Amend Senate File 2293, as amended, passed, and reprinted by the Senate, as follows:
   1.  By striking page 11, line 8, through page 15, line 14, and inserting:
   <Sec. ___.  Section 514J.102, subsections 1 and 10, Code Supplement 2011, are amended to read as follows:
   1.  “Adverse determination” means a determination by a health carrier that an admission, availability of care, continued stay, or other health care service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health carrier’s requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness, and the requested service or payment for the service is therefore denied, reduced, or terminated. 
 
“Adverse determination” includes a denial of coverage for a dental care service that is a covered benefit that has been reviewed and, based upon the information provided, does not meet the health carrier’s requirements for medical necessity, and the requested service or payment for the dental care service is therefore denied, reduced, or terminated, in whole or in part. “Adverse determination” does not include a denial of coverage for a service or treatment specifically listed in plan or evidence of coverage documents as excluded from coverage.
   10.  “Covered benefits” or “benefits” means those health care services
 
and dental care services to which a covered person is entitled under the terms of a health benefit plan.
   Sec. ___.  Section 514J.102, Code Supplement 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  11A.  “Dental care services” means services for diagnostic, preventive, maintenance, and therapeutic dental care that is provided under chapter 153.>
   2.  Page 21, by striking lines 1 through 12.
   3.  Page 21, by striking lines 17 and 18.
   4.  By renumbering as necessary.

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PETTENGILL of Benton