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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. 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, accountable care organization, plan10
or contract of insurance or any medical or hospital service contract or hospital and11
medical service contract issued or delivered in this state provides for reimbursement12
of any visual services which that are within the lawful scope of practice of a duly13
licensed optometrist as defined in R.S. 37:1041, (5), there shall be no14
discrimination in the amount of either:15
(1) Medical eye care or vision care benefits available to an insured,16
participant, or other person entitled to such benefits, whether provided by an17 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.
optometrist or physician, in instances where the services performed are within1
the lawful scope of practice of both professions.2
(2) Reimbursements or payments to the provider of such medical eye3
care or vision care services, whether performed by an optometrist or physician,4
in instances where the services performed are within the lawful scope of5
practice of both professions. the insured or other person entitled to benefits under6
such contract shall be entitled to reimbursements for such services, whether such7
services are performed by a duly licensed physician or a duly licensed optometrist,8
not withstanding any provision of the law to the contrary or any provision in any9
such contract; duly licensed optometrist shall be entitled to participate in such10
contracts providing for visual services to the same extent as duly licensed physicians.11
There shall be no discrimination in the amount of reimbursement allowed for such12
visual services, whether performed by an optometrist or physician, in instances13
where the services performed are within the lawful scope of practice of both14
professions.15
B. A duly licensed optometrist shall be entitled to participate in16
contracts or plans providing for medical eye care or vision care services as a17
healthcare provider or otherwise, to the same extent as a duly licensed18
physician, and there shall be no discrimination against any provider, whether19
an optometrist or physician, who is located within the geographic area of the20
health maintenance organization, preferred provider organization, managed21
care organization, accountable care organization, or plan or contract of22
insurance. A health maintenance organization, preferred provider23
organization, managed care organization, accountable care organization, plan24
or contract of insurance, or any medical or hospital service contract shall not25
impose a co-payment, co-insurance amount, or any other fee on a covered26
participant or insured that is greater than the amount charged for the same27
service when provided by an allopathic physician or an osteopathic physician.28
C. It shall be unlawful for a health maintenance organization, preferred29 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.
provider organization, managed care organization, accountable care1
organization, or plan or contract of insurance to require a duly licensed2
optometrist to participate as a provider in another medical or vision care plan3
or contract as a condition of or requirement for participation by such duly4
licensed optometrist as a provider in any medical or vision care plan or5
contract.6
The original instrument was prepared by Cheryl Horne. The following digest,
which does not constitute a part of the legislative instrument, was prepared
by Laura Gail Sullivan.
DIGEST
Ward (SB 669)
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, accountable 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, accountable 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, managed care organization, accountable care SB NO. 669
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Coding: Words which are struck through are deletions from existing law;
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organization, or plan or contract of insurance from requiring a duly licensed optometrist to
participate as a provider in another medical or vision care plan 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)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill
1. Includes accountable care organizations in proposed law.