Louisiana

SUMMARY

Louisiana has passed legislation regulating healthcare price transparency and legislation that allows health insurance providers to negotiate charges and fees associated with individual health policies. The state passed HB498 in June 2015, establishing an APCD.

 

LEGISLATION/REGULATION

Legislative Calendar

Louisiana’s regular legislative session has ended. Louisiana’s special legislative session began on 6/9/17.

 

Recent Legislative Developments

Healthcare Transparency

2017 SB 59 PHARMACEUTICAL PRICING & PAYMENT: The Louisiana Board of Pharmacy shall develop a website to contain prescription drug price information to be made available to Louisiana prescribers on the board’s website with a dedicated link that is prominently displayed on the board’s home page, or by a separate easily identifiable internet address. Passed – Signed by Governor on 6/14/17 and became Act No. 236.
2015 HB 498

 

PUBLIC INFORMATION CONCERNING PRICES AND QUALITY OF HEALTH SERVICES: requires the Department of Health and Hospitals to identify healthcare cost, quality, and performance data elements that would be meaningful in facilitating consumer comparisons of healthcare services and create the online process by which providers and health plans can provide the data. Reported information will include: (i) data identifying at least 15 of the most commonly used procedure codes and (ii) any emerging health trends for diagnosis and treatment related to hospitalization. It will also include a list of hospitals and other licensed health facilities that are in compliance with reporting requirements, as well as the hospitals not in compliance. The Department is required to update these databases on an annual basis. Passed—Signed by the Governor on 6/29/15. Became Act No. 338.

 

Healthcare Cost

2017 HB 407 PRODUCER FEES FOR INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES: Allows health insurance producers to negotiate charges, fees, and any other form of compensation directly with the insured for an individual health and accident policy. Passed – Signed by Governor on 6/3/17.

 

Healthcare Markets

  • None identified.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • Rev. Stat. Ann. § 40:1300.362 directs the Department of Health and Hospitals to submit an annual report respecting the Louisiana Medicaid Bayou Health program to the Senate and House committees on health and welfare in order to monitor the transition from fee-for-service based programs into managed care organized based programs. The report must contain, among other things, the number of members who chose the coordinated care network and the number who are auto-enrolled, including the amount the total payments and average per member per month payment paid to each coordinated care network. The report also must contain a number of performance metrics, utilization data, and financial statements.

 

  • Rev. Stat. Ann. § 40:1300.111 articulates the legislature’s findings that as a result of rising health care costs and a shortage of providers in the state, “there is a need to have access to provider specific health care cost, quality, and outcome data on health care facilities, health care providers, and health plans as well as continued access to global patterns and trends in the availability, use, and charges for health care services and the associated health circumstances.”

 

  • Rev. Stat. Ann. § 40:1300.113, as part of the “Louisiana Consumer’s Right to Know Act,” directs the Department of Health and Hospitals to identify the health care cost, quality, and performance data elements to be reported to the department for facilitating “meaningful comparison” by consumers of costs for specific health care services among facilities, providers, and plans. Pending the availability of funds, the Department shall provide for online publication of provider and health plan specific cost, quality, and performance data for consumer use. The website has been implemented as healthfinderla.gov.

 

Healthcare Contracting

  • Rev. Stat. Ann. § 22:263 regulates contracts between a health maintenance organization (HMO) and a provider of healthcare services, stating that an HMO is prohibited from inducing a provider to reduce, limit, delay or deny medically necessary and appropriate services through any form of incentive.

 

Healthcare Markets

  • Rev. Stat. Ann. § 40:2116 prohibits specific provider-types (abortion facilities, adult day health care, adult residential care providers, nursing homes, home and community based service providers, hospices and pediatric day health care) from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Hospitals through the state’s Facility Need Review process. A facility need review – similar to a Certificate of Need in other states – aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.

 

 

  • Rev. Stat. Ann. § 22:971 directs the Department of Insurance to provide for a patient bill of rights that guarantees patients to greater access to information and care, to expand choice, and to hold HMOs responsible for decisions that harm patients. In creating the bill of rights, the department shall establish and maintain an information collection program to track and evaluate state and federal efforts to provide for a uniform patient bill of rights, and shall submit an annual report to the legislature on recommendations to enact a uniform bill.

 

FY 2018 BUDGET

Louisiana’s fiscal year begins on July 1 and ends on June 30 the following year. Louisiana enacted its FY 2018 Budget during the special legislative session. To view Louisiana’s FY 2018 Budget, click here.

 

LITIGATION/ENFORCEMENT

  • None identified.

 

KEY RESOURCES

Louisiana State Legislature

Louisiana Office of the Attorney General