HLS 22RS-1116 ORIGINAL
2022 Regular Session
HOUSE BILL NO. 882
BY REPRESENTATIVE ROBERT OWEN
INSURANCE/HEALTH: Enacts the Louisiana Right to Shop Act
1 AN ACT
2To enact Subpart C-1 of Part III of Chapter 4 of Title 22 of the Louisiana Revised Statutes
3 of 1950, to be comprised of R.S. 22:1081 through 1088, relative to costs of
4 healthcare services and procedures for consumers; to enact the Louisiana Right to
5 Shop Act; to require a program with healthcare shopping capabilities and decision
6 support services; to require an interactive marketplace disclosing the costs of certain
7 healthcare services and procedures; to provide for definitions; to provide for
8 incentives; to require reporting; to provide for rulemaking; to provide for
9 effectiveness; and to provide for related matters.
10Be it enacted by the Legislature of Louisiana:
11 Section 1. Subpart C-1 of Part III of Chapter 4 of Title 22 of the Louisiana Revised
12Statutes of 1950, comprised of R.S. 22:1081 through 1088, is hereby enacted to read as
13follows:
14 SUBPART C-1. THE LOUISIANA RIGHT TO SHOP ACT
15 §1081. Short title
16 This Subpart shall be known and may be cited as the "Louisiana Right to
17 Shop Act".
18 §1082. Definitions
19 As used in this Subpart, the following definitions apply:
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1 (1) "Allowed amount" means the contractually agreed upon payment amount
2 between a health insurance issuer and a healthcare entity participating in the health
3 insurance issuer's network, excluding any member deductible, copayment, or other
4 obligation.
5 (2) "Commissioner" means the commissioner of insurance.
6 (3)(a) "Comparable healthcare service" includes but is not limited to the
7 following:
8 (i) Radiology and imaging services.
9 (ii) Laboratory services.
10 (iii) Infusion therapy.
11 (b) For purposes of this Subpart, "comparable healthcare service" does not
12 include radiology and imaging or laboratory services in connection with the delivery
13 of chiropractic or orthopedic healthcare services.
14 (4) "Department" means the Department of Insurance.
15 (5) "Health benefit plan" has the same meaning as provided in R.S.
16 22:1020.1.
17 (6) "Healthcare entity" means both of the following:
18 (a) A healthcare facility as defined in R.S. 22:1020.1.
19 (b) A healthcare provider as defined in R.S. 22:1020.1.
20 (7) "Health insurance issuer" or "issuer" has the same meaning as provided
21 in R.S. 22:1061.
22 (8) "Shopping and decision support program" means the program established
23 by a health insurance issuer pursuant to the provisions of this Subpart that provides
24 healthcare shopping capabilities and decision support services for enrollees.
25 §1083. Program implementation; incentives; costs; required reporting
26 A.(1) A health insurance issuer, hereinafter referred to as "issuer", offering
27 a health benefit plan in this state shall implement a shopping and decision support
28 program that provides shopping capabilities and decision support services for
29 enrollees in a health benefit plan. An issuer may provide incentives for enrollees in
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1 a health benefit plan who elect to receive a comparable healthcare service from a
2 network provider that is both of the following:
3 (a) Covered by the health benefit plan.
4 (b) Paid less than the average allowed amount paid by the issuer to network
5 providers for that comparable healthcare service before and after an enrollee's
6 out-of-pocket limit has been met.
7 (2) The shopping and decision support program may provide each enrollee
8 with at least fifty percent of the issuer's saved costs for each comparable healthcare
9 service; however, the shopping and decision support program may exclude incentive
10 payments, credits, or reductions for services where the savings to the issuer is fifty
11 dollars or less.
12 (3) Incentives may be calculated as a percentage of the difference between
13 the actual amount paid by the issuer for a given comparable healthcare service and
14 the average allowed amount for that service. Incentives may be provided as a cash
15 payment to the enrollee, a credit toward the enrollee's annual in-network deductible
16 and out-of-pocket limit, a credit or reduction of a premium, a copayment, cost
17 sharing, or a deductible.
18 (4) The average allowed amount shall be based on the actual allowed
19 amounts paid to network providers under the enrollee's health benefit plan within a
20 reasonable time frame, not to exceed one year.
21 (5) Annually, at enrollment or renewal, an issuer shall provide, at a
22 minimum, notice to enrollees of the right to obtain information described in
23 Paragraph (4) of this Subsection, the process for obtaining the information, and a
24 description of how to earn any incentives. An issuer shall provide this notice on the
25 issuer's website and in health benefit plan materials provided to enrollees.
26 B. Notwithstanding the provisions of this Subpart, the total value of
27 incentives offered to any one enrollee shall not exceed five hundred ninety-nine
28 dollars in any calendar year.
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1 C. An issuer shall make the shopping and decision support program available
2 as a component of all health benefit plans offered by the issuer in this state.
3 D. Prior to offering the shopping and decision support program to any
4 enrollee, an issuer shall file with the department a description of the shopping and
5 decision support program established by the issuer pursuant to the provisions of this
6 Subpart. The issuer has discretion as to the appropriate format for providing the
7 information required and may customize the format to provide the most relevant
8 information necessary to permit the department to determine compliance. The
9 department may review the filing made by the issuer to determine if the issuer's
10 shopping and decision support program complies with the provisions of this Section.
11 E.(1) An issuer shall annually file with the department for the most recent
12 calendar year the total number of comparable healthcare service incentive payments
13 made pursuant to the provisions of this Section, the use of comparable healthcare
14 services by category of service for which comparable healthcare service incentive
15 payments were made, the total incentive payments made to enrollees, the average
16 amount of incentive payments made by service for the transactions, and the total
17 number and percentage of the issuer's enrollees that participated in the transactions.
18 (2) Annually, on or before April first, the commissioner shall submit an
19 aggregate report for all issuers filing the information required by this Subsection to
20 the House Committee on Insurance and the Senate Committee on Insurance. The
21 commissioner may set reasonable limits on the annual reporting requirements on
22 issuers to focus on the more popular comparable healthcare services.
23 §1084. Interactive services for enrollees; out-of-pocket cost estimates
24 A.(1) An issuer offering a health benefit plan in this state shall comply with
25 the provisions of this Section.
26 (2) On and after December first, an issuer offering a health benefit plan in
27 this state shall make available the interactive member portal described in Subsection
28 B of this Section, and may make available the toll-free phone number described in
29 Subsection B of this Section.
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1 B.(1) An issuer shall make available an interactive member portal or a
2 toll-free phone number that enables an enrollee to request and obtain from the issuer
3 information on out-of-pocket costs to the enrollee for the comparable healthcare
4 services or on the average payments made by the issuer to network entities or
5 providers for comparable healthcare services, as well as quality data for those
6 providers, to the extent available.
7 (2) The member portal or toll-free phone number shall allow an enrollee
8 seeking information about the cost of a particular healthcare service to estimate
9 out-of-pocket costs applicable to that enrollee and compare the average allowed
10 amount paid to a network provider for the procedure or service under the enrollee's
11 health benefit plan within a reasonable time frame, not to exceed one year.
12 (3) The out-of-pocket estimate shall be a good faith estimate based on the
13 information provided by the enrollee or the enrollee's provider of the amount the
14 enrollee will be responsible to pay out-of-pocket for a proposed nonemergency
15 procedure or service that is determined by the issuer to be a medically necessary
16 covered benefit from an issuer's network provider, including any copayment,
17 deductible, coinsurance, or other out-of-pocket amount for any covered benefit,
18 based on the information available to the issuer at the time the request is made, and
19 subject to further medical necessity review by the issuer. An issuer may contract
20 with a third-party vendor to comply with the provisions of this Subsection.
21 (4) An issuer shall provide the information described in this Subsection by
22 the issuer's member portal or toll-free phone number, even if the enrollee requesting
23 the information has exceeded the enrollee's deductible or out-of-pocket costs
24 according to the enrollee's health benefit plan. Existing transparency mechanisms
25 or programs that estimate out-of-pocket costs for enrollees still within their
26 deductible qualify, pursuant to this Section, as long as those mechanisms or
27 programs continue to disclose the estimated average allowed amount, even after an
28 enrollee has exceeded the enrollee's deductible as well as any estimated
29 out-of-pocket costs.
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1 C. Nothing in this Section prohibits an issuer from imposing cost-sharing
2 requirements disclosed in the enrollee's policy, contract, or certificate of coverage
3 for unforeseen healthcare services that arise out of the nonemergency procedure or
4 service or for a procedure or service provided to an enrollee that was not included
5 in the original estimate.
6 D. An issuer shall notify an enrollee that the provided costs are estimated
7 costs, and that the actual amount the enrollee will be responsible to pay may vary due
8 to unforeseen services that arise out of the proposed nonemergency procedure or
9 service.
10 §1085. Comparison of comparable service
11 At the request of a patient, a healthcare provider shall provide a copy of an
12 order for a comparable healthcare service within two business days of the request.
13 §1086. Reporting requirements
14 On or before January first, the department shall publish a report on examples
15 of shared savings incentive programs in other states that directly incentivize current
16 enrollees and retirees to shop for lower cost care. The department shall provide the
17 report in writing to the House Committee on Insurance and the Senate Committee
18 on Insurance to consider the findings in implementation of a statewide shopping and
19 decision support program. The department may implement the program as part of
20 the next open enrollment period if it is believed to be cost effective.
21 §1087. Rulemaking authority
22 The commissioner may promulgate rules as necessary to implement the
23 provisions of this Subpart. The rules shall be promulgated in accordance with the
24 Administrative Procedure Act, R.S. 49:950 et seq.
25 §1088. Exclusions
26 Notwithstanding any state-mandated health benefits, this Subpart does not
27 apply to any plan described in Section 1251 of the federal Patient Protection and
28 Affordable Care Act of 2010, P.L. 111-148 and Section 2301 of the federal Health
29 Care and Education Reconciliation Act of 2010, P.L. 111-152.
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1 Section 2. Except R.S. 22:1083(E), 1084(A)(2), 1086, and 1087 as enacted by
2Section 1 of this Act, the provisions of this Act shall become effective on January 1, 2023,
3and shall apply to all health benefit plans entered into or renewed on or after that date.
4 Section 3. The provisions of R.S. 22:1083(E) and 1084(A)(2) as enacted by Section
51 of this Act shall become effective on January 1, 2024.
6 Section 4. The provisions of R.S. 22:1086 and 1087 as enacted by Section 1 of this
7Act shall become effective on August 1, 2022.
8 Section 5. The report prescribed in R.S. 22:1086 as enacted by Section 1 of this Act
9shall be submitted on or before January 1, 2023.
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 882 Original 2022 Regular Session Robert Owen
Abstract: Creates the La. Right to Shop Act, including an interactive marketplace for
consumers seeking health care.
Proposed law defines "allowed amount", "commissioner", "comparable healthcare service",
"department", "health benefit plan", "healthcare entity", "health insurance issuer", and
"shopping and decision support program".
Proposed law requires insurance companies offering health benefit plans in the state of La.
to offer a "shopping and decision support program", hereinafter "program", for enrollees
seeking healthcare services in this state. Further requires an issuer to make the program
available as a component of all health benefit plans offered by the issuer in this state.
Annually, at enrollment or renewal, proposed law requires an issuer to provide notice to
enrollees of the right to obtain information about the actual amounts paid to network
providers for services or procedures the enrollees may receive, as well as a description of
how an enrollee can earn incentives for electing to receive comparable healthcare services
from a network provider under certain circumstances.
Proposed law allows the program to provide each enrollee with at least 50% of the issuer's
saved costs for each comparable healthcare service. Further allows the program to exclude
incentive payments, credits, or reductions for services where the savings to the issuer is
$50.00 or less.
Proposed law requires the average allowed amount to be based on the actual allowed
amounts paid to network providers under the enrollee's health benefit plan within a
reasonable time frame, not to exceed 1 year.
Proposed law prohibits the total value of incentives offered to an enrollee from exceeding
$599.00 in any calendar year.
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Prior to offering the program to any enrollee, proposed law requires an issuer to file with the
La. Dept. of Insurance (LDI) a description of the program established by the issuer.
Authorizes the issuer to exercise discretion as to the appropriate format for providing the
required information. Further authorizes LDI to review the issuer's filing to determine if the
issuer's program complies with the provisions of proposed law.
Proposed law requires an issuer to annually file with LDI, for the most recent calendar year,
the total number of comparable healthcare service incentive payments made pursuant to
proposed law, the use of comparable healthcare services by category of service for which
comparable healthcare service incentive payments were made, the total incentive payments
made to enrollees, the average amount of incentive payments made by service for the
transactions, and the total number and percentage of an issuer's enrollees that participated
in the transactions.
By April 1 of each year, proposed law requires the commissioner to submit an aggregate
report for all issuers filing the information required by proposed law to the House and Senate
committees on insurance. Authorizes the commissioner to set reasonable limits on the
annual reporting requirements on issuers to focus on more popular comparable healthcare
services.
By December 1, 2024, proposed law requires an issuer to make available an interactive
member portal or a toll-free phone number that enables an enrollee to request and obtain
from the issuer information on out-of-pocket costs to the enrollee for comparable healthcare
services, or the average payments made by the issuer to network entities or providers for
comparable healthcare services.
Proposed law does not prohibit an issuer from imposing cost-sharing requirements disclosed
in the enrollee's policy, contract, or certificate of coverage for unforeseen healthcare services
that arise out of a nonemergency procedure or service or for a procedure or service provided
to an enrollee that was not included in the original estimate.
Proposed law requires an issuer to notify an enrollee that the provided costs are estimated
costs, and that the actual amount the enrollee will be responsible to pay may vary due to
unforeseen services that arise out of the proposed nonemergency procedure or service.
Proposed law requires a healthcare provider to provide a patient with a copy of an order for
a comparable healthcare service within 2 business days of the patient's request.
By January 1, 2023, proposed law requires LDI to publish a report with examples of out-of-
state shared savings incentive programs that directly incentivize enrollees and retirees to
shop for lower cost care. Requires findings of the report to be used toward implementation
of a statewide shopping and decision support program. Authorizes LDI to implement such
a program as part of the next open enrollment period if it is believed to be cost effective.
Requires LDI to share the report in writing to the House and Senate committees on
insurance.
Proposed law authorizes the commissioner to promulgate rules as necessary to implement
proposed law in accordance with the APA.
Proposed law does not apply to any plan described in certain sections of the federal Patient
Protection and Affordable Care Act or the federal Health Care and Education Reconciliation
Act.
Effective Jan. 1, 2023.
(Adds R.S. 22:1081-1088)
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