reglab/statecodes huggingface dataset:
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2195.3. Rural referral centers

RS 40:2195.3 - Rural referral centers
The Louisiana Department of Health shall, subject to federal approval, provide for adjustments in the disproportionate share Medicaid reimbursement formula to provide increased support for hospitals which are classified as rural referral centers.
Acts 1991, No. 394, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2195.4. Rules and regulations

RS 40:2195.4 - Rules and regulations
The Louisiana Department of Health shall promulgate, in accordance with provisions of the Administrative Procedure Act, rules and regulations necessary to implement the community-based and rural health care program. The rules and regulations promulgated by the department shall establish criteria and priorities for granting funds authorized by this Part.
Acts 1991, No. 394, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2198.11. Definitions

RS 40:2198.11 - Definitions
As used in this Part, the following definitions shall apply unless the content clearly states otherwise:
(1) "Board" means the Louisiana State Board of Medical Examiners.
(2) "Department" means the Louisiana Department of Health.
(3) "Pain management clinic" means a publicly or privately owned facility which primarily engages in the treatment of pain by prescribing narcotic medications.
(4) "Physician" means an individual who possesses a current, unrestricted license to practice medicine in Louisiana, who during the course of his practice has not been denied the privilege of prescribing, dispensing, administering, supplying, or selling any controlled dangerous substance and who has not during the course of his practice had board action taken against his medical license as a result of dependancy on drugs or alcohol.
Acts 2005, No. 488, §1, eff. July 11, 2005; Acts 2006, No. 665, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2198.13. Annual fee; use of proceeds

RS 40:2198.13 - Annual fee; use of proceeds
There shall be an annual license fee to be set by the department not to exceed one thousand dollars for any license issued in accordance with the provisions of this Part. Monies collected for annual fees shall be used for the investigation and enforcement of the provisions of this Part.
Acts 2005, No. 488, §1, eff. July 11, 2005.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.1. Adoption of rules; violations; alternate remedies

RS 40:2199.1 - Adoption of rules; violations; alternate remedies
A. The Louisiana Department of Health is hereby authorized to and shall adopt rules in accordance with the Administrative Procedure Act to provide remedies for healthcare facilities which have violations of the licensure standards and requirements, of certification requirements, or of the Medicaid standards of participation. Such remedies shall include but are not limited to:
(1) Denial of Medicaid payment with respect to any individual admitted to or provided services by a facility.
(2) Denial of new admissions into the facility or by the provider.
(3) Removal from the freedom of choice list.
(4) The transfer of residents, clients, patients, or individuals receiving services.
(5) Suspension of license.
(6) Alternate remedies to deter noncompliance and correct deficiencies.
B. The department, by rules adopted pursuant to the Administrative Procedure Act, shall specify criteria as to when and how each remedy is to be applied, the severity of the remedies to be used in the imposition of such remedies, and the procedure and requirements for applying each remedy.
C. The department, by rules adopted pursuant to the Administrative Procedure Act, shall provide a process for an administrative appeal of remedies imposed. If the secretary of the department determines the violations of the facility pose an imminent or immediate threat to the health, welfare, or safety of any resident, client, patient, or individual receiving services, the imposition of the remedy may be immediate and may be enforced during the pendency of the administrative appeal.
D. The department shall enforce rules adopted pursuant to this Section and, when determined necessary, may petition a court of competent jurisdiction and proper venue to judicially enforce any such rule.
Acts 2008, No. 518, §1, eff. June 30, 2008; Acts 2018, No. 206, §4; Acts 2022, No. 461, §2A.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.11. Purpose

RS 40:2199.11 - Purpose
The purpose of this Subpart is to protect public health and safety by establishing policies and practices through which incidents of workplace violence in healthcare settings can be properly addressed, mitigated, and, wherever possible, prevented.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.12. Definitions

RS 40:2199.12 - Definitions
As used in this Subpart, the following terms have the meaning ascribed to them in this Section:
(1) "Department" means the Louisiana Department of Health and any healthcare professional licensing board transferred to and placed within the department pursuant to R.S. 36:259(A).
(2) "Licensing board" means any board or commission that has the duty to license a regulated entity as defined in this Section.
(3) "Regulated entity" means any licensed healthcare facility listed in R.S. 40:2006(A)(2), a federally qualified health center as defined in R.S. 40:1185.3, a pharmacy permitted in accordance with Part IV of Chapter 14 of Title 37 of the Louisiana Revised Statutes of 1950, and any office of a healthcare provider at which five or more healthcare professionals, as defined in R.S. 14:34.8(B), treat patients and such office is not otherwise licensed by the state but provides healthcare services delivered by a licensee of a healthcare professional licensing board created in Title 37 of the Louisiana Revised Statutes of 1950.
(4) "Workplace violence" means violent acts, including battery or the intentional placing of another person in reasonable apprehension of sustaining battery, directed toward persons at work or on duty with their employment.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.13. Licensed healthcare facilities; signage addressing workplace violence required

RS 40:2199.13 - Licensed healthcare facilities; signage addressing workplace violence required
A. Each regulated entity shall display at its premises at least one sign that conforms with the specifications of Subsection B of this Section and indicates that abuse of or workplace violence against healthcare staff will not be tolerated and could result in a felony conviction under R.S. 14:38 or other applicable criminal laws.
B. Each sign displayed in accordance with the requirements of this Section shall conform with all of the following specifications:
(1) The sign shall be posted in a conspicuous location in a publicly accessible area of the regulated entity's facility.
(2) The sign shall be at least eighteen inches tall by eighteen inches wide and written in the English language with letters not less than one square inch in size.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.14. Healthcare workplace violence; public information

RS 40:2199.14 - Healthcare workplace violence; public information
A. The department shall develop, publish, and maintain public information regarding the issue of healthcare workplace violence on its website.
B. The information provided by the department pursuant to this Section shall include, at a minimum, all of the following:
(1) A listing of best practices, toolkits, and resources on the issue of healthcare workplace violence from governmental and private authorities including, without limitation, the Occupational Safety and Health Administration and the Joint Commission.
(2) Actions that regulated entities can take and policies that such entities can adopt to prevent, respond to, report, and mitigate healthcare workplace violence.
(3) A checklist of items for regulated entities to consider when developing a workplace violence prevention plan.
C. The website on which the department publishes information regarding healthcare workplace violence shall include a downloadable example of text that complies with the provisions of R.S. 40:2199.13(A) relative to signage required to be displayed at facilities of regulated entities.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.15. Healthcare workplace violence prevention plans

RS 40:2199.15 - Healthcare workplace violence prevention plans
A.(1) Each regulated entity shall develop and maintain a workplace violence prevention plan that includes, at minimum, all of the following resources:
(a) Resources for ongoing education on the issue of workplace violence.
(b) Resources for prevention of workplace violence.
(c) Resources on responding to incidents of workplace violence and debriefing with respect to such incidents and responses thereto.
(2) Each healthcare workplace violence prevention plan developed pursuant to this Section shall address and encompass all of the following:
(a) Personnel education and policies requiring all healthcare workers who provide direct care to patients to receive, at least annually, education and training in a format that provides an opportunity for interactive questions and answers with a person knowledgeable about the workplace violence prevention plan. The education and training delivered pursuant to a workplace violence prevention plan shall cover topics including but not limited to all of the following:
(i) How to recognize the potential for violence to occur.
(ii) When and how to seek assistance to prevent or respond to violence.
(iii) How to report violent incidents to law enforcement.
(iv) Resources available to employees for coping with incidents of workplace violence.
(b) A system for responding to and investigating violent incidents and situations involving violence.
(c) A system for regularly, and not less than annually, assessing and improving upon factors that may contribute to or help in preventing workplace violence. This system shall address, without limitation, all of the following aspects of the workplace:
(i) Staffing, including staffing patterns that may contribute to, or be insufficient to address, the risk of violence.
(ii) Sufficiency of security systems including alarms, emergency response systems, and availability of security personnel.
(iii) Job design, equipment, and facilities.
(iv) Security risks associated with particular units of the workplace, areas of the regulated entity's facility with uncontrolled access, late night or early morning shifts, and areas surrounding the facility such as employee parking areas.
(d) A requirement that the regulated entity maintain and make available to its employees a written safety and security plan.
B. The department may prescribe additional required content beyond the material required by Subsection A of this Section for workplace violence prevention plans.
C. Each regulated entity shall orient all permanent and temporary employees of the entity's facility to the workplace violence prevention plan of the entity.
D. Each regulated entity shall maintain its workplace violence prevention plan in effect at all times.
Acts 2022, No. 461, §1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.16. Acts of workplace violence at licensed healthcare facilities; reporting required

RS 40:2199.16 - Acts of workplace violence at licensed healthcare facilities; reporting required
A. Each regulated entity shall report to the proper authority, as required by the entity's workplace violence prevention plan, any instance of workplace violence that occurs on its property.
B. If an instance of workplace violence at a regulated entity's facility results in injury, involves the use of a firearm or other dangerous weapon, or presents an urgent or emergent threat to the welfare, health, or safety of facility personnel, the regulated entity shall report the incident within twenty-four hours.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.17. Retaliation in connection with reporting healthcare workplace violence; prohibition

RS 40:2199.17 - Retaliation in connection with reporting healthcare workplace violence; prohibition
A. No regulated entity shall take any retaliatory action against a person who, in good faith, reports an allegation of or an instance of workplace violence.
B. No regulated entity shall prohibit an employee from, or take punitive or retaliatory action against an employee for, seeking assistance and intervention from local emergency services or law enforcement when a violent incident occurs.
C. No regulated entity shall discharge, demote, suspend, threaten, or harass an employee, or discriminate against an employee in the terms and conditions of his employment, because of any lawful act engaged in by the employee, or taken on behalf of the employee, in reporting to law enforcement a crime or allegation involving workplace violence at the regulated entity's facility.
D. The employee protections provided for in this Section shall be in addition to, and shall not replace, any protections conferred by the provisions of Title 23 of the Louisiana Revised Statutes of 1950.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.18. Enforcement

RS 40:2199.18 - Enforcement
A. The department or a licensing board may take action against any license it has issued to a regulated entity or an owner of such an entity, up to and including license revocation, to enforce the provisions of this Subpart. The department may make appropriate referrals to other state or federal agencies and offices that may have jurisdiction over workplace violence or retaliation allegations.
B. With respect to enforcement of this Subpart, the department shall adopt rules and regulations in accordance with the Administrative Procedure Act to provide for all of the following:
(1) Penalties associated with violations of particular provisions of this Subpart.
(2) Notice to a regulated entity of a violation.
(3) An informal reconsideration process.
(4) An appeal procedure including judicial review.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2199.19. Rulemaking

RS 40:2199.19 - Rulemaking
The department and each licensing board shall promulgate in accordance with the Administrative Procedure Act all such rules as are necessary to implement the provisions of this Subpart.
Acts 2022, No. 461, §§1, 2B.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.1. Definitions

RS 40:2200.1 - Definitions
For the purposes of this Part, "Alzheimer's special care unit" means any adult residential care provider, as defined in R.S. 40:2166.3, or nursing home, as defined in R.S. 40:2009.2, that segregates or provides a special program or special unit for residents with a diagnosis of probable Alzheimer's disease or related disorder so as to prevent or limit access by a resident to areas outside the designated or separated area or that advertises, markets, or otherwise promotes the facility as providing specialized Alzheimer/dementia care services.
Acts 2008, No. 571, §1, eff. June 30, 2008.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.2. Dementia training; nursing facilities and Alzheimer's special care units

RS 40:2200.2 - Dementia training; nursing facilities and Alzheimer's special care units
A. All persons employed by a nursing home, as defined in R.S. 40:2009.2, shall be trained, in accordance with the provisions of this Section, in dementia training issues and practices that include or are informed by evidence-based care practices.
B. Training requirements for employees of a nursing home, as defined in R.S. 40:2009.2, who provide care on a regular basis to a resident in an Alzheimer's special care unit, shall be the following:
(1) Employees who provide nursing and nursing assistant care to residents shall be required to obtain at least eight hours of dementia specific training within ninety days of employment and five hours of dementia specific training annually. The training shall include an overview of Alzheimer's disease and related dementias, communicating with persons with dementia, behavior management, promoting independence in activities of daily living, and understanding and dealing with family issues.
(2) Employees who have regular communicative contact with residents but who do not provide nursing and nursing assistant care shall be required to obtain at least four hours of dementia specific training within ninety days of employment and one hour of dementia training annually. This training shall include an overview of dementias and communicating with persons with dementia.
(3) Employees who have only incidental contact with residents shall receive general written information provided by the facility on interacting with residents with dementia.
C. Training requirements for employees of a nursing home who provide care to residents not in an Alzheimer's special care unit shall be the following:
(1) Employees who provide nursing assistant care shall be required to obtain four hours of dementia training within ninety days of employment and two hours of dementia training annually thereafter.
(2) Employees who are not licensed and who have regular communicative contact with residents but who do not provide nursing assistant care shall be required to obtain four hours of dementia specific training within ninety days of employment and one hour of dementia training annually. The training shall include an overview of dementias and communicating with persons with dementia.
(3) Employees who have only incidental contact with residents shall receive general written information provided by the facility on interacting with residents with dementia.
D. Nothing herein shall be construed to increase the number of training hours required by the regulations promulgated by the Louisiana Department of Health and in effect on May 1, 2008.
Acts 2008, No. 571, §1, eff. June 30, 2008.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.3. Dementia training for adult residential care providers licensed by the Louisiana Department of Health

RS 40:2200.3 - Dementia training for adult residential care providers licensed by the Louisiana Department of Health
A. All persons employed by an adult residential care provider, as defined in R.S. 40:2166.3, shall be trained, in accordance with the provisions of this Section, in dementia training issues and practices that include or are informed by evidence-based care practices.
B. Training requirements for employees of an adult residential care provider who provide care to residents in an Alzheimer's special care unit shall be the following:
(1) Employees who provide direct face-to-face care to residents shall be required to obtain at least eight hours of dementia specific training within ninety days of employment and eight hours of dementia specific training annually. The training shall include an overview of Alzheimer's disease and related dementias, communicating with persons with dementia, behavior management, promoting independence in activities of daily living, and understanding and dealing with family issues.
(2) Employees who have regular contact with residents but who do not provide direct face-to-face care shall be required to obtain at least four hours of dementia specific training within ninety days of employment and two hours of dementia training annually. This training shall include an overview of dementias and communicating with persons with dementia.
(3) Employees who have only incidental contact with residents shall receive general written information provided by the facility on interacting with residents with dementia.
C. Training requirements for employees of an adult residential care provider who do not work with residents in an Alzheimer's special care unit shall be the following:
(1) Employees who provide direct face-to-face care to residents shall be required to obtain at least two hours of dementia specific training annually. This training shall include an overview of Alzheimer's disease and related dementias and communicating with persons with dementia.
(2) All other employees shall receive general written information provided by the facility on interacting with residents with dementia.
Acts 2008, No. 571, §1, eff. June 30, 2008.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.4. Approved dementia training

RS 40:2200.4 - Approved dementia training
Any dementia specific training received in a nursing or nursing assistant program approved by the Louisiana Department of Health or the Department of Children and Family Services may be used to fulfill the training hours required pursuant to this Part.
Acts 2008, No. 571, §1, eff. June 30, 2008.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.5. Rules and regulations

RS 40:2200.5 - Rules and regulations
By April 1, 2009, the Louisiana Department of Health shall promulgate rules and regulations, in accordance with the Administrative Procedure Act, necessary to implement this Part. Such rules and regulations shall include but not be limited to the qualifications of the training curriculum and appropriate penalties for violations of the training requirements. The department shall consult with and seek input from the Louisiana Alzheimer's Disease Task Force and the Department of Children and Family Services in the promulgation of such rules and regulations.
Acts 2008, No. 571, §1, eff. June 30, 2008.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.7.1. Legislative intent

RS 40:2200.7.1 - Legislative intent
A. The legislature hereby finds and declares that:
(1) It is the intent of the legislature that existing health programs and services educate healthcare professionals on the importance of early detection and timely diagnosis of cognitive impairment and dementia.
(2) It is in the public interest to provide information to increase understanding and awareness of Alzheimer's disease and other dementia diseases.
(3) It is the public policy of this state that healthcare providers in Louisiana have access to guidance and education outreach programs regarding Alzheimer's disease and other dementia diseases.
Acts 2021, No. 73, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.7.2. Alzheimer's and other dementia diseases training; rulemaking

RS 40:2200.7.2 - Alzheimer's and other dementia diseases training; rulemaking
A. The Louisiana Department of Health may in its existing public health programs and services educate healthcare providers on all of the following:
(1) The importance of effective care planning, including treatment options, support and services, long-term care options, advance directives, and care at every stage of Alzheimer's disease and other dementia diseases to include appropriate counseling.
(2) The use of validated cognitive assessment tools.
B. The office of public health within the Louisiana Department of Health may include provisions in its public health outreach programs that, at a minimum, address the following:
(1) Increasing the awareness of Alzheimer's disease and other dementia diseases including any link to chronic disease, such as vascular risk factors.
(2) Advising the public of the value of early detection of Alzheimer's disease and other dementia diseases along with information on the early signs of the diseases.
(3) Educating the public on the importance of identifying and reporting signs of Alzheimer's disease and other dementia diseases to healthcare providers for timely diagnosis.
(4) Increasing the data and surveillance applicable to Alzheimer's disease and other dementia diseases and encouraging additional data analysis and accurate reporting on death certificates.
C. The Louisiana Department of Health shall consult with the Louisiana chapter of the Alzheimer's Association and other experts, advocates, or associations to facilitate the distribution of educational materials that address Alzheimer's disease and other dementia diseases.
D. The Louisiana Department of Health may promulgate rules and regulations in accordance with the Administrative Procedure Act as are necessary to implement this Subpart. The rules and regulations may include but not be limited to the type of cognitive assessment tools available to healthcare providers. The department shall consult with and seek input from the Louisiana chapter of the Alzheimer's Association and other experts, advocates, or associations in the promulgation of the rules and regulations.
Acts 2021, No. 73, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2200.11. Surgical smoke plume evacuation policy required

RS 40:2200.11 - Surgical smoke plume evacuation policy required
A. For the purposes of this Section, "surgical smoke plume" means the byproduct of using heat-producing equipment on tissue during surgery.
B. Healthcare facilities licensed pursuant to this Chapter which provide any surgical procedure using heat-producing equipment, including but not limited to electrosurgery and lasers, shall adopt and implement policies for a surgical smoke plume evacuation plan to mitigate and remove the surgical smoke plume.
C. The Louisiana Department of Health shall verify compliance with this Section through onsite surveys that are specific to surgical services, full licensing surveys, full recertification surveys, and complaint surveys if allegations specific to surgical services are alleged.
Acts 2023, No. 35, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2201. Legislative considerations

RS 40:2201 - Legislative considerations
A. The legislature recognizes that health care costs have risen greatly over the past decade and must be contained without jeopardizing:
(1) The quality of care received by patients.
(2) The ability of health care providers to maintain, update, and expand their facilities to serve their patients and communities and to meet federal and state standards and regulations.
B. The legislature further recognizes that there must be some incentive for purchasers and providers to strive for more cost-efficient and effective methods of providing quality patient care and more efficient payment for services rendered.
C. Therefore, the state can assist in reducing health care costs by authorizing the formation of preferred provider organizations.
D. The legislature further recognizes that the state and governmental bodies can reduce the cost of providing health care benefits for their employees by contracting with a preferred provider organization.
Acts 1984, No. 374, §1, eff. July 6, 1984.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2203. Authorization for preferred provider organizations

RS 40:2203 - Authorization for preferred provider organizations
A. Any group purchaser may contract with any provider in any contractual agreement or agreements to form a preferred provider organization.
B. Such agreement shall not be construed to authorize a group purchaser to furnish medical services unless the purchaser is otherwise licensed to do so, nor shall such agreement authorize a group purchaser to direct or control the provision or selection of forms or types of medical services to the group members.
C. Group purchaser members participating in preferred provider organizations shall be guaranteed access to their standard benefits under the terms of their policy, employee benefits, self-funded organization benefits, or Taft-Hartley trust benefits, regardless of whether they choose a preferred provider or a provider who does not participate in the preferred provider contract.
D. Any entity serving as a broker or intermediary under the provisions of R.S. 40:2202(3)(b) who contracts to write or sell insurance shall be subject to the provisions of Title 22 of the Louisiana Revised Statutes of 1950. However, any entity which serves as a broker or intermediary for the formation of a preferred provider organization for a governmental body shall not be entitled to collect any fee for serving as such broker or intermediary under this Part.
E. Any person requiring emergency medical services shall be entitled to use any available provider without being denied the basic benefits provided under his policy or benefits program.
Added by Acts 1984, No. 374, §1, eff. July 6, 1984; Acts 2018, No. 206, §4.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2205. Utilization reviews; relief from liability and discovery; standards compliance

RS 40:2205 - Utilization reviews; relief from liability and discovery; standards compliance
Notwithstanding any other provision of law, any health care provider licensed in this state who participates in quality of care or utilization reviews by a peer review committee, as a peer review committee member or a treating health care provider whose patients are subject to such review and have been contracted, employed, or hired by a group purchaser shall be immune from liability for any act performed during such reviews of the activities of similarly licensed health care providers if such person acts without malice, makes a reasonable effort to obtain the facts, and believes that the action taken is warranted by the facts. A peer review committee shall not be subject to discovery, and no person in attendance at such reviews shall be required to testify as to what transpired at such reviews. The utilization review requirements and administrative treatment guidelines of the peer review committee employed or hired by the group purchaser shall not fall below the appropriate standard of care and shall not impinge upon the independent medical judgment of the treating health care provider.
Added by Acts 1991, No. 876, §1.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2206. Obstetrician or gynecological examination; coverage

RS 40:2206 - Obstetrician or gynecological examination; coverage
A.(1) Every preferred provider organization authorized under this Part shall not prevent any individual who is a recipient of health care or a beneficiary of any such preferred provider organization from selecting an empaneled obstetrician or gynecologist as a provider for routine gynecological care. This selection shall be permitted without penalty or denial of the benefits provided under the preferred provider organization.
(2) Routine gynecological care as used in this Section shall mean a minimum of two routine annual visits, provided that the second visit shall be permitted based upon medical need only, and follow-up treatment within sixty days following either visit if related to a condition diagnosed or treated during the visits, and any care related to a pregnancy. Nothing in this Section shall prevent a policy, program, or plan from requiring that an obstetrician-gynecologist treating a covered patient coordinate that care with the patient's primary care physician, if applicable.
B. Any provision in a preferred provider contract which is delivered, renewed, issued for delivery, or otherwise contracted for in this state which is contrary to this Section shall, to the extent of such conflict, be void.
Acts 1995, No. 637, §2.
NOTE: See Acts 1995, No. 637, §§3, 4.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2207. Requirements of provider contracts

RS 40:2207 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2208. Interpreter services for the deaf and hard of hearing; expenses; coverage

RS 40:2208 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2210. Prohibited discrimination; prenatal test results; genetic information

RS 40:2210 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2211. Definitions

RS 40:2211 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2212. Basic benefit plans

RS 40:2212 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2213. Lactation consultants; registry; qualifications

RS 40:2213 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2221. Definitions

RS 40:2221 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2222. Certification of organizations providing qualified plans

RS 40:2222 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2223. Limitations on implementation

RS 40:2223 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2231. Definitions

RS 40:2231 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2232. Rights of each enrollee

RS 40:2232 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2233. Participation in health care decisions

RS 40:2233 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2234. Responsibilities of an enrollee

RS 40:2234 - 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.
2023 Louisiana Laws › Revised Statutes › Title 40 - Public Health and Safety › §40:2241. Definitions

RS 40:2241 - 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.