OK SPA 24-0011 & APA WF # 24-15 Third Party Liability (TPL) Prior Authorization

In accordance with Section 202 of the Consolidated Appropriations Act, a state plan is required to attest that there is state legislation forbidding third party insurers from denying a claim solely based on the Medicaid member’s failure to obtain a prior authorization for a service, so long as that service is covered under the state plan or a waiver. Administrative rules are also being amended to align with these new prior authorization requirements.

Please view the draft SPA here: OK SPA #24-0011 and the circulation document here: APA WF # 24-15 and submit feedback via the comment box.

Circulation Date: 04/19/2024

Tribal Consultation: 04/30/2024

Comment Due Date: 05/19/2024

SPA Effective Date: 06/01/2024, Contingent Upon CMS Approval;

Rules Effective Date: 07/01/2024 or Immediately Upon Governor’s Approval, whichever is later