reglab/housing_qa huggingface dataset:
LA Rev Stat § 22:1054.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1054.1. Requirement for coverage of cancer treatment targeting a specific genetic mutation

RS 1054.1 - Requirement for coverage of cancer treatment targeting a specific genetic mutation  A. No health coverage plan delivered or issued for delivery in this state shall deny coverage for the treatment of metastatic or unresectable tumors with a medically necessary drug prescribed by a physician on the sole basis that the drug is not indicated for the location in the body of the patient's cancer if the drug is approved by the United States Food and Drug Administration for the treatment of the specific mutation of the patient's cancer. Such coverage may be denied if an alternative treatment has proven to be more effective in published randomized clinical trials and is not contraindicated in the patient.  B.(1) Any health coverage plan delivered or issued for delivery in this state shall include coverage for a minimum initial treatment period of not less than three months for a medically necessary drug prescribed by a physician that is not indicated for the location in the body of the patient's cancer if the drug is approved by the United States Food and Drug Administration for the treatment of the specific mutation of the patient's cancer.  (2) The health coverage plan shall continue to provide coverage of the prescribed drug after the initial treatment period provided for in Paragraph (1) of this Subsection if the treating physician certifies that the prescribed drug is medically necessary for the treatment of the patient's cancer based on documented improvement of the patient.  C. For purposes of this Section, "health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.  Acts 2020, No. 222, §1, eff. Jan. 1, 2021.
LA Rev Stat § 22:1055 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1055. Requirement for coverage of diagnosis and treatment for temporomandibular joint and associated musculature and neurology

RS 1055 - Requirement for coverage of diagnosis and treatment for temporomandibular joint and associated musculature and neurology  A. Every hospital, health, or medical expense insurance policy in the large group market as defined in R.S. 22:1091(B), delivered or issued for delivery in this state shall include coverage for diagnostic, therapeutic, or surgical procedures related to the temporomandibular joint (TMJ) and associated musculature and neurological conditions. This Section shall not apply to coverage provided by the Office of Group Benefits.  B. The coverage for diagnostic, therapeutic, or surgical procedures related to temporomandibular joint and associated musculature and neurological conditions shall be subject to the same conditions, limitations, precertification, prior authorization, referral procedures, copayment, and coinsurance provisions that apply to coverage for diagnostic, therapeutic, or surgical procedures involving other bones or joints of the human skeleton.  C. The provisions of this Section shall apply to all new policies, plans, certificates, and contracts issued on or after January 1, 2018. Existing policies, plans, certificates, and contracts shall include the coverage required by this Section on renewal thereof, but in no case later than January 1, 2019.  Acts 2016, No. 405, §1, eff. June 8, 2016.
LA Rev Stat § 22:1056 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1056. Health insurance coverage for incarcerated individuals

RS 1056 - Health insurance coverage for incarcerated individuals  A. Beginning January 1, 2019, every hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, every policy of group, family group, blanket, or association health and accident insurance, and every self-insurance plan, health maintenance organization plan, and preferred provider organization plan, except for the Office of Group Benefits, delivered or issued for delivery in this state shall provide benefits for health care to the insured if he is detained in a correctional facility and has not been adjudicated or convicted of a criminal offense. Nothing herein shall alter any of the terms and conditions of the applicable coverage which shall remain applicable to all such services provided.  B. The provisions of this Section shall apply only if the detainee has valid health care coverage in effect at the time medical treatment is received and any premiums for such coverage are current.  C. The provisions of this Section shall apply to all existing hospital, health, or medical expense insurance policies, hospital or medical service contracts, employee welfare benefit plans, health and accident insurance policies, policies of group, family group, blanket, or association health and accident insurance, self-insurance plans, health maintenance organizations, and preferred provider organization policies, plans, and certificates in effect on January 1, 2019, and upon their renewal.  Acts 2018, No. 20, §1.
LA Rev Stat § 22:1057 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1057. Coverage for COVID-19 tests and treatments

RS 1057 - Coverage for COVID-19 tests and treatments  A. No health coverage plan delivered or issued for delivery in this state shall deny coverage for COVID-19 diagnostic tests, antibody tests, and antiviral drugs when ordered by a physician for the purpose of making clinical decisions or treating a patient suspected of having COVID-19.  B. Any health coverage plan delivered or issued for delivery in this state shall include coverage for COVID-19 diagnostic tests, antibody tests, and antiviral drugs in accordance with this Section.  C. The coverage required in this Section shall not be subject to annual deductibles, coinsurance, copayment, or any other out-of-pocket or cost-sharing expense provisions until December 31, 2021. After December 31, 2021, these services may be subject to these cost-sharing requirements.  D. For purposes of this Section, the following definitions apply:  (1) "COVID-19" means the coronavirus disease 2019 as designated by the World Health Organization.  (2)(a) "COVID-19 antibody test" means a test that meets all of the following requirements:  (i) Is fully approved or granted an Emergency Use Authorization by the United States Food and Drug Administration (FDA).  (ii) Follows the Enzyme-Linked Immunosorbent Assay (ELISA) test methodology performed in highly complex clinical laboratories and includes an antibody titer.  (iii) Is ordered by a physician for the purpose of determining the likelihood of a previous infection.  (b) "COVID-19 antibody test" shall not include a test used for employment-related or public health surveillance testing.  (3) "COVID-19 antiviral drug or agent" is a medication that is fully approved or granted an Emergency Use Authorization by the FDA for the treatment or prevention of COVID-19 infections when ordered by a physician.  (4) "COVID-19 diagnostic test" or "diagnosis test" means a test that is fully approved or granted an Emergency Use Authorization by the FDA and is ordered by a physician for the purpose of diagnosing an active infection or determining recovery from an active infection. "COVID-19 diagnostic test" or "diagnosis test" shall not include a test used for employment-related or public health surveillance testing.  (5) "Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, high deductible health plans authorized under federal law, and short-term policies that have a term of less than twelve months.  Acts 2020, No. 230, §1, eff. June 11, 2020.
LA Rev Stat § 22:1058 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1058. Acupuncture; reimbursement

RS 1058 - Acupuncture; reimbursement  A.(1)(a) Any health coverage plan delivered or issued for delivery in this state in the large group market, as defined in R.S. 22:1091(B), shall provide coverage for any acupuncture performed by an individual licensed pursuant to R.S. 37:1356 et seq. when such services are medically necessary and not otherwise excluded from coverage.  (b) Terminology in a policy or contract deemed discriminatory against any person or method of practice, including but not limited to the manner of payment or reimbursement under the policy, shall be null and void.  (2) The coverage provided pursuant to this Section may be subject to annual deductibles, coinsurance, and copayment provisions as are consistent with those established under the health coverage plan.  (3) The coverage provided pursuant to this Section may be limited to twelve visits for acupuncture treatment per policy or contract benefit period.  B. For purposes of this Section, "health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.  Acts 2020, No. 250, §1, eff. Jan. 1, 2021.
LA Rev Stat § 22:1060.2 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1060.2. Notice and disclosure of certain information required

RS 1060.2 - Notice and disclosure of certain information required  A health insurance issuer of a health benefit plan that covers prescription drugs and uses one or more drug formularies to specify the prescription drugs covered under the plan shall do all of the following:  (1) Provide in plain language in the coverage documentation provided to each enrollee each of the following:  (a) Notice that the plan uses one or more drug formularies.  (b) An explanation of what a drug formulary is.  (c) A statement regarding the method the health insurance issuer uses to determine the prescription drugs to be included in or excluded from a drug formulary.  (d) A statement of how often the health insurance issuer reviews the contents of each drug formulary.  (e) Notice, on a form approved by the Department of Insurance, that an enrollee may contact the health insurance issuer to determine whether a specific drug is included in a particular drug formulary.  (2) Disclose to an individual upon request, not later than the third business day after the date of the request, whether a specific drug is included in a particular drug formulary.  (3) Notify an enrollee and any other individual who requests information pursuant to this Section that the inclusion of a drug in a drug formulary does not guarantee that an enrollee's physician or other authorized prescriber will prescribe the drug for a particular medical condition or mental illness.  (4)(a) If a prescribed drug is denied based upon the drug's nonformulary status, provide the prescriber with a list of the alternative comparable formulary medications in writing and attached to the letter of denial of prescription drug coverage.  (b) If a prescribed drug is excluded from coverage under the health benefit plan and other drugs in the same class and used for the same treatment as the excluded drug are covered under the plan, the issuer or its agent shall notify the prescriber of the covered drug.  (c) It shall be deemed sufficient to meet the requirements of this Paragraph if a health benefit plan includes the information required by this Paragraph in the denial letter sent by the health benefit plan or its agent. For any request made by providers utilizing electronic health records with capabilities, the notice may be sent electronically.  (d) Simple notification of the availability and location of the formulary shall not be deemed sufficient to meet the requirements of this Paragraph.  Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2019, No. 206, §1, eff. Jan. 1, 2020.
LA Rev Stat § 22:1060.3 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1060.3. Continuation of coverage required; other drugs not precluded

RS 1060.3 - Continuation of coverage required; other drugs not precluded  A. A health insurance issuer of a health benefit plan that covers prescription drugs shall offer to each enrollee at the contracted benefit level and until the enrollee's plan renewal date any prescription drug that was approved or covered under the plan for a medical condition or medical illness, regardless of whether the drug has been removed from the health benefit plan's drug formulary before the plan renewal date. Nothing herein shall prohibit the health insurance issuer from providing information to the enrollee regarding alternative covered drugs.  B. This Section shall not prohibit a physician or other authorized prescriber from prescribing a drug that is an alternative to a drug for which continuation of coverage is required by Subsection A of this Section if the alternative drug meets each of the following conditions:  (1) The drug is covered under the health benefit plan.  (2) The drug is medically appropriate for the enrollee.  C.(1) A health insurance issuer proposing to change its coverage of a particular prescription drug or intravenous infusion based on medical necessity shall give notice of the proposed change to an insured currently using that prescription drug or intravenous infusion who the health insurance issuer determines the change may affect if the health insurance issuer has covered the drug or intravenous infusion for the insured for at least the preceding sixty days. Such notice shall be sent at least sixty days prior to the effective date of the proposed change.  (2) Any insured receiving such a notice from a health insurance issuer shall have the right to appeal the proposed change during the sixty-day notification period provided for in Paragraph (1) of this Subsection in accordance with the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq. In filing such an appeal, the insured shall document that his physician or authorized prescriber considers continued use of the drug or intravenous infusion to be medically necessary.  Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2012, No. 316, §1, eff. May 25, 2012; Acts 2016, No. 573, §1, eff. Jan. 1, 2017.
LA Rev Stat § 22:1060.4 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1060.4. Adverse determination

RS 1060.4 - Adverse determination  A. The refusal of a health insurance issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for purposes of the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq., if each of the following conditions is met:  (1) The drug is not included in a drug formulary used by the health benefit plan.  (2) The enrollee's physician or other authorized prescriber has determined the drug is medically necessary.  B. The enrollee may appeal the adverse determination pursuant to the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq.  Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2016, No. 573, §1, eff. Jan. 1, 2017.
LA Rev Stat § 22:1060.5 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1060.5. Specialty drug tiers; prohibitions; limits on copayments

RS 1060.5 - Specialty drug tiers; prohibitions; limits on copayments A. A health insurance issuer of a health benefit plan that covers prescription drugs, as defined in R.S. 22:1060.1(8), and utilizes a formulary tier that is higher than a preferred or non-preferred brand drug tier, sometimes known as a specialty drug tier, shall limit any required copayment or coinsurance applicable to drugs on such tier to an amount not to exceed one hundred and fifty dollars per month for each drug up to a thirty-day supply of any single drug. This limit shall be inclusive of any copayment or coinsurance. This limit shall be applicable after any deductible is reached and until the individual's maximum out-of-pocket limit has been reached. B. A health care issuer of a health benefit plan that covers prescription drugs, as defined in R.S. 22:1060.1(8), and utilizes specialty tiers shall be required to implement an exceptions process that allows enrollees to request an exception to the formulary. Under such an exception, a non-formulary specialty drug could be deemed covered under the formulary if the prescribing physician determines that the formulary drug for treatment of the same condition either would not be as effective for the individual, would have adverse effects for the individual, or both. In the event an enrollee is denied an exception, such denial shall be considered an adverse event and shall be subject to the health plan internal review process and the state external review process. C. The provisions of this Section shall not apply to the Office of Group Benefits or to the claims of the Office of Group Benefits enrollees administered by health insurance issuers. Acts 2014, No. 453, §1, eff. Jan. 1, 2015.
LA Rev Stat § 22:1060.6 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1060.6. Limitation; patient payment

RS 1060.6 - Limitation; patient payment  A. An individual shall not be required to make a payment for pharmacists' services in an amount greater than the pharmacist or pharmacy providing the pharmacists' services may retain from all payment sources.  B. No pharmacy benefit manager, insurer, or other entity that administers prescription drug benefits programs in this state shall prohibit by contract a pharmacy or pharmacist from informing a patient of all relevant options when acquiring his prescription medication, including but not limited to the cost and clinical efficacy of a more affordable alternative if one is available and the ability to pay cash if a cash price for the same drug is less than an insurance copayment or deductible payment amount.  C. Any provision of a contract that violates the provisions of this Section shall be unenforceable and shall be deemed an unfair or deceptive act and practice pursuant to R.S. 22:1961 et seq.  Acts 2016, No. 527, §1; Acts 2018, No. 597, §1, eff. Jan. 1, 2019.
LA Rev Stat § 22:1060.7 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1060.7. Prescription medication for chronic pain

RS 1060.7 - Prescription medication for chronic pain  A. Notwithstanding any provision of law to the contrary, when a licensed physician prescribes a nonopioid medication for the treatment of chronic pain, it shall be unlawful for a health insurance issuer to deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug.  B. When an opioid prescription is deemed medically necessary and prescribed by a licensed physician, it shall be unlawful for an insurer to deny a prescribed medication and attempt to substitute an alternative medication that requires any of the following:  (1) An increased number of pills per prescription.  (2) A higher Drug Enforcement Administration schedule medication than the one prescribed.  (3) The substitution of an extended release medication that does not have defined abuse deterrent properties for a prescription of a medication that does have defined abuse deterrent properties.  Acts 2018, No. 372, §1; Acts 2018, No. 372, §1.
LA Rev Stat § 22:1062.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1062.1. Special enrollment period

RS 1062.1 - Special enrollment period  A. Every group health plan issued by a health insurer or a health maintenance organization shall provide for a special enrollment period for employees or dependents if either of the following apply:  (1) The employee or dependent loses eligibility for Medicaid or coverage under the Louisiana Children's Health Insurance Program and the employee requests, not later than sixty days after the date of termination of such coverage, coverage under a group health plan for which the employee or dependent is eligible.  (2) The employee or dependent becomes eligible to participate in a premium assistance program under Medicaid or the Louisiana Children's Health Insurance Program and the employee requests, not later than sixty days after the date of determination of eligibility, coverage under a group health plan for which the employee or dependent is eligible. In the event of such eligibility, the Louisiana Department of Health shall ensure that each eligible enrollee, or, in the case of an enrollee in the Louisiana Children's Health Insurance Program, the child's parent or guardian, receives information regarding the special enrollment period. The department shall provide consistent communication and facilitation for everyone eligible to enroll in a group health plan during the special enrollment period.  B. The Department of Insurance may promulgate rules and regulations, pursuant to the Administrative Procedure Act, as necessary to assure compliance with the provisions of this Section and Section 311 of the Children's Health Insurance Program Reauthorization Act of 2009.  Acts 2009, No. 243, §1.
LA Rev Stat § 22:1064 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1064. Certification of coverage

RS 1064 - Certification of coverage The provisions of R.S. 22:1062(D) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market. Acts 1997, No. 1138, §1, eff. July 14, 1997; Redesignated from R.S. 22:250.14 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1065.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1065.1. Redesignated as R.S. 22:822 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.

RS 1065.1 - Redesignated as R.S. 22:822 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.