Rep. Bob Morgan
Filed: 2/25/2022
 
 

 

 

 
10200HB4703ham001LRB102 24386 BMS 36889 a



1
AMENDMENT TO HOUSE BILL 4703 




2    AMENDMENT NO. ______. Amend House Bill 4703 on page 3, by 
3replacing lines 15 and 16 with the following:


4    "laboratory services, except for advanced diagnostic 
5    laboratory tests identified on the most current list 
6    published by the United States Secretary of Health and 
7    Human Services under 42 U.S.C. 300gg-132(b)(3);
8        (4)    items and services provided by other specialty 
9    practitioners as the United States Secretary of Health and 
10    Human Services specifies through rulemaking  under 42 
11    U.S.C. 300gg-132(b)(3); and
12        (5)   items and services provided by a 
13    nonparticipating"; and

 
14on page 8, by replacing lines 9 through 13 with the following:

15    ""Qualifying payment amount" has the meaning given to that 
16term in 42 U.S.C. 300gg-111(a)(3)(E) and the regulations 
17promulgated thereunder.
 
 
10200HB4703ham001- 2 -LRB102 24386 BMS 36889 a

1    "Recognized amount" means the lesser of the amount 
2initially billed by the provider or the qualifying payment 
3amount."; and

 
4on page 9, line 10, after "services.", by inserting "If the 
5cost sharing for the same item or service furnished by a 
6participating provider would have been a flat-dollar 
7copayment, that amount shall be the cost-sharing amount unless 
8the provider has billed a lesser total amount."; and
 
9on page 10, line 13, after "services.", by inserting "If the 
10cost sharing for the same item or service furnished by a 
11participating provider would have been a flat-dollar 
12copayment, that amount shall be the cost-sharing amount unless 
13the provider has billed a lesser total amount."; and
 
14on page 12, line 10, by replacing "The health insurance 
15issuer" with "Upon receipt of the provider's bill or 
16facility's bill, the health insurance issuer The"; and
 
17on page 14, line 15, after "parties.", by inserting "The 
18arbitrator shall not establish a rebuttable presumption that 
19the qualifying payment amount should be the total amount owed 
20to the provider or facility by the combination of the issuer 
21and the insured, beneficiary, or enrollee.".