On May 23, 2018, Gov. Edwards signed HB 460 into law, creating Act No. 494. This law requires plans to provide coverage for minimum mammography examination. Specifically, plans must allow mammographic examinations, including digital breast tomosynthesis. These examinations must be allowed as follows:

• Female participants who are age 35 to 39 must be allowed one baseline mammogram
• Female participants who are age 40 to 49 must be allowed one mammogram every 24 months, or more frequently if recommended by the participant’s physician
• Female participants who are age 50 and older must be allowed one annual mammogram

Plans cannot apply deductibles to mammography, and participants don’t need a referral from a physician to receive their mammogram.

Although the insurance carriers will implement this law, employers should be aware of the change. The law is effective Jan. 1, 2019.

Act No. 494 »

On May 20, 2018, Gov. Edwards signed SB 285 into law, creating Act No. 372. This law prohibits insurance carriers from denying coverage of a physician-prescribed nonopioid medication in favor of an opioid prescription drug. Further, when an opioid prescription is prescribed as medically necessary, the insurer cannot deny coverage of the opioid and attempt to substitute an alternative that requires an increased number of pills per prescription, is a higher Drug Enforcement Administration schedule medication than the one prescribed, or substitutes an extended-release medication that doesn’t have defined abuse deterrent properties for a prescription of a medication that does.

Although the insurance carriers will implement this law, employers should be aware of the change. The law is effective Jan. 1, 2019.

Act No. 372 »

On May 23, 2018, Gov. Edwards signed HB 690 into law, creating Act No. 461. This law requires plans to provide coverage for annual cancer screening for participants who were previously diagnosed with breast cancer, completed treatment for breast cancer, underwent a bilateral mastectomy and were later determined to be cancer-free.

The law also requires plans to issue a written notice regarding this available screening. The notice must be provided at enrollment and annually.

Although the insurance carriers will implement this law, employers should be aware of the change. The law is effective Jan. 1, 2019.

Act No. 461 »

On Jan. 26, 2018, the Louisiana Department of Insurance issued Bulletin 2018-03. This Bulletin rescinded Bulletin 2011-03, which defined the term “small employer” for purposes of determining the medical loss ratio (MLR) under ACA. Under the previous definition, small employers were those who employed an average of at least one but not more than 100 employees during the preceding calendar year, and at least one employee on the first day of the plan year. This amended Louisiana law to line it up with ACA.

This bulletin changes the definition for MLR purposes to recognize small employers as those who employed an average of at least one but not more than 50 employees during the preceding calendar year, and at least one employee on the first day of the plan year. This change comes as a result of the Protecting Affordable Coverage for Employees (PACE) Act, which amended the definition of “small employer” under the ACA.

Although this bulletin doesn’t directly impact Louisiana-based employers, such employers should remain abreast of these changes under Louisiana law (as they’ll determine how insurers administer fully insured plans).

Bulletin 2018-03 »

On Jan. 20, 2018, the Louisiana Department of Insurance finalized Regulation 32, which outlines Louisiana’s coordination of benefits rules. Specifically, this regulation establishes a uniform order of benefit determination for plans to pay claims. The amended regulation also clarifies the implementation of calculating benefits reserves.

The regulation applies to all fully insured health plans that are issued in Louisiana, and it’s effective as of Jan. 20, 2018. Employers should familiarize themselves with this regulation to gain a better understanding of how claims will be administered when participants have dual coverage.

Regulation 32 »

On Oct. 12, 2015, Louisiana Commissioner of Insurance Donelon, issued Bulletin 2015-07, granting transitional relief for small-group rating purposes. As background, the Louisiana legislature previously amended La. R.S. 22:1091(B)(13), changing the definition of ‘small employer’ to make it consistent with the PPACA-mandated change that was to take place under the PPACA on Jan. 1, 2016.

However, the PACE Act recently repealed the upcoming change to the definition of small employer, and allows states to choose how to define ‘small employer.’

In order to address this discrepancy, Commissioner Donelon is providing transitional relief from La. R.S. 22:1091(B)(13) which allows issuers to continue to define small employer as those with 1-50 employees during the preceding calendar year. This transitional relief will be effective for any policy that is issued or renewed on or before Dec. 31, 2016.

Bulletin 2015-07 »

On March 26, 2015, a federal judge granted an injunction in response to suits filed by attorneys general in the states of Arkansas, Louisiana, Texas and Nebraska. The injunction suspends enforcement of the DOL’s final rule related to same-sex spouses in those states. The final rule, which went into effect for 46 other states on March 27, 2015, expanded the definition of spouse under the FMLA to include same-sex spouses who were legally married in a place that recognizes such marriages, regardless of their place of residence (please see the March 10, 2015 edition of Compliance Corner for more information). The attorneys general argue that the DOL’s final rule puts states in the position of either violating state law or federal regulation.

Subsequently, on March 31, 2015, the DOL confirmed in a request for hearing court filing that they will not enforce the rule in the four states covered by the decision, stating:

“[W]hile the preliminary injunction remains in effect, the [DOL does] not intend to take any action to enforce the provisions of the Family and Medical Leave Act (FMLA) . . . against the states of Texas, Arkansas, Louisiana, or Nebraska, or officers, agencies, or employees of those states acting in their official capacity, in a manner that employs the definition of the term “spouse” contained in the February 25, 2015, final rule . . . .”

The court’s injunction temporarily suspends enforcement until a final ruling is made. Oral arguments occurred April 13. In the meantime, employers with operations in these four states should be aware that FMLA requests (or, if not requested, the employer’s knowledge that an FMLA request might be a factor) for the care of a same-sex spouse due to a serious health condition or other FMLA-qualifying reason, will require the assistance of outside legal counsel specializing in employment law until this issue is resolved. Finally, four pending cases before the U.S. Supreme Court, with a decision expected in June, may also indirectly resolve this issue (See the Feb. 10, 2015 Compliance Corner, specifically articles for Kentucky, Tennessee, Michigan and Ohio).

State of Texas vs. U.S. No. 7:15-cv-00056-O »
DOL Request for Hearing »
Supreme Court Pending Cases »

On Feb. 20, 2015, the Louisiana Department of Insurance published Bulletin 2015-02, which informs health insurance issuers and HMO issuers that the use of family composite premiums for the 2016 plan year has been approved in the small group market. The bulletin also provides the method of calculation to be used in determining family composite premiums.

Bulletin 2015-02  »

On Dec. 24, 2014, the Louisiana Department of Insurance (LDI) released Bulletin 2014-08. The bulletin informs all health insurance issuers, health maintenance organizations, utilization review organizations and independent review organizations (IROs) of the electronic process established by LDI for external reviews. The bulletin describes the new IRO Review Request Module, which will be used to submit external review requests and to assign external reviews to IROs. Anytime a plan enrollee requests an external review of their claims decision, that information will go into the module. The bulletin further discusses details of the module, and an instruction manual for the module is attached to the bulletin. The electronic process became effective Jan. 1, 2015.

Bulletin 2014-08  »