US Laws, Codes, Statutes & Cases

PART I-A.  PILOT PROGRAMS

§21.  Pilot programs; Department of Insurance; establishment

The Department of Labor and the Department of Insurance, conjunctively, after consultation with the office of workers' compensation administration in the Department of Labor, are hereby authorized to establish no more than five pilot health insurance programs, which may consist of groups or associations of employers for twenty-four-hour insurance coverage that shall terminate five years after the first date of operation of the program, unless extended by an act of the legislature.  The pilot program shall monitor the medical, hospital, and remedial care of employees and the provision of prompt, effective care and earlier restoration of earning capacity without diminution of the quality of that care of the injured or disabled employee.  In order to implement the pilot health insurance program for employees, the Department of Labor and the Department of Insurance, conjunctively, shall:

(1)  Initiate an initial pilot project for reimbursement to hospitals on diagnostic-related groups upon determination that it is cost-effective and a statistically valid method for reimbursement.

(2)  Establish alternate delivery systems using a health maintenance organization model, which includes physician fees, competitive bidding, or capitation models.

(3)  Provide for the selection of providers of medical, hospital, and remedial care and utilization review procedures established pursuant to R.S. 40:2725 to control the utilization of care by physicians providing treatment pursuant to R.S. 23:1121 through 1212.

(4)  Establish by written agreement all appropriate fees for medical, hospital, and remedial care pursuant to pertinent worker's compensation laws.

(5)  Promote effective and timely utilization of medical, hospital, and remedial care of and by insured persons under the pilot program.

(6)  Coordinate the duration of payment of disability benefits with a determination by qualified participating providers of medical, hospital, or remedial care.

(7)  Establish other methods of monitoring the reduction of costs within the worker's compensation system for health and disability care while maintaining a quality of care.

(8)  Provide public input and comment concerning the benefits, deductibles, pre-existing conditions exclusions, and related components of the health care portion of the twenty-four-hour employee insurance pilot program.

Acts 1993, No. 656, §1; Acts 1997, No. 1097, §1, eff. July 14, 1997.