HLS 22RS-379 REENGROSSED
2022 Regular Session
HOUSE BILL NO. 278
BY REPRESENTATIVE ECHOLS
INSURANCE/HEALTH: Provides requirements for the Psychiatric Collaborative Care
Model
1 AN ACT
2To enact R.S. 22:1066.2 and R.S. 40:2163, relative to health coverage plans; to provide
3 relative to the medical assistance program of this state known as Medicaid; to require
4 reimbursement for mental health and substance abuse benefits provided through the
5 Psychiatric Collaborative Care Model service delivery method; to provide for
6 definitions; and to provide for related matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1066.2 is hereby enacted to read as follows:
9 §1066.2. Psychiatric Collaborative Care Model; service delivery method
10 requirements
11 A. A health coverage plan which is delivered or issued for delivery in this
12 state that provides mental health and substance abuse benefits shall provide
13 reimbursement for such benefits that are delivered through the Psychiatric
14 Collaborative Care Model, which includes current procedural terminology (CPT)
15 billing codes established by the American Medical Association.
16 B. Any medical necessity determination made by a health coverage plan
17 shall be in compliance with the Paul Wellstone and Pete Domenici Mental Health
18 Parity and Addiction Equity Act of 2008 and its related regulations, and in
19 accordance with the Internal Claims and Appeals Process and External Review Act,
20 R.S. 22:2391 et seq.
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HB NO. 278
1 C. As used in this Section, the following terms apply:
2 (1) "Health coverage plan" means any hospital, health, or medical expense
3 insurance policy, hospital or medical service contract, employee welfare benefit plan,
4 contract or agreement with a health maintenance organization or a preferred provider
5 organization, health and accident insurance policy, or any other insurance contract
6 of this type, including a group insurance plan and the Office of Group Benefits
7 programs.
8 (2) "Mental health or substance abuse benefits" means benefits for the
9 treatment of any condition or disorder that involves a mental health condition or
10 substance use disorder that falls under any of the diagnostic categories listed in the
11 mental disorders section of the current edition of the International Classification of
12 Diseases or that is listed in the mental disorders section of the most recent version
13 of the Diagnostic and Statistical Manual of Mental Disorders.
14 (3) "Psychiatric Collaborative Care Model" means the evidence-based,
15 integrated behavioral health service delivery method described in 81 FR 80230.
16 Section 2. R.S. 40:2163 is hereby enacted to read as follows:
17 §2163. Psychiatric Collaborative Care Model in the Louisiana medical assistance
18 program
19 A. The Louisiana Department of Health shall ensure Medicaid coverage for
20 mental health and substance abuse benefits delivered through the Psychiatric
21 Collaborative Care Model which includes current procedural terminology (CPT)
22 billing codes established by the American Medical Association.
23 B. Any medical necessity determination made by a Medicaid managed care
24 organization shall be in compliance with the Paul Wellstone and Pete Domenici
25 Mental Health Parity and Addiction Equity Act of 2008 and its related regulations,
26 and in accordance with the Medicaid Managed Care Independent Claims Review
27 Process, R.S. 46:460.81 et seq.
28 C. As used in this Section, the following terms apply:
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HB NO. 278
1 (1) "Managed care organization" means the same as the term is defined in
2 R.S. 46:460.31.
3 (2) "Medicaid" means the same as the term is defined in R.S. 46:460.31.
4 (3) "Mental health or substance abuse benefits" means benefits for the
5 treatment of any condition or disorder that involves a mental health condition or
6 substance use disorder that falls under any of the diagnostic categories listed in the
7 mental disorders section of the current edition of the International Classification of
8 Diseases or that is listed in the mental disorders section of the most recent version
9 of the Diagnostic and Statistical Manual of Mental Disorders.
10 (4) "Psychiatric Collaborative Care Model" means the evidence-based,
11 integrated behavioral health service delivery method described in 81 FR 80230.
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 278 Reengrossed 2022 Regular Session Echols
Abstract: Requires private health coverage and Medicaid coverage for mental health or
substance abuse benefits delivered through the Psychiatric Collaborative Care
Model.
Proposed law (R.S. 22:1066.2) requires a health coverage plan delivered or issued for
delivery in this state that provides mental health and substance abuse benefits to reimburse
for services delivered through the Psychiatric Collaborative Care Model, which includes
current procedural terminology (CPT) billing codes established by the American Medical
Association.
Proposed law (R.S. 40:2163) further requires the La. Dept. of Health to require Medicaid
coverage for mental health and substance abuse benefits delivered through the Psychiatric
Collaborative Care Model.
Proposed law requires any medical necessity determinations made by a health coverage plan
to be made in compliance with certain federal and state law (R.S. 22:2391 et seq.). Further
requires any medical necessity determinations made by a Medicaid managed care
organization to be made in accordance with certain federal and state law (R.S. 46:460.81 et
seq.).
Proposed law defines "health coverage plan", "mental health or substance abuse benefits",
"Psychiatric Collaborative Care Model", "managed care organization", and "Medicaid".
(Adds R.S. 22:1066.2 and R.S. 40:2163)
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HB NO. 278
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
original bill:
1. Add Medicaid state plans for applicability within proposed law.
2. Delete certain CPT billing codes from specific application in proposed law.
3. Delete language relative to the commissioner of insurance updating CPT billing
codes and denial of reimbursement of CPT billing codes.
4. Make technical changes.
The House Floor Amendments to the engrossed bill:
1. Clarify with respect to terminology and applicable present law (R.S. 46:460.81
et seq.) relative to Medicaid coverage.
2. Define "managed care organization" and "Medicaid".
3. Make technical changes.
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