization that is submitted to the Commissioner. On review, the Commissioner shall approve the plan if the Commissioner finds all of the following: 1. The applicable provisions of this act, and other applicable pr…
36 O.S. § 660.6 Mutual holding company — Jurisdiction — Member rights
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and obligations. A. A mutual holding company is not an insurer for the purposes of this act. B. A mutual holding company may not dissolve or liquidate without approval by the Oklahoma Insurance Commissioner or unless required by judicial order. The Commissioner retains jurisdicti…
36 O.S. § 660.7 Multiple mutual insurers — Joint application and plan
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The concurrent reorganization of a domestic mutual insurer with one or more mutual insurers, domestic or foreign, into a single mutual insurance holding company, whether domestic or foreign, may be accomplished by a joint application and a joint plan of reorganization and may be …
36 O.S. § 660.8 Converting insurer — Holding company formation — Rights
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and obligations. A. A converting company, on approval by the Oklahoma Insurance Commissioner, may reorganize by forming a holding company based on a mutual plan and continuing the corporate existence of the converting company as a stock insurance company. B. A mutual holding comp…
36 O.S. § 660.9 Proposed reorganization plan — Commissioner review as
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alternate conversion plan. A. The Oklahoma Insurance Commissioner shall review the proposed plan of reorganization as an alternate conversion plan. The Commissioner may require as a condition of approval modifications of the proposed plan of reorganization that the Commissioner d…
36 O.S. § 6650 Short title
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Sections 2 through 13 of this act shall be known and may be cited as the “Vehicle Protection Product Act”. Added by Laws 2008, c. 353, § 2, eff. Jan. 1, 2009.
36 O.S. § 6651 Definitions
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As used in the Vehicle Protection Product Act: 1. "Administrator" means a third party other than the warrantor who is designated by the warrantor to be responsible for the administration of vehicle protection product warranties; 2. "Commissioner" means the Insurance Commissioner;…
36 O.S. § 6652 Compliance with act
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A. No vehicle protection product may be sold or offered for sale in this state unless the seller, warrantor and administrator, if any, comply with the provisions of the Vehicle Protection Product Act. B. Vehicle protection product warrantors and related vehicle protection product…
36 O.S. § 6653 Warrantor registration
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A. A person may not operate as a warrantor or represent to the public that the person is a warrantor unless the person is registered with the Insurance Department on a form prescribed by the Insurance Commissioner. B. Warrantor registration records shall be filed annually and sha…
36 O.S. § 6654 Financial security requirements for sales of products
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No vehicle protection product shall be sold or offered for sale in this state unless the warrantor meets the conditions specified in either paragraph 1 or 2 of this section in order to ensure adequate performance under the warranty. No other financial security requirements or fin…