Oklahoma SB1553 amends Medicaid rules for appeals of adverse determinations, specifying qualifications for reviewers and allowing cost recovery.

Oklahoma SB1553 amends the state Medicaid program to specify qualifications for professionals reviewing appeals of adverse determinations. The bill mandates that appeals be reviewed by a licensed physician or psychologist, or other mental health professional, who must have relevant training and experience. It prohibits the use of automated software in these reviews. The bill also allows for the recovery of costs by the reviewing professional if the adverse determination is reversed through a fair hearing, considering the time spent on the appeal. The changes become effective November 1, 2026.

Oklahoma SB1553 amends Medicaid rules for appeals of adverse determinations, specifying qualifications for reviewers and allowing cost recovery.

Oklahoma SB1553 amends the state Medicaid program to specify qualifications for professionals reviewing appeals of adverse determinations. The bill mandates that appeals be reviewed by a licensed physician or psychologist, or other mental health professional, who must have relevant training and experience. It prohibits the use of automated software in these reviews. The bill also allows for the recovery of costs by the reviewing professional if the adverse determination is reversed through a fair hearing, considering the time spent on the appeal. The changes become effective November 1, 2026.