§1077.4. Inpatient treatment following a perinatal psychiatric diagnosis; commercial
insurance
A.Any health benefit plan offered by a health insurance issuer that provides mental
health benefits with respect to treatment for perinatal psychiatric diagnoses shall provide
coverage for voluntary inpatient treatment for a patient with a perinatal psychiatric diagnosis.
Inpatient admissions, including overnight stays, and medications resulting from treatments,
including infusions and prescriptions, and counseling shall be covered services.
B.All decisions regarding voluntary inpatient treatment following a perinatal
psychiatric diagnosis shall be made solely by an attending physician, physician assistant,
psychiatrist, psychologist, medical psychologist, or nurse practitioner in consultation
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§1077.4. Inpatient treatment following a perinatal psychiatric diagnosis; commercial
insurance
A. Any health benefit plan offered by a health insurance issuer that provides mental
health benefits with respect to treatment for perinatal psychiatric diagnoses shall provide
coverage for voluntary inpatient treatment for a patient with a perinatal psychiatric diagnosis.
Inpatient admissions, including overnight stays, and medications resulting from treatments,
including infusions and prescriptions, and counseling shall be covered services.
B. All decisions regarding voluntary inpatient treatment following a perinatal
psychiatric diagnosis shall be made solely by an attending physician, physician assistant,
psychiatrist, psychologist, medical psychologist, or nurse practitioner in consultation with
the patient. All levels of maternal mental health inpatient treatment as provided for in this
Section shall be considered medically necessary and shall not be excluded from coverage.
The treating physician, physician assistant, psychiatrist, psychologist, medical psychologist,
or nurse practitioner shall consider recognized evidence based standards, such as guidelines
of InterQual or Milliman Care Guidelines (MCG), in making treatment recommendations.
Health insurance issuers shall not deny coverage for voluntary inpatient treatment for a
patient with a perinatal psychiatric diagnosis that is consistent with these standards.
C. Any voluntary admission covered by this Section shall be in accordance with R.S.
28:52.
D. The coverage required pursuant to this Section may be subject to annual
deductibles, coinsurance, and copayment provisions established under the health benefit plan.
E. For purposes of this Section, the following terms have the following meanings:
(1) "Health benefit plan" means any hospital, health, or medical expense, insurance
policy, hospital or medical service contract, employee welfare benefit plan, contract, or other
agreement with a health maintenance organization or a preferred provider organization,
health and accident insurance policy, or any other insurance contract of this type in this state,
including a group insurance plan and the Office of Group Benefits programs. "Health benefit
plan" does not include a plan providing coverage for excepted benefits as defined in R.S.
22:1061, limited benefit health insurance plans, and short-term policies that have a term of
less than twelve months.
(2) "Health insurance issuer" means an entity subject to the insurance laws and
regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or
offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of
healthcare services, including through a health benefit plan as defined in this Section, and
includes a sickness and accident insurance company, a health maintenance organization, a
preferred provider organization, or any similar entity, or any other entity providing a plan of
health insurance or health benefits.
(3) "Perinatal psychiatric diagnosis" means a psychiatric disorder requiring inpatient
treatment during pregnancy through one year postpartum, which includes one year after a
pregnancy loss.
F. The implementation of the provisions of this Section shall be subject to the
appropriation of funds by the legislature for this purpose.