Amend SB 1096 (house committee report) as follows:
(1) On page 1, line 13, strike "533.005(a)" and substitute "533.005".
(2) On page 1, line 13, immediately following "amended", insert "by amending Subsection (a) and adding Subsection (g)".
(3) On page 14, line 13, strike "and" and substitute "[and]".
(4) On page 14, strike line 16 and substitute the following:
changes;
(27) a requirement that the managed care organization:
(A) not deny a reasonable prior authorization request or claim for a technical or minimal error; and
(B) not abuse the appeals process or any other review process to deter a recipient or provider from requesting health care services;
(28) a requirement that the managed care organization:
(A) automatically, without a request from a recipient or program, continue to provide the pre-reduction or pre-denial level of services to the recipient during an internal appeal or other review of a reduction in or denial of services, unless the recipient or the recipient's parent on behalf of the recipient opts out of the automatic continuation of services; and
(B) provide the commission and the recipient with a notice of continuing services;
(29) a requirement that the managed care organization comply with any applicable review procedure and comply with the reviewer's determination; and
(30) a requirement that the managed care organization pay liquidated damages for each substantiated failure to adhere to contractual requirements.
(g) The commission shall provide guidance and additional education to managed care organizations regarding requirements under federal law and Subsection (a)(28) to continue to provide services during an internal appeal, a Medicaid fair hearing, or any other review.