HLS 15RS-1054 ORIGINAL
2015 Regular Session
HOUSE BILL NO. 257
BY REPRESENTATIVE SEABAUGH
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Provides relative to healthcare provider credentialing
1 AN ACT
2To amend and reenact R.S. 22:1009(A)(5) and (7) and to enact R.S. 22:1009(B)(5), relative
3 to healthcare provider credentialing; to specify that licensed dentists are healthcare
4 providers and dental benefit plans are health insurance issuers for purposes of
5 credentialing; to prohibit requiring recredentialing for additional practice locations;
6 and to provide for related matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1009(A)(5) and (7) are hereby amended and reenacted and R.S.
922:1009(B)(5) is hereby enacted to read as follows:
10 ยง1009. Health care provider credentialing
11 A. As used in this Section, the following words and phrases shall have the
12 following meanings ascribed for each, unless the context clearly indicates otherwise:
13 * * *
14 (5) "Health care provider" or "provider" means a physician licensed to
15 practice medicine by the Louisiana State Board of Medical Examiners Examiners,
16 a dentist licensed to practice dentistry by the Louisiana State Board of Dentistry, or
17 other individual health care practitioner licensed, certified, or registered to perform
18 specified health care services consistent with state law.
19 * * *
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 15RS-1054 ORIGINAL
HB NO. 257
1 (7) "Health insurance issuer" or "issuer" means any insurer who offers health
2 insurance coverage through a plan, policy, or certificate of insurance subject to state
3 law that regulates the business of insurance. A "health insurance issuer" or "issuer"
4 shall also include a health maintenance organization, as defined and licensed
5 pursuant to Subpart I of Part I of Chapter 2 of this Title, a dental benefit plan,
6 including an entity defined as a dental service contractor in Subpart G of this Part,
7 and shall include the Office of Group Benefits programs.
8 * * *
9 B.
10 * * *
11 (5) Once a provider has been credentialed by a health insurance issuer for
12 any location in the state of Louisiana, that provider shall be considered credentialed
13 for all locations at which that provider may legally practice medicine or dentistry in
14 the state, it being necessary only that the credentialed provider give the issuer written
15 notice of any additional location of practice beyond the primary practice location
16 and any additional practice location originally noted on the provider's initial
17 credentialing application form. There shall be no requirement that the provider be
18 recredentialed for such additional locations. The credentialing for any additional
19 location shall be effective immediately upon the receipt by the issuer of written
20 notice from the provider.
21 * * *
22 Section 2. This Act shall become effective upon signature by the governor or, if not
23signed by the governor, upon expiration of the time for bills to become law without signature
24by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
25vetoed by the governor and subsequently approved by the legislature, this Act shall become
26effective on the day following such approval.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 15RS-1054 ORIGINAL
HB NO. 257
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)]
HB 257 Original 2015 Regular Session Seabaugh
Abstract: Provides with respect to credentialing, the process of assessing and validating the
qualifications of healthcare providers applying to be approved by a health insurance
issuer to provide healthcare services to the health insurance issuer's enrollees or
insureds.
Proposed law changes present law authorizing health insurance issuers to require healthcare
providers to be credentialed, as follows:
(1)Changes the definition of a "health care provider" to specifically include a dentist
licensed to practice dentistry by the La. State Board of Dentistry.
(2)Changes the definition of a "health insurance issuer" to specifically include a dental
benefit plan, including an entity defined as a dental service contractor in present law.
(3)Provides that once a provider has been credentialed by a health insurance issuer for
any location in the state, that provider shall be considered credentialed for all
locations at which that provider may legally practice medicine or dentistry in this
state. States that it is necessary only that the credentialed provider give the issuer
written notice of any additional location of practice beyond the primary practice
location and any additional practice location originally noted on the provider's initial
credentialing application form. Prohibits any requirement that the provider be
recredentialed for such additional locations. Further provides that the credentialing
for any additional location shall be effective immediately upon receipt by the issuer
of written notice from the provider.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1009(A)(5) and (7); Adds R.S. 22:1009(B)(5))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.