Amend CSHB 3721 (house committee printing) as follows:
(1) On page 2, line 3, between "manner" and the underlined semicolon, insert "as determined by the commission".
(2) On page 2, line 10, between "(4)" and "specifies", insert "subject to Subsection (c-1),".
(3) On page 3, between lines 10 and 11, insert the following:
(c-1) The commission shall establish a common procedure for independent reviews conducted under this section. The procedure must provide that a service ordered by a health care provider is presumed medically necessary and the managed care organization bears the burden of proof to show the service is not medically necessary. Medical necessity must be based on publicly available, up-to-date, evidence-based, and peer-reviewed clinical criteria. The commission shall also establish a procedure for expedited reviews that allows the reviewer to identify an appeal that requires an expedited resolution.