House Journal: Page 1267: Wednesday, April 14, 1999

17   the decision, shall be prima facie evidence of bad

18   faith."
Amendment H?1172 lost.
Chapman of Linn offered the following amendment H?1191 filed 
by her and moved its adoption:
H-1191
 1     Amend Senate File 276, as amended, passed, and
 2   reprinted by the Senate, as follows:
 3     1.  Page 13, by inserting after line 21 the
 4   following:
 5     "Sec.     . NEW SECTION.  514J.13A  CIVIL PENALTY.
 6     The commissioner may impose a civil penalty upon a
 7   carrier or organized delivery system not to exceed ten
 8   thousand dollars for each occurrence of a denial of
 9   coverage to an enrollee if such carrier or organized
10   delivery system is found to be engaging in a pattern
11   of conduct to circumvent the purposes of this chapter.
12   Evidence that a carrier or organized delivery system
13   has lost sixty percent or more of its external appeals
14   under this chapter shall be considered prima facie
15   evidence of an attempt to circumvent the purposes of
16   this chapter."
17     2.  By renumbering as necessary.
Amendment H?1191 lost.
Osterhaus of Jackson offered the following amendment H?1176 
filed by him and moved its adoption:
H-1176
 1     Amend Senate File 276, as amended, passed, and
 2   reprinted by the Senate, as follows:
 3     1.  Page 14, by inserting after line 18 the
 4   following:
 5     "Sec.     . NEW SECTION.  514K.1  TITLE.
 6     This chapter shall be known and may be cited as
 7   "Third-party Payor Liability Act".
 8     Sec.     . NEW SECTION.  514K.2  DEFINITIONS.
 9     As used in this chapter, unless the context
10   otherwise requires:
11     1.  "Appropriate and medically necessary" means the
12   standard for health care services as determined by a
13   physician or health care provider consistent with
14   accepted practices and standards of care provided by

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