2001 REGULAR SESSION (71st)                                                                             A SB320 303

Amendment No. 303

 

Senate Amendment to Senate Bill No. 320                                                                         (BDR 57‑676)

Proposed by: Committee on Commerce and Labor

Amendment Box:

Resolves Conflicts with: N/A

Amends:         Summary:              Title:              Preamble:               Joint Sponsorship:

 

Adoption of this amendment will MAINTAIN a 2/3s majority vote requirement for final passage of SB320 (§ 6).

 

ASSEMBLY ACTION              Initial and Date              |SENATE ACTION                        Initial and Date

       Adopted       Lost                                               |          Adopted       Lost                                           

Concurred In                     Not                                                        |Concurred In  Not                                 

       Receded        Not                                               |         Receded        Not                                           

 

     Amend sec. 3, page 1, lines 7 and 8, by deleting:

“the medical necessity and appropriateness of” and inserting:

“whether or not”.

     Amend sec. 3, page 1, line 9, by deleting “insured.” and inserting:

“insured is medically necessary and appropriate, or is experimental or investigational.”.

     Amend sec. 20, page 6, line 6, by deleting “appropriate.” and inserting:

“appropriate, or is experimental or investigational.”.

     Amend sec. 24, page 6, line 35, by deleting “injury;” and inserting:

“injury according to generally accepted standards of medical practice;”.

     Amend sec. 24, page 6, line 38, after “(c)” by inserting:

“Clinically appropriate with regard to the type, frequency, extent, location and duration of care;

     (d)”.

     Amend sec. 24, page 6, by deleting line 41 and inserting:

     “(e) The most clinically appropriate level of health care that can be safely”.

     Amend the bill as a whole by adding a new section designated sec. 24.5, following sec. 24, to read as follows:

     “Sec. 24.5.  1.  A managed care organization shall develop standards for selecting independent review organizations for the performance of external reviews.

     2.  Except as otherwise provided in subsection 3, a managed care organization shall, before it enters into a contract with an independent review organization for the performance of external reviews, obtain the approval of the commissioner of the standards used by the managed care organization to select independent review organizations. The standards must include, without limitation:

     (a) Standards to ensure the independence of the independent review organizations; and

     (b) Standards to ensure the independence of each employee, agent or contractor of the independent review organizations who performs external review.

     3.  The commissioner shall approve or object to the standards within 30 days after receiving a copy of the standards from the managed care organization.  If the commissioner fails to approve or object to the standards within 30 days, the standards shall be deemed to be approved.”.

     Amend sec. 25, page 6, line 49, by deleting “two” and inserting “four”.

     Amend sec. 25, page 7, by deleting lines 1 and 2 and inserting:

     “2.  File with the commissioner a copy of each contract the managed care organization enters into with an independent review organization for the performance of external”.

     Amend sec. 26, page 7, line 12, after the italicized semicolon by inserting “and”.

     Amend sec. 26, page 7, line 14, by deleting “$1,000; and” and inserting “$500.”.

     Amend sec. 26, page 7, by deleting lines 15 through 26 and inserting:

     “2.  A managed care organization may request an external review.”.

     Amend sec. 27, page 7, lines 31, 33 and 38, by deleting “business” and inserting “working”.

     Amend sec. 27, page 7, line 40, by deleting “30” and inserting “15”.

     Amend sec. 27, page 7, line 41, by deleting “the assignment” and inserting:

“all documents and other evidence provided or demanded pursuant to this section”.

     Amend sec. 27, page 7, lines 44 and 47, by deleting “business” and inserting “working”.

     Amend sec. 28, page 8, lines 16, 21, 27 and 29, by deleting “business” and inserting “working”.

     Amend sec. 30, page 9, line 1, by deleting “The” and inserting “If the”.

     Amend sec. 30, page 9, line 2, after “is” by inserting:

“in favor of the insured, the decision is”.

     Amend sec. 32, page 9, line 36, by deleting “business” and inserting “[business] working”.

     Amend sec. 35, page 11, line 9, by deleting “[working] business” and inserting “working”.

     Amend sec. 39, page 12, line 40, by deleting “January” and inserting “July”.

     Amend sec. 40, page 12, line 42, by deleting “January” and inserting “July”.

     Amend sec. 41, page 12, line 43, by deleting “January” and inserting “July”.

     Amend the title of the bill, fifth line, by deleting “appropriate;” and inserting:

“appropriate, or are experimental or investigational;”.

     Amend the summary of the bill to read as follows:

“SUMMARY—Requires managed care organizations to establish system for independent review of final adverse determinations concerning allocations of health care resources and services. (BDR 57‑676)”.