Amend CSSB 1188, SECTION 5(a), as follows:                                   
	(1)  On page 17, line 17, by striking the word "and"                    
	(2)  On page 17, line 25, by inserting the following between 
the word "network" and the period:
	; and (15) a requirement that the managed care organization 
develop, implement and maintain a system for tracking and resolving 
all provider appeals related to claims payment, including a process 
that will require:
			(A)  a tracking mechanism to document the status 
and final disposition of each provider's claims payment appeal;
			(B)  the contracting with physicians who are not 
network providers and who are of the same or related specialty as 
the appealing physician to resolve claims disputes related to 
denial on the basis of medical necessity that remain unresolved 
subsequent to a provider appeal; and 
			(C)  the determination of the physician resolving 
the dispute to be binding on the managed care organization and 
provider.
	(3)  On page 18, line 20, by striking the word "and"                    
	(4)  On page 19, line 17, by inserting the following between 
the word "notifications" and the period:
	; and (5)  reserve the right to amend the managed care 
organization's process for resolving provider appeals of denials 
based on medical necessity to include an independent review process 
established by commission for final determination of these disputes