House File 2399 H-8080 Amend House File 2399 as follows: 1 1. Page 1, line 18, after < equipment. > by inserting < “Health 2 care services” does not include prescription drugs or dental 3 care services as that term is defined in section 514J.102. > 4 2. Page 2, by striking lines 8 through 11 and inserting: 5 < i. “Utilization review” means the same as defined in 6 section 514F.4, subsection 3. > 7 3. Page 2, by striking lines 18 and 19 and inserting: 8 < 2. a. A utilization > 9 4. Page 2, after line 27 by inserting: 10 < ___. Paragraphs “a” and “b” shall not apply in any of the 11 following circumstances: 12 (1) The health care provider or the covered person committed 13 fraud, waste, or abuse. 14 (2) The health care provider or the covered person provided 15 inaccurate information that the utilization review organization 16 relied on for the utilization review organization’s prior 17 authorization determination. 18 (3) On the date that the health care service was provided by 19 the health care provider to the covered person per the prior 20 authorization, the health care service was no longer a benefit 21 covered by the covered person’s health benefit plan. 22 (4) On the date that the health care service was provided 23 by the health care provider to the covered person per the 24 prior authorization, the health care provider was no longer 25 contracted with the health carrier that provides the covered 26 person’s health benefit plan. 27 (5) The health care provider failed to meet the health 28 carrier’s requirements related to timely filing of claims for 29 submission of a claim for the health care service provided by 30 the health care provider to the covered person per the prior 31 authorization. 32 (6) Due to coordination of benefits, the health carrier 33 does not have liability for a claim for the health care service 34 provided by the health care provider to the covered person per 35 -1- HF 2399.3374 (1) 89 ko/rn 1/ 2 #1. #2. #3. #4.

a prior authorization. 1 (7) On the date that the health care service was provided 2 by the health care provider to the covered person per the 3 prior authorization, the covered person was no longer a 4 participant in the health benefit plan in which the covered 5 person participated on the date that the prior authorization 6 was received by the health care provider. > 7 5. By renumbering, redesignating, and correcting internal 8 references as necessary. 9 ______________________________ ANDREWS of Polk -2- HF 2399.3374 (1) 89 ko/rn 2/ 2 #5.