Louisiana Revised Statutes 22:1209 – NOTE: See Subsection H and R.S. 22:1203(E)(2) regarding eff. date of this Section.
Terms Used In Louisiana Revised Statutes 22:1209
- Ambulatory surgical center: means an establishment in this state as defined in and licensed under the provisions of La. See Louisiana Revised Statutes 22:1202
- Board: means the board of directors of the plan. See Louisiana Revised Statutes 22:1202
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1202
- Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1202
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Health care provider: means a person licensed by this state to provide health care or professional services under the provisions of Title 37 of the Louisiana Revised Statutes of 1950 or any professional corporation, as a health care provider, authorized to form under the provisions of Title 12 of the Louisiana Revised Statutes of 1950 or such a person licensed by the appropriate laws of another state. See Louisiana Revised Statutes 22:1202
- Hospital: means any facility as defined in La. See Louisiana Revised Statutes 22:1202
- Insurance arrangement: means any plan, program, contract, or any other arrangement under which one or more natural or juridical persons provide to their employees or participants, whether directly or indirectly, health care services or benefits other than through an insurer. See Louisiana Revised Statutes 22:1202
- Insurer: means any insurance company or other entity authorized to transact and transacting health and accident insurance business in this state. See Louisiana Revised Statutes 22:1202
- Medicare: means coverage under both Parts A and B of Title XVIII of the Social Security Act, 42 U. See Louisiana Revised Statutes 22:1202
- Plan: means the Louisiana Health Plan as created in La. See Louisiana Revised Statutes 22:1202
- Plan of operation: means the plan of operation of the plan, including articles, bylaws, and operating rules, adopted by the board pursuant to La. See Louisiana Revised Statutes 22:1202
- Public program: means any public assistance program which provides funding for health care services rendered by a health care provider that is directly subsidized by the federal government. See Louisiana Revised Statutes 22:1202
§1209. Service charges
A.(1) Each patient who is not a private-pay patient, is not covered by Medicare or any other public program, is not covered by the Office of Group Benefits program, and is not covered by an insolvent insurer who is admitted to a hospital for treatment, other than psychiatric care or alcohol or substance abuse, shall be assessed a service charge in the amount provided in Subsection G of this Section for each day or portion thereof during which the patient is confined in that facility.
(2) Each hospital in which a patient is confined shall calculate the total service charge due for that patient’s period of confinement and shall include the total service charge in the bill for services rendered to the patient. The individual patient may be obligated to pay the service charge assessed in the event that an insurance arrangement pays for any medical charges or benefits but fails to pay the service charge assessed pursuant to this Section. The service charge shall be collected as provided for in the plan of operation of the plan established pursuant to La. Rev. Stat. 22:1205.
(3) For purposes of this Section, “hospital” shall not include any hospital operated by the state or any hospital created or operated by the Department of Veterans Affairs or other agency of the United States of America or any facility operated solely to provide psychiatric care or treatment of alcohol or substance abuse or both.
B. Each patient who is not a private-pay patient, is not covered by Medicare or any other public program directly subsidized by the federal government, is not covered by the Office of Group Benefits program, and is not covered by an insolvent insurer who is admitted to an ambulatory surgical center or to a hospital for outpatient ambulatory surgical care shall be assessed a service charge of one dollar for each admission to that facility. The service charge shall be included in the bill for services or supplies or both rendered to the patient by the ambulatory surgical center or hospital.
C.(1) Each hospital and ambulatory surgical center shall bill for and collect the service charges assessed pursuant to this Section from monies remitted to it in payment thereof in accordance with La. Rev. Stat. 22:1216, if authorized by the plan of operation under La. Rev. Stat. 22:1205. In the event that no payment is made by or on behalf of the patient for services rendered, the health care provider shall be liable for the remittance of only those fees collected. Each hospital and ambulatory surgical center shall remit to the plan for each reporting period, as established in the plan of operation, the total amount of service charges collected during that reporting period in accordance with the reporting and remittance procedures established by the plan pursuant to La. Rev. Stat. 22:1205.
(2) Unless permitted by the board, the intentional failure to bill, pay, report, or delineate service charges in accordance with this Section shall cause the hospital or ambulatory surgical center to be liable to the plan for a fine in an amount determined by the board, not to exceed five hundred dollars plus interest per failure. Any hospital or ambulatory surgical center found to have intentionally failed to bill, pay, report, or delineate service charges in accordance with this Section, unless permitted by the board, on three or more occasions during a six-month period shall be liable for a fine in an amount determined by the board, not to exceed one thousand five hundred dollars per failure, together with attorney fees and court costs.
(3) The plan or the commissioner or both are specifically authorized to conduct audits of hospitals and ambulatory surgical centers in order to enforce compliance with this Section. Fines levied pursuant to this Section shall be consistent with those levied against insurers pursuant to this Subpart.
D. The service charges imposed on hospital and ambulatory surgical center patients by this Section shall be payable by the patient’s insurer or insurance arrangement, if any, as applicable, except the charges shall not be payable by an insolvent insurer. In no event shall a hospital or ambulatory surgical center be required to remit to the plan uncollected service charges for any patient who is a private-pay patient or for any patient whose insurer or insurance arrangement is not legally required to pay the service charges.
E. If monies in the plan at the end of any fiscal year exceed actual losses and administrative expenses of the plan, the excess shall be held at interest and used by the board to offset future losses. As used in this Subsection, “future losses” includes reserves for incurred but not reported claims.
F. For the purposes of this Section, “insurance”, “insurance arrangement”, or “policy of an insurer” includes any policy or plan of insurance or of self-insurance that provides payment, indemnity, or reimbursement for charges resulting from accident, injury, or illness when an employer or insurer is responsible for those charges. The terms “insurance”, “insurance arrangement”, or “policy of an insurer” shall not include short-term, accident-only, fixed indemnity, credit insurance, automobile and homeowner’s medical payment coverage, or coverage issued as a supplement to liability insurance.
G. The service charge required by this Section shall be an amount set by the commissioner upon approval of the plan provided for in La. Rev. Stat. 22:1203(E)(2) and annually thereafter. The commissioner shall establish the amount of the service charge by rule promulgated in accordance with the Administrative Procedure Act no later than August thirty-first of the calendar year preceding the implementation of the service charge. The charge shall apply only to dates of service falling in the calendar year following promulgation of the rule. In establishing the service charge, the commissioner shall determine the amount necessary to fund the plan provided for in La. Rev. Stat. 22:1203(E)(2) but shall not establish a service charge in excess of three dollars plus an inflation factor of four percent per annum.
H. This Section shall not be effective until approval of the plan provided for in La. Rev. Stat. 22:1203(E)(2).
Acts 2020, No. 313, §1, eff. June 12, 2020.