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 594 Reengrossed 2021 Regular Session Dustin Miller
Abstract: Prohibits insurers, managed care companies, or other payors from setting caps on
reimbursement for properly ordered non-invasive ventilation treatments.
Proposed law prohibits an insurer, managed care company, or other payor from setting a maximum
dollar amount of reimbursement for non-invasive ventilators or ventilation treatments properly
ordered and being used in an appropriate care setting.
Proposed law provides with respect to the Centers for Medicare and Medicaid Services' (CMS)
classification of ventilators. Requires a durable medical equipment (DME) supplier to provide the
patient regular and comprehensive service and preventative maintenance by a certified or registered
respiratory therapist, including but not limited to masks, tubing, tracheotomy supplies, filters, and
other supporting supplies and equipment. Further requires reimbursement to be at a rate negotiated
with the payors to insure that a sustained level of service can be provided to the patient.
Proposed law requires an insurer, managed care company, subcontractor, third-party administrator,
or other payor to reimburse DME suppliers for home use non-invasive and invasive ventilators on
a continuous monthly payment basis for the duration of medical need throughout a patient's valid
prescription period.
(Adds R.S. 22:1821(G))
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the original bill:
1. Add non-invasive ventilators for required reimbursement.
2. Provide that reimbursement to cover the actual cost of a non-invasive ventilator may be
based on the reasonable and customary allowable amount for a standard ventilator.
Provide that if the actual cost of a non-invasive ventilator has been paid, such
reimbursement for the ventilator may be terminated.
3. Require reasonable reimbursement for medically necessary servicing of non-invasive
ventilators and ventilation treatments provided by a respiratory therapist. The House Floor Amendments to the engrossed bill:
1. Remove language providing that reimbursement to cover the actual cost of a non-
invasive ventilator may be based on the reasonable and customary allowable amount for
a standard ventilator. Remove language providing that if the actual cost of a
non-invasive ventilator has been paid, reimbursement for the ventilator may be
terminated.
2. Remove language requiring reasonable reimbursement for medically necessary servicing
of non-invasive ventilators and ventilation treatments provided by a respiratory therapist.
3. Add language with respect to the Centers for Medicare and Medicaid Services' (CMS)
classification of ventilators. Require a durable medical equipment (DME) supplier to
provide the patient regular and comprehensive service and preventative maintenance by
a certified or registered respiratory therapist, including masks, tubing, tracheotomy
supplies, filters, and other supporting supplies and equipment. Require reimbursement
to be at a rate negotiated with the payors to insure a sustained level of service to the
patient.
4. Require an insurer, managed care company, subcontractor, third-party administrator, or
other payor to reimburse DME suppliers for home use non-invasive and invasive
ventilators on a continuous monthly payment basis for the duration of medical need
throughout a patient's valid prescription period.