Louisiana Revised Statutes 22:1203 – Creation of the plan
Terms Used In Louisiana Revised Statutes 22:1203
- Board: means the board of directors of the plan. See Louisiana Revised Statutes 22:1202
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1202
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1202
- Executive session: A portion of the Senate's daily session in which it considers executive business.
- Insurer: means any insurance company or other entity authorized to transact and transacting health and accident insurance business in this state. See Louisiana Revised Statutes 22:1202
- Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
- Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
- Member: means a person covered by the plan. See Louisiana Revised Statutes 22:1202
- Plan: means the Louisiana Health Plan as created in Louisiana Revised Statutes 22:1202
- Plan of operation: means the plan of operation of the plan, including articles, bylaws, and operating rules, adopted by the board pursuant to Louisiana Revised Statutes 22:1202
- Small employer: means any person, firm, corporation, partnership, or association actively engaged in business which, on at least fifty percent of its working days during the preceding year, employed not less than one nor more than twenty-five eligible employees. See Louisiana Revised Statutes 22:1202
A. There is hereby created a nonprofit entity to be known as the “Louisiana Health Plan” whose legal domicile shall be in the parish of East Baton Rouge. The plan shall perform its functions under the plan of operation established and approved pursuant to La. Rev. Stat. 22:1205 and shall exercise its powers through a board of directors established by La. Rev. Stat. 22:1204. For purposes of administration and assessment, the plan shall maintain three accounts:
(1) The state guarantee account for non-federally defined eligible individuals.
(2) The federal guarantee account for federally defined eligible individuals.
(3) The small employer insurance risk account for small businesses that employ at least one but not more than twenty-five employees.
B.(1) The plan is not and may not be deemed a department, unit, agency, instrumentality, commission, or board of the state for any purpose. All debts, claims, obligations, and liabilities of the plan, whenever incurred, shall be the debts, claims, obligations, and liabilities of the plan only and not the state, its agencies, instrumentalities, officers, or employees. The debts, claims, obligations, and liabilities of the plan may not be considered to be a debt of the state or a pledge of its credit.
(2) Notwithstanding the provisions of Paragraph (1) of this Subsection, and except as provided in Paragraphs (3) and (4) of this Subsection, the plan shall be subject to the provisions of La. Rev. Stat. 44: et seq. and La. Rev. Stat. 42:4.1 et seq., and may be considered as if it were a public body for the purposes of this Section.
(3) The plan may hold an executive session pursuant to La. Rev. Stat. 42:16 for discussion of one or more of the following, and La. Rev. Stat. 44:1 et seq. shall not apply to any documents as enumerated in La. Rev. Stat. 44:1(A)(2) which relate to one or more of the following:
(a) Names of patients provided to or maintained by the plan, or the administering insurer selected under the provisions of La. Rev. Stat. 22:1208.
(b) Matters protected by an attorney-client privilege.
(c) Matters with respect to claims or claims files, except documents contained in those files which are otherwise deemed public records.
(d) Prospective litigation against the plan after formal written demand, prospective litigation by the plan after referral to counsel for review, or pending litigation by or against the plan.
(e) Any other matter now provided for or as may be provided for by the legislature.
(f) Discussion by or documents in the custody or control of any committee or subcommittee of the plan, or any member, employee, or agent, or the board of directors or its members, employees, or agents, provided the discussion or documents would otherwise be protected from disclosure by any of the exceptions provided in this Paragraph.
(4) Any specific fee, procedure, or unit of service pricing information contained in any contract or the form of any contract made, between the plan and any provider of health care services, network of providers of health care services, or managed care plan shall be deemed confidential and shall not be divulged by the plan or the board except that payment may be disclosed and become public record in any legislative, administrative, or judicial proceeding or inquiry. Any information related to payments under a contract or the form of any contract for health care services other than specific fee, procedure, or unit of service pricing shall not be subject to the provisions of this Subsection.
C. The plan and the administering insurer shall be subject to audit by the legislative auditor in accordance with the provisions of La. Rev. Stat. 24:513.
D. There shall be no liability on the part of and no cause of action of any nature shall arise or exist against the plan, its agents or employees, its board of directors, or the commissioner or his representatives for any action taken by them in the performance of their powers and duties under Subpart J of Part III of this Chapter.
E.(1) Upon a finding that federal and state law no longer prohibits carriers in the individual market from rejecting applicants for health insurance coverage based on the presence of preexisting health conditions or excluding health care coverage for preexisting conditions, the commissioner may submit written notification to the Joint Legislative Committee on the Budget and the House and Senate committees on insurance of his intention to reactivate the Louisiana Health Plan. The notice shall include the commissioner’s reasoning for finding reactivation necessary and the proposed date for the plan to restart operations.
(2) Unless one of the committees notified by the commissioner convenes and votes to reject the commissioner’s proposal to reactivate the Louisiana Health Plan no later than thirty days after the written notice is received, the board provided for in La. Rev. Stat. 22:1205 shall reconvene and submit a new plan of operation to the commissioner for approval within ninety days of the date the written notice was submitted.
Acts 1990, No. 131, §1, eff. Sept. 1, 1990; Acts 1997, No. 1154, §1, eff. Jan. 1, 1998; Acts 1999, No. 163, §1; Acts 1999, No. 294, §1; Redesignated from La. Rev. Stat. 22:233 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2012, No. 271, §1; Acts 2020, No. 313, §1, eff. June 12, 2020.
NOTE: Former La. Rev. Stat. 22:1203 redesignated as La. Rev. Stat. 22:1623 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.