Okla. Stat. tit. 85A, § 85A-64

A. Any person or entity may make written application to the

State Commissioner of Health to have a workplace medical plan

certified that provides management of quality treatment to injured

employees for injuries and diseases compensable under this act.

Each application for certification shall be accompanied by a fee of

One Thousand Five Hundred Dollars ($1,500.00). A workplace medical

plan may be certified to provide services to a limited geographic

area. A certificate is valid for a five-year period, unless revoked

or suspended. Application for certification shall be made in the

form and manner and shall set forth information regarding the

proposed program for providing services as the State Commissioner of

Health may prescribe. The information shall include, but not be

limited to:

1. A list of the names of all medical providers who shall

provide services under the plan, together with appropriate evidence

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of compliance with any licensing or certification requirements for

those providers to practice in this state; and

2. A description of the places and manner of providing services

under the plan.

B. The State Commissioner of Health shall not certify a plan

unless he or she finds that the plan:

1. Proposes to provide quality services for all medical

services which:

a. may be required by this act in a manner that is

timely, effective and convenient for the employee, and

b. utilize medical treatment guidelines and protocols

consistent with those established by the Official

Disability Guidelines;

2. Is reasonably geographically convenient to residents of the

area for which it seeks certification;

3. Provides appropriate financial incentives to reduce service

costs and utilization without sacrificing the quality of service;

4. Provides adequate methods of peer review, utilization review

and dispute resolution to prevent inappropriate, excessive or

medically unnecessary treatment, and excludes participation in the

plan by those providers who violate these treatment standards;

5. Provides aggressive case management for injured employees

and a program for early return to work;

6. Provides a timely and accurate method of reporting to the

State Commissioner of Health necessary information regarding medical

service costs and utilization to enable the State Commissioner of

Health to determine the effectiveness of the plan;

7. Authorizes necessary emergency medical treatment for an

injury provided by a provider of medical, surgical, and hospital

services who is not a part of the plan; and

8. Does not discriminate against or exclude from participation

in the plan any category of providers of medical, surgical, or

hospital services and includes an adequate number of each category

of providers of medical, surgical, and hospital services to give

participants access to all categories of providers and does not

discriminate against ethnic minority providers of medical services.

C. The State Commissioner of Health may accept findings,

licenses or certifications of other state agencies as satisfactory

evidence of compliance with a particular requirement of this

section.

D. Except for self-insured employers, if any insurer does not

contract with or provide access to a certified workplace medical

plan, an insured, after sixty (60) days' written notice to its

insurance carrier, shall be authorized to contract independently

with a plan of his or her choice for a period of one (1) year, to

provide medical care under this act. The insured shall be

authorized to contract, after sixty (60) days' written notice to its

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insurance carrier, for additional one-year periods if the insurer

has not contracted with or provided access to a certified workplace

medical plan.

E. If an employer is not experience-rated when it participates
ide medical care under this act. The insured shall be

authorized to contract, after sixty (60) days' written notice to its

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insurance carrier, for additional one-year periods if the insurer

has not contracted with or provided access to a certified workplace

medical plan.

E. If an employer is not experience-rated when it participates

in a certified workplace medical plan, its workers' compensation

insurer shall grant a ten-percent premium reduction.

F. The State Commissioner of Health shall refuse to certify or

shall revoke or suspend the certification of a plan if the State

Commissioner of Health finds that the program for providing medical

or health care services fails to meet the requirements of this

section, or service under the plan is not being provided in

accordance with the terms of the plan.

G. The State Commissioner of Health shall implement a site

visit protocol for employees of the State Department of Health to

perform an inspection of a certified workplace medical plan to

ensure that medical services to an employee and the medical

management of the employee's needs are adequately met in a timely

manner and that the certified workplace medical plan is complying

with all other applicable provisions of this act and the State

Department of Health. This protocol shall include, but not be

limited to:

1. A site visit shall be made to each certified workplace

medical plan not less often than once every year, but not later than

thirty (30) days following the anniversary date of issuance of the

initial or latest renewal certificate;

2. A site visit shall determine whether or not a certified

workplace medical plan is operating in accordance with its latest

application to the State Department of Health;

3. Compliant operations shall include, but not be limited to:

a. timely and effective medical services available with

reasonable geographic convenience,

b. treatment guidelines and protocols consistent with the

Official Disability Guidelines, and

c. effective programs for utilization review, case

management, grievances, and dispute resolution;

4. Performance of a site visit shall include:

a. inspection of organizational documentation,

b. inspection of systems documentation and processes,

c. random or systematic sampling of closed and open case

management cases,

d. workplace medical plan employee and management

interviews, as appropriate;

5. An initial site visit may occur with an interval of less

than twelve (12) months to a recently certified plan, or a site

visit may occur more often than once in every twelve (12) months if

the State Commissioner of Health has reason to suspect that a plan

is not operating in accordance with its certification;

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6. If a deficient practice is identified during a site visit,

the State Department of Health shall require a certified workplace

medical plan to submit a timely and acceptable written plan of

correction, and then may perform a follow-up visit or visits to

ensure that the deficient practice has been eliminated;

7. If a deficient practice is not remedied by a certified

workplace medical plan on a timely basis, the State Commissioner of

Health shall revoke or suspend the certification of the plan;

8. In addition to the certification fee required pursuant to

subsection A of this section, certified workplace medical plans

shall pay the State Department of Health:

a. One Thousand Five Hundred Dollars ($1,500.00) for an

initial annual site visit, and

b. One Thousand Dollars ($1,000.00) for each follow-up

visit, but only if less than two site visits occur in

a twelve-month period; and

9. In addition to the site visit fee required pursuant to

paragraph 8 of this subsection, employees of the State Department of

Health may charge to the certified workplace medical plan reasonable
red Dollars ($1,500.00) for an

initial annual site visit, and

b. One Thousand Dollars ($1,000.00) for each follow-up

visit, but only if less than two site visits occur in

a twelve-month period; and

9. In addition to the site visit fee required pursuant to

paragraph 8 of this subsection, employees of the State Department of

Health may charge to the certified workplace medical plan reasonable

travel and travel-related expenses for the site visit such as

overnight lodging and meals. A certified workplace medical plan

shall reimburse travel expenses to the State Department of Health at

rates equal to the amounts then currently allowed under the State

Travel Reimbursement Act.

I. The State Board of Health shall adopt such rules as may be

necessary to implement the provisions of this section. Such rules

shall authorize any person to petition the State Commissioner of

Health for decertification of a certified workplace medical plan for

a material violation of any rules promulgated pursuant to this

section.