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Legislation Signed into Law

2017

Primary Focus: Access to services/Eligibility
Title/Description: Substance-related and addictive disorders; treatment in state psychiatric hospitals
Citation: La. R.S. § 28:21.1
Summary: The Louisiana Department of Health is authorized to accept indigent patients suffering from co-occurring substance-related or addictive disorders and to give such patients the care and treatment required.
The purpose of this is to recognize substance-related and addictive disorders as a sickness or disease and to place those suffering from it in the same position relative to obtaining treatment as persons suffering from other diseases.
Effective Date: August 1, 2017
Notes: Enacted through HB 341 (2017 Regular Session)

2015

Primary Focus: Mandated Benefit: Provider
Title/Description: Admission by emergency certificate; extension; payment for services rendered
Citation: La. R.S. § 28:53
Summary: Section (P) states that notwithstanding any provision of law to the contrary, no claim for payment for inpatient behavioral health services provided to a person while admitted and detained in a facility that provides mental health services under an emergency certificate, issued in accordance with the provisions of this Section, shall be denied by Medicaid, an entity contracted with the state for the provision of Medicaid services, or any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs, on the basis of medical necessity if certain conditions are met.
Effective Date: August 1, 2015
Notes: Enacted by HB 307 (2015 Regular Session)

2013

Primary Focus: Access to services/Eligibility
Title/Description: Network adequacy
Citation: La. R.S. § 22:1019.2
Summary: Each health insurance issuer shall maintain a network of providers that includes but is not limited to providers that specialize in mental health and substance abuse services, facility-based physicians, and providers that are essential community providers.
Effective Date: June 10, 2013
Notes: Enacted through HB 592 (2013 General Session)

2012

HB 771
Introduced: 3/2012
Sponsor: Rep. Foil
Status: Signed into law 5/2012
Summary: This bill changed the section of the state insurance law about autism coverage to what it is currently. It increased the age limit for coverage to 20 instead of 16. It also eliminated the $140,000 lifetime maximum that had been in place (a summary of this section can be found at the bottom of this page under “Louisiana Parity Law,” “Autism”).

2011

Primary Focus: Mandated Benefit: SUD
Title/Description: Group, blanket, and association health insurance, treatment for alcoholism and drug abuse
Citation: La. R.S. § 22:1025
Summary: Any group, blanket, or association health insurance policy issued under certain law is to include as an option to be exercised by the policyholder covered benefits for the treatment of alcoholism and for the treatment of drug abuse, rendered or prescribed by a physician licensed in this state, received in any licensed hospital or in any other public or private facility, or portion thereof duly authorized by the appropriate state authority to provide alcoholism or drug abuse treatment and rehabilitation services, including freestanding, nonhospital chemical dependency units.
Effective Date: January 1, 2011
Notes: Enacted through HB 464 (2010 Regular Session)

Primary Focus: Mandated Benefit: Provider
Title/Description: Severe mental illness and other mental disorders; policy provisions; minimum requirements; group, blanket, and association policies
Citation: La. R.S. § 22:1043
Summary: Any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs, delivered or issued for delivery in this state on or after January 1, 2000, shall include benefits payable for the treatment of severe mental illness under the same circumstances and conditions or greater as benefits are paid under those policies, contracts, benefit plans, agreements, or programs for all other diagnoses, illnesses, or accidents.
La. R.S. § 22:1043 defines “severe mental illness” and sets out various other provisions.
Effective Date: January 1, 2011
Notes: Enacted through HB 464 (2010 Regular Session)

Primary Focus: Parity: General
Title/Description: Parity in the application of certain limits to mental health benefits
Citation: La. R.S. § 22:1066
Summary: The statute provides for parity in the application of certain limits in the case of group health plans, or health insurance coverage offered in connection with such plans, that provide both medical and surgical benefits and mental health benefits.
La. R.S. § 22:1066 provides for clarifications and exceptions as well as definitions used under the section.
Effective Date: January 1, 2011.
Notes: Enacted through HB 464 (2010 Regular Session)

2009

SB 294
Introduced: 4/2009
Sponsor: Sen. Nevers
Status: Signed into law 7/2009
Summary: Among many other things, this bill changed one of the sections of the insurance law about parity so that plans (except for individual plans) have to cover services provided by a “medical psychologist.”
HB 406
Introduced: 4/2009
Sponsor: Rep. Pearson
Status: Signed into law 7/2009
Summary: Among many other things, this bill changed the section of the law about autism coverage so that individual plans are specifically exempted from complying with that section of the state law.

Louisiana Parity Law

There are several sections of the state insurance law relevant to parity. They will be summarized below in this order (with appropriate hyperlinks to state law):

Mental Health Coverage

This section requires large employer fully-insured plans, small employer fully-insured plans, other group plans, and self-insured plans (except those exempted by ERISA ) to cover the following mental health conditions:

  • Schizophrenia or schizoaffective disorder
  • Bipolar disorder
  • Panic disorder
  • Obsessive-compulsive disorder
  • Major depressive disorder
  • Anorexia/bulimia
  • Intermittent explosive disorder
  • Posttraumatic stress disorder
  • Psychosis not otherwise specified in children under seventeen years of age.
  • Rett’s Disorder
  • Tourette’s Disorder

This coverage must be “under the same circumstances and conditions or greater” as coverage for other medical conditions. Plans must cover at least:

Enrollees can exchange each day of inpatient care for 4 outpatient visits or 2 days of residential treatment or partial hospitalization.

This section requires only large employer fully-insured plans to do the following regarding annual maximums and lifetime maximums:

Plans cannot use annual maximums and lifetime maximums for mental health services if they aren’t in place for other medical services. If a plan does have these in place for other medical services, they can do either of the following:

  • Make it so that both behavioral health services and other medical services count towards combined maximums OR
  • Make the maximums for mental health services no less than the ones in place for other medical services

For plans that have many different maximums for different categories of medical care, the law requires plans to use a mathematical formula involving the weighted averages these annual and lifetime maximums to decide what the limits and maximums should be for mental health services.

Plans are exempt from this section if complying with it causes premium costs to increase by 1% in any year.

Substance Use Disorders

This section requires large employer fully-insured plans and small employer fully-insured plans to offer optional coverage for substance use disorders that includes inpatient care, outpatient care, and residential treatment. However, this section does not specify anything further about how extensive this coverage should be.

Autism

This section requires large employer fully-insured plans and small employer fully-insured plans to cover autism services for individuals through age 20.

Plans must cover an annual maximum of $36,000.

Copayments, coinsurance, and deductibles must be “no less favorable” than those in place for other medical services.

There cannot be any visit limits for outpatient care.

There is no restriction on how often plans can review a child’s treatment plan.

Treatment for autism is defined as pharmacy care, psychiatric care, psychological care, therapeutic care, applied behavior analysis, habilitative care, and rehabilitative care.

Get Support

Louisiana Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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