SLS 23RS-396 REENGROSSED
2023 Regular Session
SENATE BILL NO. 188
BY SENATORS STINE, ABRAHAM, BERNARD, FESI, ROBERT MILLS, MORRIS
AND TALBOT AND REPRESENTATIVES ROBERT OWEN AND
PRESSLY
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
HEALTH/ACC INSURANCE. Provides for utilization review and approval procedures of
claims for healthcare provider services. (gov sig)
1 AN ACT
2 To enact R.S. 22:1020.62, relative to health insurance; to provide for utilization review; to
3 provide definitions; to provide for documentation and reports; to require items and
4 services subject to prior authorizations be posted on a health insurance issuer's
5 website; to require applications and enrollment materials include a health insurance
6 issuer's web address for any of its health coverage plans; and to provide for related
7 matters.
8 Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 22:1020.62 is hereby enacted to read as follows:
10 ยง1020.62. Utilization review reports; definitions
11 A. For purposes of this Section, the following terms shall have the
12 following meanings:
13 (1) "Health coverage plan" means any hospital, health, or medical
14 expense insurance policy, hospital or medical service contract, employee welfare
15 benefit plan, contract, or other agreement with a health maintenance
16 organization or a preferred provider organization, health and accident
17 insurance policy, or any other insurance contract of this type in this state,
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 188
SLS 23RS-396 REENGROSSED
1 including a group insurance plan or self-insurance plan. "Health coverage
2 plan" does not include a plan providing coverage for excepted benefits defined
3 in R.S. 22:1061, excepted benefit health insurance plans, short-term policies that
4 have a term of less than twelve months or the office of group benefits.
5 Notwithstanding excepted benefits as defined in R.S. 22:1061, a "health
6 coverage plan" subject to the provisions of Part III of this Chapter shall include
7 dental insurance plans.
8 (2) "Health insurance issuer" means an entity subject to the insurance
9 laws and regulations of this state, or subject to the jurisdiction of the
10 commissioner, that contracts or offers to contract, or enters into an agreement
11 to provide, deliver, arrange for, pay for, or reimburse any of the costs of
12 healthcare services, including a sickness and accident insurance company, a
13 health maintenance organization, a preferred provider organization or any
14 similar entity, or any other entity providing a plan of health insurance or health
15 benefits. Health insurance issuer shall not include the office of group benefits.
16 (3) "Healthcare provider" or "provider" means a healthcare
17 professional or a healthcare facility or the agent or assignee of the healthcare
18 professional or healthcare facility.
19 (4) "Healthcare services" means services, items, supplies, or drugs for
20 the diagnosis, prevention, treatment, cure, or relief of a health condition, illness,
21 injury, or disease.
22 (5) "Prior authorization" means a determination by a health insurance
23 issuer, or person contracting with a health insurance issuer that healthcare
24 services ordered by the provider for an individual are medically necessary and
25 appropriate.
26 B.(1) A health insurance issuer on an annual basis and at a time and in
27 a manner determined by the commissioner, shall submit to the department, a
28 report containing a quarterly breakdown of the following information:
29 (a) A list of all items and services that require prior authorization.
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1 (b) The percentage of standard prior authorization requests that were
2 approved, aggregated for all items and services.
3 (c) The percentage of standard prior authorization requests that were
4 denied, aggregated for all items and services.
5 (d) The percentage of standard prior authorization requests that were
6 approved after appeal, aggregated for all items and services.
7 (e) The percentage of prior authorization requests when the timeframe
8 for review was extended, and the prior authorization request was approved,
9 aggregated for all items and services.
10 (f) The percentage of expedited prior authorization requests that were
11 approved, aggregated for all items and services.
12 (g) The percentage of expedited prior authorization requests that were
13 denied, aggregated for all items and services.
14 (h) The average and median time that elapsed between the submission
15 of a request and a determination by the health insurance issuer, for standard
16 prior authorizations, aggregated for all items and services.
17 (i) The average and median time that elapsed between the submission of
18 a request and a decision by the health insurance issuer for expedited prior
19 authorizations, aggregated for all items and services.
20 (2) The commissioner shall submit an annual written report to the Senate
21 Committee on Insurance and the House Committee on Insurance that includes
22 the information submitted to the department in accordance with Subsection B
23 of this Section.
24 C.(1) A health insurance issuer shall annually publish on the health
25 insurance issuer's publicly available website a list of all items and services that
26 are subject to a prior authorization request according to each health coverage
27 plan. This list shall be published on the insurer's website prior to open
28 enrollment. If a health insurance issuer changes the list of items and services
29 that are subject to prior authorization, a health insurance issuer shall in a
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1 timely manner, update its website to reflect the changes.
2 (2) A health insurance issuer shall include a current web address on any
3 application or enrollment materials that are distributed by each health coverage
4 plan.
5 D. A health insurance issuer shall provide along with contract materials
6 to any healthcare provider or supplier who seeks to participate under a health
7 coverage plan, a list of all items and services that are subject to prior
8 authorization under the health coverage plan, and any policies or procedures
9 used by a health coverage plan for making determinations with regards to a
10 prior authorization request.
11 Section 2. This Act shall become effective upon signature of the governor or, if not
12 signed by the governor, upon expiration of the time for bills to become law without signature
13 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
14 vetoed by the governor and subsequently approved by the legislature, this Act shall become
15 effective the day following such approval.
The original instrument was prepared by Thomas L. Tyler. The following
digest, which does not constitute a part of the legislative instrument, was
prepared by Beth O'Quin.
DIGEST
SB 188 Reengrossed 2023 Regular Session Stine
Present law provides requirements for utilization review.
Proposed law retains present law but adds definitions for "health coverage plan", "healthcare
provider", "health insurance issuer", "healthcare services", and "prior authorization".
Excludes the office of group benefits from definition of "health insurance issuer".
Proposed law requires health insurance issuers to submit an annual report that provides a
quarterly breakdown that includes the following:
(1)List of all items and services that require prior authorization.
(2)Percentage of standard prior authorizations that were approved, aggregated for all
items and services.
(3)Percentage of standard prior authorizations that were denied, aggregated for all items
and services.
(4)Percentage of standard prior authorization that were approved after appeal,
aggregated for all items and services.
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(5)Percentage of prior authorization requests when the timeframe for review was
extended, and the prior authorization requests were approved, aggregated for all
items and services.
(6)Percentage of expedited prior authorization requests that were approved, aggregated
for all items and services.
(7)Percentage of prior authorization requests that were denied, aggregated for all items
and services.
(8)An average and median time that elapsed for all standard prior authorization requests
and the time between submitting a standard authorization request, and the time a
determination was made by a health insurance issuer, aggregated for all items and
services.
(9)The average and median time for an expedited review regarding a prior authorization
request and the time between submitting the expedited request and the time a
decision was made by a health insurance issuer, aggregated for all items and
services.
Proposed law requires the commissioner to submit an annual report that provides
information regarding prior authorization practices on or before March 15th to the Senate
and House Committees on Insurance.
Proposed law requires a health insurance issuer to annually publish a list of all items and
services that are subject to prior authorization and include this information prior to open
enrollment on its publicly available website, and to timely update any changes made to prior
authorization requests.
Proposed law requires a health insurance issuer to include a web address on any application
or enrollment materials that are distributed by a health coverage plan.
Proposed law requires a health insurance issuer to provide contract materials including items
and services subject to prior authorization and any policy or procedures used to determine
prior authorization to any provider or supplier who seeks to participate under a health
coverage plan.
Effective upon signature of the governor or lapse or last of time for gubernatorial action.
(Adds R.S. 22:1020.62)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill
1. Removes office of group benefits from the definition of health issuer insurer.
2. Makes technical changes.
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Adds dental insurance plans to the definition of health coverage plan.
2. Makes a technical change.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.