RÉSUMÉ DIGEST
ACT 412 (SB 173) 2019 Regular Session Mills
New law, which takes effect only after certain delays following a final and definitive
judgment ruling the Patient Protection and Affordable Care Act, P.L. 111-148, (ACA)
unconstitutional, requires every health insurance policy or contract issued or issued for
delivery in this state to adhere to certain standards. Provides for open enrollment, rate setting,
and coverage for dependent children who are under the age of 26. Prohibits preexisting
condition exclusions and annual and lifetime limits.
Requires the attorney general to notify the commissioner, the legislature, and the Louisiana
State Law Institute if a judgment ruling the ACA unconstitutional becomes final and
definitive. Provides that the provisions of new law take effect ninety days after receipt by the
commissioner of the notification.
New law requires that health insurance policies cover "essential health benefits". Charges the
commissioner with defining the essential health benefits that are required. Specifies that the
definition shall include certain categories; among these are ambulatory patient services,
emergency services, hospitalization, maternity and newborn care and pediatric services,
mental health services, prescription drugs, and wellness services. Provides a framework for
monitoring, assessing, and updating the definition of essential health benefits package.
Requires the commissioner to promulgate rules pursuant to the Administrative Procedure Act
for purposes of implementing new law. Requires initial administrative rules to be adopted
ninety days after final judgment of a court of competent jurisdiction on the constitutionality
of ACA. Authorizes the commissioner to issue emergency rules without finding an
emergency exists.
New law applies to any health insurance policy or contract issued or issued for delivery in
this state beginning ninety days after the attorney general notifies the commissioner that the
ACA has been ruled unconstitutional. New law does not abridge or affect the provisions of
insurance policies or contracts already in effect until the policies or contracts are renewed.
New law provides that in case of any conflict between the provisions of proposed law and
any other provision of law, the provisions of new law shall control unless application of new
law results in a reduction in coverage for any insured.
New law provides that applicability of new law shall occur only if the current federal tax
credit is held to be valid by a court of competent jurisdiction or is otherwise enforceable at
law, or unless adequate appropriations are timely made by the federal or state government
in an amount that is calculated in the same manner as the tax credit in Section 1401 of the
Patient Protection and Affordable Care Act.
New law provides that it shall not apply to grandfathered coverage, health benefit plans in
the large groups or to the large group market, or to limited or excepted benefits policies as
defined in prior law.
New law establishes the "Louisiana Guaranteed Benefits Pool" to be administered by the
commissioner of insurance which shall be a risk-sharing program to provide payment to
health insurance issuers for claims for healthcare services provided to eligible individuals
with expected high healthcare costs for the purpose of lowering premiums for health
insurance coverage offered in the individual market.
New law establishes program operations and parameters, actuarial analysis, approval of the
program by the Joint Legislative Committee on the Budget, and enrollment or participation
limitations.
Effective upon signature of the governor (June 11, 2019).
(Adds R.S. 22:11.1 and 1121-1138)