OK HB1810

Expands Children's Specialty Plan eligibility beginning July 1, 2026 to include children in Family Centered Services cases, children in DHS custody placed at home under court supervision, children in trial reunification, and Medicaid-enrolled parents/guardians of these children

Establishes prior authorization decision timelines: 72 hours for urgent services, 7 days for non-urgent services, and 24 hours for prescription drugs; services are deemed authorized if contracted entities miss these deadlines after receiving all necessary information

Requires contracted entities to implement Prior Authorization Application Programming Interfaces by January 1, 2027, with participating providers required to have compatible electronic health records by July 1, 2027

Prohibits prior authorization requirements for emergency services, pre-hospital transportation, and facility transfers under EMTALA; requires contracted entities to honor prior authorizations from previous plans for at least 60 days when members switch coverage

Mandates that adverse determinations and appeals be reviewed by licensed physicians or mental health professionals with relevant specialty expertise, and prohibits use of automated claim review software for appeals