HASBSB188 MCCLOUDT 2915
SENATE SUMMARY OF HOUSE AMENDMENTS
SB 188 2023 Regular Session Stine
KEYWORD AND SUMMARY AS RETURNED TO THE SENATE
HEALTH/ACC INSURANCE: Provides for utilization review and approval procedures of
claims for healthcare provider services. (1/1/24)
SUMMARY OF HOUSE AMENDMENTS TO THE SENATE BILL
1. Authorizes a health insurance issuer to refer providers and suppliers to a listing or
link on its website to comply with proposed law.
2. Changes the effective date from the signature of the governor to Jan. 1, 2024.
3. Makes technical changes.
DIGEST OF THE SENATE BILL AS RETURNED TO THE SENATE
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. HASBSB188 MCCLOUDT 2915
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.
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)
______________________
Beth O'Quin
Attorney