RDCSB110 4448 3347
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)]
SB 110 Reengrossed 2023 Regular Session Talbot
Proposed law establishes the "Cancer Patient's Right to Prompt Coverage Act".
Proposed law defines "health coverage plan", "health insurance issuer", "nationally
recognized clinical practice guidelines", "positron emission tomography", "prior
authorization", and "utilization review".
Proposed law requires a health insurance issuer (issuer) to offer an expedited review to the
provider requesting prior authorization for any service related to the diagnosis or treatment
of cancer. Requires the issuer to communicate its decision of prior authorization as soon as
possible, but no later than two business days from the receipt of the request for expedited
review. Further provides that if the issuer needs and requests additional information to make
its determination, the issuer is required to communicate its decision to the provider as soon
as possible, but no later than 48 hours from the receipt of the additional information.
For any service typically covered under the plan and 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, proposed law requires the issuer to communicate its
decision on the prior authorization request no later than 5 days from the receipt of the
request. Further provides that if the issuer needs additional information to make its
determination, the issuer is required to communicate with the provider no later than two
business days from the receipt of the additional information. Further provides that the
provisions of proposed law only apply to the diagnosis or treatment of cancer, except for
non-melanoma skin cancer.
Proposed law prohibits a health coverage plan 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 test is
recommended by nationally recognized clinical practice guidelines for use in the diagnosis
or treatment of the insured's specific type of cancer and clinical state.
Proposed law prohibits an issuer from denying coverage of a positron emission tomography
or 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. This provision shall not apply to non-
melanoma skin cancer.
Proposed law prohibits a health coverage plan from requiring an insured to 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 that is recommended by nationally
recognized clinical practice guidelines, as a precedent to receiving a positron emission
tomography, when the positron emission tomography is recommended by the guidelines of
proposed law.
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, proposed
law requires a health coverage plan to provide coverage for claims for any otherwise covered
and authorized outpatient services to the patient for the treatment of cancer.
Proposed law authorizes a health coverage plan to apply annual deductibles, coinsurance,
and copayment provisions as are consistent with those established under the health coverage
plan.
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Proposed law applies to any new policy, contract, program, or health coverage plan issued
on and after Jan. 1, 2024, and requires any policy, contract, or health coverage plan in effect
prior to Jan. 1, 2024, to conform to the provisions of proposed law on or before the renewal
date, but no later than Jan. 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.
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
reengrossed bill:
1. Make technical changes.
The Committee Amendments Proposed by House Committee on Appropriations to the
reengrossed bill:
1. Remove the definition and all references to "consensus statements".
2. Add the language "typically covered under the plan" when referring to services.
3. Change the time allowable for a decision on prior authorization from 48 hours
to two business days for an expedited review.
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4. Change the time allowable for a decision on prior authorization when additional
information is needed from 14 days to two business days.
5. Add language that the provisions regarding prior authorization shall only apply
when the request is related to the diagnosis to treatment of cancer and that it shall
not apply to non-melanomatous skin cancer.
6. Add language that proposed law shall not prohibit a health insurance issuer from
requiring utilization review to assess the effectiveness of a procedure,
pharmaceutical, or test.
7. Make technical changes.
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