SUBPART A-2. NETWORK PROVIDER DIRECTORY

ACCESSIBILITY AND ACCURACY ACT

§1020.1. Short title; purpose; scope; definitions

A. This Subpart shall be known and may be cited as the "Network Provider Directory Accessibility and Accuracy Act".

B. The purpose and intent of this Subpart is to establish standards for the creation and maintenance by a health insurance issuer of a directory of the issuer's network of healthcare providers and to ensure the accessibility and accuracy of the directory.

C. This Subpart shall apply to all health insurance issuers that offer health benefit plans in this state but shall not include excepted benefits policies as defined in R.S. 22:1061(3).

D. As used in this Subpart:

(1) "Commissioner" means the commissioner of insurance.

(2) "Covered person" means a policyholder, subscriber, enrollee, insured, or other individual participating in a health benefit plan.

(3) "Department" means the Department of Insurance.

(4) "Health benefit plan" means a policy, contract, certificate, or subscriber agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services.

(5) "Healthcare facility" means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic health settings.

(6) "Healthcare professional" means a physician or other healthcare practitioner licensed, certified, or registered to perform specified healthcare services consistent with state law.

(7) "Healthcare provider" or "provider" means a healthcare professional or a healthcare facility.

(8) "Healthcare services" means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

(9) "Health insurance issuer" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits.

(10) "Network of providers" or "network" means an entity, including a health insurance issuer, that, through contracts or agreements with healthcare providers, provides or arranges for access by groups of covered persons to healthcare services by healthcare providers who are not otherwise or individually contracted directly with a health insurance issuer.

Acts 2018, No. 290, §1, eff. Jan. 1, 2019.