The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Michelle Ridge.
DIGEST
SB 164 Original 2023 Regular Session Cloud
Present law provides that the Office of Group Benefits (office) shall require every health plan offered
through the office to furnish in writing or provide electronically, within one business day of a written
or oral request by a healthcare provider, the medical criteria and any other requirements that must
be satisfied in order for the service, procedure, or drug to be prior authorized by the health plan.
Proposed law removes the requirement that in order to receive information relative to prior
authorization requirements for certain services, procedures, or drugs, a healthcare provider must
request the information. Proposed law instead requires that the office maintain and publish on a
publicly accessible webpage a list of healthcare services, procedures, and pharmaceuticals subject
to prior authorization.
Proposed law provides that the list shall also include the time period allowed for the health plan to
render and communicate a decision and the requirements or criteria that shall be satisfied in order
for the plan to prior authorize the healthcare service, procedure, or pharmaceutical.
Proposed law prohibits a health plan offered through the office from requiring a prior authorization
to be obtained for any healthcare service, procedure, or pharmaceutical that is not included on the
list published and maintained by the office and provides that a health plan that fails to render and
communicate a prior authorization decision to the requesting healthcare provider within the
timeframe published on the list shall cause the healthcare services, procedures, or pharmaceuticals
subject to the request to no longer require prior authorization as a condition of payment of the claim.
Proposed law requires the office to make aggregate statistics available on an annual basis, delineated
by quarter, for each health plan offered through the office regarding prior authorization approvals
and denials on its website in a readily accessible format. Authorizes the chief executive officer
(CEO) of the office to determine the statistics required in order to comply with proposed law in
accordance with applicable state and federal privacy laws. Proposed law provides for an illustrative
list of statistics required for compliance.
Proposed law requires the CEO to submit the aggregate statistics annually in a written report to the
Senate Committee on Finance and the House Committee on Appropriations.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 42:812(A))