LouisianaSB 4042026 Regular SessionSenateWALLET

HEALTH CARE: Provides relative to eye care providers. (gov sig) (EN INCREASE SG EX See Note)

Sponsored By: Patrick McMath (Republican)

Signed by Governor

Health and Welfare

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Bill Overview

Analyzed Economic Effects

27 provisions identified: 24 benefits, 0 costs, 3 mixed.

Equal eye care coverage and copays

Covered plans must provide equal benefits and provider payments for the same eye care from an optometrist or physician. This applies when both professions can legally provide the service. Plans cannot charge patients higher copays, coinsurance, or other fees because an optometrist provides that service.

Fewer approval barriers for eye patients

Plans cannot require prior approval that restricts access to covered eye care services or materials. The protection applies when an eye care provider recommends the care and the patient requests it. It does not add coverage for items the plan does not cover.

Payment floors protect eye care providers

Allowed amounts for covered eye care must meet the current-year Medicare physician fee schedule. If its rate is missing or zero, the current-year Louisiana Medicaid rate sets the floor. If both rates are missing or zero, amounts must be reasonable, not token payments. Plans must pay optometrists at least as much as medical or osteopathic doctors for the same covered care within their scope. Plans must remit contracted payments when providers verify eligibility on the service date using the plan’s usual methods.

Patients get truthful vision plan claims

Plans cannot mislead the public about benefits, regional provider counts, or participating providers; deceptive advertising is an unfair practice. They cannot call covered care “free,” “no charge,” or “complimentary” to induce purchases from themselves or affiliates. Plans cannot describe care as covered unless they actually pay the participating provider at least part of the cost. Specified provider comparisons based on discounts, purchasing, or product sources must be readily verifiable by the Louisiana Department of Insurance. Plans must supply information about claimed affiliate savings and discounts when an enforcement agency requests it.

Stronger privacy protections for eye patients

Plans cannot demand protected health information without patient permission unless federal health privacy law permits disclosure without permission. They cannot require medical history or a diagnosis for routine or wellness eye exams. Requests for prescriptions, device measurements, or facial images are limited, with exceptions for making a covered product on a claim. Other required information is limited to the National Uniform Claim Committee form approved as of March 1, 2023, or its approved successor, subject to stated legal exceptions.

Vision plans disclose ownership and complaints

Vision insurers and managers must disclose their identities, addresses, ownership, regulatory oversight, lawsuits, and formal insurance department complaints. Lawsuit and complaint disclosures cover the current year and the previous five years. The information must appear prominently on a public website under “Required Transparency Information for Patients, Doctors, and Purchasers.” An identical separate document must accompany specified materials for purchasers, members, providers, and state agencies. Disclosures must use plain language and at least 10-point type.

Clearer eye care prices and coverage

Plans must use standard service codes and descriptions in fee schedules and coverage information for members and purchasers. They cannot misuse these codes or change their meaning; violating terms are unenforceable. Provider contracts must list each covered service or item, its allowed amount, provider payment, and patient cost sharing. Plans must share fee schedules when offering contracts and within 10 business days after a provider applies. Schedules must also remain available electronically at all times.

Clearer plan information for eye patients

Plans cannot block providers from seeing patients' full coverage details, including in-network and out-of-network benefits. Fee schedules must list each covered item using standard codes, with individual allowed payments and patient copays or coinsurance. Plans must provide schedules when offering contracts, within 10 business days of a patient's application, and electronically at all times. Public disclosures must identify plan operators, owners, regulators, litigation, and formal insurance complaints for the current year and previous five years. Plans cannot misrepresent benefits or call care free when payment will not be sent.

Patients can receive cheaper direct-pay offers

Participating eye care providers can offer direct payment for covered care when it costs less than the patient’s total plan out-of-pocket cost. Providers do not have to offer this option. Plans cannot audit, remove, penalize, or discriminate against providers for making a qualifying offer.

Vision protections apply by January 2027

The law sets the start dates for these protections in covered Louisiana plans and provider agreements. They begin at the earliest of plan renewal, new plan issuance, a provider agreement starting or changing, or January 1, 2027. Covered policies, contracts, addenda, and certificates include those issued, delivered, continued, or renewed in Louisiana.

Eye care providers get application deadlines

Plans must post application steps online and use fair requirements and standardized Louisiana or CAQH credentialing information. They must report known application defects within 30 business days, send contract materials within 40, and finish credentialing within 90. Denials must include detailed explanations sent electronically and by certified mail. Providers can appeal within a reasonable period, and plans must decide within 30 days. After another denial, providers receive the same written notice and can appeal to the Louisiana insurance commissioner.

Eye providers gain stronger dispute protections

Contracts cannot force providers to split arbitration expenses equally; each side pays its own costs, subject to fee-shifting rules. Plans cannot retaliate against providers for good-faith negotiations or complaints to a state agency that oversees them. The insurance commissioner can impose fines and other remedies for retaliation. Affected providers can sue for court orders, damages, and reasonable attorney fees, with statutory penalties capped at $10,000 per violation.

Eye providers keep clinical and supplier choices

Plans cannot control providers' professional judgment or practices, or employ providers to furnish covered care. They cannot restrict choices of labs, suppliers, equipment, affiliations, software, or billing services. Contracts cannot limit the sources used for covered or uncovered care. Plans also cannot vary covered-care payments because of those choices.

Eye providers keep verified claim payments

Plans cannot withhold or take back covered-care payments when the patient was shown eligible on the service date. Providers also keep protection when they relied in good faith on coverage documents and the plan's usual eligibility checks. That protection applies even if the patient is later found ineligible on the service date. Plans cannot change claim codes or modifiers to lower payment or otherwise harm providers or patients, including through downcoding or bundling. Contracted payment is due on the service date when eligibility is verified.

Fairer network access for eye providers

Licensed optometrists get the same chance to join covered plans as physicians, and participation terms must be equal across educational credentials. Plans cannot require providers to join another network or keep, offer, or sell materials in their offices. A provider already in one network cannot be blocked from joining another network offered by the same organization. Plans cannot exclude providers based on local provider numbers, patient travel time or distance, appointment availability, professional title, independent practice, or other plan participation. They also cannot reject health-center or rural-clinic providers based on practice setting, ownership, clinic designation, or participation through the clinic.

Fairer payment audits for eye providers

Plans cannot use sample results to estimate errors across a provider's broader set of claims. Audit payments or refunds must reflect actual overpayments or underpayments found through investigation, after all applicable appeals are exhausted. Contract recovery periods must match the time allowed or required to pay clean claims. This timing rule does not block audits for reasonably suspected fraud, waste, or abuse, which remain subject to written policies and law.

Plans cannot control uncovered care prices

Plans cannot set or limit provider fees unless the services or materials are defined and paid as covered items. They cannot base covered-care payment schedules on a provider's prices or discounts for uncovered care. Plans also cannot call an item covered when the provider receives only the patient's payment. These rules do not guarantee lower prices for patients.

Providers get faster answers from plans

Plans must maintain a provider phone line during business hours, allow voicemail anytime, and offer live discussion within 24 hours. They must publish mail and email contact instructions, acknowledge provider emails within one hour with a tracking number, and answer substantive emails within 72 hours. These deadlines apply to providers, not patient calls or emails. Current agreements, fee schedules, handbooks, manuals, and related policies must remain accessible to providers online. Contracts sent to current or prospective providers must include the current manuals and policies they reference.

Providers get time to review changes

Plans must email proposed changes to provider agreements, fee schedules, handbooks, manuals, and related policies. Providers get at least 90 calendar days from distribution to review and respond. Plans must itemize changes in a cover letter, mark the edits, and explain the effects of accepting or rejecting them. Amendments issued without the required review period are void and unenforceable.

Qualified eye care providers can join

Plans must accept eye care providers who meet credentialing rules and agree in writing to the provider contract. For practices using one employer or tax ID, one qualifying signer meets this participation rule for the practice’s eye care providers. Within 20 business days after signing, plans must add approved providers to the network and public and member directories. Plans cannot condition participation on providers’ usual prices or discounts for care the plan does not cover. Terms violating that pricing protection are unenforceable.

Safer contracts for eye care providers

Contracts last no more than two years from both signatures, stay separate from credentialing papers, and cannot be renewed through re-credentialing alone. Plans must give at least 90 days' notice of changes by certified letter or confirmed electronic message, show tracked changes, and offer a requested meeting. Providers must respond in writing; rejection keeps the current contract in place without removal for that reason, and three or more material changes require a new agreement. Plans can terminate only for a material breach left unfixed to their reasonable satisfaction within 30 days after written notice. Plans cannot require providers to pledge property or practice assets for money allegedly owed when an agreement ends.

Stronger payment protections for eye providers

Covered-care payments cannot be token amounts, and minimum allowed amounts follow the current Medicare physician fee schedule. When Medicare lists no amount or zero, Louisiana Medicaid rates apply; if neither provides a positive amount, payments must be reasonable. Contracts cannot require covered care at a financial loss after deductibles, copays, coinsurance, discounts, rebates, and chargebacks are counted. Plans cannot force optometrists to accept payment methods that charge processing or administrative fees. Plans also cannot impose chargebacks on patients or providers for covered items or services whose costs the plan did not incur.

Patients and providers gain enforcement protections

The Louisiana Department of Insurance must provide a complaint process for current and former vision-plan members and can enforce these rules. The attorney general also enforces unfair or deceptive practices and must enforce the discount-card-plan rules. Plans must provide requested plan, contract, sales, and advertising information to state agencies with authority over them. Eye care providers harmed by violations can sue for court orders stopping them. Winning providers can recover direct, indirect, special, and punitive damages and penalties, capped at $10,000 per violation, plus attorney fees and costs.

Eye care protections follow outsourced services

Plans cannot ask providers to opt in to or out of these protections. Applicable rules also cover plan agents, service agreements, and affiliates or subcontractors supplying covered care, including applicable penalties. Provider-to-provider subcontracts must comply when they provide licensed care to members or covered dependents and seek plan or patient payment. The protections add to existing insurer rules; stronger protections control conflicts unless federal law overrides them, and provider scopes of practice stay unchanged. The new Part applies at the earliest of plan renewal or new issuance, provider-contract initiation or modification, or January 1, 2027.

Less steering, fewer provider-linked patient rewards

Plans cannot use different deductibles, copays, coinsurance, or coverage amounts to steer patients to particular participating or affiliated providers or retailers. The ban also covers rebates, gift cards, and other financial or nonfinancial rewards. It applies to covered and noncovered eye care, including affiliated online sellers. This limits financial steering but also removes those provider-linked incentives.

Provider application deadlines and reapplication waits

Plans must post application instructions and use Louisiana's standard credentialing form or the CAQH form. Plans must identify missing information within 30 business days and provide a proposed contract and fee schedule within 40 business days of a complete application. They must decide credentialing within 90 business days; providers then have 90 business days after receiving a proposed contract to sign. After signing, plans must list the provider as participating within 20 business days and include the provider in directories. After rejection, or approval without signing, providers cannot reapply until 180 calendar days after their previous application.

Providers negotiate rates with signing deadlines

Eye care providers can negotiate payment schedules directly with plans, including rates different from those offered to other providers. Provider groups must practice under one employer or tax ID to use this group negotiation rule. Plans must supply a contract contact’s name, email, and phone number. Plans and providers must answer proposed changes and later responses within five business days. Approved providers have 90 business days after electronic contract delivery to sign; afterward, plans can withdraw unsigned offers.

Sponsors & Cosponsors

Sponsor

Patrick McMath
Republican • Senate

Cosponsors

Adam Bass
Republican • Senate
Beth Mizell
Republican • Senate
Blake Miguez
Republican • Senate
Bob Hensgens
Republican • Senate
Brach Jerad Myers
Republican • Senate
Caleb Kleinpeter
Republican • Senate
Edward J. Price
Democratic • Senate
Gerald Boudreaux
Democratic • Senate
Jeremy Stine
Republican • Senate
Katrina R. Jackson-Andrews
Democratic • Senate
Larry Selders
Affiliation unavailable
Mark Abraham
Republican • Senate
Michael "Big Mike" Fesi
Republican • Senate
Regina Barrow
Democratic • Senate
Rick Edmonds
Republican • Senate
Robert "Bob" Owen
Republican • Senate
Sam Jenkins
Democratic • Senate
Valarie Hodges
Republican • Senate
William "Bill" Wheat Jr.
Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 145 • No: 0

House vote • 5/7/2026

Read third time by title, amended, roll called on final passage, yeas 98, nays 0. Finally passed, ordered to the Senate.

Yes: 98 • No: 0

House vote • 4/28/2026

Reported with amendments

Yes: 13 • No: 0

Senate vote • 3/25/2026

Senate floor amendments read and adopted. Read by title and passed by a vote of 34 yeas and 0 nays; ordered reengrossed and sent to the House. Motion to reconsider tabled.

Yes: 34 • No: 0

Actions Timeline

Signed by the Governor. Becomes Act No. 384.
5/22/2026Senate
Effective date 5/22/2026.
5/22/2026Senate
Sent to the Governor by the Secretary of the Senate.
5/20/2026Senate
Enrolled. Signed by the President of the Senate.
5/19/2026Senate
Signed by the Speaker of the House.
5/19/2026House
Received from the House with amendments.
5/11/2026Senate
Read third time by title, amended, roll called on final passage, yeas 98, nays 0. Finally passed, ordered to the Senate.
5/7/2026House
Scheduled for floor debate on 05/07/2026.
5/6/2026House
Read by title, amended, passed to 3rd reading.
5/5/2026House
Reported with Legislative Bureau amendments.
4/29/2026House
Reported with amendments (13-0). Referred to the Legislative Bureau.
4/28/2026House
Read by title, under the rules, referred to the Committee on Health and Welfare.
3/31/2026House
Received in the House from the Senate, read by title, lies over under the rules.
3/30/2026House
Senate floor amendments read and adopted. Read by title and passed by a vote of 34 yeas and 0 nays; ordered reengrossed and sent to the House. Motion to reconsider tabled.
3/25/2026Senate
Read by title. Committee amendments read and adopted. Ordered engrossed and passed to third reading and final passage.
3/23/2026Senate
Reported with amendments.
3/18/2026Senate
Read second time by title and referred to the Committee on Health and Welfare.
3/10/2026Senate
Introduced in the Senate. Read by title and placed on the Calendar for a second reading.
3/9/2026Senate

Bill Text

Engrossed
PDF
Enrolled
PDF
Introduced
PDF
Reengrossed
PDF

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