reglab/housing_qa huggingface dataset:
LA Rev Stat § 22:1858 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1858. Coordination of benefits

RS 1858 - Coordination of benefits A. Coordination of benefit requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements: (1) No plan shall contain a provision that its benefits are "always excess" or "always secondary" except in accordance with rules adopted by the commissioner pursuant to this Subpart. (2) A coordination of benefit provision may not be used that permits a plan to reduce its benefits on the basis of any of the following: (a) That another plan exists and the covered person did not enroll in the plan. (b) That a person is or could have been covered under another plan, except with respect to Part B of Medicare. (c) That a person has elected an option under another plan providing a lower level of benefits than another option that could have been elected. B. The commissioner shall be authorized to adopt such reasonable regulations as necessary for determining the order of benefit payments when a person is covered by two or more plans of health insurance coverage. Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Redesignated from R.S. 22:250.58 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1860 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1860. Violations; cease and desist orders; penalties

RS 1860 - Violations; cease and desist orders; penalties A. Whenever the commissioner has reason to believe that any health insurance issuer is not in full compliance with the requirements of this Subpart, he shall notify such issuer in accordance and compliance with R.S. 49:961 and, after notice, the commissioner shall issue and cause to be served an order requiring the health insurance issuer to cease and desist from any violation and order any one or more of the following: (1) Payment of a monetary penalty of not more than one thousand dollars for each and every act or violation, not to exceed an aggregate penalty of one hundred thousand dollars. However, if the health insurance issuer knew or reasonably should have known that it was in violation of this Subpart, the penalty shall be not more than twenty-five thousand dollars for each and every act or violation, but not to exceed an aggregate penalty of two hundred fifty thousand dollars in any six-month period. (2) Suspension or revocation of the certificate of authority of the health insurance issuer to operate in this state if it knew or reasonably should have known it was in violation of this Subpart. However, notice of any such violation by the Office of Group Benefits shall be submitted to the governor and the chairmen of the House Committee on Appropriations and the Senate Committee on Finance. B. Any health insurance issuer who violates a cease and desist order issued by the commissioner pursuant to this Section and in accordance with R.S. 49:961 while such order is in effect shall, after notice, be subject at the discretion of the commissioner to any one or more of the following: (1) A monetary penalty of not more than twenty-five thousand dollars for each and every act or violation, not to exceed an aggregate of two hundred fifty thousand dollars. (2) Suspension or revocation of the certificate of authority of the health insurance issuer to operate in this state. However, notice of any such violation by the Office of Group Benefits shall be submitted to the governor and the chairmen of the House Committee on Appropriations and the Senate Committee on Finance. C. An aggrieved party affected by the commissioner's decision, act, or order may demand a hearing in accordance with Chapter 12 of this Title, R.S. 22:2191 et seq. Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Acts 2005, No. 209, §1, eff. July 1, 2005; Redesignated from R.S. 22:250.60 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2009, No. 317, §1.
LA Rev Stat § 22:1860.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1860.1. Reimbursement of pharmacy provider fee; sanctions; administrative hearings

RS 1860.1 - Reimbursement of pharmacy provider fee; sanctions; administrative hearings  A. It is the obligation of a health insurance issuer or its agent to reimburse a pharmacist or his agent for fees remitted by a pharmacy or pharmacist or his agent in compliance with R.S. 46:2625.  B. The failure to reimburse a pharmacy or pharmacist or his agent by a health insurance issuer or its agent for the fees authorized in R.S. 46:2625(A)(1) shall be an act for which the health insurance issuer or its agent may be sanctioned by the commissioner in accordance with R.S. 22:1860. Any person sanctioned pursuant to this Section may demand an administrative hearing in accordance with Chapter 12 of this Title, R.S. 22:2191 et seq.  Acts 2015, No. 399, §1.
LA Rev Stat § 22:1860.2 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1860.2. Certain pharmacy claims fees prohibited

RS 1860.2 - Certain pharmacy claims fees prohibited  A. A health insurance issuer or a pharmacy benefit manager shall not directly or indirectly charge or hold a pharmacist or pharmacy responsible for any fee related to a claim that is any of the following:  (1) Not apparent at the time of claim processing.  (2) Not reported on the remittance advice of an adjudicated claim.  (3) After the initial claim is adjudicated.  B. For purposes of this Section, "pharmacy benefit manager" means a person, other than a pharmacy or pharmacist, who acts as an administrator in connection with pharmacy benefits.  Acts 2016, No. 148, §1; Acts 2019, No. 105, §1, eff. June 4, 2019.
LA Rev Stat § 22:1860.3 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1860.3. Reimbursements

RS 1860.3 - Reimbursements  A. A pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager shall not reimburse a pharmacy or pharmacist in this state an amount less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benefit manager for providing the same services. The amount shall be calculated on a per-unit basis using the same generic product identifier or generic code number.  B.(1) Any pharmacy or pharmacist who has a contract, either directly or through a pharmacy services administration organization, with a pharmacy benefit manager administering any type of drug or pharmacy benefit plan to provide covered drugs, devices, or services at a contractual reimbursement rate may decline to provide a covered drug, device, or service if the pharmacy or pharmacist will be or is paid less than the acquisition cost for the covered drug, device, or service.  (2) If the pharmacy or pharmacist declines to provide the drug, device, or service as authorized in this Subsection, then the pharmacy or pharmacist shall provide the customer with adequate information as to where the prescription for the drug, device, or service may be filled.  (3) No pharmacy benefit manager, pharmacy services administration organization, or any person acting for or on behalf of a pharmacy benefit manager or pharmacy services administration organization shall cancel any contract with the pharmacy or pharmacist, sue for breach of contract, use the decision to decline as a cause for not renewing the contract, or retaliate against or penalize the pharmacy or pharmacist in any way.  C. The commission of any act prohibited by this Section shall be considered an unfair method of competition and unfair practice or act which shall subject the violator to any and all actions, including investigative demands, private actions, remedies, and penalties, provided for in the Unfair Trade Practices and Consumer Protection Law, R.S. 51:1401 et seq.  D. Any provision of a contract that is contrary to any provision of this Section shall be null, void, and unenforceable in this state.  Acts 2018, No. 597, §1, eff. Jan. 1, 2019; Acts 2019, No. 161, §1, eff. June 6, 2019.
LA Rev Stat § 22:1861 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1861. Regulations

RS 1861 - Regulations The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act. Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Redesignated from R.S. 22:250.61 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1862 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1862. Applicability

RS 1862 - Applicability The provisions of Subpart B of Part II of this Chapter, R.S. 22:1831 et seq., shall not apply to this Subpart. Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Redesignated from R.S. 22:250.62 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1863 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1863. Definitions

RS 1863 - Definitions  As used in this Subpart, the following definitions apply:  (1) "Drug Shortage List" means a list of drug products posted on the United States Food and Drug Administration drug shortage website.  (2) "Maximum Allowable Cost List" means a listing of the National Drug Code used by a pharmacy benefit manager setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist may be based. "Maximum Allowable Cost List" shall include any term that a pharmacy benefit manager or a healthcare insurer may use to establish reimbursement rates for generic and multi-source brand drugs to a pharmacist or pharmacy for pharmacist services. The term "Maximum Allowable Cost List" shall not include any rate mutually agreed to and set forth in writing in the contract between the pharmacy benefit manager and the pharmacy or its agent and shall not include the National Average Drug Acquisition Cost. A pharmacy benefit manager may use effective rate pricing for a pharmacist or pharmacy that is not a local pharmacy or local pharmacist as defined in R.S. 46:460.36(A).  (3) "NDC" means the National Drug Code, a numerical identifier assigned to all prescription drugs.  (4) "Pharmacist" means a licensed pharmacist as defined in R.S. 22:1852(8).  (5) "Pharmacist services" means products, goods, or services provided as a part of the practice of pharmacy as defined in R.S. 22:1852(9).  (6) "Pharmacy" means any appropriately licensed place where prescription drugs are dispensed as defined in R.S. 22:1852(10).  (7) "Pharmacy benefit manager" means an entity that administers or manages a pharmacy benefits plan or program.  (8) "Pharmacy benefits plan" or "pharmacy benefits program" means a plan or program that pays for, reimburses, covers the cost of, or otherwise provides for pharmacist services to individuals who reside in or are employed in Louisiana.  (9) "Spread pricing" means any amount a pharmacy benefit manager charges or claims from a health plan provider or managed care organization for payment of a prescription or for pharmacy services that is different than the amount the pharmacy benefit manager paid to the pharmacist or pharmacy who filled the prescription or provided the pharmacy services.  Acts 2014, No. 391, §1; Acts 2018, No. 597, §1, eff. Jan. 1, 2019; Acts 2019, No. 124, §1, eff. July 1, 2020.
LA Rev Stat § 22:1864 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1864. Requirements for use of the National Drug Code by a pharmacy benefit manager

RS 1864 - Requirements for use of the National Drug Code by a pharmacy benefit manager  A. Before a pharmacy benefit manager places or continues a particular NDC or Maximum Allowable Cost List, the following requirements shall be met:  (1) The prescription drug to which the NDC is assigned shall be listed as "A" or "B" rated in the most recent version of the FDA's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book, or have an "NR" or "NA" rating or a similar rating by a nationally recognized reference.  (2) The prescription drug to which the NDC is assigned shall be available for purchase by pharmacies in the state from national or regional wholesalers.  (3) The prescription drug to which the NDC is assigned shall not be considered obsolete, temporarily unavailable, or listed on a drug shortage list.  (4) For every drug for which the pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the pharmacy benefit manager shall make available to all pharmacies both of the following:  (a) Information identifying the national drug pricing compendia or sources used to obtain the drug price data.  (b) The comprehensive list of drugs subject to maximum allowable cost by plan and the actual maximum allowable cost by plan for each drug.  B. A pharmacy benefit manager shall do all of the following:  (1) Provide access to its Maximum Allowable Cost List to each pharmacy subject to the list.  (2) Update its Maximum Allowable Cost List on a timely basis, but in no event longer than seven calendar days from a change in the methodology on which the Maximum Allowable Cost List is based or in the value of a variable involved in the methodology.  (3) Provide a process for each pharmacy subject to the list to review an update to the Maximum Allowable Cost List.  Acts 2014, No. 391, §1; Acts 2018, No. 597, §1, eff. Jan. 1, 2019.
LA Rev Stat § 22:1866 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1866. Rulemaking authority; administrative appeals

RS 1866 - Rulemaking authority; administrative appeals  A. The commissioner may promulgate rules and regulations in accordance with the Administrative Procedure Act that are necessary or proper to carry out the provisions of this Subpart.  B. Any pharmacy benefit manager, insurer, or other entity that administers prescription drug benefits programs in the state that is aggrieved by an act of the commissioner may apply for a hearing pursuant to Chapter 12 of this Title, R.S. 22:2191 et seq.  Acts 2018, No. 597, §1, eff. Jan. 1, 2019.
LA Rev Stat § 22:1867 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1867. Prohibition on spread pricing; notice exception

RS 1867 - Prohibition on spread pricing; notice exception  A. A pharmacy benefit manager is prohibited from conducting or participating in spread pricing in this state unless the pharmacy benefit manager provides written notice as provided in Subsection B of this Section.  B. The notice issued by a pharmacy benefit manager, or a health insurance issuer where the health insurance issuer has agreed to issue the notice, that utilizes spread pricing shall be:  (1) Required for each health insurance issuer or plan provider in which the pharmacy benefit manager engaged or participated in spread pricing.  (2) Delivered to the policy holder.  (3) Provided at least biannually.  (4) Indicative of the aggregate amount of spread pricing charged by the pharmacy benefit manager during the period.  (5) Written in plain, simple, and understandable English.  C. Any violation of this Section that is committed or performed with such frequency as to indicate a general business practice shall be subject to the provisions of the Unfair Trade Practices and Consumer Protection Law, R.S. 51:1401 et seq., as provided in R.S. 40:2870(B).  Acts 2019, No. 124, §1, eff. July 1, 2020.
LA Rev Stat § 22:1871 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1871. Short title

RS 1871 - Short title This Subpart shall be known and may be cited as the "Health Care Consumer Billing and Disclosure Protection Act". Acts 2003, No. 1157, §1, eff. Jan. 1, 2004; Redesignated from R.S. 22:250.41 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1875 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1875. Billing by noncontracted facility-based physicians providing services in a base health care facility

RS 1875 - Billing by noncontracted facility-based physicians providing services in a base health care facility If a facility-based physician who is a noncontracted health care provider provides health care services in a base health care facility to an enrollee or insured and files a claim with a health insurance issuer for such facility-based services, the health insurance issuer shall provide the facility-based physician with an explanation of benefits as to any payment determination thereof. Nothing contained in this Subpart shall supercede the provisions of R.S. 22:263(D). Acts 2003, No. 1157, §1, eff. Jan. 1, 2004; Redesignated from R.S. 22:250.45 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2012, No. 271, §1.
LA Rev Stat § 22:1876 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1876. Correction of credit records

RS 1876 - Correction of credit records Any contracted health care provider who files, refers, or sends a report to a credit reporting agency for nonpayment by an enrollee or insured of any amount that he is prohibited by R.S. 22:1874(A) from billing or collecting shall assist in correcting the credit record of the enrollee or insured by providing a letter to the credit reporting agency and to the enrollee or insured. Such letter shall state that such amount is not due from the enrollee or insured to the contracted health care provider. If such letter is not sent within ten days of receipt of written notice from the enrollee or insured, the health insurance issuer, or the commissioner, the contracted health care provider shall be liable for all reasonable costs, including reasonable attorney fees and court costs, incurred by the enrollee or insured with correcting such erroneous credit record. Acts 2003, No. 1157, §1, eff. Jan.1, 2004; Redesignated from R.S. 22:250.46 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1878 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1878. Exception

RS 1878 - Exception  Regardless of any contractual provisions contained in a health insurance contract or plan delivered in this state, should a patient receive a dental or vision diagnosis from a contracted provider for which the patient qualifies for a covered dental or vision service pursuant to the patient's health plan, the patient may choose either of the following:  (1) The covered service designated by the patient's health, dental, or vision plan for treatment of the condition diagnosed.  (2) An alternate type, form, or quality of a dental or vision procedure or product to treat the diagnosed condition which procedure or product is of equal or greater price, provided that the patient approves the alternate procedure or product in advance and in writing. For alternate services, procedures, or products provided pursuant to this Subsection, the provider shall be paid for the dental or vision procedure or product as follows:  (a) The insurer shall pay the amount due for the covered procedure or product which was an approved service or product for the treatment of the diagnosed condition.  (b) The patient shall pay that amount which is the difference between the amount of the covered service or product and the amount of the chosen alternate service, procedure, or product.  Acts 2004, No. 607, §1; Redesignated from R.S. 22:250.48 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2020, No. 315, §1.
LA Rev Stat § 22:1880.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1880.1. Provider-based entity disclosure

RS 1880.1 - Provider-based entity disclosure  If a facility meets the definition of a provider-based entity, as defined by 42 CFR 413.65, and the facility is located off of the main hospital campus, the facility shall publicly post a notice to every patient disclosing the following:  (1) That the enrollee or insured is receiving services in a hospital-based outpatient facility where the facility provides the use of the facility, medical, or technical equipment, supplies, staff, and services.  (2) That depending on the enrollee's or insured's health insurance benefit plan and the actual services furnished by the facility, the patient may receive a facility charge billed separately from the physician that covers the fees for the use of the facility, medical, or technical equipment, supplies, staff, and services.  Acts 2018, No. 288, §1, eff. May 18, 2018.
LA Rev Stat § 22:1881 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1881. Reimbursement of monies paid to health insurers under automobile medical payment provisions; limitation on amounts reimbursed

RS 1881 - Reimbursement of monies paid to health insurers under automobile medical payment provisions; limitation on amounts reimbursed A. Except as provided in this Section or by agreement between the parties and in accordance with regulations of the Department of Insurance governing the coordination of benefits, no health insurance issuer shall seek reimbursement from an insurer that provides automobile medical payment coverage to the health insurance issuer's insured or member without obtaining the prior written consent of the insured or member or his legal representative. After a period of nine months from the date of the accident from which medical claims arise, the health insurance issuer may seek reimbursement from the medical payments insurer for only the outstanding balance remaining under the automobile policy for medical coverage. B. The provisions of this Section shall not prohibit or impair the rights of an insurer or provider from seeking reimbursement of monies paid pursuant to an insurance policy, plan, or self-insurance fund provided the total amount to be reimbursed shall not exceed the amount actually paid by the insurer or provider. C. The provisions of this Section shall not apply to Medicare Advantage plans or self-insured plans. Acts 2011, No. 382, §1.
LA Rev Stat § 22:1891 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1891. Automobile liability coverage, medical payments

RS 1891 - Automobile liability coverage, medical payments  A policy of automobile liability insurance which provides for medical payments coverage shall not limit the time period during which the insured is entitled to payment or reimbursement for medical expenses incurred as a result of injuries caused by a covered accident when the injuries are diagnosed within one year of the accident and are reported to the insurer within three years of the accident. Acts 1991, No. 807, §1; Redesignated from R.S. 22:636.7 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
LA Rev Stat § 22:1892.1 (2021)
2021 Louisiana Laws|Revised Statutes|Title 22 - Insurance|§1892.1. Arbitration or other type of binding mediation by automobile insurers

RS 1892.1 - Arbitration or other type of binding mediation by automobile insurers No automobile insurer shall use arbitration or any other type of binding mediation to determine fault for purposes of settling a claim resulting from an automobile accident for the purpose of raising insurance premiums of an insured without notifying the insured as to the percentage of fault prior to arbitration. Acts 2010, No. 828, §1, eff. June 1, 2010.