§ 22:2187 — Actuarial reviews of proposed healthcare legislation

Louisiana § 22:2187

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§2187. Actuarial reviews of proposed healthcare legislation
A. On or before February first, the department shall retain by contract one or more
entities that have experience in actuarial reviews and healthcare policy for the purpose of
performing actuarial reviews of legislative proposals that may impose a new health benefit
coverage mandate on health benefit plans or reduce or eliminate coverage mandated under
health benefit plans. At least one of the contracted entities shall be an actuary or actuarial
firm or a Louisiana-based university department or academic faculty with experience
analyzing health insurance premiums. The department shall ensure that contractors are
independent and free from conflicts of interest that might affect the neutrality of the actuarial
reviews. The contractors, under the direction of the department, shall conduct actuarial
reviews of legislative proposals.
B. A member of the legislature who requests an actuarial review of a legislative
proposal shall submit the request to the department no later than December first of the year
preceding the regular session of the legislature in which the legislative proposal will be
proposed.
C. A contractor shall consider in its actuarial review the predicted effects of the
legislative proposal during the year immediately following the effective date of the legislative
proposal, or during another time period following the effective date of the legislative
proposal if such consideration is more actuarially feasible, including all of the following:
(1) An estimate of the number of state residents who will be directly affected by the
legislative proposal.
(2) Estimates of changes in the rates of utilization of specific healthcare services that
may result from the legislative proposal.
(3) Estimates concerning any changes in consumer cost sharing that would result
from the legislative proposal.
(4) Estimates of any increases or decreases in premiums charged to covered persons
or employers for health benefit plans offered in the individual, small group, and large group
markets that would result from the legislative proposal.
(5) An estimate of the out-of-pocket healthcare cost changes associated with the
legislative proposal.
(6) An estimate of the potential long-term healthcare cost changes associated with
the legislative proposal.
(7)(a) An estimate of the amounts necessary to defray the cost of the mandate for
health insurance products subject to state or federal laws requiring payments to defray such
costs, including an evaluation of whether the legislative proposal includes a mandate
requiring defrayal of costs.
(b) The department may seek the evaluation described in this Paragraph prior to
requesting the remaining actuarial review required by this Section.
(8) Identification of any potential health benefits for individuals or communities that
would result from the legislative proposal.
(9) To the extent practicable, the social and economic impacts of the legislative
proposal.
D. Contractors shall provide all of the following in the report of an actuarial review
performed pursuant to this Section:
(1) Information described in Paragraph (C)(4) of this Section in terms of percentage
increase or decrease and in terms of per-member, per-month charges.
(2) Information described in Paragraph (C)(5) of this Section in terms of dollar
amounts.
(3) Information described in Paragraph (C)(7) of this Section in terms of
per-member, per-month costs and monthly enrollment estimates by a health benefit plan.
(4) If available, information concerning who would benefit from any cost changes
and health benefits from the legislative proposal, as identified in Paragraphs (C)(3) through
(8) of this Section, and any disproportionate effects that the legislative proposal would have
on state residents, which information, if available, shall be disaggregated, at a minimum, by
race, ethnicity, sex, gender, and age.
(5) To the extent practicable, a qualitative analysis of the impact of the legislative
proposal. For purposes of this Paragraph, a member of the legislature who requests an
actuarial review of a legislative proposal pursuant to this Section may designate one or more
persons to provide data to the contractors in order to inform this qualitative analysis.
E. In performing actuarial reviews of legislative proposals, the contractors may
utilize data from any reasonable source, including data collected from insurers. Insurers shall
provide information to, and otherwise cooperate with, the contractors and the department for
purposes of this Section.
F. A request for an actuarial review pursuant to this Section and the final report
resulting from such a request shall be treated as confidential until the legislative proposal that
is the subject of the actuarial review is introduced in the regular legislative session following
submission of the request for the actuarial review or, if no such legislative proposal is
introduced, until after the end of the legislative session following the submission of the
request.
G. Upon enactment of any legislative proposal for which a defrayal cost has been
estimated pursuant to Paragraph (C)(7) of this Section, the department shall notify, in
writing, the commissioner of administration and the chairmen of the House Committee on
Appropriations and the Senate Committee on Finance of the estimated cost. Upon receipt
of the written notification, the commissioner of administration shall request an appropriation
to pay the estimated defrayal cost of each enacted legislative proposal prior to
implementation in the subsequent plan year.
H. Each year following initial implementation, the department shall require insurers
to provide actuarial estimates, based on appropriate claims and other data, of the
per-member, per-month amount necessary to defray the cost of the enacted mandate for the
subsequent plan year. After determining these estimates to be actuarially sound, the
department shall notify the commissioner of administration and the chairmen of the House
Committee on Appropriations and the Senate Committee on Finance of the amounts needed
to defray the cost of the enacted mandates for each health benefit plan. The commissioner
of administration shall request an appropriation to pay these amounts prior to implementation
in the subsequent plan year.
I. Nothing in this Section delegates or requires delegation of any state or federal
authority to a nonstate entity, including but not limited to the authority to request fiscal
impact analyses from the legislative fiscal office or the authority to make determinations
regarding the legal status of state benefit mandates pursuant to state and federal law.
J. Notwithstanding any other provision of law to the contrary, the department shall
not engage any contractor to perform an actuarial review as described in this Section unless
the department determines that there are adequate resources available within existing
appropriations to compensate the contractor for actuarial review.
K. Any claims, reimbursement, and other data, cost estimates, and other information
provided by a health insurer, health plan, or other health insurance issuer to a contractor, the
department, or any other entity pursuant to the provisions of this Section shall be kept
confidential.

Legislative History

Acts 2024, No. 714, §§1, 3.