ENROLLED
ACT No. 63
2015 Regular Session
HOUSE BILL NO. 257
BY REPRESENTATIVE SEABAUGH
1 AN ACT
2 To 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.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1009(A)(introductory paragraph), (5), and (7) are hereby amended
9 and 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 * * *
20 (7) "Health insurance issuer" or "issuer" means any insurer who offers health
21 insurance coverage through a plan, policy, or certificate of insurance subject to state
22 law that regulates the business of insurance. A "health insurance issuer" or "issuer"
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1 shall also include a health maintenance organization, as defined and licensed
2 pursuant to Subpart I of Part I of Chapter 2 of this Title, a dental benefit plan,
3 including an entity defined as a dental service contractor in Subpart G of this Part,
4 and shall include the Office of Group Benefits programs.
5 * * *
6 B.
7 * * *
8 (5) A provider who has been credentialed by a health insurance issuer for
9 any location in the state of Louisiana and is current on all credentialing at such
10 location or locations, shall be considered credentialed for all other locations at which
11 that provider may legally practice medicine or dentistry in the state of Louisiana,
12 provided that each of the following conditions are met:
13 (a) Not less than thirty days prior to the time at which the provider begins
14 practicing at any additional location, another provider who is current on all
15 credentialing with that health insurance issuer legally practiced there.
16 (b) The provider gives the health insurance issuer written notice of any
17 additional location of practice beyond his primary practice location and any
18 additional practice location originally noted on the provider's initial credentialing
19 application form. The health insurance issuer may require that such notice include
20 such additional information as may be reasonably necessary in order to process
21 claims filed by the provider from the additional location. The credentialing of the
22 provider for any additional location shall be effective immediately upon the receipt
23 by the health insurance issuer of such written notice from the provider.
24 (6) Pursuant to Paragraph (5) of this Subsection, there shall be no other
25 requirements placed upon the provider in order to be credentialed by a health
26 insurance issuer for any additional location.
27 * * *
28 Section 2. This Act shall become effective upon signature by the governor or, if not
29 signed by the governor, upon expiration of the time for bills to become law without signature
30 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
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1 vetoed by the governor and subsequently approved by the legislature, this Act shall become
2 effective on the day following such approval.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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