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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2012
SENATE BILL NO. 231
BY SENATORS MURRAY, MI LLS AND THOMPSON
HEALTH/ACC INSURANCE. Provides relative to prior authorization forms. (gov sig)
AN ACT1
To enact R.S. 22:1006.1, relative to prior authorization forms; to provide with respect to the2
issuance and use of prior authorization forms; to provide for an effective date; and3
to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1006.1 is hereby enacted to read as follows:6
ยง1006.1. Prior authorization forms required; criteria7
A. As used in this Section:8
(1) "Health insurance issuer" means any entity that offers health9
insurance coverage through a plan, policy, or certificate of insurance subject to10
state law that regulates the business of insurance. "Health insurance issuer"11
shall also include a health maintenance organization, as defined and licensed12
pursuant to Subpart I of Part I of Chapter 2 of this Title.13
(2) "Health benefit plan", "plan", "benefit", or "health insurance14
coverage" means services consisting of medical care, provided directly, through15
insurance or reimbursement, or otherwise, and including items and services16
paid for as medical care under any hospital or medical service policy or17 SB NO. 231
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
certificate, hospital or medical service plan contract, preferred provider1
organization, or health maintenance organization contract offered by a health2
insurance issuer. However, excepted benefits are not included as a "health3
benefit plan".4
(3) "Prior authorization" shall mean a utilization management criteria5
utilized to seek permission or waiver of a drug to be covered under a health6
benefit plan that provides prescription drug benefits.7
(4) "Prior authorization form" shall mean a standardized, uniform8
application developed by a health insurance issuer for the purpose of obtaining9
prior authorization.10
B. Notwithstanding any other provision of law to the contrary, in order11
to establish uniformity in the submission of prior authorization forms, on and12
after January 1, 2013, a health insurance issuer shall utilize only a single,13
standardized prior authorization form for obtaining any prior authorization for14
prescription drug benefits. Such form shall not exceed two pages in length,15
excluding any instructions or guiding documentation. Such form shall be16
accessible through multiple computer operating systems. Additionally, the17
health insurance issuer shall submit its prior authorization forms to the18
Department of Insurance to be kept on file on or after January 1, 2013. A copy19
of any subsequent replacements or modifications of a health insurance issuer's20
prior authorization form shall be filed with the Department of Insurance within21
fifteen days prior to use or implementation of such replacements or22
modifications.23
Section 2. This Act shall become effective upon signature by the governor or, if not24
signed by the governor, upon expiration of the time for bills to become law without signature25
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If26
vetoed by the governor and subsequently approved by the legislature, this Act shall become27
effective the day following such approval.28 SB NO. 231
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
The original instrument was prepared by Cheryl Horne. The following digest,
which does not constitute a part of the legislative instrument, was prepared
by Jeanne Johnston.
DIGEST
Murray (SB 231)
Proposed law provides for definitions as follows:
"Health insurance issuer" means an entity that offers health insurance coverage through a
plan, policy, or certificate of insurance subject to state law regulating the business of
insurance. Includes health maintenance organizations as defined in present law in such
definition.
"Health benefit plan", "plan", "benefit" or "health insurance coverage" means services
consisting of medical care provided directly through insurance or reimbursement, or
otherwise, including items and services paid for as medical care under a hospital or medical
service policy or certificate, hospital or medical service plan contract, preferred provider
organization, or health maintenance organization contract offered by a health insurance
issuer. Specifies that excepted benefits are not included as a health benefit plan.
"Prior authorization" means a utilization management criteria utilized to seek permission or
waiver of a drug to be covered under a health benefit plan that provides prescription drug
benefits.
"Prior authorization form" means a standardized, uniform application developed by a health
insurance issuer for the purposes of obtaining prior authorization.
Proposed law, applicable on and after January 1, 2013, requires a health insurance issuer that
provides prescription drug benefits to use only a single, standardized prior authorization
form for obtaining any prior authorization for prescription drug benefits. Provides that such
form shall not exceed two pages in length (exclusive of instructions or guiding
documentation), be accessible through multiple computer operating systems, and be filed
with the Department of Insurance on or after January 1, 2013. Further provides that
replacements or modifications of a prior authorization form must be filed with the Dept. of
Insurance within 15 days prior to use or implementation.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 22:1006.1)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill.
1. Provides definitions for "health insurance issuer", "health benefit plan",
"plan", "benefit", "health insurance coverage", "prior authorization" and
"prior authorization form".
2. Requires a health insurance issuer to use only a single, standardized prior
authorization form for obtaining any prior authorization for prescription drug
benefits. Requires the form to be accessible through multiple computer
operating systems. Further provides that such form shall not exceed two
pages in length and be filed with the Department of Insurance on or after
January 1, 2013. SB NO. 231
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Senate Floor Amendments to engrossed bill.
1. Makes technical changes.