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2024 Regular Session
SENATE BILL NO. 58
BY SENATOR TALBOT
INSURANCE POLICIES. Provides for patient's right to prompt coverage. (gov sig)
1 AN ACT
2 To amend and reenact R.S. 22:1060.14 and to enact R.S. 22:1060.12(7) and 1060.17,
3 relative to health insurance; to provide a definition for consensus statements; to
4 prohibit a health coverage plan from denying a prior authorization or payment of
5 claims for cancer under certain circumstances; to provide enforcement procedures;
6 to provide for technical changes; to provide for applicability; to provide an effective
7 date; and to provide for related matters.
8 Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 22:1060.14 is hereby amended and reenacted and R.S. 22:1060.12(7)
10 and 1060.17 are hereby enacted to read as follows:
11 §1060.12. Definitions
12 As used in this Subpart, the following definitions apply unless the context
13 indicates otherwise:
14 * * *
15 (7) "Consensus statements" means statements developed by an
16 independent, multidisciplinary panel of experts utilizing a transparent
17 methodology and reporting structure and with a conflict-of-interest policy that
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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. 58
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1 are published in impactful scientific journals. The statements are aimed at
2 specific, and often times rare, clinical circumstances and based on the best
3 available evidence for the purpose of optimizing the outcomes of clinical care.
4 * * *
5 §1060.14. Requirement to cover services consistent with nationally recognized
6 clinical practice guidelines or consensus statements
7 A. No health coverage plan that is renewed, delivered, or issued for delivery
8 in this state that provides coverage for cancer in accordance with the Louisiana
9 Insurance Code shall deny a request for prior authorization or the payment of a claim
10 for any procedure, pharmaceutical, or diagnostic test typically covered under the plan
11 to be provided or performed for the diagnosis and treatment of cancer if the
12 procedure, pharmaceutical, or diagnostic test is recommended by nationally
13 recognized clinical practice guidelines or consensus statements for use in the
14 diagnosis or treatment for the insured's particular type of cancer and clinical state.
15 B. The provisions of this Section shall not prohibit a health insurance issuer
16 from requiring utilization review to assess the effectiveness of the procedure,
17 pharmaceutical, or test for the insured's condition, but if the procedure,
18 pharmaceutical, or test is what is recommended by nationally recognized clinical
19 practice guidelines or consensus statements for use in the diagnosis or treatment for
20 the insured's particular type of cancer and clinical state, then any associated prior
21 authorization shall be approved within the time limit specified in R.S. 22:1060.13.
22 * * *
23 §1060.17. Enforcement provisions
24 A. Whenever the commissioner has reason to believe that any health
25 insurance issuer is not in compliance with any of the provisions of this Subpart,
26 he shall notify the health insurance issuer. The commissioner may, in addition
27 to the penalties in Subsection C of this Section, issue and cause to be served
28 upon the health insurance issuer an order requiring the health insurance issuer
29 to cease and desist from any violation.
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words in boldface type and underscored are additions. SB NO. 58
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1 B. Any health insurance issuer who violates a cease and desist order
2 issued by the commissioner pursuant to this Subpart while the order is in effect
3 shall be subject to one or more of the following at the commissioner's discretion:
4 (1) A monetary penalty of not more than twenty-five thousand dollars for
5 each act or violation and every day the health insurance issuer is not in
6 compliance with the cease and desist order, not to exceed an aggregate of two
7 hundred fifty thousand dollars for any six-month period.
8 (2) Suspension or revocation of the health insurance issuer's certificate
9 of authority to operate in this state.
10 (3) Injunctive relief from the district court of the district in which the
11 violation may have occurred or in the Nineteenth Judicial District Court.
12 C. As a penalty for violating this Subpart, the commissioner may refuse
13 to renew, or may suspend or revoke the certificate of authority of any health
14 insurance issuer. In lieu of suspension or revocation of a certificate of authority,
15 the commissioner may levy a monetary penalty of not more than one thousand
16 dollars for each act or violation, not to exceed an aggregate of two hundred fifty
17 thousand dollars.
18 D. An aggrieved party affected by the commissioner's decision, act, or
19 order may demand a hearing in accordance with Chapter 12 of this Title, R.S.
20 22:2191 et seq., except as otherwise provided by this Subpart. If a health
21 insurance issuer has demanded a timely hearing, the penalty, fine, or order by
22 the commissioner shall not be imposed until the time as the division of
23 administrative law makes a finding that the penalty, fine, or order is warranted
24 in a hearing held in the manner provided in Chapter 12 of this Title.
25 Section 2. The provisions of this Act apply to any new policy, contract, program, or
26 health coverage plan issued on and after January 1, 2025.
27 Section 3. This Act shall become effective upon signature by the governor or, if not
28 signed by the governor, upon expiration of the time for bills to become law without signature
29 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
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1 vetoed by the governor and subsequently approved by the legislature, this Act shall become
2 effective on the day following such approval.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Beth O'Quin.
DIGEST
SB 58 Engrossed 2024 Regular Session Talbot
Present law defines "health coverage plan", "health insurance issuer", "nationally recognized
clinical practice guidelines", "positron emission tomography", "prior authorization", and
"utilization review".
Proposed law retains present law but adds a definition for "consensus statements" to mean
statements developed by an independent, multidisciplinary panel of experts that utilize a
transparent methodology and reporting structure and provides for a conflict-of-interest
policy that are published in impactful scientific journals. Proposed law provides these
statements are aimed at specific clinical circumstances and based on the best available
evidence for the purpose of optimizing the outcomes of clinical care.
Present law prohibits a health coverage plan from denying a prior authorization or payment
of claims for any procedure, pharmaceutical, or diagnostic test to be provided or performed
for the diagnosis and treatment of cancer, if the procedure, pharmaceutical, or test is
recommended by nationally recognized clinical practice guidelines for use in the diagnosis
or treatment of the insured's specific type of cancer and clinical state.
Proposed law retains present law but prohibits a health coverage plan from denying a prior
authorization or payment of claims for any procedure, pharmaceutical, or diagnostic test to
be provided or performed for the diagnosis and treatment of cancer, if the procedure,
pharmaceutical, or test is recommended by nationally recognized consensus statements for
use in the diagnosis or treatment of the insured's specific type of cancer and clinical state.
Proposed law provides that the commissioner of insurance (commissioner) may issue
penalties or cease and desist orders if he determines that any health insurance issuer is not
in compliance with proposed law.
Proposed law provides monetary penalties for violations of cease and desist orders.
Proposed law authorizes the commissioner to revoke, suspend, or nonrenew a certificate of
authority of any health insurance issuer for noncompliance. Proposed law permits any
aggrieved health insurance issuer the opportunity to seek judicial review of certain decisions
by the commissioner.
Proposed law applies to any new policy, contract, program, or health coverage plan issued
on or after Jan. 1, 2025.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1060.14; adds R.S. 22:1060.12(7) and 1060.17)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill
1. Makes technical changes.
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2. Changes the consensus statement definition.
3. Removes positron emission tomography from proposed law.
4. Changes the applicability date to January 1, 2025.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.