The original instrument was prepared by Michelle D. Ridge. The following digest,
which does not constitute a part of the legislative instrument, was prepared by Tracy
Sabina Sudduth.
DIGEST
SB 164 Reengrossed 2023 Regular Session Cloud
Present law provides that the office shall require every self-funded 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 self-funded 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 provides that beginning January 1, 2024, the provisions of proposed law shall apply
to self-funded health plans offered by the office.
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 self-funded
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 self-funded 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 self-funded 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 self-funded 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))
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Beginning January 1, 2024, the provisions of proposed law shall apply to self-funded
health plans offered by the office.
2. Provides that the provisions of proposed law shall only apply to self-funded health
plans.