Managed Care: LA Department of Insurance Emergency Rule 37
Laws and regulations are changing rapidly. After the publication of this article they are subject to change. Check back regularly for updates.
The Louisiana Department of Insurance (LDI) issued Emergency Rule 37, a package of regulations to address COVID-19 issues. The regulation applies to all HMOs, MCOs, PPOs, TPAs, PBMs and all other entities licensed by the LDI. It provides for the following:
For geographic accessibility requirements, the LDI waives plan’s obligations to comply with those requirements except for:
- Emergency services
- Services related to the testing or treatment of COVID-19, and
- Services that have not been ordered postponed by Healthcare Facility Notice #2020-COVID19-ALL-006 on March 18, 2020, and
- Services ancillary to any of the above.
For telemedicine services, plans must:
- Waive limits on the use of audio-only telephone consults in the provision of telemedicine, to the extent allowed by OCR and DHHS guidance;
- Waive coverage limits that would restrict access to providers included in the plan’s telemedicine network;
- Cover mental health services provided via telemedicine, to the extent those services would be covered if they were in person; and
- Waive coverage limits that require provider-to-provider consults and cover telemedicine consults between a patient and a provider, to the extent those services would be covered if they were in person.
For member cost sharing, the plans are directed to evaluate in-network and out-of-network requirements and take appropriate steps to ensure that patients in surge areas are not subject to unreasonable cost sharing requirements due to access limits.
A copy of the rule is available here:
