The Office of Group Benefits must offer coverage for certain severe obesity treatments, subject to listed eligibility rules, prior authorization, facility accreditation, and annual limits.
§860. Severe obesity; legislative findings; coverage required A. The legislature hereby finds and declares that obesity is a significant health problem affecting hundreds of thousands of Louisiana residents. Severe obesity increases the mortality rate more than threefold, causes physical and emotional disability, and is often associated with comorbid health conditions, including hypertension, cardiopulmonary conditions, and diabetes, all of which compound the impact of obesity on longevity and quality of life. Louisiana residents with obesity are ninety percent more likely to have diabetes and fifty percent more likely to have high blood pressure than those who are not obese. Therapeutic interventions can alter the course and severity of obesity and severe obesity has been successfully treated through established surgical treatments. B. As used in this Section, the following terms shall have the following meanings: (1) "Body mass index" means a practical marker used to assess the degree of obesity, calculated by dividing the weight in kilograms by the height in meters squared. (2) "Severe obesity" means either of the following: (a) A body mass index equal to or greater than forty kilograms per meter squared. (b) A body mass index equal to or greater than thirty-five kilograms per meter squared along with an associated comorbidity including but not limited to hypertension, cardiopulmonary conditions, sleep apnea, or diabetes. C. The Office of Group Benefits programs shall offer a provision stating that benefits shall be payable for the treatment of severe obesity through gastric bypass surgery, sleeve gastrectomy, duodenal switch, single anastomosis duodeno-ileostomy with sleeve, or other methods recognized by the American Society for Metabolic and Bariatric Surgery as effective for the long-term reversal of severe obesity if all of the following criteria are met: (1) The surgery or other treatment method is for an active state employee or retired state employee. (2) The employee has participated in an Office of Group Benefits self-funded health plan for at least one year prior to the surgery or other treatment method and pre-authorization. (3)(a) The employee complies with all requirements of the Office of Group Benefits during the pre-operative period. (b) The pre-operative period shall be no less than four months. (4) The employee has a body mass index greater than or equal to forty kilograms per meter squared, or greater than or equal to thirty-five kilograms per meter squared with two or more comorbidities. D. The benefits provided for in this Section shall be limited to a maximum of three hundred surgeries per year. E. Nothing in this Section shall be construed to provide coverage or other benefits for skin removal surgery. F. The Office of Group Benefits programs shall offer reimbursement to hospitals, physicians, and clinics which is reasonable and customary. G. The Office of Group Benefits benefit will be restricted to services provided in facilities holding accreditation by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery's Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). H. Coverage of bariatric surgery shall require prior authorization. Acts 2021, No. 388, §1.