§ 22:2221 — Pilot programs; Department of Insurance; establishment

§2221. Pilot programs; Department of Insurance; establishment
Louisiana Works and the Department of Insurance, conjunctively, after consultation
with the office of workers' compensation administration in Louisiana Works, are hereby
authorized to establish no more than five pilot health insurance programs, which may consist
of groups or associations of employers for twenty-four-hour insurance coverage. The pilot
program shall monitor the medical, hospital, and remedial care of employees and the
provision of prompt, effective care and earlier restoration of earning capacity without
diminution of the quality of that care of the injured or disabled employee. In order to
implement the pilot health insurance program for employees, Louisiana Works and the
Department of Insurance, conjunctively, shall:
(1) Initiate an initial pilot project for reimbursement to hospitals on diagnostic-related groups upon determination that it is cost-effective and a statistically valid method for
reimbursement.
(2) Establish alternate delivery systems using a health maintenance organization
model, which includes physician fees, competitive bidding, or capitation models.
(3) Provide for the selection of providers of medical, hospital, and remedial care and
utilization review procedures established pursuant to R.S. 40:2725 to control the utilization
of care by physicians providing treatment pursuant to R.S. 23:1121 through 1212.
(4) Establish by written agreement all appropriate fees for medical, hospital, and
remedial care pursuant to pertinent workers' compensation laws.
(5) Promote effective and timely utilization of medical, hospital, and remedial care
of and by insured persons under the pilot program.
(6) Coordinate the duration of payment of disability benefits with a determination
by qualified participating providers of medical, hospital, or remedial care.
(7) Establish other methods of monitoring the reduction of costs within the workers'
compensation system for health and disability care while maintaining a quality of care.
(8) Provide public input and comment concerning the benefits, deductibles, pre-existing conditions exclusions, and related components of the health care portion of the
twenty-four-hour employee insurance pilot program.

Legislative History

Acts 1993, No. 656, §1; Acts 1997, No. 1097, §1, eff. July 14, 1997; Redesignated from R.S. 22:21 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2008, No. 743, §7, eff. July 1, 2008; Acts 2012, No. 271, §1.