2011 Louisiana Laws
TITLE 42 — Public officers and employees
RS 42:854 — Fee schedules; discounts
§854. Fee schedules; discounts
A.(1) The Office of Group Benefits shall adopt and promulgate a schedule of maximum fees for medical and surgical services and professional services provided in hospitals. The fees shall be determined by, or on behalf of the board, and shall be limited to the usual and customary charges for the medical services.
(2)(a) Health care providers may specifically agree in writing with the Office of Group Benefits to accept the fees determined by the Office of Group Benefits' fee schedule as their sole reimbursement for medical services, treatment, or health care. In the absence of a specific written assignment agreement with the Office of Group Benefits to limit his reimbursement to the amount authorized by the fee schedule, a health care provider may receive direct reimbursement from the Office of Group Benefits for the amount established by the fee schedule and may bill the plan member or covered patient directly for the balance of the fees charged.
(b) When required laboratory, radiology, or other diagnostic services or physical, occupational, or speech or hearing therapy are to be provided by a medical, hospital, or surgical provider, or preferred provider organization which is known by the referring health care provider to not be a provider in the Office of Group Benefits preferred provider network, the plan member or covered person shall be informed by the referring health care provider, prior to a referral for such services, that such referral may necessitate additional expense not paid by the plan.
(3) Any "signature on file" claim made by a health care provider shall be treated as a valid act of assignment of benefits between the provider and the plan member or covered patient. A health care provider filing a "signature on file" claim shall not bill the plan member or covered patient directly for the balance of the fees charged.
(4) If there is no assignment of benefits and there are no specific instructions otherwise by the plan member, a claim for reimbursement may be submitted to the Office of Group Benefits by the plan member, by the covered patient, or by the health care provider. In the absence of an assignment of benefits or any specific instructions otherwise by the plan member, a health care provider may also bill the plan member or covered patient directly for the balance of the fees charged over and above the amount established by the fee schedule.
(5) The reimbursement paid to the member by the Office of Group Benefits shall be determined by the fee authorized by the schedule. Adjustments to the fee schedule may be made by the office.
B. Health care providers may agree in writing to the office to provide medical, surgical, and hospital services or medical equipment or pharmaceuticals at a reduced rate for members of the Office of Group Benefits programs. The office shall promulgate a list of such health care providers; the services, equipment, or pharmaceuticals that have been offered at a reduced rate for members; and the rate at which those services, equipment, or pharmaceuticals have been offered. Services, equipment, or pharmaceuticals for which the office has promulgated a fee schedule must be offered at a rate lower than the charge listed on the schedule in order to qualify for inclusion in the discount list.
C. Notwithstanding any other provision of law to the contrary, any money received by or under the control of the Office of Group Benefits shall not be used, loaned, or borrowed by the state for cash flow purposes or any other purpose inconsistent with the purposes of or the proper administration of the Office of Group Benefits.
Acts 2001, No. 1178, §5, eff. June 29, 2001.
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