HLS 15RS-1054 ENGROSSED
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)(introductory paragraph), (5), and (7) and to enact
3 R.S. 22:1009(B)(5) and (6), relative to healthcare provider credentialing; to specify
4 that licensed dentists are healthcare providers and dental benefit plans are health
5 insurance issuers for purposes of credentialing; to prohibit requiring recredentialing
6 for additional practice locations; and to provide for related matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1009(A)(introductory paragraph), (5), and (7) are hereby amended
9and reenacted and R.S. 22:1009(B)(5) and (6) are 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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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) A provider who has been credentialed by a health insurance issuer for
12 any location in the state of Louisiana and is current on all credentialing at such
13 location or locations, shall be considered credentialed for all other locations at which
14 that provider may legally practice medicine or dentistry in the state of Louisiana,
15 provided that each of the following conditions are met:
16 (a) Not less than thirty days prior to the time at which the provider begins
17 practicing at any additional location, another provider who is current on all
18 credentialing with that health insurance issuer legally practiced there.
19 (b) The provider gives the health insurance issuer written notice of any
20 additional location of practice beyond his primary practice location and any
21 additional practice location originally noted on the provider's initial credentialing
22 application form. The health insurance issuer may require that such notice include
23 such additional information as may be reasonably necessary in order to process
24 claims filed by the provider from the additional location. The credentialing of the
25 provider for any additional location shall be effective immediately upon the receipt
26 by the health insurance issuer of such written notice from the provider.
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HB NO. 257
1 (6) Pursuant to Paragraph (5) of this Subsection, there shall be no other
2 requirements placed upon the provider in order to be credentialed by a health
3 insurance issuer for any additional location.
4 * * *
5 Section 2. This Act shall become effective upon signature by the governor or, if not
6signed by the governor, upon expiration of the time for bills to become law without signature
7by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
8vetoed by the governor and subsequently approved by the legislature, this Act shall become
9effective on the day following such approval.
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 Engrossed 2015 Regular Session Seabaugh
Abstract: Provides with respect to credentialing, the process of assessing and validating the
qualifications of health care providers applying to be approved by a health insurance
issuer to provide health care services to the health insurance issuer's enrollees or
insureds.
Proposed law changes present law authorizing health insurance issuers to require health care
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 a provider who has been credentialed by a health insurance issuer for
any location in the state and is current on all credentialing at that location shall be
considered credentialed for all locations at which that provider may legally practice
medicine or dentistry, provided that each of the following conditions are met:
(a)Not less than 30 days prior to the time at which the provider begins
practicing at any additional location, another provider who is current on all
credentialing with that issuer legally practiced there.
(b)The provider gives the issuer written notice of any additional location of
practice beyond his primary practice location and any additional practice
location originally noted on the provider's initial credentialing application
form. Allows the issuer to require that such notice include such additional
information as may be reasonably necessary in order to process claims filed
by the provider from the additional location. Makes the credentialing of the
provider for any additional location effective immediately upon the receipt
by the issuer of such written notice from the provider.
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HB NO. 257
(4)Provides that, pursuant to proposed law, there shall be no other requirements placed
upon the provider in order to be credentialed by an issuer for any additional practice
location.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1009(A)(intro. para.), (5), and (7); Adds R.S. 22:1009(B)(5) and (6))
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
original bill:
1. Delete provisions providing that: (a) a provider credentialed by a health
insurance issuer for any location in the state shall be considered credentialed for
all locations; (b) 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; and (c) any requirement that the provider
be recredentialed for such additional locations shall be prohibited.
2. Add provisions placing specific conditions on a provider to be credentialed for
additional practice locations. Also prohibits any other requirement being placed
upon a provider in order to be credentialed for such an additional location.
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CODING: Words in struck through type are deletions from existing law; words underscored
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