HLS 16RS-2594 ORIGINAL
2016 Regular Session
HOUSE BILL NO. 1140 (Substitute for House Bill No. 705 by Representative
Broadwater)
BY REPRESENTATIVE BROADWATER
INSURANCE/HEALTH: Prohibits certain contractual provisions in provider contracts with
health insurance issuers
1 AN ACT
2To amend and reenact R.S. 22:1007(J) and to enact R.S. 22:1007(K), relative to managed
3 care organizations; to provide for certain prohibited clauses in provider contracts; to
4 provide that a managed care organization may not require as a condition of contract
5 that a healthcare provider provide healthcare services under all health benefit plans
6 offered by the managed care organization; to provide that a managed care
7 organization may not terminate a healthcare provider when the provider refuses to
8 provide certain services; to provide an exception for out-of-state services; and to
9 provide for related matters.
10Be it enacted by the Legislature of Louisiana:
11 Section 1. R.S. 22:1007(J) is hereby amended and reenacted and R.S. 22:1007(K)
12is hereby enacted to read as follows:
13 ยง1007. Requirements of provider contracts; communications
14 * * *
15 J.(1) A managed care organization that offers coverage for healthcare
16 services through one or more managed care plans shall not require a provider, as a
17 condition of participation or continuation in the provider network of one or more
18 health benefit plans of the managed care organization, to serve in the provider
19 network of all or additional health benefit plans of the managed care organization.
Page 1 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-2594 ORIGINAL
HB NO. 1140
1 A managed care organization is prohibited from terminating a provider agreement
2 based on the provider's refusal to serve in its network for such additional plans.
3 (2) Nothing in this Subsection shall prohibit a managed care organization
4 from enabling its affiliated members from other states to obtain healthcare service
5 benefits while traveling or living in the managed care organization's service area
6 including extending the provisions of the provider contract to provide for such
7 services.
8 K. Any contract provision, written policy, or written procedure in violation
9 of this Section shall be deemed to be unenforceable and null and void.
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 1140 Original 2016 Regular Session Broadwater
Abstract: Prohibits managed care organizations from terminating providers from their
network because the provider refuses to participate in all health plans and provider
networks offered by the organization, or requiring a provider to participate in all
health plans offered by the organization as a condition of the provider contracting
with the organization.
Present law regulates the terms and provisions of contracts between healthcare providers and
managed care organizations. Proposed law additionally prohibits managed care
organizations from terminating a contractual relationship with a provider due to the provider
refusing to participate in all healthcare plans and provider networks offered by the insurer.
Proposed law prohibits managed care organizations from requiring healthcare providers
agree to participate in all healthcare plans and provider networks offered by the managed
care organization as a condition of the provider entering a contractual relationship with the
insurer.
Proposed law provides an exception for insureds from other states traveling in Louisiana.
(Amends R.S. 22:1007(J); Adds R.S. 22:1007(K))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.