HLS 25RS-885 ORIGINAL
2025 Regular Session
HOUSE BILL NO. 467
BY REPRESENTATIVE HILFERTY
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Requires health insurance coverage for amino acid-based
elemental formulas
1 AN ACT
2To enact R.S. 22:1059.6 and R.S. 40:1081.13, relative to health insurance coverage; to
3 require coverage for amino acid-based elemental formulas for infants and children
4 when medically necessary; to provide application to Medicaid coverage; and to
5 provide for related matters.
6Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1059.6 is hereby enacted to read as follows:
8 §1059.6. Required coverage for amino acid-based elemental formulas
9 A. A health insurance issuer offering health coverage plans in this state that
10 provide benefits for maternity services shall provide coverage for amino acid-based
11 elemental formulas, regardless of the formula delivery method, if the treating
12 physician issues a written order stating that the amino acid-based elemental formula
13 is medically necessary to treat an infant or child for any of the following:
14 (1) Immunoglobulin E and non-immunoglobulin E mediated allergies to
15 multiple food proteins.
16 (2) Severe food protein-induced enterocolitis syndrome.
17 (3) Eosinophilic disorders, as evidenced by the results of a biopsy.
18 (4) Impaired absorption of nutrients caused by disorders affecting the
19 absorptive surface, functional length, and motility of the gastrointestinal tract.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 25RS-885 ORIGINAL
HB NO. 467
1 B. Coverage pursuant to this Section may be subject to annual deductibles,
2 coinsurance, and copayments consistent with those established under the health
3 coverage plan.
4 C.(1) A health coverage plan shall provide coverage pursuant to this Section
5 on a basis no less favorable than the basis on which prescription drugs and other
6 medications and related services are covered by the plan, and to the same extent that
7 the plan provides coverage for drugs that are available only on the orders of a
8 physician.
9 (2) A utilization review agent acting on behalf of a health benefit plan issuer
10 may review a treating physician's determination of the medical necessity of the use
11 of an amino acid-based elemental formula for the treatment of a covered infant or
12 child who is diagnosed with a disease or disorder listed in Subsection A of this
13 Section.
14 Section 2. R.S. 40:1081.13 is hereby enacted to read as follows:
15 §1081.13. Medicaid coverage; amino acid-based elemental formulas
16 A. The Louisiana Department of Health shall make available to persons who
17 are eligible for Medicaid benefits under Title XIX of the Social Security Act, 42
18 U.S.C. 1396 et seq., coverage for amino acid-based elemental formulas, regardless
19 of the formula delivery method, if the treating physician issues a written order stating
20 that the amino acid-based elemental formula is medically necessary to treat an infant
21 or child for any of the following:
22 (1) Immunoglobulin E and non-immunoglobulin E mediated allergies to
23 multiple food proteins.
24 (2) Severe food protein-induced enterocolitis syndrome.
25 (3) Eosinophilic disorders, as evidenced by the results of a biopsy.
26 (4) Impaired absorption of nutrients caused by disorders affecting the
27 absorptive surface, functional length, and motility of the gastrointestinal tract.
28 B. Coverage provided pursuant to this Section may be subject to
29 copayments, deductibles, or other cost-sharing mechanisms.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 25RS-885 ORIGINAL
HB NO. 467
1 C.(1) A health maintenance organization, health insurance organization, or
2 managed care organization that contracts with the state to provide or coordinate
3 healthcare services to any person otherwise eligible for Medicaid shall provide
4 coverage on a basis no less favorable than the basis on which prescription drugs and
5 other medications and related services are covered by the organization, and to the
6 same extent that the organization provides coverage for drugs that are available only
7 on the orders of a physician.
8 (2) A utilization review agent acting on behalf of an organization listed in
9 this Subsection may review a treating physician's determination of the medical
10 necessity of the use of an amino acid-based elemental formula for the treatment of
11 a covered infant or child who is diagnosed with a disease or disorder listed in
12 Subsection A of this Section.
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)]
HB 467 Original 2025 Regular Session Hilferty
Abstract: Requires health insurers, including Medicaid provider organizations, to cover
amino acid-based elemental formulas for infants and children with certain diagnoses.
Proposed law requires a health insurance issuer offering health coverage plans that provide
benefits for maternity services to provide coverage for amino acid-based elemental formulas,
regardless of formula delivery method, if a treating physician issues a written order stating
that the formula is medically necessary to treat an infant or child for certain mediated
allergies to food proteins or other certain disorders affecting the absorptive abilities of the
gastrointestinal tract. Extends coverage requirements to Medicaid programs.
Proposed law authorizes health coverage plans and Medicaid provider organizations to apply
annual deductibles, coinsurance, copayments, or other established cost-sharing mechanisms.
Proposed law requires coverage on a basis no less favorable than the basis on which
prescription drugs and other medications and related services are covered, and to the same
extent that coverage is provided for drugs that are available only on the orders of a
physician.
Proposed law authorizes a utilization review agent acting on behalf of a health benefit plan
issuer or Medicaid provider organization to review a treating physician's determination of
the medical necessity of the use of an amino acid-based elemental formula for the treatment
of a covered infant or child who is diagnosed pursuant to proposed law.
(Adds R.S. 22:1059.6 and R.S. 40:1081.13)
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.