{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6570.9","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6570.9","heading":"Treatment of chronic conditions — Validity period for","body":"prior authorization of inpatient and non-inpatient care.\n\nA. If a prior authorization is required for a health care\n\nservice, other than for inpatient care, for the treatment of a\n\nchronic condition of an enrollee, then the prior authorization shall\n\nremain valid for at least six (6) months from the date the health\n\ncare provider receives the prior authorization approval, unless\n\nclinical criteria changes and notice of the change in clinical\n\ncriteria is provided as stipulated in this act.\n\nB. If a prior authorization is required for inpatient acute\n\ncare for the treatment of a chronic condition of an enrollee, then\n\nthe prior authorization shall remain valid for at least fourteen\n\n(14) calendar days from the date the health care provider receives\n\nthe prior authorization approval.\n\n1. If an enrollee requires inpatient care beyond the length of\n\nstay that was previously approved by the utilization review entity,\n\nthen the utilization review entity shall evaluate any prior\n\nauthorization requests for the continuation of inpatient care\n\naccording to the provisions of this act. A utilization review\n\nentity shall not use any stricter criteria to determine medical\n\nnecessity and appropriateness of the continuation of inpatient care\n\nas the utilization review entity used to evaluate the initial\n\nrequest for authorization of inpatient care. A utilization review\n\nentity shall review any relevant and pertinent literature or data\n\nprovided by the health care provider to determine the medical\n\nnecessity and appropriateness of the requested length of stay and/or\n\ncontinuation of inpatient care. A prior authorization for the\n\ncontinuation of inpatient care shall remain valid for a maximum of\n\nfourteen (14) calendar days from the date the health care provider\n\nreceives the prior authorization approval.\n\n2. If a utilization review entity fails to respond to a health\n\ncare provider's timely prior authorization request for the\n\ncontinuation of inpatient acute care before the termination of the\n\npreviously approved length of stay, then the health benefit plan\n\nshall continue to compensate the health care provider at the\n\ncontracted rate for inpatient care provided until the utilization\n\nreview entity issues its determination on the prior authorization\n\nrequest.\n\nFor the purposes of this section, a timely request for\n\ncontinuation of inpatient care means a request that is submitted at\n\nleast twenty-four (24) hours prior to the termination of the\n\npreviously approved prior authorization and includes all necessary\n\ninformation for the utilization review entity to make a\n\ndetermination.\n\n3. If a utilization review entity issues an adverse\n\ndetermination to a health care provider's prior authorization\n\nrequest for continuation of inpatient acute care and the health care\n\nprovider appeals the adverse determination according to the\n\nprovisions of this act, then the health benefit plan shall continue\n\nto compensate the health care provider at the contracted rate for\n\ninpatient care provided until the appeal has been finalized.\n\nC. This section does not require a health benefit plan to cover\n\ncare, treatment, or services for a health condition that the terms\n\nof coverage otherwise completely exclude from the policy's covered\n\nbenefits without regard for whether the care, treatment, or services\n\nare medically necessary.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"4e1e208d0228131d55472e5b4b5a74fb8ce252717c36fb05064391f6e7614a61","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6570.8","next":"us-ok/okla.-stat.-tit.-36-36-6571"},"notice":"GroundRules: Original legal text. Not legal advice."}