Louisiana Administrative Code

A. The accepted data record formats are the UB-92 1450 version 4.1 format and the UB-92 1300 flat file format. The definition specified for each data element is in general agreement with the definition in the UB-92 Users Manual. Hospitals using data sources other than uniform bil…

A. The purpose of Regulation 107 is to repromulgate the fire/commercial insurance policy disclosure form contained in Appendix A and to amend the homeowners insurance policy disclosure forms contained in Appendices B and C developed by the commissioner of insurance for use by all…

A. Regulation 107 shall be applicable to all property and casualty insurers for all new fire/commercial policies and homeowner policies and all renewals of existing fire/commercial policies and homeowner policies.

A. Every property and casualty insurer issuing, delivering or renewing homeowners or fire/commercial insurance policies that provide coverage for damage to property in Louisiana shall present to the insured as an insert in the front of the policy upon issuance, delivery or renewa…

A. The commissioner of insurance reserves the right to amend, modify, alter or rescind all or any portion of Regulation 107.

A. If any provision of Regulation 107, or the application thereof to any circumstance, is held invalid, such determination shall not affect other provisions or applications of Regulation 107 which can be given effect without the invalid provision or application, and to that end t…

A. The forms previously promulgated in Appendices B and C shall continue in use until May 30, 2020. B. The amendments to Appendices B and C shall be used for all new and renewal policies issued or renewed on or after May 30, 2020. C. The form previously promulgated in Appendix A …

A. Appendix A Important Information Required by the Louisiana Department of Insurance Fire Insurance Policy Coverage Disclosure Summary (other than Homeowners) Or Commercial Insurance Policy Coverage Disclosure Summary This form is promulgated pursuant to La. R.S. 22:1319 THIS IS…

A. All treatment services must be medically necessary.

A. The following services provided by Opioid Treatment Programs shall be reimbursed under the Medicaid Program: 1. the administration and dispensing of medications; and 2. treatment phases outlined in LAC 48:I.5725.

A. Each Opioid Treatment Program shall enter into a contract with the managed care organizations (MCOs) and the coordinated system of care (CSoC) contractor in order to receive reimbursement for Medicaid covered services. B. Opioid treatment programs shall deliver all services in…

A. Regulation 109 implements the provisions of Act 154, of the 2017 Regular Session of the Louisiana Legislature, specifically R.S. 22:821(B)(3) and 22:1546(B)(1)(a), in addition to 22:1547(C)(1), 22:255, 22:1545, 22:1554, 22:1558, 22:1563, 22:1671, 22:1694, 22:1808.8 and 22:1922…

A. Regulation 109 shall apply to all persons and all business entities seeking licensure or who hold a license as an insurance producer, claims adjuster, public adjuster or insurance consultant.

A. Regulation 109 is promulgated by the commissioner pursuant to the authority granted under the Louisiana Insurance Code, R.S. 22:1 et seq., particularly R.S. 22:11, and specifically R.S. 22:821(B)(3), 22:1546(B)(1)(a), 22:1547(C)(1), 22:255, 22:691.2(3), 22:1545, 22:1550, 22:15…

A. For the purposes of Regulation 109 the following terms shall have the meaning ascribed herein unless the context clearly indicates otherwise. Applicant⎯a person making application to the Louisiana Department of Insurance to obtain an insurance producer, claims adjuster, public…

A. Every application for an insurance license shall be made on a form required by the commissioner and shall include all such information the commissioner deems necessary to determine compliance with the applicable statutes. B. Complete application shall include all of the follow…

A. Scheduling of examinations shall be as follows. 1. An applicant for a type of license for which an examination is required may schedule and sit for the examination prior to making application to the commissioner for such insurance license. 2. An individual seeking licensure fo…

A. An individual making application for a resident insurance license shall submit a full set of fingerprints as required by the applicable provisions of the Louisiana Insurance Code. The fingerprints shall be submitted in the manner required by the commissioner. B. The commission…

A. Insurance licenses shall expire in the following manner. 1. An individual insurance license where the last number of the license is an even number shall expire on the last date of the birth month of the individual in even-numbered years. 2. An individual insurance license wher…

A. Individual insurance producer appointments shall expire on January 1 of each year. Business entity producer appointments shall expire on August 1 of each year. Appointments shall be renewed by payment of the renewal fee. The commissioner shall issue a renewal invoice for all a…

A. Every person who holds an insurance license shall report to the commissioner all administrative actions within 30 days of the final disposition of the action in the manner required by the commissioner. The report shall include a copy of the order, consent agreement, stipulatio…

A. Any failure to comply with this regulation shall be considered a violation of R.S. 22:1543, 22:1554, 22:1558, 22:1563, 22:1574, 22:1663, 22:1693, 22:1808.1 and 22:1808.8. Violations of this regulation shall subject the violators to penalties as provided by R.S. 22:1554, 22:167…

A. Regulation 109 shall become effective upon final publication in the Louisiana Register and shall apply to any act or practice committed on or after the effective date.

A. If any Section or provision of Regulation 109 or the application to any person or circumstance is held invalid, such invalidity or determination shall not affect other Sections or provisions or the application of Regulation 109 to any persons or circumstances that can be given…

A. The purpose of Regulation 110 is to define declaratory orders and to provide for the filing and prompt disposition of declaratory orders, as authorized by R.S. 49:962.

A. As used in Regulation 110, the following terms shall have the meanings specified. Commissioner—the commissioner of the Louisiana Department of Insurance. Department―the Louisiana Department of Insurance. Declaratory Order―a written statement issued by the department at the req…

A. A declaratory order is not an agency rule or regulation but shall have the same status as a final agency decision or an order in an adjudicated case. B. A declaratory order shall have effect only upon the person requesting it and the commissioner and shall continue in effect u…

A. The commissioner shall decide within 60 days after the filing of a petition for a declaratory order whether to accept or reject the petition. B. A petition for a declaratory order shall be submitted in writing to the commissioner, in the manner specified on the department’s we…

A. The commissioner reserves the right to change positions reflected in prior declaratory orders. If a declaratory order is rescinded due to a change in the commissioner’s position, the rescinded declaratory order ceases to be effective as of 30 days after the date of the resciss…

A. The commissioner shall maintain as confidential or privileged any documents, materials, or other information submitted with or included in a petition for a declaratory order that are required to be maintained as confidential or privileged pursuant to any provision of Title 22 …

A. Regulation 110 shall become effective upon promulgation in the Louisiana Register.

A. If any Section or provision of Regulation 110 or the application to any person or circumstance is held invalid, such invalidity or determination shall not affect other Sections or provisions or the application of Regulation 110 to any persons or circumstances that can be given…

A. Reimbursement rates for Opioid Treatment Programs shall be a bundled rate included in the Specialized Behavioral Health Fee Schedule as determined by the department.

A. Act 819 (the Act) defines primary service area of a rural hospital as the smaller of either a radius of 25 miles from the rural hospital main campus or the number of postal zip codes, commencing with the rural hospital's zip code, in which 75 percent of a rural hospital's pati…

A. Geographic Determination. As of July 6 2007, Louisiana has 51 rural hospitals. The 25 miles radius of each rural hospital has been identified by geocoding the zip code of each rural hospital and the 25 miles radius surrounding each of these hospitals. A map depicting the 25 mi…

A. The Department of Health and Hospitals proposes the following process to determine if the hospital's primary service area is the smaller of either the 25 miles radius of the rural hospital or the number of postal zip codes, commencing with the rural hospital's zip code, in whi…

A. Regulation 111 implements the provisions of R.S. 22:1464.E, which authorizes the commissioner to approve an application by an insurer to impose upon an insured a rate in excess of the insurer’s filed and previously approved rates for a specific risk, provided the insurer compl…

A. Regulation 111 shall apply to any consent to rate application made by any insurer for any property and casualty insurance policy written or issued for delivery in Louisiana, or for any risk located in Louisiana, in which the insurer seeks to obtain the approval of the commissi…

A. Regulation 111 is promulgated by the commissioner pursuant to the authority granted under the Louisiana Insurance Code, R.S. 22:1 et seq., specifically R.S. 22:11 and R.S. 22:1473.

A. For the purposes of Regulation 111, the following terms shall have the meaning ascribed herein unless the context clearly indicates otherwise. Commissioner—the Louisiana Commissioner of Insurance. Consent to Rate—an agreement between the insured and the insurer based on inform…

A. An insurer seeking the approval of the commissioner to charge an insured a rate in excess of the manual rate for property and casualty insurance coverage shall file a consent to rate application with the commissioner within 45 calendar days of the effective date of the policy.…

A. If an insurer’s consent to rate application under Regulation 111 is disapproved for any reason, then the premium charged to the insured shall revert to the approved manual rate for the duration of the policy term, and the insurer shall refund the difference between the excess …

A. An insurer seeking the approval of the commissioner pursuant to a consent to rate application for any property and casualty insurance coverage shall file with the commissioner a written application packet, which shall contain the following documentation. 1. The consent to rate…

A. If any section or provision of Regulation 111 or the application to any person or circumstance is held to be invalid, such invalidity or determination shall not affect other Sections or provisions or the application of Regulation 111 to any persons or circumstances that can be…

A. Regulation 111 shall become effective on January 1, 2019.

A. In accordance with the requirements of Act 1249 of the 2003 Regular Session of the Louisiana Legislature, the Department of Health and Hospitals adopts admission criteria for inpatient facilities operated by the Department of Health and Hospitals. Admission criteria are specif…

Adult—anyone age 18 and over. Axis I Diagnosis—a reporting group in the Diagnostic and Statistical Manual for all the various mental disorders or conditions in the Classification except for Personality Disorders and Mental Retardation. Child—anyone under age 18. DSM—the Diagnosti…

A. The following admission requirements apply to New Orleans Home and Rehabilitation Center and Villa Feliciana Medical Complex, both of which are long term care facilities operated by the Office of the Secretary. B. Initial Requirements for Admission Consideration 1. The person …

A. In order to be admitted a person must qualify as a candidate for services in an inpatient setting as indicated on a published Level of Functioning Scale or other instrument identified by the Office of Mental Health as clinically appropriate. Such Level of Functioning Scale mus…

A. Referral for persons not currently residents of an ICF/MR facility should come through the State Office for Citizens with Developmental Disabilities (OCDD) Regional Office System responsible for serving the individual but referrals from other community sources or the individua…