HASBSB110 TYLERT 2688
SENATE SUMMARY OF HOUSE AMENDMENTS
SB 110 2023 Regular Session Talbot
KEYWORD AND SUMMARY AS RETURNED TO THE SENATE
INSURANCE POLICIES: Provides for patient's right to prompt coverage. (8/1/23)
(RE2 INCREASE SG EX See Note)
SUMMARY OF HOUSE AMENDMENTS TO THE SENATE BILL
1. Removes the definition and all references to "consensus statements".
2. Clarifies services are "typically covered under the plan".
3. Changes the time allowable for a decision on prior authorization from 48
hours to two business days for an expedited review.
4. Changes the time allowable for a decision on prior authorization when
additional information is needed from 14 days to two business days.
5. Adds a requirement that prior authorization only applies to the diagnosis or
treatment of cancer.
6. Excludes non-melanomatous skin cancer from the proposed law.
7. Prohibits a health insurance issuer from requiring utilization review to assess
the effectiveness of a procedure, pharmaceutical, or test.
8. Makes technical changes.
DIGEST OF THE SENATE BILL AS RETURNED TO THE SENATE
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 five 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 HASBSB110 TYLERT 2688
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.
The provisions of this Act apply 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 Act on or before the
renewal date, but no later than Jan. 1, 2025.
(Adds R.S. 22:1060.11-1060.16)
______________________
Beth O'Quin
Attorney