2023 Regular Session ENROLLED 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 AND REPRESENTATIVE GAROFALO Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana. 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 Revised 10 Statutes of 1950, comprised of R.S. 22:1060.11 through 1060.16, is hereby enacted to read 11 as follows: 12 SUBPART B-2. CANCER PATIENT'S RIGHT 13 TO PROMPT COVERAGE ACT 14 §1060.11. Short title 15 This Subpart shall be known and may be cited as the "Cancer Patient's Page 1 of 6 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 110 ENROLLED 1 Right to Prompt Coverage Act". 2 §1060.12. Definitions 3 As used in this Subpart, the following definitions apply unless the context 4 indicates otherwise: 5 (1) "Health coverage plan" means any hospital, health, or medical 6 expense insurance policy, hospital or medical service contract, employee welfare 7 benefit plan, contract, or other agreement with a health maintenance 8 organization or a preferred provider organization, health and accident 9 including a group insurance plan or self-insurance plan and the office of group 10 benefits. "Health coverage plan" does not include a plan providing coverage for 11 excepted benefits defined in R.S. 22:1061, limited benefit health insurance plans, 12 and short-term policies that have a term of less than twelve months. 13 (2) "Health insurance issuer" means an entity subject to the Louisiana 14 Insurance Code and applicable regulations, or subject to the jurisdiction of the 15 commissioner, that contracts or offers to contract, or enters into an agreement 16 to provide, deliver, arrange for, pay for, or reimburse any of the costs of 17 healthcare services, including a sickness and accident insurance company, a 18 health maintenance organization, a preferred provider organization or any 19 similar entity, or any other entity providing a plan of health insurance or health 20 benefits. 21 (3) "Nationally recognized clinical practice guidelines" means 22 evidence-based clinical guidelines developed by independent organizations or 23 medical professional societies, including but not limited to the National 24 Comprehensive Cancer Network, the American Society of Clinical Oncology, 25 and the American Society of Hematology, utilizing a transparent methodology 26 and reporting structure and having policies against conflicts of interest. The 27 guidelines shall establish best practices informed by a systematic review of 28 evidence, an assessment of the benefits and costs of alternative care options, and 29 recommendations intended to optimize patient care. 30 (4) "Positron emission tomography" means an imaging test that uses Page 2 of 6 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 110 ENROLLED 1 radioactive substances to visualize and measure metabolic processes in the body 2 to help reveal how tissue and organs are functioning. The provisions of this 3 Section shall not apply to non-melanomatous skin cancer. 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 include 11 but are not limited to ambulatory review, prior authorization, second opinion, 12 certification, concurrent review, case management, discharge planning, or 13 retrospective review. Utilization review does not include elective requests for 14 clarification of coverage. 15 §1060.13. Prior authorization; time periods 16 A. For any services typically covered under the plan and related to the 17 diagnosis or treatment of cancer for which prior authorization is required 18 under a health coverage plan, the health insurance issuer shall offer an 19 expedited review to the provider requesting prior authorization. The health 20 insurance issuer shall communicate its decision on the prior authorization 21 request to the provider as soon as possible, but in all cases no later than two 22 business days from the receipt of the request for expedited review. If additional 23 information is needed and requested for the issuer to make its determination, 24 the issuer shall communicate its decision to the provider as soon as possible, but 25 no later than forty-eight hours from receipt of the additional information. 26 B. For any services typically covered under the plan and related to the 27 diagnosis or treatment of cancer for which prior authorization is required 28 under a health coverage plan and for which the health insurance issuer does not 29 receive a request for expedited review from the provider, the issuer shall 30 communicate its decision on the prior authorization request no later than five Page 3 of 6 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 110 ENROLLED 1 days from the receipt of the request. If additional information is needed and 2 requested for the issuer to make its determination, the issuer shall communicate 3 its decision to the provider no more than two business days from receipt of the 4 additional information. 5 C. The provisions of this Section shall apply only when the requesting 6 provider clearly indicated that the request is related to the diagnosis or 7 treatment of cancer. 8 D. The provisions of this Section shall not apply to non-melanomatous 9 skin cancer. 10 §1060.14. Requirement to cover services consistent with nationally recognized 11 clinical practice guidelines 12 A. No health coverage plan that is renewed, delivered, or issued for 13 delivery in this state that provides coverage for cancer in accordance with the 14 Louisiana Insurance Code shall deny a request for prior authorization or the 15 payment of a claim for any procedure, pharmaceutical, or diagnostic test 16 typically covered under the plan to be provided or performed for the diagnosis 17 and treatment of cancer if the procedure, pharmaceutical, or diagnostic test is 18 recommended by nationally recognized clinical practice guidelines for use in the 19 diagnosis or treatment for the insured's particular type of cancer and 20 clinical state. 21 B. The provisions of this Section shall not prohibit a health insurance 22 issuer from requiring utilization review to assess the effectiveness of the 23 procedure, pharmaceutical, or test for the insured's condition, but if the 24 procedure, pharmaceutical, or test is what is recommended by nationally 25 recognized clinical practice guidelines for use in the diagnosis or treatment for 26 the insured's particular type of cancer and clinical state, then any associated 27 prior authorization shall be approved within the time limit specified in R.S. 28 22:1060.13. 29 §1060.15. Required coverage for positron emission tomography or other 30 recommended imaging for cancer Page 4 of 6 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 110 ENROLLED 1 A. No health insurance issuer shall deny coverage of a positron emission 2 tomography or other recommended imaging for the purpose of diagnosis, 3 treatment, appropriate management, restaging, or ongoing monitoring of an 4 individual's disease or condition if the imaging is being requested for the 5 diagnosis, treatment, or ongoing surveillance of cancer and is recommended by 6 nationally recognized clinical practice guidelines. 7 B. No health coverage plan that is renewed, delivered, or issued for 8 delivery in this state shall require an insured to undergo any imaging test for 9 the purpose of diagnosis, treatment, appropriate management, restaging, or 10 ongoing monitoring of an insured's disease or condition of cancer that is not 11 recommended by nationally recognized clinical practice guidelines, as a 12 condition precedent to receiving a positron emission tomography or other 13 recommended imaging, when the positron emission tomography or other 14 recommended imaging is recommended by the guidelines provided by this 15 Subpart. 16 C. 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 §1060.16. Coverage for outpatient cancer treatments 20 A. All health coverage plans renewed, delivered, or issued for delivery 21 in this state shall, in addition to providing coverage for an insured admitted on 22 an inpatient basis to a licensed hospital providing rehabilitation, long-term 23 acute care or skilled nursing services, provide coverage for claims for any 24 otherwise covered and authorized outpatient services provided to the patient for 25 the treatment of cancer. 26 B. The coverage provided in this Section may be subject to annual 27 deductibles, coinsurance, and copayment provisions as are consistent with those 28 established under the health coverage plan. 29 Section 2. The provisions of this Act shall apply to any new policy, contract, 30 program, or health coverage plan issued on and after January 1, 2024. Any policy, contract, Page 5 of 6 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 110 ENROLLED 1 or health coverage plan in effect prior to January 1, 2024, shall convert to conform to the 2 provisions of this Act on or before the renewal date, but no later than January 1, 2025. PRESIDENT OF THE SENATE SPEAKER OF THE HOUSE OF REPRESENTATIVES GOVERNOR OF THE STATE OF LOUISIANA APPROVED: Page 6 of 6 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions.