SLS 23RS-352 REENGROSSED
2023 Regular Session
SENATE BILL NO. 110
BY SENATORS TALBOT, BARROW, BOUDREAUX, BOUIE, CARTER, CATHEY,
CLOUD, CONNICK, CORTEZ, DUPLESSIS, FESI, HARRIS, HENRY,
HENSGENS, HEWITT, JACKSON, MCMATH, MILLIGAN, FRED
MILLS, ROBERT MILLS, MIZELL, MORRIS, PEACOCK, REESE,
SMITH, STINE, TARVER, WHITE AND WOMACK
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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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 and 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
15 healthcare services, including a sickness and accident insurance company, a
16 health maintenance organization, a preferred provider organization or any
17 similar 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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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 healthcare
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, healthcare services, procedures, or settings. Techniques, shall
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 A. For any services related to the diagnosis or treatment of cancer for
20 which prior authorization is required under a health coverage plan, the health
21 insurance issuer shall offer an expedited review to the provider requesting prior
22 authorization. The health insurance issuer shall communicate its decision on the
23 prior authorization request to the provider as soon as possible, but in all cases
24 no later than forty-eight hours from the receipt of the request for expedited
25 review. If additional information is needed and requested for the issuer to make
26 its determination, the issuer shall communicate its decision to the provider as
27 soon as possible, but no later than forty-eight hours from receipt of the
28 additional information.
29 B. For any services related to the diagnosis or treatment of cancer for
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1 which prior authorization is required under a health coverage plan and for
2 which the health insurance issuer does not receive a request for expedited
3 review from the provider, the issuer shall communicate its decision on the prior
4 authorization request no later than five days from the receipt of the request. If
5 additional information is needed and requested for the issuer to make its
6 determination, the issuer shall communicate its decision to the provider no more
7 than fourteen days from receipt of the additional information.
8 §1060.14. Requirement to cover services consistent with nationally recognized
9 clinical practice guidelines or consensus statements
10 No health coverage plan that is renewed, delivered, or issued for delivery
11 in this state that provides coverage for cancer in accordance with the Louisiana
12 Insurance Code shall deny a request for prior authorization or the payment of
13 a claim for any procedure, pharmaceutical, or diagnostic test to be provided or
14 performed for the diagnosis and treatment of cancer if the procedure,
15 pharmaceutical, or diagnostic test is recommended by nationally recognized
16 clinical practice guidelines or consensus statements for use in the diagnosis or
17 treatment for the insured's particular type of cancer and clinical state.
18 §1060.15. Required coverage for positron emission tomography or other
19 recommended imaging for cancer
20 A. No health insurance issuer shall deny coverage of a positron emission
21 tomography or other recommended imaging for the purpose of diagnosis,
22 treatment, appropriate management, restaging, or ongoing monitoring of an
23 individual's disease or condition if the imaging is being requested for the
24 diagnosis, treatment, or ongoing surveillance of cancer and is recommended by
25 nationally recognized clinical practice guidelines or consensus statements.
26 B. No health coverage plan that is renewed, delivered, or issued for
27 delivery in this state shall require an insured to undergo any imaging test for
28 the purpose of diagnosis, treatment, appropriate management, restaging, or
29 ongoing monitoring of an insured's disease or condition of cancer that is not
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1 recommended by nationally recognized clinical practice guidelines or consensus
2 statements as a condition precedent to receiving a positron emission
3 tomography or other recommended imaging when the positron emission
4 tomography or other recommended imaging is recommended by the guidelines
5 provided by this Subpart.
6 C. The coverage provided in this Section may be subject to annual
7 deductibles, coinsurance, and copayment provisions as are consistent with those
8 established under the health coverage plan.
9 §1060.16. Coverage for outpatient cancer treatments
10 A. All health coverage plans renewed, delivered, or issued for delivery
11 in this state shall, in addition to providing coverage for an insured admitted on
12 an inpatient basis to a licensed hospital providing rehabilitation, long-term
13 acute care or skilled nursing services, provide coverage for claims for any
14 otherwise covered and authorized outpatient services provided to the patient for
15 the treatment of cancer.
16 B. The coverage provided in this Section may be subject to annual
17 deductibles, coinsurance, and copayment provisions as are consistent with those
18 established under the health coverage plan.
19 Section 2. The provisions of this Act shall apply to any new policy, contract,
20 program, or health coverage plan issued on and after January 1, 2024. Any policy, contract,
21 or health coverage plan in effect prior to January 1, 2024, shall convert to conform to the
22 provisions of this Act on or before the renewal date, but no later than January 1, 2025.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Beth O'Quin.
DIGEST
SB 110 Reengrossed 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 for any service related to the diagnosis or treatment of cancer which
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requires prior authorization under the health coverage plan requires an expedited review to
the provider requesting prior authorization, and requires the health insurance issuer to
communicate its decision on the prior authorization request as soon as possible, but no later
than 48 hours from the receipt of the request for expedited review. Provides that if the issuer
needs additional information to make its determination, the proposed law requires the issuer
to communicate with the provider as soon as possible, but no later than 48 hours from the
receipt of the additional information.
Proposed law requires for any service related to the diagnosis or treatment of cancer which
requires prior authorization under the health coverage plan and the provider did not request
an expedited review, the issuer is required to communicate its decision on the prior
authorization request no later than five days from the receipt of the request for expedited
review. Provides that if the issuer needs additional information to make its determination,
the proposed law requires the issuer to communicate with the provider no later than 14 days
from the receipt of the additional information.
Proposed law prohibits a health insurance coverage plan that has coverage for cancer from
denying a prior authorization or payment of claims for any procedure, pharmaceutical or
diagnostic test to be provided or performed for the diagnosis and treatment of 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 for use in the diagnosis or treatment for the insured's
particular type of cancer and clinical state.
Proposed law prohibits a health issuer 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 imaging is being requested for the diagnosis, treatment,
or ongoing monitoring of cancer and is recommended by nationally recognized clinical
practice guidelines or consensus statements.
Proposed law prohibits a health coverage plan that is renewed, delivered, or issued for
delivery in this state shall undergo any imaging test for the purpose of diagnosis, treatment,
appropriate management, restaging, or ongoing monitoring of an insured's disease or
condition if the imaging is being requested for the diagnosis, treatment, or ongoing
monitoring of cancer and is recommended by nationally recognized clinical practice
guidelines or consensus statements as a precedent to receiving a positron emission
tomography or other recommended imaging is recommended by the guidelines provided by
the 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 otherwise covered and authorized 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.
The Act is effective for any new policy, contract, program, or health coverage plan in effect
prior to January 1, 2024, and for any policy, contract, or health coverage plan in effect prior
to January 1, 2024, the policy, contract, or health coverage in effect is required to conform
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to the provisions of this Act on or before the renewal date, but no later than January 1, 2025.
(Adds R.S. 22:1060.11-1060.16)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill
1. Clarifies that no plan shall deny a request for utilization review or payment
of any procedure or test performed on an insured with a prior history of
cancer.
2. Makes technical changes.
Senate Floor Amendments to engrossed bill
1. Changes the prior authorization time period for a request by a provider for
an expedited review from 36 hours to 48 hours, and adds if the issuer needs
additional information, the issuer is required to make its determination as
soon as possible or no later than 48 hours from the receipt of the information.
2. Adds the prior authorization time period for a request by a provider that is
not an expedited request is five days from the receipt of the request, and if
the issuer needs additional information, no later than 14 days from the receipt
of the information.
3. Changes from a utilization review to prior authorization.
4. Changes the conditions for a positron emission tomography (PET)test.
5. Adds imaging to tests that an insured would have to undergo for a PET test.
6. Adds otherwise covered and authorized for outpatient treatment.
7. The effective date is changed to January 1, 2024, for any new policy,
contract, program, or health plan, and requires any policy, contract, program
or health plan issued prior to January 1, 2024, to conform the provisions of
this Act on or before the renewal date, but no later than January 1, 2025.
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