HLS 12RS-830 ORIGINAL
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are additions.
Regular Session, 2012
HOUSE BILL NO. 387
BY REPRESENTATIVE GISCLAIR
INSURANCE/HEALTH: Right to choice of method of treatment for a life-threatening
medical condition for a person with health insurance coverage
AN ACT1
To enact R.S. 22:1019, relative to health insurance coverage; to provide for the right to2
choice of the method of treatment for a life-threatening medical condition for a3
person with health insurance coverage; to provide for parity for the chosen method4
of treatment; to provide for definitions; to provide for applicability; and to provide5
for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:1019 is hereby enacted to read as follows: 8
ยง1019. Right to choice of method of treatment for a life-threatening medical9
condition for a person with health insurance coverage10
A. It is hereby declared that it is the public policy of this state that every11
person within this state with health insurance coverage shall have the right to choose12
the method of treatment to be pursued for any life-threatening medical condition13
suffered by that person so long as such method of treatment is a covered health care14
service recommended by a contracted health care provider, as such a decision affects15
the person's overall, long-term health and quality of life.16
B. (1) A covered person with a life-threatening medical condition shall have17
the right to obtain one or more second opinions from physicians who are both18
clinical peers and contracted health care providers regarding the method of treatment19
of his life-threatening medical condition. If such physicians render their second20 HLS 12RS-830 ORIGINAL
HB NO. 387
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opinions in writing and such opinions recommend, on the basis of evidence-based1
standards, alternative methods of treatment which are covered health care services,2
it shall be the right of the covered person to choose and receive his chosen method3
of treatment.4
(2)(a) A health insurance issuer shall provide for coverage of such chosen5
method of treatment on a basis no less favorable than the alternative method of6
treatment for the life-threatening condition that is the least costly covered health care7
service to the health insurance issuer.8
(b) Health insurance coverage of such chosen method of treatment shall not9
be subject to any prior authorization, dollar limit, copayment, deductible, or other10
out-of-pocket expense that does not apply to the alternative method of treatment for11
the life-threatening condition that is the least costly covered health care service to the12
health insurance issuer.13
C. As used in this Section:14
(1) "Clinical peer" means a physician who holds a nonrestricted license in the15
same or an appropriate specialty that typically manages or treats the life-threatening16
medical condition.17
(2) "Contracted health care provider" means a physician that has entered into18
a contract or agreement directly with a health insurance issuer or with a health19
insurance issuer through a network of providers for the provision of covered health20
care services.21
(3) "Covered health care services" means services for the treatment of a life-22
threatening medical condition that is covered and payable under the terms of health23
insurance coverage.24
(4) "Covered person" means a policyholder, subscriber, enrollee, or other25
individual enrolled in or insured by a health insurance issuer for health insurance26
coverage.27
(5) "Evidence-based standard" means the conscientious, explicit, and28
judicious use of the current best medical or scientific evidence based on the overall29 HLS 12RS-830 ORIGINAL
HB NO. 387
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systematic review of the research in making decisions about the treatment of a life-1
threatening medical condition.2
(6) "Health insurance coverage" or "coverage" means benefits consisting of3
medical care provided or arranged for directly, through insurance or reimbursement,4
or through a network or otherwise and including services paid for as medical care5
under any hospital or medical service policy or certificate, hospital or medical6
service plan contract, preferred provider organization agreement, or health7
maintenance organization contract offered by a health insurance issuer.8
(7) "Health insurance issuer" means any entity that offers health insurance9
coverage through a policy or certificate of insurance subject to state law that10
regulates the business of insurance. For purposes of this Section, a "health insurance11
issuer" shall include a health maintenance organization, as defined and licensed12
pursuant to Subpart I of Part I of Chapter 2 of this Title, nonfederal government13
plans subject to the provisions of Subpart B of this Part, and the Office of Group14
Benefits.15
(8) "Life-threatening medical condition" means a severe, acute, or serious16
condition for which death is possible, including but not limited to cancer, heart17
disease, heart stroke, or kidney disease.18
(9) "Network of providers" or "network" means an entity other than a health19
insurance issuer that, through contracts with health care providers, provides or20
arranges for access by groups of covered persons to covered health care services by21
health care providers who are not otherwise or individually contracted directly with22
a health insurance issuer.23
(10) "Physician" means a person licensed to practice medicine as a medical24
doctor.25
(11) "Second opinion" means an opportunity or requirement to obtain a26
clinical evaluation by a physician other than the one originally making a27
recommendation for a proposed covered health care service to assess the clinical28
necessity and appropriateness of the initial proposed covered health care service.29 HLS 12RS-830 ORIGINAL
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(12) "Treatment" means the prevention, treatment, management, cure, or1
relief of a life-threatening medical condition.2
D. The provisions of this Section shall not apply to the following with the3
exception of those which specifically cover cancer:4
(1) Individually underwritten, guaranteed renewable health insurance5
policies.6
(2) Limited benefit health insurance policies or contracts.7
Section 2. This Act shall be applicable to health insurance coverage issued for8
delivery, delivered, renewed, or otherwise contracted for in this state on or after January 1,9
2013, except as otherwise provided in this Act. 10
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Gisclair HB No. 387
Abstract: Provide for the right to choice of the method of treatment for a life-threatening
medical condition, defined as a severe, acute, or serious condition for which death
is possible, including but not limited to cancer, heart disease, heart stroke, or kidney
disease, under health insurance coverage.
Proposed law declares it to be the public policy of this state that every person within this
state with health insurance coverage shall have the right to choose the method of treatment
to be pursued for any life-threatening medical condition suffered by that person so long as
such method of treatment is a covered health care service recommended by a contracted
health care provider, as such a decision affects the person's overall, long-term health and
quality of life.
Proposed law specifically requires that a covered person with a life-threatening medical
condition shall have the right to obtain one or more second opinions from physicians who
are both clinical peers and contracted health care providers regarding the method of
treatment of his life-threatening medical condition. Further provides that if such physicians
render their second opinions in writing and such opinions recommend, on the basis of
evidence-based standards, alternative methods of treatment which are covered health care
services, it shall be the right of the covered person to choose and receive his chosen method
of treatment.
Proposed law prohibits a health insurance issuer from providing for coverage of such chosen
method of treatment on a basis less favorable than the alternative method of treatment for
the life-threatening condition that is the least costly covered health care service to the health
insurance issuer. Further provides that health insurance coverage of such chosen method of
treatment shall not be subject to any prior authorization, dollar limit, copayment, deductible,
or other out-of-pocket expense that does not apply to the alternative method of treatment for
the life-threatening condition that is the least costly covered health care service to the health
insurance issuer. HLS 12RS-830 ORIGINAL
HB NO. 387
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Proposed law provides for definitions, including defining "life-threatening medical
condition" as a severe, acute, or serious condition for which death is possible, including but
not limited to cancer, heart disease, heart stroke, or kidney disease.
Proposed law specifies that it is applicable to health insurance issuers, including a health
maintenance organization, certain nonfederal government plans, and the Office of Group
Benefits.
Proposed law specifies that it is not applicable to individually underwritten, guaranteed
renewable health insurance policies and limited benefit health insurance policies or contracts
with the exception of those which cover cancer.
Proposed law shall be applicable to health insurance coverage that provides coverage for
cancer treatment issued for delivery, delivered, renewed, or otherwise contracted for in this
state on or after Jan. 1, 2013, except as otherwise provided in proposed law.
(Adds R.S. 22:1019)