Louisiana Revised Statutes 40:2204 – Hospital participation; tangible benefit presumed
Terms Used In Louisiana Revised Statutes 40:2204
- Contract: A legal written agreement that becomes binding when signed.
- Governmental body: means any department, commission, council, board, office, bureau, committee, institution, agency, government, corporation, or establishment of the executive branch of this state. See Louisiana Revised Statutes 40:2202
- Group purchaser: shall mean an organization or entity which contracts with providers for the purpose of establishing a preferred provider organization. See Louisiana Revised Statutes 40:2202
- Hospital: shall mean any institution, place, building, or agency, public or private, whether for profit or not, including a facility subject to the jurisdiction of a hospital service district, devoted primarily to the maintenance and operation of facilities for ten or more individuals for the diagnosis, treatment, or care of persons admitted for overnight stay or longer who are suffering from illness, injury, infirmity, deformity, or other physical condition for which obstetrical, medical, or surgical services would be available and appropriate. See Louisiana Revised Statutes 40:2202
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Oversight: Committee review of the activities of a Federal agency or program.
- Provider: shall mean one or more entities which offer health care services and shall include but not be limited to hospitals, individuals, or groups of physicians, individuals or groups of psychologists, nurse midwives, ambulance service companies, and other health care entities. See Louisiana Revised Statutes 40:2202
- Tangible benefit: shall mean but not be limited to:
(a) Any reasonable expectation of a demonstrable increase in or maintenance of usage of the provider's services. See Louisiana Revised Statutes 40:2202
A. Whenever any hospital or governmental body is a party to a preferred provider organization contract, there shall be a rebuttable presumption that such hospital or governmental body contracted with the expectation of receiving a tangible benefit rather than making a donation of services in violation of La. Const. Art. VII, § 14(A) of Louisiana.
B. Unless clearly indicated otherwise in a preferred provider organization contractual arrangement, it shall be presumed that the hospital, governmental body, or other provider negotiated the contract with the knowledge that such agreement would result in a tangible benefit to the hospital or governmental body and would not constitute a donation of its services to a group purchaser in violation of the Constitution of Louisiana, Article VII, Section 14(A).
C. Whenever a hospital or governmental body is a party to a preferred provider organization contract, the provisions of La. Rev. Stat. 39:1481 et seq. shall not apply.
D.(1) The state, or any agency of the state authorized by law to contract with or develop preferred provider organizations or other managed health care arrangements, including the Office of Group Benefits, when interested in developing or participating in a preferred provider organization or other managed care arrangement, shall develop criteria governing the state’s or the agency’s contracting with health care providers or with preferred provider organizations or other managed care arrangements. All such criteria shall be approved by the appropriate standing committees of the legislature having jurisdiction over review of that agency’s rules, or the subcommittees on oversight of such standing committees, and the office of state procurement of the division of administration.
(2) Each agency authorized by law to develop or contract with preferred provider organizations or other managed care arrangements shall promulgate rules and regulations to establish a process through which notice of intent to contract with health care providers, preferred provider organizations, or other managed care arrangements is given. The rules and regulations shall contain provisions requiring written or published notice of the agency’s intent to seek contracts for the requested services and the availability, upon request, of a detailed explanation of the services sought and of the criteria that are to be used in developing contracts. There shall be a written public announcement of the contractor or contractors awarded the contract. Upon request, any entity submitting a proposal which is not accepted shall be furnished a written explanation for the agency’s action. Any contract executed in violation of rules and regulations promulgated under this Subsection shall be void.
(3) All contracts shall be approved by the chief executive officer in the Office of Group Benefits.
(4) The provisions of this Section shall not be applicable to the Louisiana Department of Health.
Added by Acts 1984, No. 374, §1, eff. July 6, 1984. Amended by Acts 1990, No. 585, §1, eff. July 19, 1990; Acts 1992, No. 864, §1; Acts 1993, No. 783, §1; Acts 2001, No. 1178, §4, eff. June 29, 2001; Acts 2014, No. 864, §§4 and 5.