GREEN SHEET REDIGEST
HB 307 2015 Regular Session Jackson
(KEYWORD, SUMMARY, AND DIGEST as amended by Senate committee
amendments)
MENTAL HEALTH. Provides relative to coverage and payment for services rendered
to a person admitted under an emergency certificate.
DIGEST
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.
Proposed law provides that in the event that funding is necessary pursuant to these
provisions, the utilization of available Community Development Block Grant (CDBG) funds
shall be authorized only upon the approval of the Centers for Medicare and Medicaid
Services (CMS).
(Adds R.S. 28:53(P))
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Prepared by Jay Lueckel. 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.
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Finance to the engrossed
bill
1. Provides that in the event that funding is necessary pursuant to these provisions,
the utilization of available Community Development Block Grant (CDBG) funds
shall be authorized only upon the approval of the Centers for Medicare and
Medicaid Services (CMS).
Page 2 of 2
Prepared by Jay Lueckel.