The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Beth O'Quin.
DIGEST
SB 58 Original 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. 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.
Present law prohibits an issuer from denying coverage of a positron emission tomography (PET) or
recommended imaging for the purpose of diagnosis, treatment, appropriate management, restaging,
or ongoing monitoring of an insured's disease or condition if the imaging is being requested for the
diagnosis, treatment, or ongoing monitoring of cancer and is recommended by nationally recognized
clinical practice guidelines. Present law further provides this law does not apply to nonmelanoma
skin cancer.
Proposed law retains present law but prohibits an issuer from denying coverage of a PET or
recommended imaging for the purpose of diagnosis, treatment, appropriate management, restaging,
or ongoing monitoring of an insured's disease or condition if the imaging is being requested for the
diagnosis, treatment, or ongoing monitoring of cancer and is recommended by nationally recognized
consensus statements that are requested for the diagnosis, treatment, or ongoing monitoring of
cancer.
Present law prohibits a health coverage plan from requiring an insured to undergo any imaging test
for the purpose of diagnosis, treatment, appropriate management, restaging, or ongoing monitoring
of an insured's disease or condition if the imaging is being requested for the diagnosis, treatment, or ongoing monitoring of cancer and is not recommended by nationally recognized clinical practice
guidelines, as a precedent to receiving a PET or other recommended imaging provided by the
guidelines of present law.
Proposed law retains present law but prohibits a health coverage plan from requiring an insured to
undergo any imaging test for the purpose of diagnosis, treatment, appropriate management, restaging,
or ongoing monitoring of an insured's disease or condition if the imaging is being requested for the
diagnosis, treatment, or ongoing monitoring of cancer but is not recommended by nationally
recognized consensus statements, as a precedent to receiving a PET, or other recommended imaging
provided by the guidelines of present law.
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 and requires any policy, contract, or health coverage plan in effect prior to Jan. 1, 2025,
shall convert to conform to the provisions of this Act on or before the renewal date, but no later than
Jan. 1, 2026.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1060.14 and 1060.15(A) and (B); adds R.S. 22:1060.12(7) and 1060.17)