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 Nancy Vicknair.
DIGEST
SB 173 Re-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 January 1, 2017, 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, and patient self-management education
training. This provision shall not apply to the Office of Group Benefits nor to small group insurance
plans or to grandfathered large group plans as defined by federal law.
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 the
American Society for Metabolic Bariatric Surgery as a comprehensive bariatric facility. Proposed
law authorizes health insurance issuers providing coverage pursuant to proposed law to limit such
coverage to services provided by a specific limited network of providers based on quality and
efficiency factors.
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.
Proposed law provides that a health insurance insurer is only required to cover the services provided
for in proposed law to persons between the ages of 17 and 65 years of age.
Proposed law authorizes a health insurance issuer to establish the following limitations regarding
any surgery provided for in proposed law: (1)Require that the insured and his provider provide documented evidence that he has exhausted
all reasonable, nonsurgical options prior to seeking surgery as provided by the Centers for
Medicare and Medicaid Services National Coverage Determination for Bariatric Surgery.
Such options shall include but not be limited to diet, exercise, and approved medications.
(2)Establish guidelines for the insured and his provider to follow that ensure that candidates for
surgery receive comprehensive medical and behavioral clearance from the provider prior to
being approved for surgery.
(3)Limit coverage for surgery to not more than one surgery per lifetime for any insured, unless
surgery is required due to complications due to a prior surgery covered in accordance with
proposed law.
(4)Limit the benefit payable for any surgical procedure to not more than $15,000 per lifetime.
Any additional amounts payable for such surgery shall be the responsibility of the insured.
Proposed law authorizes a health insurance issuer providing coverage under proposed law to exclude
coverage for the following items:
(1) Any membership or access fee charged by a provider.
(2)Meals or meal supplements.
Effective January 1, 2017.
(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.
Senate Floor Amendments to reengrossed bill
1. Makes technical changes.
2. Changes the effective date from October 1, 2015, to January 1, 2017.
3. Removes coverage for therapeutic exercises.
4. Provides that small group insurance plans or grandfathered large group plans as
defined by certain federal laws are exempt from the provisions of proposed law.
5. Authorizes health insurance issuers providing coverage pursuant to proposed law to
limit such coverage to services provided by a specific limited network of providers
based on certain factors.
6. Provides that health insurance issuers shall only be required to cover the services
provided in proposed law to persons between the ages of 17 and 65.
7. Authorizes health insurance issuers to establish certain limitations on coverage.
8. Authorizes health insurance issuers to exclude coverage for certain items.