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Code · Louisiana · Title 22 — Insurance

RS 22:1060.14

213 words·~1 min read·/la/title-22/22-2578

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RS 22:1060.14
§1060.14. Requirement to cover services consistent with nationally recognized clinical practice guidelines or consensus statements
A. No health coverage plan that is renewed, delivered, or issued for delivery in this state that provides coverage for cancer in accordance with this Title shall deny a request for prior authorization or the payment of a claim for any procedure, pharmaceutical, or diagnostic test typically covered under the plan to be provided or performed for the diagnosis and treatment of cancer if the procedure, pharmaceutical, or diagnostic test is recommended by nationally recognized clinical practice guidelines or consensus statements for use in the diagnosis or treatment for the insured's particular type of cancer and clinical state.
B. The provisions of this Section shall not prohibit a health insurance issuer from requiring utilization review to assess the effectiveness of the procedure, pharmaceutical, or test for the insured's condition, but if the procedure, pharmaceutical, or test is what is recommended by nationally recognized clinical practice guidelines or consensus statements for use in the diagnosis or treatment for the insured's particular type of cancer and clinical state, then any associated prior authorization shall be approved within the time limit specified in R.S. 22:1060.13.
Acts 2023, No. 254, §1; Acts 2024, No. 162, §1, eff. May 23, 2024.
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