Senate
File
2293
H-8412
Amend
Senate
File
2293,
as
amended,
passed,
and
1
reprinted
by
the
Senate,
as
follows:
2
1.
By
striking
page
11,
line
8,
through
page
15,
3
line
14,
and
inserting:
4
<
Sec.
___.
Section
514J.102,
subsections
1
and
10,
5
Code
Supplement
2011,
are
amended
to
read
as
follows:
6
1.
“Adverse
determination”
means
a
determination
7
by
a
health
carrier
that
an
admission,
availability
8
of
care,
continued
stay,
or
other
health
care
service
9
that
is
a
covered
benefit
has
been
reviewed
and,
10
based
upon
the
information
provided,
does
not
meet
the
11
health
carrier’s
requirements
for
medical
necessity,
12
appropriateness,
health
care
setting,
level
of
13
care,
or
effectiveness,
and
the
requested
service
or
14
payment
for
the
service
is
therefore
denied,
reduced,
15
or
terminated.
“Adverse
determination”
includes
a
16
denial
of
coverage
for
a
dental
care
service
that
is
17
a
covered
benefit
that
has
been
reviewed
and,
based
18
upon
the
information
provided,
does
not
meet
the
health
19
carrier’s
requirements
for
medical
necessity,
and
20
the
requested
service
or
payment
for
the
dental
care
21
service
is
therefore
denied,
reduced,
or
terminated,
22
in
whole
or
in
part.
“Adverse
determination”
does
not
23
include
a
denial
of
coverage
for
a
service
or
treatment
24
specifically
listed
in
plan
or
evidence
of
coverage
25
documents
as
excluded
from
coverage.
26
10.
“Covered
benefits”
or
“benefits”
means
those
27
health
care
services
and
dental
care
services
to
which
28
a
covered
person
is
entitled
under
the
terms
of
a
29
health
benefit
plan.
30
Sec.
___.
Section
514J.102,
Code
Supplement
2011,
31
is
amended
by
adding
the
following
new
subsection:
32
NEW
SUBSECTION
.
11A.
“Dental
care
services”
means
33
services
for
diagnostic,
preventive,
maintenance,
and
34
therapeutic
dental
care
that
is
provided
under
chapter
35
153.
>
36
2.
Page
21,
by
striking
lines
1
through
12.
37
3.
Page
21,
by
striking
lines
17
and
18.
38
4.
By
renumbering
as
necessary.
39
______________________________
PETTENGILL
of
Benton
-1-
SF2293.5620
(3)
84
av/nh
1/
1
#1.
#2.
#3.
#4.