{"data":{"id":"us-ok/okla.-stat.-tit.-85a-85a-64","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 85A, § 85A-64","heading":"Certification of workplace medical plan","body":"A. Any person or entity may make written application to the\n\nState Commissioner of Health to have a workplace medical plan\n\ncertified that provides management of quality treatment to injured\n\nemployees for injuries and diseases compensable under this act.\n\nEach application for certification shall be accompanied by a fee of\n\nOne Thousand Five Hundred Dollars ($1,500.00). A workplace medical\n\nplan may be certified to provide services to a limited geographic\n\narea. A certificate is valid for a five-year period, unless revoked\n\nor suspended. Application for certification shall be made in the\n\nform and manner and shall set forth information regarding the\n\nproposed program for providing services as the State Commissioner of\n\nHealth may prescribe. The information shall include, but not be\n\nlimited to:\n\n1. A list of the names of all medical providers who shall\n\nprovide services under the plan, together with appropriate evidence\n\nof compliance with any licensing or certification requirements for\n\nthose providers to practice in this state; and\n\n2. A description of the places and manner of providing services\n\nunder the plan.\n\nB. The State Commissioner of Health shall not certify a plan\n\nunless he or she finds that the plan:\n\n1. Proposes to provide quality services for all medical\n\nservices which:\n\na. may be required by this act in a manner that is\n\ntimely, effective and convenient for the employee, and\n\nb. utilize medical treatment guidelines and protocols\n\nconsistent with those established by the Official\n\nDisability Guidelines;\n\n2. Is reasonably geographically convenient to residents of the\n\narea for which it seeks certification;\n\n3. Provides appropriate financial incentives to reduce service\n\ncosts and utilization without sacrificing the quality of service;\n\n4. Provides adequate methods of peer review, utilization review\n\nand dispute resolution to prevent inappropriate, excessive or\n\nmedically unnecessary treatment, and excludes participation in the\n\nplan by those providers who violate these treatment standards;\n\n5. Provides aggressive case management for injured employees\n\nand a program for early return to work;\n\n6. Provides a timely and accurate method of reporting to the\n\nState Commissioner of Health necessary information regarding medical\n\nservice costs and utilization to enable the State Commissioner of\n\nHealth to determine the effectiveness of the plan;\n\n7. Authorizes necessary emergency medical treatment for an\n\ninjury provided by a provider of medical, surgical, and hospital\n\nservices who is not a part of the plan; and\n\n8. Does not discriminate against or exclude from participation\n\nin the plan any category of providers of medical, surgical, or\n\nhospital services and includes an adequate number of each category\n\nof providers of medical, surgical, and hospital services to give\n\nparticipants access to all categories of providers and does not\n\ndiscriminate against ethnic minority providers of medical services.\n\nC. The State Commissioner of Health may accept findings,\n\nlicenses or certifications of other state agencies as satisfactory\n\nevidence of compliance with a particular requirement of this\n\nsection.\n\nD. Except for self-insured employers, if any insurer does not\n\ncontract with or provide access to a certified workplace medical\n\nplan, an insured, after sixty (60) days' written notice to its\n\ninsurance carrier, shall be authorized to contract independently\n\nwith a plan of his or her choice for a period of one (1) year, to\n\nprovide medical care under this act. The insured shall be\n\nauthorized to contract, after sixty (60) days' written notice to its\n\ninsurance carrier, for additional one-year periods if the insurer\n\nhas not contracted with or provided access to a certified workplace\n\nmedical plan.\n\nE. If an employer is not experience-rated when it participates\nide medical care under this act. The insured shall be\n\nauthorized to contract, after sixty (60) days' written notice to its\n\ninsurance carrier, for additional one-year periods if the insurer\n\nhas not contracted with or provided access to a certified workplace\n\nmedical plan.\n\nE. If an employer is not experience-rated when it participates\n\nin a certified workplace medical plan, its workers' compensation\n\ninsurer shall grant a ten-percent premium reduction.\n\nF. The State Commissioner of Health shall refuse to certify or\n\nshall revoke or suspend the certification of a plan if the State\n\nCommissioner of Health finds that the program for providing medical\n\nor health care services fails to meet the requirements of this\n\nsection, or service under the plan is not being provided in\n\naccordance with the terms of the plan.\n\nG. The State Commissioner of Health shall implement a site\n\nvisit protocol for employees of the State Department of Health to\n\nperform an inspection of a certified workplace medical plan to\n\nensure that medical services to an employee and the medical\n\nmanagement of the employee's needs are adequately met in a timely\n\nmanner and that the certified workplace medical plan is complying\n\nwith all other applicable provisions of this act and the State\n\nDepartment of Health. This protocol shall include, but not be\n\nlimited to:\n\n1. A site visit shall be made to each certified workplace\n\nmedical plan not less often than once every year, but not later than\n\nthirty (30) days following the anniversary date of issuance of the\n\ninitial or latest renewal certificate;\n\n2. A site visit shall determine whether or not a certified\n\nworkplace medical plan is operating in accordance with its latest\n\napplication to the State Department of Health;\n\n3. Compliant operations shall include, but not be limited to:\n\na. timely and effective medical services available with\n\nreasonable geographic convenience,\n\nb. treatment guidelines and protocols consistent with the\n\nOfficial Disability Guidelines, and\n\nc. effective programs for utilization review, case\n\nmanagement, grievances, and dispute resolution;\n\n4. Performance of a site visit shall include:\n\na. inspection of organizational documentation,\n\nb. inspection of systems documentation and processes,\n\nc. random or systematic sampling of closed and open case\n\nmanagement cases,\n\nd. workplace medical plan employee and management\n\ninterviews, as appropriate;\n\n5. An initial site visit may occur with an interval of less\n\nthan twelve (12) months to a recently certified plan, or a site\n\nvisit may occur more often than once in every twelve (12) months if\n\nthe State Commissioner of Health has reason to suspect that a plan\n\nis not operating in accordance with its certification;\n\n6. If a deficient practice is identified during a site visit,\n\nthe State Department of Health shall require a certified workplace\n\nmedical plan to submit a timely and acceptable written plan of\n\ncorrection, and then may perform a follow-up visit or visits to\n\nensure that the deficient practice has been eliminated;\n\n7. If a deficient practice is not remedied by a certified\n\nworkplace medical plan on a timely basis, the State Commissioner of\n\nHealth shall revoke or suspend the certification of the plan;\n\n8. In addition to the certification fee required pursuant to\n\nsubsection A of this section, certified workplace medical plans\n\nshall pay the State Department of Health:\n\na. One Thousand Five Hundred Dollars ($1,500.00) for an\n\ninitial annual site visit, and\n\nb. One Thousand Dollars ($1,000.00) for each follow-up\n\nvisit, but only if less than two site visits occur in\n\na twelve-month period; and\n\n9. In addition to the site visit fee required pursuant to\n\nparagraph 8 of this subsection, employees of the State Department of\n\nHealth may charge to the certified workplace medical plan reasonable\nred Dollars ($1,500.00) for an\n\ninitial annual site visit, and\n\nb. One Thousand Dollars ($1,000.00) for each follow-up\n\nvisit, but only if less than two site visits occur in\n\na twelve-month period; and\n\n9. In addition to the site visit fee required pursuant to\n\nparagraph 8 of this subsection, employees of the State Department of\n\nHealth may charge to the certified workplace medical plan reasonable\n\ntravel and travel-related expenses for the site visit such as\n\novernight lodging and meals. A certified workplace medical plan\n\nshall reimburse travel expenses to the State Department of Health at\n\nrates equal to the amounts then currently allowed under the State\n\nTravel Reimbursement Act.\n\nI. The State Board of Health shall adopt such rules as may be\n\nnecessary to implement the provisions of this section. Such rules\n\nshall authorize any person to petition the State Commissioner of\n\nHealth for decertification of a certified workplace medical plan for\n\na material violation of any rules promulgated pursuant to this\n\nsection.","path":["OK Code","Title 85A"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os85A.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"f4f5d13d54f9c7df26957ed5797a3cf7d7ff2f1dd8ef23bc5caccaac597bd289","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-85a-85a-63","next":"us-ok/okla.-stat.-tit.-85a-85a-65"},"notice":"GroundRules: Original legal text. Not legal advice."}