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.