PART VIII. LOUISIANA MANDATED HEALTH BENEFITS COMMISSION
§2187. Louisiana Mandated Health Benefits Commission
A. The Louisiana Mandated Health Benefits Commission is hereby created and shall
exercise its powers, duties, functions, and responsibilities in the manner provided in R.S.
36:802. The commission shall be staffed by the office of health, life, and annuity within the
Department of Insurance.
B. The commission shall be comprised of the following members:
(1) The chairman of the House Committee on Insurance or his designee.
(2) The chairman of the Senate Committee on Insurance or his designee.
(3) The commissioner of administration or his designee.
(4) Two persons appointed by the commissioner of insurance.
C. Members of the commission shall serve on an ex officio basis except that the two
persons appointed by the commissioner of insurance shall serve terms concurrent with that
of the commissioner of insurance.
D. The commission shall conduct its duties under the direction of the commissioner
of insurance. The commission shall elect its own chair, who shall preside at meetings, and
its own vice chair, who shall preside in the absence of the chair. The commission shall
conduct its business according to Robert's Rules of Order. A quorum for conducting
business shall be a majority of the members. All members shall be voting members.
E. The commissioner of insurance shall have the authority, in addition to the
authority of the chairman of the commission, to order the commission to convene to conduct
its business.
F. Pursuant to 42 U.S.C. 18031(d)(3)(B), the annual cost of any mandated benefit
in excess of Essential Health Benefits, hereinafter referred to as "EHBs", for Qualified Health
Plans, hereinafter referred to as "QHPs", shall be a legal obligation of the state of Louisiana
and shall be defrayed by the state through direct reimbursement to any health insurance issuer
entitled to such reimbursement pursuant to 42 U.S.C. 18031(d)(3)(B).
G. The duties of the commission shall include:
(1) Reviewing proposed legislation in any session of the legislature to determine if
the legislation creates a mandated health benefit that would require the state to defray the
costs of the mandate for QHPs in excess of EHBs pursuant to 42 U.S.C. 18031(d)(3)(B).
The commission shall give full consideration to relevant implementing regulations in Title
45 of the Code of Federal Regulations.
(a) After reviewing such proposed legislation, the commission, if it determines that
a mandate for QHPs is in excess of EHBs, shall, in consultation with the Department of
Insurance, notify the House and Senate committees on insurance of the commission's
determination that a mandate has been proposed and shall provide an actuarial cost projection
for the cost of the proposed mandate for QHPs and non-QHPs.
(b) In the event that the legislature enacts a mandate that is in excess of EHBs, the
commission shall determine, pursuant to the review process specified in this Paragraph, what
the cost of the enacted mandate is to all QHPs and shall, by majority vote in an open meeting,
adopt an actuarially sound cost estimate for the first plan or policy year for the mandate in
excess of EHBs for all QHPs in this state.
(c) Following the adoption of the cost estimate by majority vote, the commission
shall tender the cost estimate to the division of administration, the speaker of the House of
Representatives, the president of the Senate, and the chairman of the House Committee on
Appropriations, the chairman of the House Committee on Insurance, the chairman of the
Senate Committee on Finance, and the chairman of the Senate Committee on Insurance.
(d) For any policy or plan years following the initial effective policy or plan year, the
commission shall include historical experience of the cost of the mandate in excess of EHBs
in its deliberative process.
(e) Following adoption of the cost estimate, the commission shall, in conjunction
with the Department of Insurance, give formal notice of such adoption in the State Register.
(2) Conducting the review process specified in this Subsection for any mandate that
was enacted after December 31, 2011, and if determined to be a mandate in excess of EHBs
for QHPs, the commission shall follow the process for adoption of the cost of the enacted
mandate in the manner prescribed in Subparagraphs (1)(b) through (e) of this Subsection.
(3) Promulgating rules and regulations pursuant to the Administrative Procedure Act.
(4) Any functions necessary and proper for the completion of the duties specified in
this Subsection.
H. Any health insurance issuer that issues QHPs shall have the right to appear and
be heard and to submit information to the commission for consideration in the performance
of the duties of the commission.
I. Any health insurance issuer that objects to the adoption of the cost estimate
pursuant to Subsection G of this Section shall have the right to file an appeal in the
Nineteenth Judicial District Court of the state of Louisiana within thirty days of the adoption
of the cost estimate in open meeting.
J. For purposes of this Section, "health insurance issuer" means an entity subject to
the insurance laws and regulations of this state, or subject to the jurisdiction of the
commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or
reimburse any of the costs of health care services, including through a health benefit plan,
and shall include a sickness and accident insurance company, a health maintenance
organization, a preferred provider organization or any similar entity, or any other entity
providing a plan of health insurance or health benefits.
Acts 2016, No. 45, §1.