Louisiana House Bill HB849

Louisiana 2016 Regular Session

• Introduced: 3/4/16
• Refer: 3/4/16
• Refer: 3/14/16
• Report Pass: 4/27/16

Caption

Provides a time frame for appeals of adverse determinations made regarding the medical necessity of prescription drugs and intravenous infusions

Impact

The implications of HB 849 are significant for both patients and health insurance providers. By setting a strict timeline for the appeal process, the bill aims to protect patients from abrupt cessation of necessary medical treatments without the opportunity for contest. This change seeks to facilitate a more transparent and organized mechanism for individuals seeking to challenge adverse determinations, thereby aligning the healthcare insurance process more closely with patients' needs.

Summary

House Bill 849, introduced by Representative Robert Johnson, establishes a structured timeframe for appealing adverse determinations made by health insurance issuers regarding the medical necessity of prescription drugs and intravenous infusions. The bill mandates that when such determinations occur, notice must be provided to the affected individual no later than 60 days prior to the discontinuation of the treatment they have been receiving for at least 90 days. This ensures that patients are adequately informed and have sufficient time to appeal before their treatment is terminated.

Sentiment

General sentiment towards HB 849 appears to be positive among advocates for patient rights and healthcare access. Supporters argue that the bill is a necessary advancement towards ensuring that patients remain informed about their treatments and that they have adequate recourse in the event of an adverse determination. Critics, if any, may raise concerns about the additional administrative burden placed on insurance providers to comply with the new requirements, although explicit opposition has not been noted in the discussions associated with the bill.

Contention

Notable points of contention surrounding HB 849 include concerns about the implementation and adherence to the mandated timelines by insurance companies. Opponents may argue that while the intention to protect patients is commendable, the reality of enforcing such regulations could prove challenging. Additionally, the bill is marked by its clear applicability limited to plans issued or renewed after January 1, 2016, which raises questions about coverage for individuals whose plans were established beforehand.