Louisiana Administrative Code

Agent―a person or entity designated by a health insurance issuer to act on behalf of, or in place of, a health insurance issuer for purposes of the payment and adjudication of claims for prescription drugs, other products and supplies, and pharmacist services. Commissioner―the Co…

A. Pursuant to R.S. 22:1853.B, health insurance issuers or health maintenance organizations are required to submit to the Department, for approval, a "Prompt Payment Procedures Plan for Non-Electronic Pharmacy Claims" detailing statutory compliance for the receipt, acceptance, pr…

A. Pursuant to R.S. 22:1851, health insurance issuers and health maintenance organizations are required to submit to the department, for approval, a "Prompt Payment Procedures Plan for Electronic Pharmacy Claims" detailing statutory compliance for the receipt, acceptance, process…

A. Pharmacy audits of records shall, with the exception of fraud or willful misrepresentation audits, be the sole mechanism a health insurance issuer or its agent may require a pharmacy to participate in for the purpose of systematic review of the pharmacy’s compliance with contr…

A. Claim reviews shall be limited to a determination of whether a claim is payable or has been paid correctly. Inappropriate aggregation of claim reviews, excessive application of claim reviews upon a single pharmacy, and similar activities serve to convert a claim review into a …

A. Quality assurance reviews shall be limited to reviews of pharmacy compliance with contractual and claim filing requirements and shall only be performed prior to reimbursement. The purpose of a quality assurance review must be to test and maintain compliance with contract terms…

A. Pursuant to any Executive Order issued by the governor transferring authority to the department on matters pertaining to insurance, and pursuant to the plenary authority vested in the commissioner under Title 22, the department shall be authorized to issue emergency regulation…

A. If any Section or provision of Regulation 90 or its application to any person or circumstance is held invalid, such invalidity or determination shall not affect other sections or provisions that can be given effect without the invalid sections or provisions or application, and…

A. Regulation 90 shall become effective upon final publication in the Louisiana Register.

A. The Louisiana Department of Insurance shall maintain any and all confidential documents considered trade secrets or fall under the Louisiana public records law under R.S. 44:1 et al.

A. As used in R.S. 40:40(13) public bodies include the state of Louisiana, agencies of the state of Louisiana, the United States government, agencies of the United States government, the individual states of the United States, agencies of the individual states of the United State…

A. To protect the integrity of vital records and ensure their proper use, the state registrar of vital records shall disclose information in accordance with the provisions set forth as follows: 1. All birth rosters released to city and parish supervisors of child welfare and atte…

A. Pursuant to R.S. 40:41C, persons seeking to obtain copies of Orleans parish marriage records, which are the only marriage records on file in the Vital Records Registry, are not required to demonstrate a tangible interest; however, space, personnel, and equipment limitations an…

A. Certified Records through the Mail. Certified copies of records in the custody of the state registrar may be purchased by writing to Vital Records Registry, Box 60630, New Orleans, LA 70160. Release of these records is possible when the requirements as set forth in R.S. 40:32 …

A. Definitions Department—Department of Health and Hospitals Human Subject—A person to whom the record pertains or his next of kin as described in R.S. 40:41(C). Limited Research—The investigator or researcher provides the name, date and place of birth/death for all requests and …

A. Access to Vital Records Registry Database 1. The state registrar of vital records shall facilitate online computer access by the clerk of district court in each parish to birth and death databases via the data network operated by the office of the Secretary of State to the ext…

A. Children’s Choice Waiver participants who experience a crisis that increases the need for paid supports to a level that cannot be accommodated within the service cap specified in §11301.A on waiver expenditures, may request consideration for a crisis designation. A crisis is d…

A. In order to be considered a crisis, one of the following circumstances must exist: 1. death of the caregiver with no other supports (i.e., other family) available; or 2. the caregiver is incapacitated with no other supports (i.e., other family) available; or 3. the participant…

A. Additional services (crisis support) outside of the waiver cap amount shall be approved by the OCDD state office. Crisis designation is time-limited, depending on the anticipated duration of the causative event. Each request for crisis designation may be approved for a maximum…

A. The targeted population for case management services shall consist of individuals with intellectual disabilities who are participants in the New Opportunities Waiver.

A. An electronic visit verification (EVV) system shall be used for verifying in-home or face-to-face visit requirements for case management services. 1. Case management providers identified by the department shall use the (EVV) system designated by the department; 2. Reimbursemen…

A. The Louisiana Medical Facilities Inventory is not included as part of the 1985-1990 State Health Plan. The Louisiana health system is constantly changing. Including a static picture of this dynamic system as part of the State Health Plan is not helpful since most inventories a…

A. The purpose of this regulation is to require producers, as defined in this regulation, to act in the best interest of the consumer when making a sale or recommendation of an annuity and to require insurers to establish and maintain a system to supervise annuity recommendations…

A. This regulation shall apply to any sale or recommendation of an annuity.

A. This regulation is promulgated under the authority of R.S. 22:11, R.S. 22:919, and R.S. 22:1576(B)(10).

A. Unless otherwise specifically included, this regulation shall not apply to transactions involving: 1. direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to this regulation; 2. contracts used to fund: a. an e…

Annuity—an annuity that is an insurance product under state law that is individually solicited, whether the product is classified as an individual or group annuity. Cash Compensation—any discount, concession fee, service fee, commission, sales charge, loan, override, or cash bene…

A. Best Interest Obligations. A producer, when making a sale or recommendation of an annuity, shall act in the best interest of the consumer under the circumstances known at the time the recommendation is made, without placing the producer’s or the insurer’s financial interest ah…

A. A producer shall not solicit the sale of an annuity product unless the producer has adequate knowledge of the product to recommend the annuity and the producer is in compliance with the insurer’s standards for product training. A producer may rely on insurer-provided product-s…

A. An insurer is responsible for compliance with this regulation. If a violation occurs, either because of the action or inaction of the insurer or its producer, the Department may order: 1. an insurer to take reasonably appropriate corrective action for any consumer harmed by a …

A. Insurers, general agents, independent agencies and producers shall maintain or be able to make available to the commissioner records of the information collected from the consumer, disclosures made to the consumer, including summaries of oral disclosures, and other information…

A. If any provision or item of this regulation, or the application thereof, is held to be invalid, such invalidity shall not affect other provisions, items, or applications of the regulation, which can be given effect without the invalid provisions, item, or application.

A. Regulation 89, as amended, shall become effective upon final promulgation in the Louisiana Register.

A. Insurance Agent (Producer) Disclosure for Annuities APPENDIX A INSURANCE AGENT (PRODUCER) DISCLOSURE FOR ANNUITIES Do Not Sign Unless You Have Read and Understand the Information in this Form Date: INSURANCE AGENT (PRODUCER) INFORMATION (“Me”, “I”, “My”) First Name: Last Name:…

A. key component of any health care system is its manpower. Manpower planning is important because the status of health as well as the effectiveness of that system is heavily dependent upon both the quantity and quality of health professionals who provide health services. A short…

A. Introduction 1. In the late 1960's, a study was published by the Carnegie Institute which identified and forecast a large manpower shortage in the United States in the area of supply of physicians. Throughout the 1970's, a disproportionately large number of students entered me…

A. Introduction 1. Dentists are an important primary health care provider. Like primary care physicians, it is essential that dentists be available and reasonably accessible to a population if regular preventive care is to be obtained and acute health problems minimized. B. Avail…

A. Introduction. In the mid 1970s both the federal Department of Health, Education and Welfare and the Louisiana Board of Regents reported that the state and the nation were well on their way to solving previously noted shortages in the area of nursing manpower. In light of this …

A. The Health Manpower Training Act of 1972 defined allied health professions in the following manner: "Allied health professions are those with training and responsibilities for supporting and complementing or supplementing the professional functions of physicians, dentists and …

A. The LGE shall have the responsibility for making the determinations as to the matters set forth in this Chapter 119. Persons who have elected or whose legal representatives have elected that they receive services under the Children’s Choice Waiver have the right to appeal any …

A. This regulation is promulgated by the Commissioner of Insurance pursuant to authority granted under the Louisiana Insurance Code, Title 22, §22:1 et seq., particularly the Standard Valuation Law, see Title 22, §163.B.(1)(a) and Subsections 10909.A and B of Regulation 85.

A. The purpose of this regulation is to recognize, permit and prescribe the use of mortality tables that reflect differences in mortality between preferred and standard lives in determining minimum reserve liabilities in accordance with Title 22, §163.B.(1)(a) and Subsections 109…

A. For purposes of this regulation: 2001 CSO Mortality Table―that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society …

A. At the election of the company, for each calendar year of issue, for any one or more specified plans of insurance and subject to satisfying the conditions stated in this regulation, the 2001 CSO Preferred Class Structure Mortality Table may be substituted in place of the 2001 …

A. For each plan of insurance with separate rates for preferred and standard nonsmoker lives, an insurer may use the super preferred nonsmoker, preferred nonsmoker, and residual standard nonsmoker tables to substitute for the nonsmoker mortality table found in the 2001 CSO Mortal…

A. If any provision of this regulation or its application to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of the provision to other persons or circumstances shall not be affected.

A. This regulation shall become effective on the date of its final publication in the Louisiana Register.

A. Notice of Deaths Filed—Registrar of Voters 1. The first working day of each months the local registrar of vital records in which of the parishes of the state shall prepare on forms provided by the state registrar, in triplicate, by parish of residence of the decedents, separat…

A. Certified Copies of Death Certificates. The state registrar of vital records shall indicate on the original of each death certificate the date that said certificate is received in his office. The state registrar shall indicate by date stamp, the date requests for certified cop…

A. Approval of alternate designed plumbing systems will be considered on an individual basis.