The original instrument was prepared by Christopher D. Adams. The following
digest, which does not constitute a part of the legislative instrument, was prepared
by Jay Lueckel.
DIGEST
SB 173 Reengrossed 2015 Regular Session Heitmeier
Proposed law provides for health insurance coverage for the treatment of morbid obesity which is
defined as the condition that exists when a person has a body mass index greater than 40 kilograms
per meter squared and also has the two comorbidity factors of diabetes and hypertension.
Proposed law defines "body mass index" to mean a practical marker used to assess the degree of
obesity and is calculated by dividing the weight in kilograms by the height in meters squared.
Proposed law requires any group insurance plan providing comprehensive major medical benefits
which is issued or renewed in this state on or after October 1, 2015, or notwithstanding the
provisions of R.S. 22:1016, any prepaid entity that participates in the Louisiana Medicaid Program
to provide coverage for the medically-necessary expenses of the diagnosis and treatment of morbid
obesity as defined in proposed law, including but not limited to bariatric surgery, physician office
visits, health and behavior assessments, nutrition education, patient self-management education
training, and therapeutic exercises. This provision shall not apply to the office of Group Benefits.
Proposed law provides the coverage required pursuant to proposed law for bariatric surgery shall be
limited to facilities of surgical services that are accredited by the Metabolic and Bariatric Surgery
Accreditation and Quality Improvement Program of the American College of Surgeons and
American Society of Metabolic Bariatric Surgery as a comprehensive bariatric facility.
Proposed law requires the fee schedule used for payment of services associated with the treatment
of morbid obesity to be the same as the fee schedule used by the Louisiana Medicaid Bayou Health
program.
Proposed law requires the Heads Up Program operated by the office of Group Benefits and the
Pennington Biomedical Research Center to continue to serve 100 surgical participants annually
through June 30, 2017, or beyond, at the direction of the office of Group Benefits.
Effective October 1, 2015.
(Adds R.S. 22:1055)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original bill
1. Defines morbid obesity. 2. Restricts application only to group health plans.
3. Requires the use of the Louisiana Medicaid Bayou Health fee schedule.
4. Requires the Heads Up program to seek to increase its number of participants to 300
per year by 2018.
Committee Amendments Proposed by Senate Committee on Finance to the engrossed bill
1. Clarifies that any group insurance plan offering major medical shall provide coverage
relative to morbid obesity, but such provisions shall not apply to the office of Group
Benefits (OGB).
2. Provides that the Heads Up Program which operates in partnership with OGB shall
continue to serve 100 surgical participants annually through June 30, 2017, or
beyond, at the direction of OGB.
3. Technical amendment.