SLS 16RS-453 ORIGINAL
2016 Regular Session
SENATE BILL NO. 181
BY SENATOR LONG
HEALTH/ACC INSURANCE. Provides relative to the Network Adequacy Act. (8/1/16)
1 AN ACT
2 To amend and reenact R.S. 22:1019.2(A) and 1019.3(B) and to enact R.S. 22:1019.1(D)(21),
3 relative to network adequacy; to provide for the definition of rural hospital; to
4 provide with respect to an independent review by the commissioner upon the
5 submission of a formal complaint by a rural hospital; and to provide for related
6 matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1019.2(A) and 1019.3(B) are hereby amended and reenacted and
9 R.S. 22:1019.1(D)(21) is hereby enacted to read as follows:
10 §1019.1. Short title; purpose; scope; and definitions
11 * * *
12 D. As used in this Subpart:
13 * * *
14 (21) "Rural hospital" has the meaning provided for in the Rural Hospital
15 Preservation Act, R.S. 40:1190.3 et seq.
16 §1019.2. Network adequacy
17 A. A health insurance issuer providing a health benefit plan shall maintain
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 181
SLS 16RS-453 ORIGINAL
1 a network that is sufficient in numbers and types of health care providers to ensure
2 that all health care services to covered persons will be accessible without
3 unreasonable delay. In the case of emergency services and any ancillary emergency
4 health care services, covered persons shall have access twenty-four hours per day,
5 seven days per week. Sufficiency shall be determined by the commissioner in
6 accordance with the requirements of this Subpart. In determining sufficiency criteria,
7 such criteria shall include but not be limited to ratios of health care providers to
8 covered persons by specialty, ratios of primary care providers to covered persons,
9 geographic accessibility, waiting times for appointments with participating
10 providers, hours of operation, and volume of technological and specialty services
11 available to serve the needs of covered persons requiring technologically advanced
12 or specialty care.
13 * * *
14 §1019.3. Enforcement provisions; penalties; and regulations
15 * * *
16 B.(1) The commissioner shall not act to arbitrate, mediate, or settle disputes
17 regarding a decision not to include a health care provider in a health benefit plan or
18 in a provider network if the health insurance issuer has an adequate network as
19 determined by the commissioner pursuant to the requirements contained in this
20 Subpart.
21 (2) Notwithstanding any provision of law to the contrary, in the event a
22 formal complaint is filed with the commissioner by a rural hospital regarding
23 a health insurance issuer's decision to exclude or not to include a physician
24 credentialed on the medical staff of a rural hospital in a health benefit plan or
25 in a provider network, the commissioner shall conduct an independent review,
26 notwithstanding the filing and approval of an access plan or the submission by
27 a health issuer of proof of accreditation as required by R.S. 22:1019.2(B)(5). The
28 commissioner shall determine whether the health insurance issuer's decision
29 complies with the requirements of network adequacy as set forth in R.S.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 181
SLS 16RS-453 ORIGINAL
1 22:1019.2. If, after the independent review, the commissioner determines the
2 requirements of network adequacy have not been met, the commissioner shall
3 notify the health insurance issuer in writing of the deficiency. The health
4 insurance issuer shall have thirty days to voluntarily comply with the directives
5 of the commissioner to cure the deficiency. Failure to comply with the directives
6 of the commissioner shall result in the penalty provisions stipulated in R.S.
7 22:1019.3.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Cooper.
DIGEST
SB 181 Original 2016 Regular Session Long
Present law provides for the purpose, scope, and definitions relative to the Network
Adequacy Act.
Proposed law provides that rural hospital has the same meaning as in present law Rural
Hospital Preservation Act.
Present law prohibits the commissioner from acting to arbitrate, mediate, or settle disputes
regarding a decision not to include a health care provider in a health benefit plan or provider
network.
Proposed law retains present law and adds that in the event a formal complaint is filed with
the commissioner by a rural hospital regarding a health insurance issuer's decision to exclude
or not to include a physician credentialed on the medical staff of a rural hospital in a health
benefit plan or provider network, the commissioner shall conduct an independent review to
determine whether the health insurance issuer's decision complies with the provisions of
present law.
Proposed law requires the commissioner to notify a health insurance issuer in writing in the
event he determines the requirements of network adequacy have not been met. Further
provides 30 days for a health insurance issuer to voluntarily comply with the directives of
the commissioner to cure the network deficiency. Provides that failure to comply shall result
in the penalty provisions in present law.
Effective August 1, 2016.
(Amends R.S. 22:1019.2(A) and 1019.3(B); adds R.S. 22:1019.1(D)(21))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.