HLS 15RS-990 ORIGINAL
2015 Regular Session
HOUSE BILL NO. 702
BY REPRESENTATIVE THIERRY
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Requires health insurance issuers to cover contested healthcare
services, including prescription drugs, during the appeal or review process
1 AN ACT
2To enact R.S. 22:2396 and 2397, relative to the appeal or review process for adverse
3 determinations made by health insurance issuers; to provide with respect to notice
4 of such determinations; to provide relative to continued coverage of healthcare
5 services, including prescription drugs, during the appeal or review process; and to
6 provide for related matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:2396 and 2397 are hereby enacted to read as follows:
9 §2396. Time for notice of adverse determinations
10 Notwithstanding any other provision of this Chapter to the contrary, notice
11 of an adverse determination or a final adverse determination shall be provided by a
12 health insurance issuer to a covered person no later than the thirtieth day before the
13 date on which the healthcare services that are the subject of the appeal or review will
14 be discontinued.
15 §2397. Continuation of healthcare services during an appeal or review
16 Notwithstanding any other provision of this Chapter to the contrary, the
17 procedures for appealing any adverse determination made under this Chapter shall
18 do all of the following:
19 (1) Require that coverage or benefits for the contested healthcare services,
20 including prescription drugs, that are the subject of the adverse determination
Page 1 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 15RS-990 ORIGINAL
HB NO. 702
1 continues under the covered person's health benefit plan while the appeal or review
2 is being considered to the same extent and in the same manner as if no adverse
3 determination had been made or upheld.
4 (2) Require, without regard to whether the adverse determination is upheld
5 on appeal or review, any health insurance issuer to cover the contested healthcare
6 services, including prescription drugs, received during the period that the appeal was
7 considered to the same extent and in the same manner, including the same benefit
8 level, as if no adverse determination had been made or upheld.
9 (3) Prohibit, without regard to whether the adverse determination is upheld
10 on appeal or review, any health insurance issuer from recouping, based upon an
11 adverse determination, any payment made to a healthcare provider pursuant to the
12 continued coverage or benefits specified in Paragraphs (1) and (2) of this Section.
13 Section 2. This Act shall apply only to an adverse determination made in relation to
14coverage or benefits under a health benefit plan delivered, issued for delivery, or renewed
15on or after January 1, 2016. This Act shall not apply to an adverse determination made in
16relation to coverage or benefits under a health plan delivered, issued for delivery, or
17renewed before January 1, 2016.
18 Section 3. This Act shall become effective on January 1, 2016.
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 702 Original 2015 Regular Session Thierry
Abstract: Requires a health insurance issuer to cover contested healthcare services,
including prescription drugs, during the appeal or review of an adverse
determination.
Present law provides for various levels of review and appeal of adverse determinations by
health insurance issuers. Generally defines an adverse determination as the denial,
reduction, termination, or failure to pay or provide for a benefit under a covered person's
health benefit plan.
Proposed law provides that, notwithstanding any other provision of present law to the
contrary, notice of an adverse determination or a final adverse determination shall be
provided by a health insurance issuer to a covered person no later than the thirtieth day
Page 2 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 15RS-990 ORIGINAL
HB NO. 702
before the date on which the healthcare services that are the subject of the appeal or review
will be discontinued.
Proposed law provides that, notwithstanding any other provision of present law to the
contrary, the procedures for appealing any adverse determination shall:
(1) Require that coverage or benefits for the contested healthcare services,
including prescription drugs, that are the subject of the adverse determination
continues under the covered person's health benefit plan while the appeal or
review is being considered to the same extent and in the same manner as if
no adverse determination had been made or upheld.
(2)Require, without regard to whether the adverse determination is upheld on
appeal or review, any health insurance issuer to cover the contested
healthcare services, including prescription drugs, received during the period
that the appeal was considered to the same extent and in the same manner,
including the same benefit level, as if no adverse determination had been
made or upheld.
(3) Prohibit, without regard to whether the adverse determination is upheld on
appeal or review, any health insurance issuer from recouping, based upon an
adverse determination, any payment made to a healthcare provider pursuant
to the continued coverage or benefits specified in proposed law.
Proposed law provides that it shall apply only to an adverse determination made in relation
to coverage or benefits under a health benefit plan delivered, issued for delivery, or renewed
on or after Jan. 1, 2016, and shall not apply to an adverse determination made in relation to
coverage or benefits under a health plan delivered, issued for delivery, or renewed before
Jan. 1, 2016.
Effective on January 1, 2016.
(Adds R.S. 22:2396 and 2397 )
Page 3 of 3
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.