§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.