Louisiana Department of Insurance Issues Emergency Rule Amid Coronavirus Outbreak

To address the public health emergency in Louisiana as a result of the novel coronavirus (COVID-19), the Louisiana Department of Insurance has issued Emergency Rule 36. Here is a breakdown of the rule:

When is the rule effective?

Emergency Rule 36 became effective on March 17 and will continue until April 9, which is the date the State of Emergency issued by Gov. John Bel Edwards is set to expire.

To whom and what does the rule apply?

Emergency Rule 36 applies to:

• all health maintenance organizations (HMOs), managed care organizations (MCOs), preferred provider organizations (PPOs), pharmacy benefit managers, third party administrators and any other health insurance entity doing business in Louisiana and/or regulated by the Commissioner
• all types of health insurance
• all insureds with a policy that was in effect as of 12:01 a.m. on March 17, 2020

What does the rule do?

Emergency Rule 36 requires all health insurance issuers in Louisiana to do the following:

• Waive Cost-Sharing, Prior Authorizations and Restrictions for COVID-19 Testing: Under the rule, insurers must waive cost-sharing requirements (e.g., copayments, coinsurance, and deductibles) for COVID-19 screening and testing when ordered in accordance with CDC guidelines. This includes fees for hospital, emergency department, urgent care, telehealth, telemedicine and provider office visits, as well as for lab testing and any immunizations that are made available. Insurers must also waive any prior-authorization requirements or restrictions for COVID-19 screening and diagnostic testing. Finally, insurers are required to notify their contracted providers and their own customer service centers and nurse advice lines of these waivers so that accurate information is relayed to insureds.
• Enhance Access to Prescription Drugs: Under the rule, insurers must permit early prescription refills, except for drugs in certain drug classes like opioids, when consistent with doctor and/or pharmacist approvals. Insurers are also required to prohibit the use of precertification or step-therapy procedures (i.e., requiring members to try cheaper drugs first before stepping up to more expensive medications) in order to fill a prescription for a 30-day supply, and they must waive any restrictions on out-of-network access to pharmacy services or prescriptions. Finally, the rule enhances access to mail order pharmaceuticals by suspending Insurance Code provisions that restrict replacement prescriptions pertaining to mail order prescriptions. It also mandates that mail order prescriptions be sent to an alternate address upon request by the insured.
• Continue to Ensure Network Adequacy:The rule specifically directs insurers to verify that their provider networks are adequate to handle the anticipated increase in demand for health care services due to COVID-19.

Are there any sanctions or penalties for violating the rule?

Emergency Rule 36 provides that any health insurance issuer who violates the rule shall be subject to regulatory action by the Commissioner in accordance with the provisions of the Insurance Code.

Where can I read the rule?

The Louisiana Department of Insurance posted a copy of Emergency Rule 36 on its website. Additionally, other COVID-19 resources can be found on the Louisiana Department of Insurance website.

The Phelps Health Care team will continue to monitor Louisiana’s legislative and regulatory responses to COVID-19.