1|ENGROSSED HOUSE | |BILL NO. 3190 By: Newton, Boles, Manger, | 2| Munson, Humphrey, Burns, | | McDugle, McBride, | 3| Rosecrants, Schreiber, | | Caldwell (Chad), Hasenbeck, | 4| Dollens, West (Kevin), | | Talley, Deck, Moore, West | 5| (Rick), May, Pfeiffer, | | Ford, West (Tammy), Osburn | 6| of the House | | | 7| and | | | 8| Garvin of the Senate | | | 9| | | | 10| | | | 11| [ health insurance - Ensuring Transparency in Prior | | | 12| Authorization Act definitions - disclosure and | | | 13| review of prior authorization - adverse | | | 14| determinations - consultation - reviewing | | | 15| physicians - obligations - utilization review | | | 16| entity - retrospective denial - length of prior | | | 17| authorization - continuity of care severability | | | 18| noncodification codification - effective date ] | | | 19| | | | 20| | | | 21|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 22| SECTION 1. NEW LAW A new section of law not to be | | | 23|codified in the Oklahoma Statutes reads as follows: | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 1 ___________________________________________________________________________
1| This act shall be known and may be cited as the "Ensuring | | | 2|Transparency in Prior Authorization Act". | | | 3| SECTION 2. NEW LAW A new section of law to be codified | | | 4|in the Oklahoma Statutes as Section 6570.1 of Title 36, unless there | | | 5|is created a duplication in numbering, reads as follows: | | | 6| As used in this act: | | | 7| 1. "Adverse determination" means a determinization by a health | | | 8|carrier or its designee utilization review entity that an admission, | | | 9|availability of care, continued stay, or other health care service | | | 10|that is a covered benefit has been reviewed and, based upon the | | | 11|information provided, does not meet the health carrier's | | | 12|requirements for medical necessity, appropriateness, health care | | | 13|setting, level of care, or effectiveness, and the requested service | | | 14|or payment for the service is therefore denied, reduced, or | | | 15|terminated as defined by Section 6475.3 of Title 36 of the Oklahoma | | | 16|Statutes; | | | 17| 2. "Chronic condition" means a condition that lasts one (1) | | | 18|year or more and requires ongoing medical attention or limits | | | 19|activities of daily living or both; | | | 20| 3. "Clinical criteria" means the written policies, written | | | 21|screening procedures, determination rules, determination abstracts, | | | 22|clinical protocols, practice guidelines, medical protocols, and any | | | 23|other criteria or rationale used by the utilization review entity to | | | 24|determine the necessity and appropriateness of health care services; | | | arsid2845662 ENGR. H. B. NO. 3190 Page 2 ___________________________________________________________________________
1| 4. "Emergency health care services", with respect to an | | | 2|emergency medical condition as defined in 42 U.S.C.A., Section | | | 3|300gg-111, means: | | | 4| a. a medical screening examination, as required under | | | 5| Section 1867 of the Social Security Act, 42 U.S.C., | | | 6| Section 1395dd, or as would be required under such | | | 7| section if such section applied to an independent, | | | 8| freestanding emergency department, that is within the | | | 9| capability of the emergency department, of a hospital | | | 10| or of an independent, freestanding emergency | | | 11| department, as applicable, including ancillary | | | 12| services routinely available to the emergency | | | 13| department to evaluate such emergency medical | | | 14| condition, and | | | 15| b. within the capabilities of the staff and facilities | | | 16| available at the hospital or the independent, | | | 17| freestanding emergency department, as applicable, such | | | 18| further medical examination and treatment as are | | | 19| required under Section 1395dd of the Social Security | | | 20| Act, or as would be required under such section if | | | 21| such section applied to an independent, freestanding | | | 22| emergency department, to stabilize the patient, | | | 23| regardless of the department of the hospital in which | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 3 ___________________________________________________________________________
1| such further examination or treatment is furnished, as | | | 2| defined by 42 U.S.C.A., Section 300gg-111; | | | 3| 5. "Emergency Medical Treatment and Active Labor Act" or | | | 4|"EMTALA" means Section 1867 of the Social Security Act and | | | 5|associated regulations; | | | 6| 6. "Enrollee" means an individual who is enrolled in a health | | | 7|care plan, including covered dependents, as defined by Section | | | 8|6592.1 of Title 36 of the Oklahoma Statutes; | | | 9| 7. "Health care provider" means any person or other entity who | | | 10|is licensed pursuant to the provisions of Title 59 or Title 63 of | | | 11|the Oklahoma Statutes, or pursuant to the definition in Section | | | 12|1-1708.1C of Title 63 of the Oklahoma Statutes; | | | 13| 8. "Health care services" means any services provided by a | | | 14|health care provider, or by an individual working for or under the | | | 15|supervision of a health care provider, that relate to the diagnosis, | | | 16|assessment, prevention, treatment, or care of any human illness, | | | 17|disease, injury, or condition, as defined by Section 1-1708.1C.2 of | | | 18|Title 63 of the Oklahoma Statutes. | | | 19|The term also includes the provision of mental health and substance | | | 20|use disorder services, as defined by Section 6060.10 of Title 36 of | | | 21|the Oklahoma Statutes, and the provision of durable medical | | | 22|equipment. The term does not include the provision, administration, | | | 23|or prescription of pharmaceutical products or services; | | | 24| 9. "Licensed mental health professional" means: | | | arsid2845662 ENGR. H. B. NO. 3190 Page 4 ___________________________________________________________________________
1| a. a psychiatrist who is a diplomate of the American | | | 2| Board of Psychiatry and Neurology, | | | 3| b. a psychiatrist who is a diplomate of the American | | | 4| Osteopathic Board of Neurology and Psychiatry, | | | 5| c. a physician licensed pursuant to the Oklahoma | | | 6| Allopathic Medical and Surgical Licensure and | | | 7| Supervision Act or the Oklahoma Osteopathic Medicine | | | 8| Act, | | | 9| d. a clinical psychologist who is duly licensed to | | | 10| practice by the State Board of Examiners of | | | 11| Psychologists, | | | 12| e. a professional counselor licensed pursuant to the | | | 13| Licensed Professional Counselors Act, | | | 14| f. a person licensed as a clinical social worker | | | 15| pursuant to the provisions of the Social Worker's | | | 16| Licensing Act, | | | 17| g. a licensed marital and family therapist as defined in | | | 18| the Marital and Family Therapist Licensure Act, | | | 19| h. a licensed behavioral practitioner as defined in the | | | 20| Licensed Behavioral Practitioner Act, | | | 21| i. an advanced practice nurse as defined in the Oklahoma | | | 22| Nursing Practice Act, | | | 23| j. a physician assistant who is licensed in good | | | 24| standing in this state, or | | | arsid2845662 ENGR. H. B. NO. 3190 Page 5 ___________________________________________________________________________
1| k. a licensed alcohol and drug counselor/mental health | | | 2| (LADC/MH) as defined in the Licensed Alcohol and Drug | | | 3| Counselors Act; | | | 4| 10. "Medically necessary" means services or supplies provided | | | 5|by a health care provider that are: | | | 6| a. appropriate for the symptoms and diagnosis or | | | 7| treatment of the enrollee's condition, illness, | | | 8| disease, or injury, | | | 9| b. in accordance with standards of good medical | | | 10| practice, | | | 11| c. not primarily for the convenience of the enrollee or | | | 12| the enrollee's health care provider, and | | | 13| d. the most appropriate supply or level of service that | | | 14| can safely be provided to the enrollee as defined by | | | 15| Section 6592 of Title 36 of the Oklahoma Statutes; | | | 16| 11. "Notice" means communication delivered either | | | 17|electronically or through the United States Postal Service or common | | | 18|carrier; | | | 19| 12. "Physician" means an allopathic or osteopathic physician | | | 20|licensed by the State of Oklahoma or another state to practice | | | 21|medicine; | | | 22| 13. "Prior authorization" means the process by which | | | 23|utilization review entities determine the medical necessity and | | | 24|medical appropriateness of otherwise covered health care services | | | arsid2845662 ENGR. H. B. NO. 3190 Page 6 ___________________________________________________________________________
1|prior to the rendering of such health care services. The term shall | | | 2|include "authorization", "pre-certification", and any other term | | | 3|that would be a reliable determination by a health benefit plan. | | | 4|The term shall not be construed to include or refer to such | | | 5|processes as they may pertain to pharmaceutical services; | | | 6| 14. "Urgent health care service" means a health care service | | | 7|with respect to which the application of the time periods for making | | | 8|an urgent care determination, which, in the opinion of a physician | | | 9|with knowledge of the enrollee's medical condition: | | | 10| a. could seriously jeopardize the life or health of the | | | 11| enrollee or the ability of the enrollee to regain | | | 12| maximum function, or | | | 13| b. in the opinion of a physician with knowledge of the | | | 14| claimant's medical condition, would subject the | | | 15| enrollee to severe pain that cannot be adequately | | | 16| managed without the care or treatment that is the | | | 17| subject of the utilization review; and | | | 18| 15. "Utilization review entity" means an individual or entity | | | 19|that performs prior authorization for a health benefit plan as | | | 20|defined by Section 6060.4 of Title 36 of the Oklahoma Statutes, but | | | 21|shall not include any health plan offered by a contracted entity | | | 22|defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that | | | 23|provides coverage to members of the state Medicaid program or other | | | 24|insurance subject to the Long Term Care Insurance Act. | | | arsid2845662 ENGR. H. B. NO. 3190 Page 7 ___________________________________________________________________________
1| SECTION 3. NEW LAW A new section of law to be codified | | | 2|in the Oklahoma Statutes as Section 6570.2 of Title 36, unless there | | | 3|is created a duplication in numbering, reads as follows: | | | 4| A utilization review entity shall make any current prior | | | 5|authorization requirements and restrictions, including written | | | 6|clinical criteria, readily accessible on its website to enrollees | | | 7|and health care providers. Prior authorization requirements shall | | | 8|be described in detail but also in easily understandable language. | | | 9| If a utilization review entity intends either to implement a new | | | 10|prior authorization requirement or restriction, or amend an existing | | | 11|requirement or restriction, the utilization review entity shall | | | 12|ensure that the new or amended requirement or restriction is not | | | 13|implemented unless the utilization review entity's website has been | | | 14|updated to reflect the new or amended requirement or restriction. | | | 15| If a utilization review entity intends either to implement a new | | | 16|prior authorization requirement or restriction, or amend an existing | | | 17|requirement or restriction, the utilization review entity shall | | | 18|provide contracted health care providers credentialed to perform the | | | 19|service, or enrollees who have a chronic condition and are already | | | 20|receiving the service for which the prior authorization changes will | | | 21|impact, notice of the new or amended requirement or restriction no | | | 22|less than sixty (60) days before the requirement or restriction is | | | 23|implemented. | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 8 ___________________________________________________________________________
1| SECTION 4. NEW LAW A new section of law to be codified | | | 2|in the Oklahoma Statutes as Section 6570.3 of Title 36, unless there | | | 3|is created a duplication in numbering, reads as follows: | | | 4| A utilization review entity shall ensure that all adverse | | | 5|determinations are made by a physician or licensed mental health | | | 6|professional. The physician or licensed mental health professional | | | 7|shall: | | | 8| 1. Possess a current and valid nonrestricted license in any | | | 9|United States jurisdiction; | | | 10| 2. Have the appropriate training, knowledge, or expertise to | | | 11|apply appropriate clinical guidelines to the health care service | | | 12|being requested; and | | | 13| 3. Make the adverse determination under the clinical direction | | | 14|of one of the utilization review entity's medical directors who is | | | 15|responsible for the provision of reviewing health care services to | | | 16|enrollees of Oklahoma. All such medical directors must be | | | 17|physicians licensed in any United States jurisdiction. | | | 18| SECTION 5. NEW LAW A new section of law to be codified | | | 19|in the Oklahoma Statutes as Section 6570.4 of Title 36, unless there | | | 20|is created a duplication in numbering, reads as follows: | | | 21| A utilization review entity shall ensure that all appeals are | | | 22|reviewed by a physician or licensed mental health professional. The | | | 23|physician or licensed mental health professional shall: | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 9 ___________________________________________________________________________
1| 1. Possess a current and valid unrestricted license in any | | | 2|United States jurisdiction; | | | 3| 2. Be of the same or similar specialty as a physician or | | | 4|licensed mental health professional who typically manages the | | | 5|medical condition or disease, which means that the physician either | | | 6|maintains board certification for the same or similar specialty as | | | 7|the medical condition in question or whose training and experience: | | | 8| a. includes treating the condition, | | | 9| b. includes treating complications that may result from | | | 10| the service or procedure, and | | | 11| c. is sufficient for the physician or licensed mental | | | 12| health professional to determine if the service or | | | 13| procedure is medically necessary or clinically | | | 14| appropriate, | | | 15|except for appeals coming from a licensed mental health | | | 16|professional, which may be conducted by another licensed mental | | | 17|health professional as opposed to a physician; | | | 18| 3. Not have been directly involved in making the adverse | | | 19|determination; | | | 20| 4. Not have any financial interest in the outcome of the | | | 21|appeal; and | | | 22| 5. Consider all known clinical aspects of the health care | | | 23|service under review, including, but not limited to, a review of | | | 24|those medical records which are pertinent and relevant to the active | | | arsid2845662 ENGR. H. B. NO. 3190 Page 10 ___________________________________________________________________________
1|condition provided to the utilization review entity by the | | | 2|enrollee's health care provider, or a health care facility, and any | | | 3|pertinent medical literature provided to the utilization review | | | 4|entity by the health care provider. | | | 5| SECTION 6. NEW LAW A new section of law to be codified | | | 6|in the Oklahoma Statutes as Section 6570.5 of Title 36, unless there | | | 7|is created a duplication in numbering, reads as follows: | | | 8| A. For plan years beginning on or after January 1, 2027, a | | | 9|health benefit plan must implement and maintain a Prior | | | 10|Authorization Application Programming Interface (API), as described | | | 11|in 45 C.F.R. Part 156. | | | 12| B. By July 1, 2027, health care providers must have electronic | | | 13|health records or practice management systems that are compatible | | | 14|with the API. | | | 15| C. As of the effective date of this act, a utilization review | | | 16|entity must provide health care providers with the following | | | 17|opportunities for communication during the prior authorization | | | 18|process: | | | 19| 1. Make staff available at least eight (8) hours a day during | | | 20|normal business hours for inbound telephone calls regarding prior | | | 21|authorization issues; | | | 22| 2. Allow staff to receive inbound communication regarding prior | | | 23|authorization issues after normal business hours; and | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 11 ___________________________________________________________________________
1| 3. Provide a treating provider with the opportunity to discuss | | | 2|a prior authorization denial with an appropriate reviewer. | | | 3| SECTION 7. NEW LAW A new section of law to be codified | | | 4|in the Oklahoma Statutes as Section 6570.6 of Title 36, unless there | | | 5|is created a duplication in numbering, reads as follows: | | | 6| A. If a utilization review entity requires prior authorization | | | 7|of a health care service, the utilization review entity must make a | | | 8|prior authorization or adverse determination and notify the enrollee | | | 9|and the enrollee's health care provider of the prior authorization | | | 10|or adverse determination in accordance with the time frames set | | | 11|forth below: | | | 12| 1. For purposes of approving prior authorization for urgent | | | 13|health care services, within seventy-two (72) hours of obtaining all | | | 14|necessary information to make the prior authorization or adverse | | | 15|determination; or | | | 16| 2. For purposes of approving prior authorization for non-urgent | | | 17|health care services, within seven (7) days of obtaining all | | | 18|necessary information to make the prior authorization or adverse | | | 19|determination. | | | 20| For purposes of this section, "necessary information" includes, | | | 21|but is not limited to, the results of any face-to-face clinical | | | 22|evaluation or second opinion that may be required. | | | 23| B. For those health care providers that submit all necessary | | | 24|information through the utilization review entity's authorized prior | | | arsid2845662 ENGR. H. B. NO. 3190 Page 12 ___________________________________________________________________________
1|authorization system, health care services are deemed authorized if | | | 2|a utilization review entity fails to comply with the deadlines set | | | 3|forth in this section. | | | 4| C. In the notification to the health care provider that a prior | | | 5|authorization has been approved, the utilization review entity shall | | | 6|include in such notification the duration of the prior authorization | | | 7|or the date by which the prior authorization will expire. | | | 8| SECTION 8. NEW LAW A new section of law to be codified | | | 9|in the Oklahoma Statutes as Section 6570.7 of Title 36, unless there | | | 10|is created a duplication in numbering, reads as follows: | | | 11| A. A utilization review entity shall not require prior | | | 12|authorization for pre-hospital transportation, for the provision of | | | 13|emergency health care services, or for transfers between facilities | | | 14|as required by the Emergency Medical Treatment and Active Labor Act. | | | 15| B. A utilization review entity shall allow an enrollee and the | | | 16|enrollee's health care provider a minimum of twenty-four (24) hours | | | 17|following an emergency admission or provision of emergency health | | | 18|care services for the enrollee or health care provider to notify the | | | 19|utilization review entity of the admission or provision of health | | | 20|care services. If the admission or health care service occurs on a | | | 21|holiday or weekend, a utilization review entity cannot require | | | 22|notification until the next business day after the admission or | | | 23|provision of the health care services. | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 13 ___________________________________________________________________________
1| C. A utilization review entity shall cover emergency health | | | 2|care services in accordance with the requirements of Section 6907 of | | | 3|Title 36 of the Oklahoma Statutes. | | | 4| SECTION 9. NEW LAW A new section of law to be codified | | | 5|in the Oklahoma Statutes as Section 6570.8 of Title 36, unless there | | | 6|is created a duplication in numbering, reads as follows: | | | 7| A. A health benefit plan may not revoke, limit, condition, or | | | 8|restrict a prior authorization if care is provided within forty-five | | | 9|(45) business days from the date the health care provider received | | | 10|the prior authorization unless the enrollee was no longer eligible | | | 11|for care on the day care was provided. | | | 12| B. A health benefit plan must pay a contracted health care | | | 13|provider at the contracted payment rate for a health care service | | | 14|provided by the health care provider per a prior authorization, | | | 15|unless: | | | 16| 1. The health care provider knowingly and materially | | | 17|misrepresented the health care service in the prior authorization | | | 18|request with the specific intent to deceive and obtain an unlawful | | | 19|payment from a utilization review entity; | | | 20| 2. The health care service was no longer a covered benefit on | | | 21|the day it was provided; | | | 22| 3. The health care provider was no longer contracted with the | | | 23|patient's health benefit plan on the date the care was provided; | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 14 ___________________________________________________________________________
1| 4. The health care provider failed to meet the utilization | | | 2|review entity's timely filing requirements; or | | | 3| 5. The patient was no longer eligible for health care coverage | | | 4|on the day the care was provided. | | | 5| SECTION 10. NEW LAW A new section of law to be codified | | | 6|in the Oklahoma Statutes as Section 6570.9 of Title 36, unless there | | | 7|is created a duplication in numbering, reads as follows: | | | 8| A. If a prior authorization is required for a health care | | | 9|service, other than for inpatient care, for the treatment of a | | | 10|chronic condition of an enrollee, then the prior authorization shall | | | 11|remain valid for at least six (6) months from the date the health | | | 12|care provider receives the prior authorization approval, unless | | | 13|clinical criteria changes and notice of the change in clinical | | | 14|criteria is provided as stipulated in this act. | | | 15| B. If a prior authorization is required for inpatient acute | | | 16|care for the treatment of a chronic condition of an enrollee, then | | | 17|the prior authorization shall remain valid for at least fourteen | | | 18|(14) calendar days from the date the health care provider receives | | | 19|the prior authorization approval. | | | 20| 1. If an enrollee requires inpatient care beyond the length of | | | 21|stay that was previously approved by the utilization review entity, | | | 22|then the utilization review entity shall evaluate any prior | | | 23|authorization requests for the continuation of inpatient care | | | 24|according to the provisions of this act. A utilization review | | | arsid2845662 ENGR. H. B. NO. 3190 Page 15 ___________________________________________________________________________
1|entity shall not use any stricter criteria to determine medical | | | 2|necessity and appropriateness of the continuation of inpatient care | | | 3|as the utilization review entity used to evaluate the initial | | | 4|request for authorization of inpatient care. A utilization review | | | 5|entity shall review any relevant and pertinent literature or data | | | 6|provided by the health care provider to determine the medical | | | 7|necessity and appropriateness of the requested length of stay and/or | | | 8|continuation of inpatient care. A prior authorization for the | | | 9|continuation of inpatient care shall remain valid for a maximum of | | | 10|fourteen (14) calendar days from the date the health care provider | | | 11|receives the prior authorization approval. | | | 12| 2. If a utilization review entity fails to respond to a health | | | 13|care provider's timely prior authorization request for the | | | 14|continuation of inpatient acute care before the termination of the | | | 15|previously approved length of stay, then the health benefit plan | | | 16|shall continue to compensate the health care provider at the | | | 17|contracted rate for inpatient care provided until the utilization | | | 18|review entity issues its determination on the prior authorization | | | 19|request. | | | 20| For the purposes of this section, a timely request for | | | 21|continuation of inpatient care means a request that is submitted at | | | 22|least seventy-two (72) hours prior to the termination of the | | | 23|previously approved prior authorization and includes all necessary | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 16 ___________________________________________________________________________
1|information for the utilization review entity to make a | | | 2|determination. | | | 3| 3. If a utilization review entity issues an adverse | | | 4|determination to a health care provider's prior authorization | | | 5|request for continuation of inpatient acute care and the health care | | | 6|provider appeals the adverse determination according to the | | | 7|provisions of this act, then the health benefit plan shall continue | | | 8|to compensate the health care provider at the contracted rate for | | | 9|inpatient care provided until the appeal has been finalized. | | | 10| C. This section does not require a health benefit plan to cover | | | 11|care, treatment, or services for a health condition that the terms | | | 12|of coverage otherwise completely exclude from the policy's covered | | | 13|benefits without regard for whether the care, treatment, or services | | | 14|are medically necessary. | | | 15| SECTION 11. NEW LAW A new section of law to be codified | | | 16|in the Oklahoma Statutes as Section 6570.10 of Title 36, unless | | | 17|there is created a duplication in numbering, reads as follows: | | | 18| A. On receipt of information documenting a prior authorization | | | 19|from the enrollee or from the enrollee's health care provider, a | | | 20|utilization review entity shall honor a prior authorization granted | | | 21|to an enrollee from a previous utilization review entity for at | | | 22|least the initial sixty (60) days of an enrollee's coverage under a | | | 23|new health plan. | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 17 ___________________________________________________________________________
1| B. During the time period described in subsection A of this | | | 2|section, a utilization review entity may perform its own review to | | | 3|grant a prior authorization or make an adverse determination. | | | 4| C. A utilization review entity shall continue to honor a prior | | | 5|authorization it has granted to an enrollee when the enrollee | | | 6|changes products under the same health insurance company for the | | | 7|initial sixty (60) days of an enrollee's coverage under the new | | | 8|product unless the service is no longer a covered service under the | | | 9|new product. | | | 10| SECTION 12. NEW LAW A new section of law to be codified | | | 11|in the Oklahoma Statutes as Section 6570.11 of Title 36, unless | | | 12|there is created a duplication in numbering, reads as follows: | | | 13| If any provision of this act or the application thereof to any | | | 14|person or circumstance is held invalid, such invalidity shall not | | | 15|affect other provisions or applications of the act which can be | | | 16|given effect without the invalid provision or application, and to | | | 17|this end, the provisions of this act are declared to be severable. | | | 18| SECTION 13. This act shall become effective January 1, 2025. | | | 19| Passed the House of Representatives the 13th day of March, 2024. | | | 20| | | | 21| | | Presiding Officer of the House | 22| of Representatives | | | 23| | | | 24| Passed the Senate the ___ day of __________, 2024. | | | arsid2845662 ENGR. H. B. NO. 3190 Page 18 ___________________________________________________________________________
1| | | | 2| | | Presiding Officer of the Senate | 3| | | | 4| | | | 5| | | | 6| | | | 7| | | | 8| | | | 9| | | | 10| | | | 11| | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | arsid2845662 ENGR. H. B. NO. 3190 Page 19