2006 Louisiana Laws - RS 22:3070 — Medical necessity

CHAPTER 7.  MEDICAL NECESSITY

REVIEW ORGANIZATIONS

§3070.  Legislative findings; purpose; short title

A.  Without standards for entities that determine the medical necessity of health care services, Louisianians may face unreasonable delays or denials of requests for coverage from their health benefit plans.

B.  Health insurance issuers are not authorized by law to engage in the practice of medicine or adopt administrative treatment guidelines that impinge upon or encumber the independent medical judgment of treating physicians or health care providers.

C.  Only entities that are licensed to practice medicine or otherwise authorized by law to determine what medical services or procedures are medically necessary for an individual should be allowed to make medical necessity determinations.

D.  The purpose of this Chapter is to establish the minimum standards required for any entity that determines what medical services or procedures will be covered under a health benefit plan based on medical necessity.

E.  This Chapter shall be known and may be cited as the "Medical Necessity Review Organization Act".

Acts 1999, No. 401, §1, eff. Jan. 1, 2000.

NOTE:  See Acts 1999, No. 401, §2, regarding applicability.