A qualifying state pilot program may be created to coordinate health care reimbursements, but it must follow the section’s requirements and report to the state.
§2247. Community-based health care access programs A.(1) A program operating in this state that is, or has been supported by grant funds from the Healthy Communities Access Program Grant from the United States Department of Health and Human Services, may establish a pilot program to coordinate health care provider reimbursements in order to test innovations in payment for health care services. (2) A pilot program established under Paragraph (1) of this Subsection shall meet the requirements of this Section. B.(1) A pilot program established under this Section: (a) May enroll participants who have not purchased insurance in at least twelve months and whose income is at or below three hundred percent of the federal poverty level. (b) Is limited to employees of employers who have not offered commercial health insurance for a period of time to be established by each pilot program, but to be no less than the previous twelve months and who are not covered or eligible for other reimbursement programs, such as the Louisiana Children's Health Insurance Plan, Medicaid, or Medicare Program. (c) Shall drop any employer found falsifying information or dumping existing commercial health insurance coverage. (d) Shall coordinate payment from enrollees, and employers of enrollees, to be used to obtain available funding to assist in providing reimbursements to health care providers of enrollees. (e) Shall enter into agreements with health care providers to coordinate and provide services to enrollees. (2) Agreements that are entered into under Subparagraph (1)(e) of this Subsection are contingent on the health care provider agreeing to the provision of payment by the pilot program based on available funding to the pilot program for the health care services being provided. C. A pilot program established under this Section: (1) Shall be considered as a non-insurance program. (2) Is not subject to insurance laws or regulation by the commissioner of insurance. D. A pilot program established pursuant to this Section shall be administered by a nonprofit corporation duly incorporated in the state of Louisiana. E. A pilot program established under this Section shall issue a report to the state which shall include the following: (1) An analysis of the financial status of the pilot. (2) Data on enrollees and providers. (3) A description of enrollee services utilized. (4) Other information as requested by the committees. Acts 2004, No. 593, §1; Redesignated from R.S. 22:249 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.