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2021 Regular Session
SENATE BILL NO. 130
BY SENATOR JACKSON
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE POLICIES. Provides for payment of health insurance provider claim payment
claims. (8/1/21)
1 AN ACT
2 To amend and reenact R.S. 22:1016(A) and to enact R.S. 22:1828 and 1964(30), relative to
3 health insurance; to provide for provider claim payment and data information
4 protections; to provide for definitions; to provide for payment by electronic funds
5 transfer; to provide for violations; to provide for unfair or deceptive acts or practices
6 in the business of insurance; and to provide for related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1016(A)is hereby amended and reenacted and R.S. 22:1828 and
9 1964(30) are hereby enacted to read as follows:
10 §1016. Regulation by the Department of Insurance and the Department of Health of
11 prepaid entities participating in the Louisiana Medicaid Program
12 A. Notwithstanding any law to the contrary, any prepaid entity that
13 participates in the Louisiana Medicaid Program is required to obtain an insurer
14 license or certificate of authority from the Louisiana Department of Insurance. Such
15 a prepaid entity participating in the Louisiana Medicaid Program shall be regulated
16 by the Louisiana Department of Insurance with respect to licensure and financial
17 solvency but shall, solely with respect to its products and services offered pursuant
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1 to the Louisiana Medicaid Program, be regulated by the Louisiana Department of
2 Health subject to 42 USCA §1396 et seq., and all applicable federal and state laws,
3 rules, and regulations relating to the Louisiana Medicaid Program. The Louisiana
4 Department of Health shall have the authority to may adopt and promulgate such
5 rules and regulations, including certification, relating to the Louisiana Medicaid
6 Program. Except for licensure, and financial solvency requirements, and the
7 provisions of R.S. 22:1828, no other provisions of this Title shall apply to a prepaid
8 entity with respect to the participation of the prepaid entity in the Louisiana
9 Medicaid Program.
10 * * *
11 §1828. Provider claim payment and information protection
12 A. As used in this Section:
13 (1) "Electronic funds transfer" means an electronic funds transfer
14 through the federal Health Insurance Portability and Accountability Act of
15 1996, P.L. 104-191, as amended, standard automated clearing-house network.
16 (2) "Health insurance issuer" means an entity subject to the insurance
17 laws and regulations of this state, that contracts or offers to contract, or enters
18 into an agreement to provide, deliver, arrange for, pay for, or reimburse any of
19 the costs for health care services, including a health and accident insurance
20 company, a health maintenance organization, a preferred provider organization
21 or any similar entity, any other entity providing a plan of health insurance or
22 health benefits, or a "managed care organization" as defined by 42 CFR 438.2.
23 B. Within the time period prescribed by a health insurance issuer in
24 which the health insurance issuer can review or audit a claim for purposes of
25 reconsidering the validity of the claim, if a health care provider submits a
26 request orally or in writing to a health insurance issuer, the health insurance
27 issuer shall provide a copy of all documentation transmitted between the health
28 care provider and the health insurance issuer or their respective agents, that is
29 associated with a claim for payment for services. The health insurance issuer
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1 shall provide the requested documentation within two business days of the
2 request submitted by the health care provider. A health insurance issuer may,
3 in lieu of providing a physical copy, provide electronic access to the provider of
4 the documentation through the use of a provider portal or other electronic
5 means. All information or documentation required to be provided by this
6 Section to a health care provider by a health insurance issuer, whether by
7 physical copy or electronic access, shall be provided at no cost to the health care
8 provider.
9 C.(1) Any health insurance plan issued, amended, or renewed on or after
10 January 1, 2022, between a health insurance insurer, its contracted vendor or
11 agent, and a health care provider that covers health care services to a plan
12 enrollee shall not restrict the method of payment from the health insurance
13 issuer or its vendor to the health care provider in which the only acceptable
14 payment method for services rendered requires the health care provider to pay
15 a transaction fee, provider subscription fee, or any other type of fee or cost in
16 order to accept payment from the health insurance issuer or that results in a
17 monetary reduction in the payment to the health care provider for the health
18 care services rendered.
19 (2) If initiating or changing payments to a health care provider using
20 electronic funds transfer payments the health insurance issuer, its contracted
21 vendor, or agent shall:
22 (a) Notify the health care provider if any fees are associated with a
23 particular payment method.
24 (b) Advise the provider of the available methods of payment and provide
25 instructions to the health care provider for selection of an alternative payment
26 method that does not require the health care provider to pay a transaction fee,
27 provider subscription fee, or any other type of fee or cost in order for the health
28 care provider to accept payment from the health insurance issuer.
29 D. The provisions of this Section shall not be waived by contract, and any
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1 contractual clause in conflict with the provisions of this Section or that purport
2 to waive the requirements of this Section shall be null and void.
3 E. Any violation of the provision of this Section shall be declared and
4 deemed to be unfair methods of competition and unfair or deceptive acts or
5 practices in the business of insurance and subject to the provisions of Part IV
6 of Chapter 7 of this Title.
7 * * *
8 §1964. Methods, acts, and practices which are defined as unfair or deceptive
9 The following are declared to be unfair methods of competition and unfair
10 or deceptive acts or practices in the business of insurance:
11 * * *
12 (30) Any violation of R.S. 22:1828.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Cooper.
DIGEST
SB 130 Original 2021 Regular Session Jackson
Proposed law requires if, during the time a health insurance issuer conducts a review or audit
for purposes of reconsidering the validity of a claim filed with the issuer a health care
provider submits a request either orally or in writing to a health insurance issuer, the health
insurance issuer shall provide, within two business days of the request, a copy of all
documentation transmitted between the health care provider and the health insurance issuer
at no cost to the health care provider. Allows electronic access to the documentation.
Proposed law provides that any health insurance plan issued, amended, or renewed on or
after January 1, 2022, shall not restrict the method of payment from the health insurance
issuer or its vendor to the health care provider in the which the only acceptable method for
health care services rendered requires the health care provider to pay a transaction fee,
provider subscription fee, or any other type of fee or cost in order to accept payment from
the health insurance issuer.
Proposed law requires a health insurance issuer initiating or changing payments to a health
care provider using electronic funds transfer payments to notify a health care provider if any
fees are associated with a particular payment method and to advise the provider of the
available methods of payment and provide instructions to the health care provider as to how
to select an alternative payment method that does not require payment of a transaction fee,
provider subscription fee, or any other type of fee or cost to accept payment from the health
insurance issuer.
Proposed law provides that violations of proposed law are deemed unfair methods of
competition and subject to provisions regarding unfair or deceptive acts or practices
according to present law.
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Effective August 1, 2021.
(Amends R.S. 22:1016(A); adds R.S. 22:1828 and 1964(30))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.