Gross Negligence or Willful Misconduct Must Be Shown to Establish Liability Against Health Care Providers in Louisiana During a Declared Public Health Emergency

The Louisiana Department of Insurance (LDI) issued Emergency Rule 37, a package of regulations to address COVID-19 issues. The regulation applies to all HMOs, MCOs, PPOs, TPAs, PBMs and all other entities licensed by the LDI. It provides for the following:

For geographic accessibility requirements, the LDI waives plan’s obligations to comply with those requirements except for:

  1. Emergency services
  2. Services related to the testing or treatment of COVID-19, and
  3. Services that have not been ordered postponed by Healthcare Facility Notice #2020-COVID19-ALL-006 on March 18, 2020, and
  4. Services ancillary to any of the above.

For telemedicine services, plans must:

  • Waive limits on the use of audio-only telephone consults in the provision of telemedicine, to the extent allowed by OCR and DHHS guidance;
  • Waive coverage limits that would restrict access to providers included in the plan’s telemedicine network;
  • Cover mental health services provided via telemedicine, to the extent those services would be covered if they were in person; and
  • Waive coverage limits that require provider-to-provider consults and cover telemedicine consults between a patient and a provider, to the extent those services would be covered if they were in person.

For member cost sharing, the plans are directed to evaluate in-network and out-of-network requirements and take appropriate steps to ensure that patients in surge areas are not subject to unreasonable cost-sharing requirements due to access limits.

A copy of the rule is available here:

https://www.ldi.la.gov/docs/emergency-rule-37?utm_source=Media+Press+Release&utm_medium=newsletter&utm_campaign=3-23-20+Emergency+Rule+37

Written By: Cullen J. Dupuy & Katherine M. Cook

 

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