2006 Louisiana Laws - RS 22:3073 — Procedure for application to act as an mnro

§3073.  Procedure for application to act as an MNRO

A.  Any applicant for licensure other than a health insurance issuer shall submit an application to the commissioner and pay the initial licensure fee specified in R.S. 22:3074(D).  The application shall be on a form and accompanied by any supporting documentation required by the commissioner and shall be signed and verified by the applicant.  The information required by the application shall include but need not be limited to the following:

(1)  The name of the entity operating as an MNRO and any trade or business names used by that entity in connection with making medical necessity determinations.

(2)  The names and addresses of every officer and director of the entity operating as an MNRO, as well as the name and address of the corporate officer designated by the MNRO as the corporate representative to receive, review, and resolve all grievances addressed to the MNRO.

(3)  The name and address of every person owning, directly or indirectly, five percent or more of the entity operating as an MNRO.

(4)  The principal place of business of the MNRO.

(5)  A general description of the operation of the MNRO which includes a statement that the MNRO does not engage in the practice of medicine or act to impinge or encumber the independent medical judgement of treating physicians or health care providers.

(6)  A copy of the MNRO's procedures manual which meets the requirements of this Chapter for making medical necessity determinations and resolving disputes on an internal and external basis.

(7)  A sample copy of any contract, absent fees charged, with a health insurance issuer, nonfederal government health benefit plan, or other group health plan for making determinations of medical necessity.

(8)  The names, addresses, and qualifications of individuals being designated to make adverse medical necessity determinations pursuant to this Chapter.

B.  A health insurance issuer holding a valid certificate of authority to operate in this state may be authorized to act as an MNRO under the requirements of this Chapter following submission to the commissioner of appropriate documentation for review and approval that shall include but need not be limited to the following:

(1)  A general description of the operation of the MNRO which includes a statement that the MNRO does not engage in the practice of medicine or act to impinge upon or encumber the independent medical judgement of treating physicians or health care providers.

(2)  A copy of the MNRO's program description or procedures manual which meets the requirements of this Chapter for making medical necessity determinations and resolving disputes on an internal and external basis.

(3)  A sample copy of any contract, absent fees charged, with another health insurance issuer for making determinations of medical necessity.

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

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