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 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.