{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6933","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6933","heading":"Provision of basic health care services directly or by","body":"contract or agreement - Standards and procedures for selection of\n\nproviders - Chiropractic and vision care services - Referrals.\n\nA. A health maintenance organization shall provide basic health\n\ncare services directly or by contract or agreement with other\n\npersons, corporations, institutions, associations, foundations or\n\nother legal entities, public or private, in accordance with the laws\n\ngoverning such professions and services.\n\nB. Each health maintenance organization shall have a defined\n\nset of standards and procedures for selecting providers, including\n\nspecialists, to serve enrollees. The standards and procedures shall\n\nbe drafted in such a manner as to be applicable to all categories of\n\nproviders and shall be utilized by the health maintenance\n\norganization in a manner that is without bias for or discrimination\n\nagainst a particular category or categories of providers.\n\nC. With respect to chiropractic services, such covered services\n\nshall be provided on a referral basis within the network at the\n\nrequest of an enrollee who has a condition of an orthopedic or\n\nneurological nature if:\n\n1. A referral is necessitated in the judgment of the primary\n\ncare physician; and\n\n2. Treatment for the condition falls within the licensed scope\n\nof practice of a chiropractic physician.\n\nD. 1. Any health maintenance organization that offers services\n\nfor vision care or medical diagnosis and treatment for the eye shall\n\nallow optometrists to be providers of those services.\n\n2. Once a fee schedule has been negotiated, ophthalmologists\n\nand optometrists shall be paid equally for the same services so long\n\nas the services provided by the optometrists are within the scope of\n\nthe practice of optometry.\n\n3. No health maintenance organization shall require a provider\n\nof vision care or medical diagnosis and treatment for the eye to\n\nhave hospital privileges if hospital privileges are not usual and\n\ncustomary for the services the provider provides.\n\n4. With respect to optometric services, such covered services\n\nshall be provided on a referral basis within the medical group or\n\nnetwork at the request of an enrollee who has a condition requiring\n\nvision care or medical diagnosis and treatment of the eye if:\n\na. a referral is necessitated in the judgment of the\n\nprimary care physician, and\n\nb. treatment for the condition falls within the licensed\n\nscope of practice of an optometrist.\n\n5. Nothing in this subsection shall be construed to:\n\na. prohibit any health maintenance organization that\n\noffers services for vision care or medical diagnosis\n\nand treatment for the eye from determining the\n\nadequacy of the size of its network,\n\nb. limit, expand or otherwise affect the scope of\n\npractice of optometry, or\n\nc. alter, repeal, modify or affect the laws of this state\n\nexcept where such laws are in conflict or are\n\ninconsistent with the express provisions of this\n\nsection.\n\n6. Existing contracts shall comply with the requirements of\n\nthis subsection upon issuance or renewal on or after the effective\n\ndate of this act.\n\nE. 1. A health maintenance organization shall not:\n\na. engage in the practice of medicine or any other\n\nprofession except as provided by law, or\n\nb. prohibit or restrict a primary care physician from\n\nreferring a patient to a specialist within the network\n\nif such referral is deemed medically necessary in the\n\njudgment of the primary care physician.\n\n2. A health maintenance organization shall provide basic health\n\ncare services in a manner that is reasonably geographically\n\nconvenient to residents of the service area for which it seeks a\n\nlicense.","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":"f7cbc0a5b42202eff81997dec08f1fa5a5c3f58bfeab48d24e998be572e1e10b","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6931","next":"us-ok/okla.-stat.-tit.-36-36-6934"},"notice":"GroundRules: Original legal text. Not legal advice."}