Adopted

AMENDMENT NO 2 TO AMENDMENT NO 1 PROPOSED TO

Senate Bill No. 2799

BY: Representative Hines

AMEND by inserting the following new paragraph (3) after line 1623, and renumber or reletter the subsequent paragraphs and any references to those paragraphs:

          "(3)  Each health maintenance organization, coordinated care organization, provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division under this section shall use a clear set of level of care guidelines in the determination of medical necessity and in all utilization management practices, including the prior authorization process, concurrent reviews, retrospective reviews and payments, that are consistent with widely accepted professional standards of care (including the Level of Care Utilization System [LOCUS], Child and Adolescent Level of Care Utilization System [CALOCUS] and the American Society of Addiction Medicine [ASAM], Child and Adolescent Service Intensity Instrument [CASSI]).  Organizations participating in a managed care program or coordinated care program implemented by the division may not use any additional criteria that would result in denial of care that would be determined appropriate and, therefore, medically necessary under those level of care guidelines."