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words in boldface type and underscored are additions.
Regular Session, 2012
SENATE BILL NO. 669
BY SENATOR WARD
HEALTH/ACC INSURANCE. Provide with respect to eye or vision care services provided
by choice of practitioners. (8/1/12)
AN ACT1
To amend and reenact R.S. 22:997, relative to visual services and choice of practitioners; to2
provide with respect to vision care services performed by a licensed optometrist; and3
to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:997 is hereby amended and reenacted to read as follows:6
ยง997. Visual services, choice of practitioners7
A. Whenever any medical eye care or vision care benefits are provided by8
or available through a health maintenance organization, preferred provider9
organization, managed care organization, plan or contract of insurance or any10
medical or hospital service contract or hospital and medical service contract issued11
or delivered in this state provides for reimbursement of any visual services which12
that are within the lawful scope of practice of a duly licensed optometrist as defined13
in R.S. 37:1041, (5), there shall be no discrimination in the amount of either:14
(1) Medical eye care or vision care benefits available to an insured,15
participant, or other person entitled to such benefits, whether provided by an16
optometrist or physician, in instances where the services performed are within17 SB NO. 669
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
the lawful scope of practice of both professions.1
(2) Reimbursements or payments to the provider of such medical eye2
care or vision care services, whether performed by an optometrist or physician,3
in instances where the services performed are within the lawful scope of4
practice of both professions. the insured or other person entitled to benefits under5
such contract shall be entitled to reimbursements for such services, whether such6
services are performed by a duly licensed physician or a duly licensed optometrist,7
not withstanding any provision of the law to the contrary or any provision in any8
such contract; duly licensed optometrist shall be entitled to participate in such9
contracts providing for visual services to the same extent as duly licensed physicians.10
There shall be no discrimination in the amount of reimbursement allowed for such11
visual services, whether performed by an optometrist or physician, in instances12
where the services performed are within the lawful scope of practice of both13
professions.14
B. A duly licensed optometrist shall be entitled to participate in15
contracts or plans providing for medical eye care or vision care services as a16
healthcare provider or otherwise, to the same extent as a duly licensed17
physician, and there shall be no discrimination against any provider, whether18
an optometrist or physician, who is located within the geographic area of the19
health maintenance organization, preferred provider organization, managed20
care organization, or plan or contract of insurance. A health maintenance21
organization, preferred provider organization, managed care organization,22
plan or contract of insurance, or any medical or hospital service contract shall23
not impose a co-payment, co-insurance amount, or any other fee on a covered24
participant or insured that is greater than the amount charged for the same25
service when provided by an allopathic physician or an osteopathic physician.26
C. It shall be unlawful for a health maintenance organization, preferred27
provider organization, managed care organization, or plan or contract of28
insurance to require a duly licensed optometrist to participate as a provider in29 SB NO. 669
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
another medical or vision care plan or contract as a condition of or requirement1
for participation by such duly licensed optometrist as a provider in any medical2
or vision care plan or contract.3
D. The requirements of this Section shall also apply to all healthcare4
providers and insurance companies as well as any healthcare benefits delivered5
through a health maintenance organization as defined in R.S. 22:242(7), or a6
managed care organization as defined in R.S. 40:2207(C)(1), or a preferred7
provider organization as defined in R.S. 40:2202(5)(a).8
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Present law provides whenever any contract of insurance, or medical or hospital service
contract, or hospital and medical service contract issued in La. provides for reimbursement
of any visual services which are within the lawful scope of practice by a duly licensed
optometrist, the person entitled to benefits under such contract shall be entitled to
reimbursements for services, whether performed by a duly licensed physician or optometrist.
Further provides that licensed optometrists shall be entitled to participate in contracts for
visual services to the same extent as licensed physicians. Prohibits discrimination in the
amount of reimbursement allowed for visual services, whether performed by an optometrist
or physician, in instances where the services performed are within the lawful scope of
practice of both professions.
Proposed law provides whenever any medical eye care benefits within the lawful scope of
practice of a duly licensed optometrist as defined in present law, are provided by or available
through a health maintenance organization ("HMO"), preferred provider organization
("PPO"), managed care organization, plan or contract of insurance, or any medical hospital
service contract, discrimination is prohibited in the amount of either:
1. Medical eye care or vision care benefits available to any person entitled to benefits,
whether provided by an optometrist or physician, in instances where the services
performed are within the lawful scope of practice of both professions.
2. Reimbursements or payments to the provider of medical eye care or vision care
services, whether performed by an optometrist or physician, in instances where the
services performed are within the lawful scope of practice of both professions.
Proposed law further provides that a duly licensed optometrist shall be entitled to participate
in contracts or plans providing medical eye care or vision care services, as a healthcare
provider or otherwise, to the same extent as licensed physicians. Further prohibits
discrimination against any provider, whether optometrist or physician, who is located within
the geographic area of the HMO, PPO, managed care organization, or plan or contract of
insurance. Prohibits imposing a co-payment, co-insurance amount, or any other fee on a
covered participant or insured that is greater than the amount charged for the same service
when provided by an allopathic or osteopathic physician.
Proposed law prohibits an HMO, a PPO, or plan or contract of insurance from requiring a
duly licensed optometrist to participate as a provider in another medical or vision care plan SB NO. 669
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or contract as a condition of participation as a provider in any medical or vision care plan
or contract.
Effective August 1, 2012.
(Amends R.S. 22:997)