reglab/housing_qa huggingface dataset:
LA Rev Stat § 40:2207 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2207. Requirements of provider contracts

RS 2207 - Requirements of provider contracts A. A health maintenance organization, managed care organization, or their contracting entities shall not include provisions in their contracts with health care providers which include incentive or specific payment made directly, in any form, to a health care provider or health care provider group as an inducement to deny, reduce, limit, or delay specific, medically necessary, and appropriate services provided with respect to a specific insured or groups of insured with similar medical conditions. B. Nothing in this Section shall be construed to prohibit contracts that contain incentive plans that involve general payments, such as capitation payments, or shared-risk arrangements that are not tied to specific medical decisions involving specific insured or groups of insured with similar medical conditions. The payments rendered or to be rendered to physicians, physician groups, or other licensed health care practitioners under these arrangements shall be deemed confidential information. C. As used in this Section, the following definitions shall apply: (1) "Managed care organization" means a licensed insurance company, hospital, or medical benefit plan or program, health maintenance organization, integrated health care delivery system, an employer or employee organization, or a managed care contractor which operates a managed care plan. A managed care entity may include but it is not limited to a preferred provider organization, health maintenance organization, exclusive provider organization, independent practice association, clinic without walls, management services organization, managed care services organization, physician hospital organization, and hospital physician organization. (2) "Managed care plan" means a plan operated by a managed care organization which provides for the financing and delivery of health care and treatment services to individuals enrolled in such plan through its own employed health care providers or contracting with selected specific providers that conform to explicit selection, standards, or both. A managed care plan shall also mean a plan that has a formal organizational structure for continual quality assurance, a certified utilization review program, dispute resolution, and financial incentives for individual enrollees to use the plan's participating providers and procedures. Acts 1997, No. 897, §2.
LA Rev Stat § 40:2208 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2208. Interpreter services for the deaf and hard of hearing; expenses; coverage

RS 2208 - Interpreter services for the deaf and hard of hearing; expenses; coverage  As a requirement for authorization to do business in this state pursuant to R.S. 40:2203, all preferred provider organizations shall provide coverage for expenses incurred by any covered patient who is deaf or hard of hearing for services performed by a qualified interpreter/translator, other than a family member of the covered patient, when such services are used by the covered patient in connection with medical treatment or diagnostic consultations performed by the healthcare provider.  Acts 1997, No. 1313, §2; Acts 2017, No. 146, §8.
LA Rev Stat § 40:2209 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2209. Repealed by Acts 2016, No. 145, §2, eff. May 19, 2016.

RS 2209 - Repealed by Acts 2016, No. 145, §2, eff. May 19, 2016.
LA Rev Stat § 40:2210 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2210. Prohibited discrimination; prenatal test results; genetic information

RS 2210 - Prohibited discrimination; prenatal test results; genetic information Every preferred provider organization authorized under this Part shall comply with the provisions of R.S. 22:1022 and 1023, relative to the use of prenatal test results and genetic information. Acts 1997, No. 1418, §2; Acts 2008, No. 415, §2, eff. Jan. 1, 2009.
LA Rev Stat § 40:2211 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2211. Definitions

RS 2211 - Definitions  For the purposes of this Part:  (1) "Department" means the Louisiana Department of Health.  (2) "Enrollee" means any Medicaid recipient or indigent, uninsured, or underinsured person enrolled in a qualified plan for the provision of health care services whose enrollment costs are paid wholly or in part by the state under a federal waiver to the Medicaid program.  (3) "Qualified plan" means a basic benefits plan that may be established under a health maintenance organization, health insurance organization, or managed care organization that contracts with the state to provide or coordinate the provision of health care services to an enrollee.  Acts 1995, No. 621, §1, eff. June 18, 1995.
LA Rev Stat § 40:2212 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2212. Basic benefit plans

RS 2212 - Basic benefit plans A. A qualified plan shall provide full disclosure of services to each enrollee or prospective enrollee, including covered benefits, restrictions and/or limitations, specialty care, prescription drugs and biologics, the inclusion of essential community providers, the use of providers outside of a plan's provider network, and experimental treatments. B. Each qualified plan shall disclose to each enrollee or prospective enrollee orally or in writing in a manner understandable at a fifth grade reading level and reviewed and approved by the literacy program of the Louisiana State University Health Sciences Center in Shreveport: (1) A definition of basic covered benefits. (2) Guidelines for confidential communication with caregivers. (3) Availability and access to choice of providers. (4) Quality assurance requirements. (5) Disclosure of protocols as it relates to courteous treatment, timely referrals, and access to specialty care. (6) Disclosure of deductibles. (7) Extent of inclusion or exclusion of preventive health services in all basic benefit programs. (8) Disclosure of definition of "necessary treatment". (9) Information regarding appeal process. C.(1) Any qualified plan shall not exclude from direct reimbursement health care services provided by an advanced practice registered nurse who provides health care services in accordance with the collaborative practice agreement for basic benefit services covered by the basic health plan. (2) Any qualified plan shall not reimburse health care services provided by an advanced practice registered nurse at a rate less than the rate paid to other health care providers who perform the same services. Acts 1995, No. 621, §1, eff. June 18, 1995; Acts 1999, No. 802, §5, eff. July 2, 1999; Acts 2001, No. 704, §1; Acts 2006, No. 106, §1.
LA Rev Stat § 40:2213 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2213. Lactation consultants; registry; qualifications

RS 2213 - Lactation consultants; registry; qualifications  A. The office of public health of the Louisiana Department of Health shall create a registry of persons certified in the state of Louisiana to provide services as a lactation consultant.  B. To be eligible for inclusion on the Lactation Consultant Registry, a person shall be certified as an International Board Certified Lactation Consultant (IBCLC), and maintain such educational and re-examination requirements for certification in good standing.  C. An "International Board Certified Lactation Consultant", as used in this Section, is an allied health care provider who, by meeting eligibility requirements and passing an examination administered by the International Board of Lactation Consultant Examiners (IBLCE), possesses the skills, knowledge, and attitudes to provide breastfeeding assistance to babies and mothers.  Acts 1999, No. 627, §1.
LA Rev Stat § 40:2221 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2221. Definitions

RS 2221 - Definitions  For the purposes of this Part:  (1) "Department" means the Louisiana Department of Health.  (2) "Enrollee" means any Medicaid recipient or indigent, uninsured, or underinsured person enrolled in a qualified plan for the provision of health care services whose enrollment costs are paid wholly or in part by the state under a federal waiver to the Medicaid program.  (3) "Qualified plan" means a basic benefits plan that may be established under a health maintenance organization, health insurance organization, or managed care organization certified by the secretary of the Louisiana Department of Health to contract with the state to provide or coordinate the provision of health care services to an enrollee.  Acts 1995, No. 1211, §1, eff. June 29, 1995.
LA Rev Stat § 40:2222 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2222. Certification of organizations providing qualified plans

RS 2222 - Certification of organizations providing qualified plans A. No health maintenance organization, health insurance organization, managed care organization, or other entity may contract with the state to provide a qualified plan to an enrollee unless so certified by the department. B. No health maintenance organization, health insurance organization, managed care organization, or other entity shall be certified to provide a qualified plan unless that plan meets minimum standards established by the department by the adoption and promulgation of rules and regulations in accordance with the Administrative Procedure Act. Such standards shall include, but not be limited to: (1) Access to routine, urgent, and emergency care by enrollees. (2) Primary care including location, hours, waiting times, and access to care when needed. (3) Availability of specialty care. (4) Technical competence of health care providers. (5) Implementation of a peer review program. (6) Health and medical standards. C. Any qualified plan provider that fails to maintain the minimum standards as determined by the department shall be subject to penalties, including revocation of any authority to participate in the state program or a prohibition on enrolling any new member. Acts 1995, No. 1211, §1, eff. June 29, 1995.
LA Rev Stat § 40:2223 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2223. Limitations on implementation

RS 2223 - Limitations on implementation  The secretary shall not implement the provisions of this Part unless a federal Medicaid waiver submitted to the United States Department of Health and Human Services, Health Care Financing Administration, or its successor, on or after December 31, 1994, authorizing the state to utilize health insurance organizations, health maintenance organizations, or managed care organizations for Medicaid recipients is received. However, the secretary may take actions necessary to implement this Part upon receiving such federal waiver approval.  Acts 1995, No. 1211, §1, eff. June 29, 1995; Acts 2018, No. 206, §4.
LA Rev Stat § 40:2231 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2231. Definitions

RS 2231 - Definitions  For the purposes of this Part:  (1) "Department" means the Louisiana Department of Health.  (2) "Enrollee" means any Medicaid recipient or indigent, uninsured, or underinsured person enrolled in a qualified plan for the provision of health care services whose enrollment costs are paid wholly or in part by the state under a federal waiver to the Medicaid program.  (3) "Qualified plan" means a basic benefits plan that may be established under a health maintenance organization, health insurance organization, or managed care organization that contracts with the state to provide or coordinate the provision of health care services to an enrollee.  Acts 1995, No. 1212, §1, eff. June 29, 1995.
LA Rev Stat § 40:2232 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2232. Rights of each enrollee

RS 2232 - Rights of each enrollee A. Each enrollee shall have the right to courteous treatment, timely referral and access to specialty care, reasonable choice of providers as provided in the basic benefit plan, and confidential communications with caregivers as provided by law. B. Any qualified plan shall provide to an enrollee or prospective enrollee information, orally or in writing, using understandable, objective, truthful, and consumer-tested terms, about the policy or plan prepared in a manner understandable at a fifth grade reading level and reviewed and approved by the literacy program of the Louisiana State University Health Sciences Center in Shreveport, including: (1) The range of covered benefits, highlighting restrictions or limitations on basic services, specialty care, prescription drugs and biologics, "experimental" treatments, and the use of providers outside a plan's provider network. (2) The amount of deductibles, copayments, and other potential out-of-pocket expenses. (3) The cost of proposed services and fully itemized bills for services rendered. (4) The expertise of available providers on specific diseases and disorders if a plan has a provider network. (5) How "medically necessary" treatment is defined. (6) How and whether coverage decisions can be fairly and simply appealed. (7) The criteria for selecting and dismissing physicians if a plan has a provider network. (8) Potential conflicts of interest or economic incentives on the part of providers which may influence care decisions. Acts 1995, No. 1212, §1, eff. June 29, 1995; Acts 1999, No. 802, §5, eff. July 2, 1999.
LA Rev Stat § 40:2233 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2233. Participation in health care decisions

RS 2233 - Participation in health care decisions Each enrollee should actively participate in decisions related to the enrollee's health care and treatment. Each enrollee has the right to: (1) Obtain complete information about their specific condition and treatment options and to seek second options. (2) Information about available experimental treatments and clinical trials and how such research can be accessed. (3) Have legal advanced directives or living wills respected by providers. (4) Obtain assistance in decisionmaking from a patient ombudsman knowledgeable about the enrollee's specific policy or plan. Acts 1995, No. 1212, §1, eff. June 29, 1995.
LA Rev Stat § 40:2234 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2234. Responsibilities of an enrollee

RS 2234 - Responsibilities of an enrollee An enrollee must be responsible for his own health care by becoming an informed and active participant in such care by:  (1) Living healthy lifestyles and averting behaviors known to be detrimental to one's health. (2) Becoming knowledgeable about their policy's/plan's coverage provisions, rules, and restrictions. (3) Asking questions of providers to determine the potential risks, benefits, and costs of treatment alternatives and then making care decisions after carefully weighing these and other pertinent factors. (4) Cooperating fully with providers in following mutually acceptable courses of treatment, providing accurate medical and personal histories, being present at scheduled appointments and reporting on treatment progress, such as notifying caregivers promptly if serious side effects, complications, or worsening of the condition arises. Acts 1995, No. 1212, §1, eff. June 29, 1995.
LA Rev Stat § 40:2241 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2241. Definitions

RS 2241 - Definitions  A. For the purposes of this Part, "essential community providers" means health care providers who have historically served medically needy or indigent patients, including each of the following:  (1) Federally qualified health centers.  (2) Rural health clinics.  (3) Hospitals owned or operated by the state.  (4) Community health centers.  (5) Small rural and service district hospitals.  (6) Physicians who have historically served Medicaid and indigent patients.  (7) Children's hospital as defined by 42 CFR Section 412.23(d).  B. Essential community providers shall include only those providers who are licensed, certified, and enrolled as available to participate in the Medicaid program.  C. Essential community providers shall not include any health care providers who have been convicted of fraud against the Medicaid program.  D. Essential community providers shall meet all quality assurance standards required by the Louisiana Department of Health and the United States Department of Health and Human Services for participation in the Medicaid program and any waiver program approved for the Medicaid program.  Acts 1995, No. 1187, §1, eff. June 29, 1995; Acts 1997, No. 3, §5, eff. July 1, 1997.
LA Rev Stat § 40:2242 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2242. Participation in state health care delivery system required

RS 2242 - Participation in state health care delivery system required  A. Any health care delivery system established by the state pursuant to a federal Medicaid waiver to provide health care to persons otherwise eligible for Medicaid and to indigent, uninsured, or underinsured persons shall recognize and include essential community providers as available and required in the health care delivery systems and networks including but not limited to referrals to specialists and health extenders.  B. Any basic benefits plan that may be established under a health maintenance organization, health insurance organization, or managed care organization that contracts with the state to provide or coordinate the provision of health care services to persons otherwise eligible for Medicaid and to indigent, uninsured, or underinsured persons shall include essential community providers as available and required as active medical and health professionals. However, the essential community provider shall agree to provide services that meet all the terms and requirements, including the same administrative, financial, licensure, and professional conditions which apply to health care providers which have been designated as providers in a network established by the basic benefits plan.  C. The secretary of the Louisiana Department of Health shall promulgate rules and regulations in accordance with the Administrative Procedure Act for the implementation of this Part which shall include but not be limited to the establishment of minimum levels of participation of essential community providers in such plans. Any plan provider that does not maintain the minimum level of participation as determined by the secretary shall be subject to penalties, including revocation of any authority to participate in the state program or a prohibition on enrolling new members as determined by the secretary.  Acts 1995, No. 1187, §1, eff. June 29, 1995.
LA Rev Stat § 40:2243 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2243. Limitations on implementation

RS 2243 - Limitations on implementation  The secretary shall not implement the provisions of this Part unless a federal Medicaid waiver submitted to the United States Department of Health and Human Services, Health Care Financing Administration, or its successor, on or after December 31, 1994, authorizing the state to utilize health insurance organizations, health maintenance organizations, or managed care organizations for Medicaid recipients is received. However, the secretary may take actions necessary to implement this Part upon such federal waiver approval.  Acts 1995, No. 1187, §1, eff. June 29, 1995; Acts 2018, No. 206, §4.
LA Rev Stat § 40:2251 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2251. Definitions

RS 2251 - Definitions  A. For the purposes of this Part, "essential community provider" means a health care provider who has historically served medically needy or indigent patients, including any of the following who have historically served such patients:  (1) A federally qualified health center.  (2) A rural health clinic.  (3) Any hospital owned or operated by the state.  (4) A community health center.  (5) Any small rural hospital or any hospital owned or operated by a hospital service district.  (6) A physician who has historically served Medicaid and indigent patients.  (7) Any children's hospital as defined in 42 CFR Section 412.23(d).  (8) Any home health agency.  B. Essential community providers shall include only those providers who are licensed, certified, enrolled, and available to participate in the Medicaid program.  C. Essential community providers shall not include any health care providers who have been convicted of fraud against the Medicaid program.  D. Essential community providers shall meet all quality assurance standards required by the Louisiana Louisiana Department of Health and the United States Department of Health and Human Services for participation in the Medicaid program and any waiver program approved for the Medicaid program.  Acts 1995, No. 1282, §1, eff. June 29, 1995; Acts 1997, No. 3, §5, eff. July 1, 1997.
LA Rev Stat § 40:2252 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2252. Participation in state health care delivery system required

RS 2252 - Participation in state health care delivery system required  A. Any health care delivery system established by the state, pursuant to a federal Medicaid waiver, to provide health care to any person otherwise eligible for Medicaid and to any indigent, uninsured, or underinsured person shall recognize and include essential community providers as available and required in the health care delivery systems and networks.  B. Any basic benefits plan that may be established under a health maintenance organization, health insurance organization, or managed care organization that contracts with the state to provide or coordinate to provide health care services to any person otherwise eligible for Medicaid and any indigent, uninsured, or underinsured person shall include essential community providers as available and required as active medical and health professionals.  C. The Louisiana Department of Health shall promulgate rules and regulations, in accordance with the Administrative Procedure Act, which shall include, but not be limited to, the establishment of minimum levels of participation of essential community providers in such plans. Any plan provider that fails to maintain the minimum level of participation as determined by the department shall be subject to penalties, including revocation of any authority to participate in the state program or a prohibition on enrolling new members as determined by the department.  Acts 1995, No. 1282, §1, eff. June 29, 1995.
LA Rev Stat § 40:2253 (2021)
2021 Louisiana Laws|Revised Statutes|Title 40 - Public Health and Safety|§2253. Limitations on implementation

RS 2253 - Limitations on implementation  The department shall not implement this Part unless approval of a federal Medicaid waiver submitted to the United States Department of Health and Human Services, Health Care Financing Administration, or its successor, on or after December 31, 1994, authorizing the state to utilize health insurance organizations, health maintenance organizations, or managed care organizations for Medicaid recipients is received.  Acts 1995, No. 1282, §1, eff. June 29, 1995; Acts 2018, No. 206, §4.