SLS 23RS-352 ORIGINAL
2023 Regular Session
SENATE BILL NO. 110
BY SENATOR TALBOT
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE POLICIES. Provides for patient's right to prompt coverage. (8/1/23)
1 AN ACT
2 To enact Subpart B-2 of Part III of Chapter 4 of Title 22 of the Louisiana Revised Statutes
3 of 1950, to be comprised of R.S. 22:1060.11 through 1060.16, relative to health
4 insurance; to provide for a short title; to provide for definitions; to provide for time
5 periods for prior authorization determinations; to provide for insurance coverage for
6 positron emission tomography imaging under certain conditions; and to provide for
7 related matters.
8 Be it enacted by the Legislature of Louisiana:
9 Section 1. Subpart B-2 of Part III of Chapter 4 of Title 22 of the Louisiana
10 Revised Statutes of 1950, comprised of R.S. 22:1060.11 through 1060.16, is hereby
11 enacted to read as follows:
12 SUBPART B-2 Cancer Patient's Right to Prompt Coverage Act
13 §1060.11. Short title
14 This Subpart shall be known and may be cited as the "Cancer Patient's
15 Right to Prompt Coverage Act".
16 §1060.12. Definitions
17 As used in this Subpart the following definitions apply unless the context
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 110
SLS 23RS-352 ORIGINAL
1 indicates otherwise:
2 (1) "Health coverage plan" means any hospital, health, or medical
3 expense insurance policy, hospital or medical service contract, employee welfare
4 benefit plan, contract, or other agreement with a health maintenance
5 organization or a preferred provider organization, health and accident
6 insurance policy, or any other insurance contract of this type in this state,
7 including a group insurance plan or self-insurance plan and the office of group
8 benefits. "Health coverage plan" does not include a plan providing coverage for
9 excepted benefits defined in R.S. 22:1061, limited benefit health insurance plans
10 or, short-term policies that have a term of less than twelve months.
11 (2) "Health insurance issuer" means an entity subject to the Louisiana
12 Insurance Code and applicable regulations, or subject to the jurisdiction of the
13 commissioner, that contracts or offers to contract, or enters into an agreement
14 to provide, deliver, arrange for, pay for, or reimburse any of the costs of health
15 care services, including a sickness and accident insurance company, a health
16 maintenance organization, a preferred provider organization or any similar
17 entity, or any other entity providing a plan of health insurance or health
18 benefits.
19 (3) "Nationally recognized clinical practice guidelines" means
20 evidence-based clinical guidelines developed by independent organizations or
21 medical professional societies, including but not limited to National
22 Comprehensive Cancer Network, the American Society of Clinical Oncology,
23 or the American Society of Hematology, utilizing a transparent methodology
24 and reporting structure and having policies against conflict-of-interest. The
25 guidelines shall establish best practices informed by a systematic review of
26 evidence and an assessment of the benefits and costs alternative care options
27 and include recommendations intended to optimize patient care.
28 (4) "Consensus statements" means statements developed by an
29 independent, multidisciplinary panel of experts utilizing a transparent
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 110
SLS 23RS-352 ORIGINAL
1 methodology and reporting structure and with a conflict-of-interest policy. The
2 statements are aimed at specific clinical circumstances and based on the best
3 available evidence for the purpose of optimizing the outcomes of clinical care.
4 (5) "Prior authorization" means a determination by a health insurance
5 issuer, or person contracting with a health insurance issuer that health care
6 services ordered by the provider to an individual or an enrollee are medically
7 necessary and appropriate.
8 (6) "Utilization review" means a set of formal techniques designed to
9 monitor the use of, or evaluate the clinical necessity, appropriateness, efficacy,
10 or efficiency of, health care services, procedures, or settings. Techniques
11 include, but are not limited to, ambulatory review, prior authorization, second
12 opinion, certification, concurrent review, case management, discharge planning
13 or retrospective review. Utilization review shall not include elective requests for
14 clarification of coverage.
15 (7) "Positron emission tomography" means an imaging test that uses
16 radioactive substances to visualize and measure metabolic processes in the body
17 to help reveal how tissue and organs are functioning.
18 §1060.13. Prior authorization; time periods
19 As expeditiously as required by the insured's health condition, but in all
20 cases no later than thirty-six hours from the time a request for utilization
21 review was submitted to a health insurance issuer by a health care provider
22 requesting, a utilization review determination for any procedure,
23 pharmaceutical or diagnostic test to be provided or performed for an insured
24 with a history of cancer, symptoms that indicate the possibility of a cancer
25 diagnosis, or has an ongoing case involving cancer and the procedure,
26 pharmaceutical, or diagnostic test is related to that cancer, the health insurance
27 issuer shall render a determination and communicate that determination to the
28 health care provider.
29 §1060.14. Requirement to cover services consistent with nationally recognized
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 110
SLS 23RS-352 ORIGINAL
1 clinical practice guidelines or consensus statements
2 No health coverage plan that is renewed, delivered, or issued for delivery
3 in this state that provides coverage for cancer in accordance with the Louisiana
4 Insurance Code shall deny a request for utilization review or the payment of
5 claim for any procedure, pharmaceutical or diagnostic test to be provided or
6 performed for an insured with a history of cancer, symptoms that indicate the
7 possibility of a cancer diagnosis, or has an ongoing case involving cancer if the
8 procedure, pharmaceutical, or diagnostic test is related to that cancer, and the
9 procedure, pharmaceutical, or diagnostic test is recommended by nationally
10 recognized clinical practice guidelines or consensus statements.
11 §1060.15. Required coverage for positron emission tomography or other
12 recommended imaging for cancer
13 A. No health insurance issuer shall deny coverage of a positron emission
14 tomography or other recommended imaging for the purpose of diagnosis,
15 treatment, appropriate management, restaging, or ongoing monitoring of an
16 individual's disease or condition if the insured has a prior history of cancer or
17 the insured has symptoms that indicate the possibility of a cancer diagnosis, and
18 the positron emission tomography or other recommended imaging is
19 recommended for the diagnosis, treatment, appropriate management, restaging,
20 or ongoing monitoring of the patient's cancer diagnosis by nationally recognized
21 clinical practice guidelines or consensus statements.
22 B. No health coverage plan that is renewed, delivered, or issued for
23 delivery in this state shall require an insured to undergo any test for the
24 purpose of diagnosis, treatment, appropriate management, restaging, or
25 ongoing monitoring of an insured's disease or condition of cancer that is not
26 recommended by nationally recognized clinical practice guidelines or consensus
27 statements as a condition precedent to receiving a positron emission
28 tomography or other recommended imaging when the positron emission
29 tomography or other recommended imaging is recommended by the guidelines
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 110
SLS 23RS-352 ORIGINAL
1 provided by this Subpart.
2 C. The coverage provided in this Section may be subject to annual
3 deductibles, coinsurance, and copayment provisions as are consistent with those
4 established under the health coverage plan.
5 §1060.16. Coverage for outpatient cancer treatments
6 A. All health coverage plans renewed, delivered, or issued for delivery
7 in this state shall, in addition to providing coverage for an insured admitted on
8 an inpatient basis to a licensed hospital providing rehabilitation, long-term
9 acute care or skilled nursing services, provide coverage for claims for any
10 outpatient services provided to the patient for the treatment of cancer.
11 B. The coverage provided in this Section may be subject to annual
12 deductibles, coinsurance, and copayment provisions as are consistent with those
13 established under the health coverage plan.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Beth O'Quin.
DIGEST
SB 110 Original 2023 Regular Session Talbot
Proposed law establishes the "Cancer Patient's Right to Prompt Coverage Act".
Proposed law adds definitions for health coverage plan, health insurance issuer, nationally
recognized clinical practice guidelines, consensus statements, prior authorization, utilization
review, and positron emission tomography.
Proposed law requires an expeditious review when an insured's health condition requires an
expeditious review that in all cases is no later than 36 hours from the time a request for
utilization review was submitted to a health insurance issuer from a health insurance
provider requesting a utilization review determination for any procedure, pharmaceutical or
diagnostic test to be provided or performed for an insured with a history of cancer,
symptoms that indicate the possibility of a cancer diagnosis, or has an ongoing case
involving cancer and the procedure, pharmaceutical, or diagnostic test is related to that
cancer, the health insurance issuer shall render a determination and communicate that
determination to the health care provider.
Proposed law prohibits a health insurance coverage plan that has coverage for cancer from
denying a utilization review or payment of claims for any procedure, pharmaceutical or
diagnostic test to be provided or performed for an insured with a history of cancer,
symptoms that indicate the possibility of a cancer diagnosis, or has an ongoing case
involving cancer if the procedure, pharmaceutical, or diagnostic test is related to that cancer,
and the procedure, pharmaceutical, or diagnostic test is recommended by nationally
recognized clinical practice guidelines or consensus statements.
Proposed law prohibits a health coverage plan that has coverage for cancer from denying a
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 110
SLS 23RS-352 ORIGINAL
request for utilization review or the payment of claim for any procedure, pharmaceutical or
diagnostic test to be provided or performed for an insured with a history of cancer,
symptoms that indicate the possibility of a cancer diagnosis, or has an ongoing case
involving cancer if the procedure, pharmaceutical, or diagnostic test is related to that cancer,
and the procedure, pharmaceutical, or diagnostic test is recommended by nationally
recognized clinical practice guidelines or consensus statements.
Proposed law prohibits a health coverage plan that provides coverage for cancer to deny
coverage of a positron emission tomography or other recommended imaging for the purpose
of diagnosis, treatment, appropriate management, restaging, or ongoing monitoring of an
insured's disease or condition if the insured has a prior history of cancer or the insured's
symptoms indicate the possibility of a cancer diagnosis, and the positron emission
tomography or other recommended imaging is recommended for the diagnosis, treatment,
appropriate management, restaging, or ongoing monitoring of the patient's cancer diagnosis
by nationally recognized clinical practice guidelines or consensus statements.
Proposed law prohibits a health coverage plan that provides coverage for cancer to require
an insured to undergo any test for the purpose of diagnosis, treatment, appropriate
management, restaging, or ongoing monitoring of an insured's disease or condition of cancer
that is not recommended by nationally recognized clinical practice guidelines or consensus
statements as a condition precedent to receiving a positron emission tomography or other
recommended imaging when the positron emission tomography or other recommended
imaging is recommended by the guidelines provided by proposed law.
Proposed law provides a health insurance plan under this proposed law is authorized to apply
annual deductibles, coinsurance, and copayment provisions as are consistent with those
established under the health coverage plan.
Proposed law requires all health coverage plans under this proposed law to provide in
addition to providing coverage for an insured admitted on an inpatient basis to a licensed
hospital providing rehabilitation, long-term acute care or skilled nursing services, to provide
coverage for claims for any outpatient services provided to the patient for the treatment of
cancer.
Proposed law provides a health insurance plan under this proposed law is authorized to apply
annual deductibles, coinsurance, and copayment provisions as are consistent with those
established under the health coverage plan.
Effective August 1, 2023.
(Adds R.S. 22:1060.11-1060.16)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.