2023 Regular Session ENROLLED
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.
1 AN ACT
2 To enact R.S. 22:1020.62 and 1260.41(10), relative to health insurance; to provide for
3 utilization review; to provide definitions; to provide for documentation and reports;
4 to require items and services subject to prior authorizations to be posted on a health
5 insurance issuer's website; to require applications and enrollment materials to include
6 a health insurance issuer's web address for any of its health coverage plans; to
7 provide for an effective date; and to provide for related 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 §1020.62. Utilization review reports; definitions
11 A. For purposes of this Section, the following terms have the following
12 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,
18 including a group insurance plan or self-insurance plan. "Health coverage
19 plan" does not include a plan providing coverage for excepted benefits defined
20 in R.S. 22:1061, excepted benefit health insurance plans, short-term policies that
21 have a term of less than twelve months, or the office of group benefits.
22 Notwithstanding excepted benefits as defined in R.S. 22:1061, a "health
23 coverage plan" subject to the provisions of Part III of this Chapter includes
24 dental insurance plans.
25 (2) "Health insurance issuer" means an entity subject to the insurance
26 laws and regulations of this state, or subject to the jurisdiction of the
ACT No. 333
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1 commissioner, that contracts or offers to contract, or enters into an agreement
2 to provide, deliver, arrange for, pay for, or reimburse any of the costs of
3 healthcare services, including a sickness and accident insurance company, a
4 health maintenance organization, a preferred provider organization or any
5 similar entity, or any other entity providing a plan of health insurance or health
6 benefits. Health insurance issuer does not include the office of group benefits.
7 (3) "Healthcare provider" or "provider" means a healthcare
8 professional or a healthcare facility or the agent or assignee of the healthcare
9 professional or healthcare facility.
10 (4) "Healthcare services" means services, items, supplies, or drugs for
11 the diagnosis, prevention, treatment, cure, or relief of a health condition, illness,
12 injury, or disease.
13 (5) "Prior authorization" means a determination by a health insurance
14 issuer or person contracting with a health insurance issuer that healthcare
15 services ordered by the provider for an individual are medically necessary and
16 appropriate.
17 B.(1) A health insurance issuer, on an annual basis and at a time and in
18 a manner determined by the commissioner, shall submit a report to the
19 department containing a quarterly breakdown of the following information:
20 (a) A list of all items and services that require prior authorization.
21 (b) The percentage of standard prior authorization requests that were
22 approved, aggregated for all items and services.
23 (c) The percentage of standard prior authorization requests that were
24 denied, aggregated for all items and services.
25 (d) The percentage of standard prior authorization requests that were
26 approved after appeal, aggregated for all items and services.
27 (e) The percentage of prior authorization requests when the timeframe
28 for review was extended, and the prior authorization request was approved,
29 aggregated for all items and services.
30 (f) The percentage of expedited prior authorization requests that were
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1 approved, aggregated for all items and services.
2 (g) The percentage of expedited prior authorization requests that were
3 denied, aggregated for all items and services.
4 (h) The average and median time that elapsed between the submission
5 of a request and a determination by the health insurance issuer for standard
6 prior authorizations, aggregated for all items and services.
7 (i) The average and median time that elapsed between the submission of
8 a request and a decision by the health insurance issuer for expedited prior
9 authorizations, aggregated for all items and services.
10 (2) The commissioner shall submit an annual written report to the Senate
11 Committee on Insurance and the House Committee on Insurance that includes
12 the information submitted to the department in accordance with Subsection B
13 of this Section.
14 C.(1) A health insurance issuer shall annually publish on the health
15 insurance issuer's publicly available website a list of all items and services that
16 are subject to a prior authorization request according to each health coverage
17 plan. This list shall be published on the insurer's website prior to open
18 enrollment. If a health insurance issuer changes the list of items and services
19 that are subject to prior authorization, a health insurance issuer shall, in a
20 timely manner, update its website to reflect the changes.
21 (2) A health insurance issuer shall include a current web address on any
22 application or enrollment materials that are distributed by each health coverage
23 plan.
24 D. A health insurance issuer shall provide, along with contract materials
25 to any healthcare provider or supplier who seeks to participate under a health
26 coverage plan a list of all items and services that are subject to prior
27 authorization under the health coverage plan and any policies or procedures
28 used by a health coverage plan for making determinations with regards to a
29 prior authorization request. A health insurance issuer may refer such providers
30 or suppliers to a listing or link on its website to comply with this Subsection.
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1 Section 2. R.S. 22:1260.41(10) is hereby enacted to read as follows:
2 §1260.41. Definitions
3 For purposes of this Subpart, the following terms have the following
4 meanings unless the context clearly indicates otherwise:
5 * * *
6 (10)(a) "Health insurance issuer" means the same as the term is defined
7 in R.S. 22:1019.1, except as provided in Subparagraph (c) of this Paragraph.
8 (b) The provisions of this Subpart shall not apply to an entity that
9 provides limited scope dental or vision benefits.
10 * * *
11 Section 3. Section 2 of this Act shall become effective if and when the Act that
12 originated as House Bill No. 468 of the 2023 Regular Session of the Legislature becomes
13 effective. To the extent there is any conflict between the provisions of the Act that
14 originated as House Bill No. 468 of the 2023 Regular Session of the Legislature and
15 Section 2 of this Act, the provisions of this Act shall supercede and control.
16 Section 4. Section 1, 3, and this Section of this Act shall become effective January 1,
17 2024.
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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