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.