HB0035sam001 104TH GENERAL ASSEMBLY

Sen. Laura Fine

Filed: 5/12/2025

10400HB0035sam001

LRB104 03558 BAB 26005 a

1 AMENDMENT TO HOUSE BILL 35

2 AMENDMENT NO. ______. Amend House Bill 35 on page 4, by

3 replacing lines 10 through 25 with the following:

4 "(b) Even if a health care plan or other utilization

5 review program, as defined in Section 10 of the Managed Care

6 Reform and Patient Rights Act, uses an algorithmic automated

7 process in the course of utilization review for medical

8 necessity, the health care plan or other utilization review

9 program shall ensure that only a clinical peer makes any

10 adverse determination based on medical necessity and that any

11 subsequent appeal is processed as required by Section 45 of

12 the Managed Care Reform and Patient Rights Act, including the

13 restriction that only a clinical peer may review an appeal. A

14 health care plan or other utilization review program using an

15 automated process shall have the accreditation and the

16 policies and procedures required by subsection (b-10) of

17 Section 85 of the Managed Care Reform and Patient Rights

18 Act.".