ENROLLED
ACT No. 290
2018 Regular Session
HOUSE BILL NO. 875
BY REPRESENTATIVE TALBOT
1 AN ACT
2 To amend and reenact R.S. 22:1873(B)(4) and 1879(B)(3), to enact Subpart A-2 of Part III
3 of Chapter 4 of the Louisiana Revised Statutes of 1950, to be comprised of R.S.
4 22:1020.1 through 1020.6, and to repeal R.S. 22:1019.2(B)(4), relative to health
5 insurance network provider directories; to provide for the content of a directory; to
6 require the directory to be electronically searchable and publicly accessible; to
7 require continuous review and updating; to set a time period for updates after certain
8 events; to provide for the reporting of inaccurate information; to provide for
9 investigations for compliance; to authorize an assessment on investigated insurers
10 to pay for the costs of investigations; to provide for penalties; to limit liability; to
11 provide for applicability; to provide for an effective date; and to provide for related
12 matters.
13 Be it enacted by the Legislature of Louisiana:
14 Section 1. R.S. 22:1873(B)(4) and 1879(B)(3) are hereby amended and reenacted
15 and Subpart A-2 of Part III of Chapter 4 of the Louisiana Revised Statutes of 1950,
16 comprised of R.S. 22:1020.1 through 1020.6, is hereby enacted to read as follows:
17 SUBPART A-2. NETWORK PROVIDER DIRECTORY
18 ACCESSIBILITY AND ACCURACY ACT
19 §1020.1. Short title; purpose; scope; definitions
20 A. This Subpart shall be known and may be cited as the "Network Provider
21 Directory Accessibility and Accuracy Act".
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1 B. The purpose and intent of this Subpart is to establish standards for the
2 creation and maintenance by a health insurance issuer of a directory of the issuer's
3 network of healthcare providers and to ensure the accessibility and accuracy of the
4 directory.
5 C. This Subpart shall apply to all health insurance issuers that offer health
6 benefit plans in this state but shall not include excepted benefits policies as defined
7 in R.S. 22:1061(3).
8 D. As used in this Subpart:
9 (1) "Commissioner" means the commissioner of insurance.
10 (2) "Covered person" means a policyholder, subscriber, enrollee, insured, or
11 other individual participating in a health benefit plan.
12 (3) "Department" means the Department of Insurance.
13 (4) "Health benefit plan" means a policy, contract, certificate, or subscriber
14 agreement entered into, offered, or issued by a health insurance issuer to provide,
15 deliver, arrange for, pay for, or reimburse any of the costs of healthcare services.
16 (5) "Healthcare facility" means an institution providing healthcare services
17 or a healthcare setting, including but not limited to hospitals and other licensed
18 inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers,
19 diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic
20 health settings.
21 (6) "Healthcare professional" means a physician or other healthcare
22 practitioner licensed, certified, or registered to perform specified healthcare services
23 consistent with state law.
24 (7) "Healthcare provider" or "provider" means a healthcare professional or
25 a healthcare facility.
26 (8) "Healthcare services" means services, items, supplies, or drugs for the
27 diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury,
28 or disease.
29 (9) "Health insurance issuer" means an entity subject to the insurance laws
30 and regulations of this state, or subject to the jurisdiction of the commissioner, that
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1 contracts or offers to contract, or enters into an agreement to provide, deliver,
2 arrange for, pay for, or reimburse any of the costs of healthcare services, including
3 a sickness and accident insurance company, a health maintenance organization, a
4 preferred provider organization or any similar entity, or any other entity providing
5 a plan of health insurance or health benefits.
6 (10) "Network of providers" or "network" means an entity, including a health
7 insurance issuer, that, through contracts or agreements with healthcare providers,
8 provides or arranges for access by groups of covered persons to healthcare services
9 by healthcare providers who are not otherwise or individually contracted directly
10 with a health insurance issuer.
11 §1020.2. Provider directory; content; accessibility
12 A. A health insurance issuer shall maintain a directory of the issuer's
13 network of providers on the internet.
14 B. The directory shall include the name, specialty, if any, street address, and
15 telephone number of each healthcare provider and indicate whether the provider is
16 accepting new patients.
17 C. The directory shall be all of the following:
18 (1) Electronically searchable by healthcare provider name, specialty, if any,
19 and location.
20 (2) Publicly accessible without necessity of providing a password, a user
21 name, or personally identifiable information.
22 §1020.3. Continuous review required
23 A. A health insurance issuer shall conduct an ongoing review of the issuer's
24 provider directory and correct or update the information as necessary. Except as
25 provided in Subsections B and C of this Section, corrections and updates, if any,
26 shall be made not less than once every twenty business days.
27 B. The health insurance issuer shall update the directory to list a healthcare
28 provider not later than ten business days after the effective date of the provider's
29 credentialing with the health insurance issuer.
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1 C. The health insurance issuer shall update the directory to remove a
2 healthcare provider not later than ten business days after the effective date of the
3 termination of the provider's credentialing with the health insurance issuer.
4 §1020.4. Reporting of inaccurate information
5 A. A health insurance issuer shall conspicuously display in the issuer's
6 provider directory an email address, a toll-free telephone number, or another
7 mechanism that is easily accessible to any individual by which the individual may
8 report any inaccuracy in the directory.
9 B. If the health insurance issuer receives a report from any person that
10 specifically identified directory information may be inaccurate, the issuer shall
11 investigate the report and correct the information, as necessary, in accordance with
12 the following schedule:
13 (1) Not later than the second business day after the date the report is received
14 if the report concerns the health insurance issuer's representation of the network
15 participation status of a healthcare provider.
16 (2) Not later than the fifth business day after the date the report is received
17 if the report concerns any other type of information in the directory.
18 §1020.5. Investigation by the commissioner; assessment; penalties; applicability
19 A. If, in any thirty-day period, a health insurance issuer receives three or
20 more reports that allege the issuer's directory inaccurately represents a healthcare
21 provider's network participation status and that are confirmed by the issuer's
22 investigation, the health insurance issuer shall immediately report that occurrence to
23 the commissioner.
24 B. On receipt of a report pursuant to Subsection A of this Section, the
25 commissioner shall investigate the health insurance issuer's compliance with the
26 provisions of this Subpart.
27 C. The department may collect an assessment in an amount determined by
28 the commissioner from the health insurance issuer at the time of the investigation to
29 cover all expenses attributable directly to the investigation, including but not limited
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1 to the salaries and expenses of department employees and all reasonable expenses
2 of the department necessary for the administration of this Subpart.
3 D. Except as otherwise provided in Subsection F of this Section, the
4 Department of Insurance may promulgate rules and regulations to provide for civil
5 fines payable by a health insurance issuer not to exceed five hundred dollars for each
6 act of violation of the requirements of this Subpart, not to exceed an aggregate fine
7 of fifty thousand dollars. For purposes of this Subsection, "act of violation" is limited
8 to an intentional act or an act of gross negligence.
9 E.(1) A health insurance issuer shall not be responsible for information that
10 is inaccurately submitted or not submitted by healthcare providers as stated in their
11 contract.
12 (2) The penalties provided for in this Section shall be the exclusive remedy
13 for any violations and there shall be no independent cause of action by any person
14 based upon a violation or other information reported.
15 F. The provisions of this Subpart shall apply to the Office of Group Benefits;
16 however, the commissioner of insurance shall not levy an assessment or fine against
17 the Office of Group Benefits. If the commissioner of insurance concludes that the
18 Office of Group Benefits has violated this Subpart, the commissioner of insurance
19 shall notify the commissioner of administration in writing within thirty days of the
20 violation.
21 §1020.6. Printed form available upon request
22 The directory of network providers required pursuant to this Subpart shall be
23 furnished in printed form to any covered person upon request.
24 * * *
25 §1873. Notice requirements
26 * * *
27 B. Health insurance issuer notice requirements shall be as follows:
28 * * *
29 (4) A health insurance issuer shall maintain and update its a list of contracted
30 health care healthcare providers on at least an annual basis in accordance with the
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1 Network Provider Directory Accessibility and Accuracy Act, R.S. 22:1020.1 et seq.,
2 and shall make the current version available to enrollees or insureds on request.
3 * * *
4 §1879. Louisiana consumer health care provider network disclosure
5 * * *
6 B.
7 * * *
8 (3) A health insurance issuer shall update its website as soon as possible but
9 not later than thirty days following receipt of any updated information or within
10 thirty days of the effective date of a contract. in accordance with the Network
11 Provider Directory Accessibility and Accuracy Act, R.S. 22:1020.1 et seq.
12 * * *
13 Section 2. R.S. 22:1019.2(B)(4) is hereby repealed in its entirety.
14 Section 3. This Act shall become effective on January 1, 2019.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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