Amendment H-8080 to HF 2399
Relating to reimbursement for health care services provided after receipt of a prior authorization, and including applicability provisions
Adopted · February 24, 2022
Filed February 23, 2022 in the House by
What it changes
- Page 1, line 18, after “equipment.” by inserting ““Health care services” does not include prescription drugs or dental care services as that term is defined in section 514J.102.”
- Page 2, by striking lines 8 through 11 and inserting: “i. “Utilization review” means the same as defined in section 514F.4, subsection
- ”
- Page 2, by striking lines 18 and 19 and inserting: “
- a. A utilization”
- Page 2, after line 27 by inserting: “___. Paragraphs “a” and “b” shall not apply in any of the following circumstances: (1) The health care provider or the covered person committed fraud, waste, or abuse. (2) The health care provider or the covered person provided inaccurate information that the utilization review organization relied on for the utilization review organization’s prior authorization determination. (3) On the date that the health care service was provided by the health care provider to the covered person per the prior authorization, the health care service was no longer a benefit covered by the covered person’s health benefit plan. (4) On the date that the health care service was provided by the health care provider to the covered person per the prior authorization, the health care provider was no longer contracted with the health carrier that provides the covered person’s health benefit plan. (5) The health care provider failed to meet the health carrier’s requirements related to timely filing of claims for submission of a claim for the health care service provided by the health care provider to the covered person per the prior authorization. (6) Due to coordination of benefits, the health carrier does not have liability for a claim for the health care service provided by the health care provider to the covered person per a prior authorization. (7) On the date that the health care service was provided by the health care provider to the covered person per the prior authorization, the covered person was no longer a participant in the health benefit plan in which the covered person participated on the date that the prior authorization was received by the health care provider.”
- By renumbering, redesignating, and correcting internal references as necessary.