2023 REGULAR SESSION – BY THE ISSUES LSMS Requested Legislation ACT 312 (HB 468) creates an infrastructure and minimum standards for health insurance issuers requiring a utilization review process for healthcare services and pharmaceuticals.
ACT 312
• Requires health insurance issuers to:
• Maintain documented PA programs utilizing evidenced based clinical review criteria.
This legislation was offered by Rep. Thomas Pressly at the request of LSMS. Our thanks to Rep. Pressly for going above and beyond in his support of physicians and this legislation! Joining him on our list of thank you’s for this Act are Senators Gary Smith and Katrina Jackson who pushed hard to keep important components of the legislation intact as it moved through the Senate.
• Acknowledge receipt of and maintain information submitted by providers throughout the appeals process.
LOUISIANA LEGISLATURE REGULAR SESSION 2023
• Provide specific clinical review criteria within 72 hours.
• Allow providers to submit requests for utilization review outside normal business hours.
• Establishes timeframes shown in chart below:
EXPEDITED
STANDARD
CONCURRENT REVIEW RETROSPECTIVE REVIEW
Before beginning a brief summary of the session, please know that LSMS did have a good session – an excellent session, in fact. Both pieces of prior authorization legislation requested by the Society were passed and have now been signed by the Governor. Congratulations and thank you to all of you who invested your time and resources to help the Society succeed! Now for that summary…
Urgent but not emergent * Medications
Knee Surgery Colonoscopy * Medications
Inpatient hospital
Service already performed
a few, there was legislation on abortion, gender affirming care, foreign property ownership and spending cap increases. These issues further impacted the session by spilling over into other debates by virtue of authors being forced to support (or oppose) or refusing to support (or oppose) varying bills. The result of this was to have legislators on edge throughout the session. In the end and over the objection of legislators from both parties, the budget bills (three in total) received a combined less than 30 minutes of debate before being finally passed and sent to the Governor. Retrospectively, how and why this was allowed to happen, as well as the impacts associated with the unknown aspects of each bill is being discussed in various legislative committees. The questions everyone is left trying to answer are:
From beginning to end, this legislative session was fast paced to the point of being manic. As a fiscal session, it is constitutionally both shorter and limited in number of general bills available to legislative authors. Specifically, a fiscal session is earmarked for: • Measures to enact a general appropriation bill; enact the comprehensive capital budget; make an appropriation; levy or authorize a new tax; increase an existing tax; levy, authorize, increase, decrease, or repeal a fee; dedicate revenue; legislate with regard to tax exemptions, exclusions, deductions, reductions, repeals, or credits; or legislate with regard to issuance of bonds.
2 business days
5 business days
24 hours
30 days
• Prohibits additional utilization review requirements during the perioperative period when a PA was not required or had already been approved.
• Prohibits claim denial based solely on failure to obtain PA when PA request is not determined timely.
• Limits the reasons for the claim denial when the PA for the service was approved (guarantee of payment).
• Establishes a process for adverse determinations.
• Establishes a “truer” peer-to-peer review.
• Requires a PA to be valid for a minimum of 3 months.
• Local bills (those that are constitutionally required to be, and have been, advertised).
Can the budget bills be fixed?
• Any other subject matter not covered above. However, any bill in this category MUST be PREFILED, and no member may prefile more than 5 such bills. Predictably, fiscal sessions see a lower number of instruments introduced for consideration. This year was no exception. Not including resolutions in the total, there were 661 House Bills and 223 Senate Bills introduced.
• If so, will it require a special session?
• Or could the Governor utilize line-item vetoes to make the needed changes?
• And how will what happened impact the elections this fall?
These are wait and see questions. What isn’t wait and see is outlined below in our “By The Issues” report.
What was not predictable were the highly emotional, controversial issues that were included and subsequently debated. To name
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J LA MED SOC | VOL 175 | SUMMER 2023
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