RDCSB188 3264 2735
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 188 Reengrossed 2023 Regular Session Stine
Present law provides requirements for utilization review.
Proposed law retains present law and adds definitions for "health coverage plan", "healthcare
provider", "health insurance issuer", "healthcare services", and "prior authorization".
Excludes the office of group benefits from the 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 authorizations that were approved after appeal,
aggregated for all items and services.
(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 of insurance to submit an annual report that
provides information regarding prior authorization practices 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.
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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 authorizations to any provider or supplier who seeks to participate under a health
coverage plan. Authorizes a health insurance issuer to refer providers or suppliers to a
listing or link on its website to comply with proposed law.
Effective Jan. 1, 2024.
(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.
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
reengrossed bill:
1. Authorize a health insurance issuer to refer providers and suppliers to a listing
or link on its website to comply with proposed law.
2. Change the effective date from the signature of the governor to Jan. 1, 2024.
3. Make technical changes.
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