Amend the floor substitute for CSHB 1862 as follows: (1) On page 1, line 7, between "Preauthorization" and "means", insert the following: means a determination by the insurer that the medical care or health care services proposed to be provided to a patient are medically necessary and appropriate. (15) "Verification" (2) On page 4, line 12, between "claim" and "the full", insert "the lesser of". (3) On page 4, lines 14-16, strike ", except that the insurer is not required to pay a preferred provider an amount of billed charges that exceeds the amount billable" and substitute "or two times the contracted rate and interest on that amount at a rate of 15 percent annually. Billed charges shall be established". (4) On page 9, between lines 15 and 16, insert the following: (d) In this section, "verification" includes any required preauthorization process. (e) An insurer may establish a time certain for the validity of verification. (f) If an insurer has verified medical care or health care services, the insurer may not deny or reduce payment to a physician or health care provider for those services unless: (1) the physician or provider has materially misrepresented the proposed medical or health care services or has substantially failed to perform the proposed medical or health care services; or (2) the insurer certifies in writing: (A) that the patient was not a covered enrollee of the health plan; (B) the insurer was notified on or before the 30th day after the date the patient's enrollment ended; and (C) the physician or provider was notified that the patient's enrollment ended on or before the 30th day after the date of verification under this section. (5) On page 11, lines 1 and 2, strike "or a physician or health care provider requests preauthorization of proposed medical care or health care services". (6) On page 11, lines 9-11, strike "If the determination requires a determination of medical necessity and appropriateness of the proposed medical care or health care services, the" and substitute "The". (7) Strike page 11, lines 28-31, and page 12, line 1, and substitute the following: physician or health care provider for those services unless: (1) the physician or provider has materially misrepresented the proposed medical or health care services or has substantially failed to perform the proposed medical or health care services; or (2) the insurer certifies in writing: (A) that the patient was not a covered enrollee of the health plan; (B) the insurer was notified on or before the 30th day after the date the patient's enrollment ended; and (C) the physician or provider was notified that the patient's enrollment ended on or before the 30th day after the date of verification under this section. (8) On page 13, line 22, strike "preauthorization" and substitute "verification". (9) On page 14, line 16, between "Preauthorization" and "means", insert the following: means a determination by the health maintenance organization that the medical care or health care services proposed to be provided to a patient are medically necessary and appropriate. (gg) "Verification" (10) On page 23, between lines 17 and 18, insert the following: (d) In this section, "verification" includes any required preauthorization process. (e) A health maintenance organization may establish a time certain for the validity of verification. (f) If a health maintenance organization has verified medical care or health care services, the health maintenance organization may not deny or reduce payment to a physician or health care provider for those services unless: (1) the physician or provider has materially misrepresented the proposed medical or health care services or has substantially failed to perform the proposed medical or health care services; or (2) the health maintenance organization certifies in writing: (A) that the patient was not a covered enrollee of the health plan; (B) the health maintenance organization was notified on or before the 30th day after the date the patient's enrollment ended; and (C) the physician or provider was notified that the patient's enrollment ended on or before the 30th day after the date of verification under this section. (11) On page 25, lies 7-8, strike "or a physician or provider requests preauthorization of proposed medical care or health care services". (12) On page 25, lines 15-17, strike "If the determination requires a determination of medical necessity and appropriateness of the proposed medical care or health care services, the" and substitute "The". (13) On page 26, strike lines 4-7, and substitute the following: provider for those services unless: (1) the physician or provider has materially misrepresented the proposed medical or health care services or has substantially failed to perform the proposed medical or health care services; or (2) the health maintenance organization certifies in writing: (A) that the patient was not a covered enrollee of the health plan; (B) the health maintenance organization was notified on or before the 30th day after the date the patient's enrollment ended; and (C) the physician or provider was notified that the patient's enrollment ended on or before the 30th day after the date of verification under this section.