§ 22:1209 — Service charges

Louisiana § 22:1209

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

NOTE: See Subsection H and R.S. 22:1203(E)(2) regarding eff. date of this Section.
§1209. Service charges
A.(1) Each patient who is not a private-pay patient, is not covered by Medicare or
any other public program, is not covered by the Office of Group Benefits program, and is not
covered by an insolvent insurer who is admitted to a hospital for treatment, other than
psychiatric care or alcohol or substance abuse, shall be assessed a service charge in the
amount provided in Subsection G of this Section for each day or portion thereof during
which the patient is confined in that facility.
(2) Each hospital in which a patient is confined shall calculate the total service
charge due for that patient's period of confinement and shall include the total service charge
in the bill for services rendered to the patient. The individual patient may be obligated to pay
the service charge assessed in the event that an insurance arrangement pays for any medical
charges or benefits but fails to pay the service charge assessed pursuant to this Section. The
service charge shall be collected as provided for in the plan of operation of the plan
established pursuant to R.S. 22:1205.
(3) For purposes of this Section, "hospital" shall not include any hospital operated
by the state or any hospital created or operated by the Department of Veterans Affairs or
other agency of the United States of America or any facility operated solely to provide
psychiatric care or treatment of alcohol or substance abuse or both.
B. Each patient who is not a private-pay patient, is not covered by Medicare or any
other public program directly subsidized by the federal government, is not covered by the
Office of Group Benefits program, and is not covered by an insolvent insurer who is admitted
to an ambulatory surgical center or to a hospital for outpatient ambulatory surgical care shall
be assessed a service charge of one dollar for each admission to that facility. The service
charge shall be included in the bill for services or supplies or both rendered to the patient by
the ambulatory surgical center or hospital.
C.(1) Each hospital and ambulatory surgical center shall bill for and collect the
service charges assessed pursuant to this Section from monies remitted to it in payment
thereof in accordance with R.S. 22:1216, if authorized by the plan of operation under R.S.
22:1205. In the event that no payment is made by or on behalf of the patient for services
rendered, the health care provider shall be liable for the remittance of only those fees
collected. Each hospital and ambulatory surgical center shall remit to the plan for each
reporting period, as established in the plan of operation, the total amount of service charges
collected during that reporting period in accordance with the reporting and remittance
procedures established by the plan pursuant to R.S. 22:1205.
(2) Unless permitted by the board, the intentional failure to bill, pay, report, or
delineate service charges in accordance with this Section shall cause the hospital or
ambulatory surgical center to be liable to the plan for a fine in an amount determined by the
board, not to exceed five hundred dollars plus interest per failure. Any hospital or ambulatory
surgical center found to have intentionally failed to bill, pay, report, or delineate service
charges in accordance with this Section, unless permitted by the board, on three or more
occasions during a six-month period shall be liable for a fine in an amount determined by the
board, not to exceed one thousand five hundred dollars per failure, together with attorney
fees and court costs.
(3) The plan or the commissioner or both are specifically authorized to conduct
audits of hospitals and ambulatory surgical centers in order to enforce compliance with this
Section. Fines levied pursuant to this Section shall be consistent with those levied against
insurers pursuant to this Subpart.
D. The service charges imposed on hospital and ambulatory surgical center patients
by this Section shall be payable by the patient's insurer or insurance arrangement, if any, as
applicable, except the charges shall not be payable by an insolvent insurer. In no event shall
a hospital or ambulatory surgical center be required to remit to the plan uncollected service
charges for any patient who is a private-pay patient or for any patient whose insurer or
insurance arrangement is not legally required to pay the service charges.
E. If monies in the plan at the end of any fiscal year exceed actual losses and
administrative expenses of the plan, the excess shall be held at interest and used by the board
to offset future losses. As used in this Subsection, "future losses" includes reserves for
incurred but not reported claims.
F. For the purposes of this Section, "insurance", "insurance arrangement", or "policy
of an insurer" includes any policy or plan of insurance or of self-insurance that provides
payment, indemnity, or reimbursement for charges resulting from accident, injury, or illness
when an employer or insurer is responsible for those charges. The terms "insurance",
"insurance arrangement", or "policy of an insurer" shall not include short-term, accident-only,
fixed indemnity, credit insurance, automobile and homeowner's medical payment coverage,
or coverage issued as a supplement to liability insurance.
G. The service charge required by this Section shall be an amount set by the
commissioner upon approval of the plan provided for in R.S. 22:1203(E)(2) and annually
thereafter. The commissioner shall establish the amount of the service charge by rule
promulgated in accordance with the Administrative Procedure Act no later than August
thirty-first of the calendar year preceding the implementation of the service charge. The
charge shall apply only to dates of service falling in the calendar year following promulgation
of the rule. In establishing the service charge, the commissioner shall determine the amount
necessary to fund the plan provided for in R.S. 22:1203(E)(2) but shall not establish a service
charge in excess of three dollars plus an inflation factor of four percent per annum.
H. This Section shall not be effective until approval of the plan provided for in R.S.
22:1203(E)(2).

Legislative History

Acts 2020, No. 313, §1, eff. June 12, 2020.