HLS 15RS-700 ENGROSSED
2015 Regular Session
HOUSE BILL NO. 307
BY REPRESENTATIVE JACKSON
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MENTAL HEALTH: Provides relative to coverage and payment for services rendered to
a person admitted under an emergency certificate
1 AN ACT
2To enact R.S. 28:53(P), relative to admission by emergency certificate; to prohibit denial of
3 coverage or refusal to pay claims for inpatient behavioral health services rendered
4 while under an emergency certificate on the basis of medical necessity; to provide
5 for exclusions; to require the opportunity for voluntary admission; to require
6 evaluation within twenty-four hours of arrival at an admitting facility; to provide for
7 definitions; and to provide for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 28:53(P) is hereby enacted to read as follows:
10 ยง53. Admission by emergency certificate; extension; payment for services rendered
11 * * *
12 P.(1) Notwithstanding any provision of law to the contrary, no claim for
13 payment for inpatient behavioral health services provided to a person while admitted
14 and detained in a facility that provides mental health services under an emergency
15 certificate, issued in accordance with the provisions of this Section, shall be denied
16 by Medicaid, an entity contracted with the state for the provision of Medicaid
17 services, or any hospital, health, or medical expense insurance policy, hospital or
18 medical service contract, employee welfare benefit plan, contract or other agreement
19 with a health maintenance organization or a preferred provider organization, health
20 and accident insurance policy, or any other insurance contract of this type in this
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HB NO. 307
1 state, including a group insurance plan, a self-insurance plan, and the Office of
2 Group Benefits programs, on the basis of medical necessity if all of the following
3 conditions are met:
4 (a) Claims for payment of services issued in accordance with this Subsection
5 shall be limited to behavioral health expenditures and shall exclude payment for
6 non-behavioral health services or other medical expenses not directly related to the
7 provision of behavioral health care, treatment, or services with the exception of usual
8 and customary laboratory services necessary to monitor patient progress.
9 (b) The admitting physician and the evaluating psychiatrist or medical
10 psychologist shall offer the subject of the emergency certificate the opportunity for
11 voluntary admission pursuant to R.S. 28:53.
12 (c) Any patient committed under an emergency certificate to inpatient
13 treatment by a facility that provides mental health services shall be evaluated by a
14 psychiatrist or medical psychologist in the admitting facility within twenty-four
15 hours of arrival at the admitting facility. After the psychiatric evaluation, payment
16 of claims shall be determined by medical necessity. For purposes of this Subsection,
17 "admitting facility" means a crisis receiving center, acute treatment hospital or
18 facility, distinct part psychiatric unit, or free-standing psychiatric hospital or facility.
19 (2) Nothing in this Subsection shall be construed or interpreted to require
20 payment of claims in a manner other than in accordance with the terms and
21 conditions of the health insurance contract.
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 307 Engrossed 2015 Regular Session Jackson
Abstract: Prohibits the denial of a claim for payment of services provided to a person
admitted under an emergency certificate on the basis of medical necessity.
Present law provides that a person who is mentally ill or a person who is suffering from
substance abuse may be admitted and detained at a treatment facility for observation,
diagnosis, and treatment for a period not to exceed 15 days under an emergency certificate.
Further provides that a person suffering from substance abuse may be detained at a treatment
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HB NO. 307
facility for one additional period, not to exceed 15 days, provided that a second emergency
certificate is executed.
Proposed law prohibits an insurer, including an entity contracted with the state for the
provision of Medicaid services and the Office of Group Benefits programs, from denying
payment for inpatient behavioral health services provided to a person while admitted and
detained in a facility that provides mental health services under an emergency certificate on
the basis of medical necessity, if all of the following conditions are met:
(1)Claims for payment of services are limited to behavioral health expenditures and
exclude payment for non-behavioral health services or other medical expenses not
directly related to the provision of behavioral health care, treatment, or services with
the exception of usual and customary laboratory services necessary to monitor
patient progress.
(2)The admitting physician and the evaluating psychiatrist or medical psychologist offer
the subject of the emergency certificate the opportunity for voluntary admission.
(3)Any patient committed under an emergency certificate to inpatient treatment by a
facility that provides mental health services is evaluated by a psychiatrist or medical
psychologist in the admitting facility within 24 hours of arrival at the admitting
facility.
Proposed law provides that after the psychiatric evaluation, payment of claims shall be
determined by medical necessity.
Proposed law defines "admitting facility" as a crisis receiving center, acute treatment
hospital or facility, distinct part psychiatric unit, or free-standing psychiatric hospital or
facility.
Nothing in proposed law shall be construed or interpreted to require payment of claims in
a manner other than in accordance with the terms and conditions of the health insurance
contract.
(Adds R.S. 28:53(P))
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to
the original bill:
1. Make technical changes.
2. Clarify that the provisions of proposed law apply to inpatient behavioral health
services.
3. Require the opportunity for voluntary admission.
4. Require a psychiatric evaluation within 24 hours of arrival at the admitting
facility.
5. Provide for payment of claims after the psychiatric evaluation based on medical
necessity.
6. Define admitting facility.
7. Provide for the payment of claims in the manner specified in the health insurance
contract.
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