RDCSB164 2549 3747
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 164 Reengrossed 2023 Regular Session Cloud
Present law provides that the Office of Group Benefits (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 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 appropriation of funds by the legislature for the implementation of proposed
law.
(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.
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Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Appropriations to the
reengrossed bill:
1. Delete provision making proposed law effective upon signature of governor.
2. Make effectiveness of proposed law subject to appropriation of monies by the
legislature for the implementation of proposed law.
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