Updated April 13, 2020
The Louisiana Department of Insurance (DOI) extended Emergency Rules 36 and 37 on April 8, 2020, which will remain in effect until May 12, 2020. These Rules are intended to provide greater access to healthcare by minimizing and streamlining processes and by expanding the use of (and reimbursement for) telemedicine services during the COVID-19 pandemic for both pandemic and non-pandemic related care. These Rules apply to providers of health insurance (health insurance issuers) licensed to and doing business in Louisiana. The Rules cover all types of care, not just that related to COVID-19.
Health insurance issuers must:
- All cost sharing, deductibles and prior authorization requirements for screening, testing and immunizations (when available) for COVID-19
- All provider coverage restrictions for telemedicine
- The “established patient” restrictions so providers can deliver telemedicine services to new patients
- Any requirements limiting coverage to provider-to-provider consultations (to only in-network providers)
- Allow out-of-network treatment (including pharmacy services and prescriptions)
- Permit telemedicine visits conducted by phone (audio only) or personal device
- Cover (and reimburse for) mental health services via telemedicine to the extent they would be covered in-person, except when those treatments are not appropriate for remote delivery
- Modify prescription drug coverage to:
- Suspend step therapy and pre-certification on prescriptions
- Allow early refills (with physician and/or pharmacist approval). (This does not apply to drugs prone to abuse.)
- Allow mail order prescriptions to be sent to an alternate address
The DOI regulates all health insurance issuers including:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Managed Care Organizations (MCO)
- Pharmacy Benefit Managers (PBM)
- Third Party Administrators (TPA)
It should be noted that the HHS and OCR have waived any potential claims of HIPAA violations during this emergency when made through good faith use of telemedicine, thus allowing providers to use any nonpublic facing remote communication product, such as Facebook Messenger, Skype and Apple FaceTime. For further details see the Notification of Enforcement Discretion on Telehealth Remote Communications.
As always the visit should be documented in full, along with the fact that the patient has verbally agreed to proceed by a telemedicine modality.
The DOI does not regulate Medicaid, Medicare, Medicare Advantage, Self-Insured or Workers’ Compensation policies in Louisiana. These agencies have already made changes to policy in response to COVID-19. The health insurance issuers’ current COVID-19 policies and procedures are available on their websites. Please review the Authorization, Coding and Billing Information for COVID-19 on the LAMMICO website. The health insurance issuers’ current COVID-19 policies and procedures are available on their websites. Please review the Telehealth Matrix for payor-specific policies and information.