SB 404 — HEALTH CARE: Provides relative to eye care providers. (gov sig) (EN INCREASE SG EX See Note)

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 as defined in R.S.

(9)"Healthbenefitplan"meansapolicy,contract,oragreementofferedPage byaninsurer,thirdpartyadministrator,orsubcontractortoanenrolleetopay5 for,of reimburse,33 discount,Coding: or offset healthcare costs.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED (9)"Healthbenefitplan"meansapolicy,contract,oragreementoffered byaninsurer,thirdpartyadministrator,orsubcontractortoanenrolleetopay for, reimburse, discount, or offset healthcare costs.

An entity is considered an insurer for purposes of this Part irrespective of:of any of the following:

(11) "Material" means an ophthalmic device including but not limited to lenses, devices containing lenses, artificial intraocular lenses, ophthalmic frames, and other lens mounting apparatus, prisms, lens treatments, and coatings, contact lenses, low vision devices, vision therapy devices, and Pageprostheticdevicesto 6correct,relieve,or treatdefectsorabnormal conditions of 35the Coding:human eye or the ocular adnexa, or any material allowed to be utilized by the Louisiana State Board of Optometry Examiners and the Louisiana Optometry Practice Act.

(12) "Nominal" means, when there is no corresponding reimbursement inthecurrentyear'spublishedPhysicianFeeSchedulereleasedannuallybythe CentersforMedicareand MedicaidServicesorin thecurrentyear'spublished Page 6 of 33 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 prostheticdevicesENROLLED tostate correct,relieve,ortreatdefectsorabnormalMedicaid conditionsfee ofschedule, thean humanamount eyeless orthan the ocularreasonable adnexa,compensation orto anythe materialvision allowedcare toprovider berendering utilizedthe bycovered theservice Louisianaor Statecovered Boardmaterials, oftakingintoaccounttheprovider'sdirectandindirectcosts,includingtheactual Optometryacquisition Examinerscosts and theactual Louisianapro Optometryrata Practiceoverhead Act.costs, and reasonable profit.

(12) "Nominal" means, when there is no corresponding reimbursement inthecurrentyear'spublishedPhysicianFeeSchedulereleasedannuallybythe CentersforMedicareand MedicaidServicesorin thecurrentyear'spublished state Medicaid fee schedule, an amount less than the reasonable compensation to the vision care provider rendering the covered service or covered materials, takingintoaccounttheprovider'sdirectandindirectcosts,includingtheactual acquisition costs and actual pro rata overhead costs, and reasonable profit.

(14) "Participating eye care provider" means an eye care provider that hasenteredintoacontractualagreementorotherbusinessrelationshipwithan insurer,visionbenefitmanager,thirdinsurer,visionbenefitmanager,third-partyadministrator,orsubcontractorto partyadministrator,orsubcontractorto provide covered services or covered materials.

(16) "Third"Third-party party administrator" means an individual, company, organization, group, or other entity that provides services, including but not limitedtoadministrative,operational,regulatory,humanresource,compliance, and claim adjudication services for an insurer, vision benefit manager, individual, company, organization, group, or other entity under a contract or Pageagreement. 7 of 35 Coding:

(17) "Vision benefit discount plan" means a policy, contract, or agreement offered by an insurer or vision benefit manager to an enrollee that solely provides for a discount for vision care services or materials.

(18)"Visionbenefitplan"meansapolicy,contract,oragreementoffered by an insurerorvision benefitmanagertoan enrolleeto pay for, reimburse, or offset health and vision care costs.

(19) "Vision benefit manager" means an individual, company, Page 7 of 33 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 agreement.ENROLLED organization,group,orotherentity,includingbutnotlimitedtoinsurers,third- party administrators, and subcontractors, that creates, promotes, sells, provides, advertises, or administersan integratedorstand-alonevision benefit plan, vision benefit discount plan, or other insurance policy or contract which provides vision benefits or discounts to an enrollee pertaining to the provision of covered services or covered materials.

(17)"Visionbenefitplan"meansapolicy,contract,oragreementoffered§1809.5. by an insurerorvision benefitmanagerto an enrollee to pay for, reimburse, or offset health and vision care costs.

(18) "Vision benefit discount plan" means a policy, contract, or agreement offered by an insurer or vision benefit manager to an enrollee that solely provides for a discount for vision care services or materials.

(19) "Vision benefit manager" means an individual, company, organization,group,orotherentity,including butnotlimitedtoinsurers,third party administrators, and subcontractors, that creates, promotes, sells, provides, advertises,oradministersan integrated or stand-alone vision benefit plan, vision benefit discount plan, or other insurance policy or contract which provides vision benefits or discounts to an enrollee pertaining to the provision of covered services or covered materials.

§1809.4.

An insurer or vision benefit manager shall only use only standardized codes, names, descriptions, and definitions published in the Healthcare Common Procedure Coding System, including Current Procedural Terminology codes published by the American Medical Association and Level II codes published by the Centers for Medicare and Medicaid Services, to identify and describe all covered services and covered materials of the vision benefit plan to purchasers and enrollees of the vision benefit plan.

An insurer or vision benefit manager shall only use only standardized Pagecodes, 8names, descriptions, and definitions published in the Healthcare Common Procedure Coding System, including all Current Procedural Terminology codes published by the American Medical Association and all Level II codes published by the Centers for Medicare and Medicaid Services, to create and offer a fee schedule of 35allowed Coding:amounts for covered services and covered materials in a contract or agreement between the insurer or vision benefit manager and an eye care provider.

D.

An insurer or vision benefit manager shall not misuse, misrepresent, or change the meaning of any of the standardized codes, names, descriptions, Page 8 of 33 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 codes,ENROLLED names,anddefinitionspublishedintheHealthcareCommonProcedureCodingSystem, descriptions,includingallCurrentProceduralTerminologycodespublishedbytheAmerican and definitions published in the Healthcare Common Procedure Coding System, including all Current Procedural Terminology codes published by the American Medical Association and all Level II codes published by the Centers for Medicare and Medicaid Services,Services. to create and offer a fee schedule of allowed amounts for covered services and covered materials in a contract or agreement between the insurer or vision benefit manager and an eye care provider.

D.

An insurer or vision benefit manager shall not misuse, misrepresent, or change the meaning of any of the standardized codes, names, descriptions, anddefinitionspublishedintheHealthcareCommonProcedureCodingSystem, includingallCurrentProceduralTerminologycodespublishedbytheAmerican Medical Association and all Level II codes published by the Centers for Medicare and Medicaid Services.

All fee schedule allowed amounts and all reimbursements paid by an insurerorvisionbenefitmanagerforeachcoveredserviceandcoveredmaterial shall be clearly and individually listed on a fee schedule made available to the eye care provider:provider at all of the following times:

Page(1) 9At ofthe 35time Coding:a contract or agreement is offered to the eye care provider by an insurer or vision benefit manager.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 (1) At the time a contract or agreement is offered to the eye care provider by an insurer or vision benefit manager.

A contract or agreement between an insurer or vision benefit managerandaneyecareprovidershallincludeafeeschedulethatincludesand individually identifies each covered service and covered material and its corresponding allowed amount, reimbursement amount paid to the eye care provider,andPage any9 formofof acost-sharingamountpaidbytheenrolleetotheeye33 careCoding: provider.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED provider,andanyformof acost-sharingamount paidbytheenrolleetotheeye care provider.

A service or material provided by a participating eye care provider shall not be designated as a covered service or covered material by the insurer orvisionbenefitmanagerinthedesignoforvisionbenefitmanagerinthedesignofahealthbenefitplan ahealthbenefitplanorvisionbenefitorvisionbenefit planifthereimbursementamounttotheparticipatingeyecareproviderisonly comprised of an enrollee's payment to the participating eye care provider.

InsurersInsurersor or vision benefitmanagersshallbenefit managers shall not condition application to anetworkorparticipationinahealthbenefitplan,visionbenefitplan,orvision benefit discount plan by an eye care provider based on the eye care provider's usual and customary pricing or discounts on usual and customary pricing for servicesormaterialsthatarenotcoveredservicesornotcoveredmaterials.Any such contractual language, policies, or procedures set by the insurer or vision Pagebenefit 10manager in violation of 35the Coding:foregoing shall be void and unenforceable.

K.Aninsurerorvisionbenefitmanagershallnotmakeconditional afee schedule proposed or made to an eye care provider of a health benefit plan, vision benefit plan, or vision benefit discount plan for covered services or coveredmaterialsbasedontheeyecareprovider'susualandcustomarypricing or discounts on usual and customary pricing for services or materials that are not covered services or not covered materials.

Any such contractual language, policies, orproceduressetby the insurer or vision benefit manager in violation of the foregoing shall be void and unenforceable.

L.Acontractoragreementbetweenaninsurerorvisionbenefitmanager and an eye care provider shall not contain a provision, fee schedule, or Page 10 of 33 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 benefitENROLLED managerreimbursementamountrequiringtheeyecareprovider,takingintoaccountany inapplicabledeductibles,copays,coinsurances,discounts,rebates,orchargebacks, violationto ofprovide thecovered foregoingservices shallor becovered voidmaterials andto unenforceable.an enrollee at a financial loss.

K.Aninsurerorvisionbenefitmanagershallnotmakeconditional afee schedule proposed or made to an eye care provider of a health benefit plan, vision benefit plan, or vision benefit discount plan for covered services or coveredmaterialsbasedontheeyecareprovider'susualandcustomarypricing or discounts on usual and customary pricing for services or materials that are not covered services or not covered materials.

Any such contractual language, policies, orproceduresset by the insurer or vision benefit manager in violation of the foregoing shall be void and unenforceable.

L.Acontractoragreementbetweenaninsurerorvisionbenefitmanager and an eye care provider shall not contain a provision, fee schedule, or reimbursementamountrequiringtheeyecareprovider,takingintoaccountany applicabledeductibles,copays,coinsurances,discounts,rebates,orchargebacks, to provide covered services or covered materials to an enrollee at a financial loss.

All fee schedule-allowed amounts in a provider agreement between an insurer or vision benefit manager and an eye care provider for all covered services and covered materials shall not be less than the current year's published Physician Fee Schedule released annually by the Centers for Medicare and Medicaid Services, unless:unless either of the following occurs:

(1) In the event that a coveredserviceorcoveredmaterialdoescoveredserviceor coveredmaterialdoes not have anallowedamountlistedoriftheallowedamountislistedatzerointhecurrent year's published Physician Fee Schedule released annually by the Centers for MedicareMedicareandMedicaidServices,theallowedamountforthecoveredserviceor & Medicaid Services, the allowed amount for the covered service or covered material shall not be less than the current year's published state Medicaid fee schedule rate.

(2)In the event that a coveredserviceor coveredmaterialdoescoveredmaterial nothavedoes Pagenot 11have ofanallowedamountlistedoriftheallowedamountislistedatzerointhecurrent 35year's Coding:published Physician Fee Schedule released annually by the Centers for Medicare and Medicaid Services or in the current year's published state Medicaid fee schedule rate, the allowed amount for the covered service or covered material shall be reasonable, and not nominal or de minimis.

N.Theperiodoftimeprescribedbyacontractoragreementbetweenan insurer or vision benefit manager and an eye care provider for the insurer or visionbenefitmanagertorecoveranyreimbursementamountfromaneyecare provider shall be the same period of time allowed or required for any insurer or vision benefit manager to remit the applicable reimbursement following an eye care provider's submission of a clean claim for services rendered or materials furnished.

The foregoing shall not limit an insurer or vision benefit Page 11 of 33 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 anallowedamountlistedoriftheallowedamountislistedatzerointhecurrentENROLLED year'smanager's publishedability Physicianto Feeconduct Schedulean releasedaudit annuallyof byclaims, in accordancewith the Centersinsurer fororvisionbenefitplanmanager'swrittenpoliciesandapplicablelaw,intheevent Medicare&MedicaidServicesorinthecurrentyear'spublishedstateMedicaidthat feethe scheduleinsurer rate,or thevision allowedbenefit amountmanager forhas thea coveredreasonable servicebelief orthat coveredthe materialeye shallcare beprovider reasonable,has andengaged notin nominalfraud, waste, or deabuse. minimis.

N.Theperiodoftimeprescribedbyacontractoragreementbetweenan insurer or vision benefit manager and an eye care provider for the insurer or visionbenefitmanagertorecoveranyreimbursementamountfromaneyecare provider shall be the same period of time allowed or required for any insurer or vision benefit manager to remit the applicable reimbursement following an eye care provider's submission of a clean claim for services rendered or materials furnished.

The foregoing shall not limit an insurer or vision benefit manager's ability to conduct an audit of claims, in accordancewith the insurer orvisionbenefitplanmanager'swrittenpoliciesandapplicablelaw,intheevent that the insurer or vision benefit manager has a reasonable belief that the eye care provider has engaged in fraud, waste, or abuse.

Q.Aninsurerorvisionbenefitmanagershallnotofferenrolleesvarying Pagedeductibles, 12copays, ofcoinsurances, 35coverage Coding:amounts, rebates, gift cards, or other monetary or nonmonetary incentives to obtain covered services, covered materials,noncoveredservices,ornoncoveredmaterialsatanyofthefollowing:

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 deductibles, copays, coinsurances, coverage amounts, rebates, gift cards, or other monetary or nonmonetary incentives to obtain covered services, covered materials, noncovered services, or noncovered materials:

An insurer or vision benefit manager shall not engage in marketing oradvertisingactivitiesthatmaybemisleadingordeceptivetothepublic.Upon request by a jurisdictional enforcement agency, insurers and vision benefit managersshallsubmitallinformationmanagersshall regardingallegedsavingssubmitallinformationregardingallegedsavings and discounts offeredPage by12 affiliates of the33 insurerCoding: or vision benefit manager.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED offered by affiliates of the insurer or vision benefit manager.

T.Aparticipatingeyecareproviderisallowed,butnotrequired,tooffer an enrollee the opportunity to pay the participating eye care provider directly forcoveredservicesandcoveredmaterialsifsuchdirectpaymentwouldbeless costlytotheenrolleethancostlytotheenrolleethanthetotalout-of-pocketcostrequiredunder thetotalout-of-pocketcostrequiredunder theterms of a health benefit plan or vision benefit plan.

PageU. 13 of 35 Coding:

An insurer or vision benefit manager shall not retroactively reverse a reimbursement or withhold a future reimbursement to an eye care provider who relied in good faith on an individual's presented coverage credentials and the customary verification methods of the insurer or vision benefits manager, if the insurer or vision benefit manager later determines that the enrollee was ineligibletoreceivecoveredservicesorcoveredmaterialsonthedateofservice.

V.Aninsurerorvisionbenefitmanagershallnotrequireaparticipating eyecareprovider,purchaser,orenrolleeofahealthbenefitplan, vision benefit plan, or vision benefit discount plan to obtain prior authorization, preauthorization, precertification, or any similar mechanism that restricts the enrolleefromreceivingacoveredserviceorcoveredmaterialrecommendedby the eye care provider and requested by the enrollee.

W.(1) An insurer or vision benefit manager shall not, in the course of adjudicatingaclaimforreimbursementbyaparticipatingeyecareproviderfor Page 13 of 33 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 U.ENROLLED a covered service or covered material, alter, delete, substitute, or otherwise change any code or modifier submitted by the eye care provider, including downcoding, bundling, orreassigning to adifferentcode,if such changewould reduce payment or otherwise adversely affect the provider or enrollee.

An insurer or vision benefit manager shall not retroactively reverse a reimbursement or withhold a future reimbursement to an eye care provider who relied in good faith on an individual's presented coverage credentials and the customary verification methods of the insurer or vision benefits manager, if the insurer or vision benefit manager later determines that the enrollee was ineligibletoreceivecoveredservicesorcoveredmaterialsonthedateofservice.

V.Aninsurerorvisionbenefitmanagershallnotrequireaparticipating eyecareprovider,purchaser,orenrolleeof ahealth benefitplan, visionbenefit plan, or vision benefit discount plan to obtain prior authorization, preauthorization, precertification, or any similar mechanism that restricts the enrolleefromreceivingacoveredserviceorcoveredmaterialrecommended by the eye care provider and requested by the enrollee.

W.(1) An insurer or vision benefit manager shall not, in the course of adjudicatingaclaimforreimbursementbyaparticipatingeyecareproviderfor a covered service or covered material, alter, delete, substitute, or otherwise change any code or modifier submitted by the eye care provider, including downcoding, bundling, orreassigning toadifferentcode,if such change would reduce payment or otherwise adversely affect the provider or enrollee.

(a)"Downcoding"meanstoalter,delete,substitute,orassignacodethat(a) results"Bundling" inmeans ato lowercombine, levelsubstitute, ofor service,treat atwo lower-valuedor code,more distinct services, supplies, or amaterials reducedreported reimbursementamountrelativetothecodesubmittedbytheeyecareprovider.on the same claim, date, or serviceasincludedwithinasinglecode,package,orglobalservice,anddenying, reducing, or disallowing separate reimbursement for one or more of the codes.

(b)(b)"Downcoding"meanstoalter,delete,substitute,orassignacodethat "Bundling"results meansin toa combine,lower substitute,level orof treatservice, twoa orlower-valued morecode, distinct services, supplies, or materialsa reportedreduced onreimbursementamountrelativetothecodesubmittedbytheeyecareprovider. the same claim, date, or serviceasincludedwithinasinglecode,package,orglobalservice,anddenying, reducing, or disallowing separate reimbursement for one or more of the codes.

The provisions of this Section shall apply to any affiliate or subcontractor that is used by an insurer or vision benefit manager to supply covered services or covered materials to an eye care provider or enrollee and Pagebe 14subject ofto 35all Coding:applicable penalties as provided for in this Part.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 be subject to all applicable penalties as provided for in this Part.

§1809.5.§1809.6.

No contract or agreement between an insurer or vision benefit manager and an eye care provider shall require an eye care provider to participateparticipatewith, with, be credentialedby,orenterintocredentialed acontractorby, agreementor withenterinto acontractoragreementwith anyspecificvisionbenefitplanorvisionbenefitdiscountplanasaconditionfor participationinthehealthbenefitplanprovidernetworkoftheinsurerorvision benefitmanagertoprovidecoveredservicestotheenrolleesofthehealthbenefit plan.

Any insurer or vision benefit manager issuing or renewing a health benefitplan,visionbenefitplan,orvisionbenefitdiscountplan,whichprovides benefitsforcoveredservicesorcoveredmaterialsrenderedbyamedicaldoctorPage or14 an osteopathic doctor that is within the scope of practice33 ofCoding: an optometrist, shall provide no less than the same reimbursement for covered services or covered materials to optometrists as allowed for those covered services or covered materials rendered by medical doctors or osteopathic doctors.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED benefitsforcoveredservicesorcoveredmaterialsrenderedbyamedicaldoctor or an osteopathic doctor that is within the scope of practice of an optometrist, shall provide no less than the same reimbursement for covered services or covered materials to optometrists as allowed for those covered services or covered materials rendered by medical doctors or osteopathic doctors.

Any such contractual language, policies, or procedures set by the insurer or vision benefit manager Pagein 15violation of 35the Coding:foregoing shall be void and unenforceable.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 in violation of the foregoing shall be void and unenforceable.

§1809.6.§1809.7.

It is prohibited for an insurer or vision benefit manager that offers multiple health benefit plans, vision benefit plans, or vision benefit discount plans to require an eye care provider, as a condition of participation in the networkforahealthbenefitplan,visionbenefitplan,orvisionbenefitdiscount plan, to participate in the network of any of the insurer's or vision benefit manager'sPage other15 healthof benefit33 plans,Coding: vision benefit plans, or vision benefit discount plans.

A contract provision or agreement violating this Subsection shall be void.

The penalties and remedies provided for violation of provisions of this Part shall not waive, limit, or otherwise affect the applicability of Louisiana'sUnfairTradePracticesandConsumerProtectionLaw,R.S.51:1401 etseq.,oranyotherlawprovidingforcivilorcriminalpenaltiesorremediesfor unfair, deceptive, or unlawful business practices.

B.

It is prohibited for an insurer or vision benefit manager that offers multiple health benefit plans, vision benefit plans, or vision benefit discount plans to withhold participation in the network of one or more of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans, or vision benefit discount plans if theeyecareprovider is already participating in the network of one or more of the insurer's or vision benefit manager's health Page 16 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 benefitENROLLED plans, vision benefit plans, or vision benefit discount plans and seeks to participate in the network of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans, or vision benefit discount plans.

C.ThisA Sectionappliescontract toallprovision plantypesthatahealthbenefitplan,vision benefit plan, or visionagreement benefitviolating discountthis planSubsection sells,shall administers,be orvoid. offers, including but not limited to individually purchased plans and employer-sponsored plans.

§1809.7.The penalties and remedies provided for violation of provisions of this Part shall not waive, limit, or otherwise affect the applicability of the Unfair Trade Practices and Consumer ProtectionLaw, R.S.

51:1401 et seq., or any other law providing for civil or criminal penalties or remedies for unfair, deceptive, or unlawful business practices.

B.

It is prohibited for an insurer or vision benefit manager that offers multiple health benefit plans, vision benefit plans, or vision benefit discount plans to withhold participation in the network of one or more of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans, or vision benefit discount plans if the eyecareprovideris alreadyparticipating in the network of one or more of the insurer's or vision benefit manager's health benefit plans, vision benefit plans, or vision benefit discount plans and seeks to participate in the network of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans, or vision benefit discount plans.

C.This Sectionappliestoallplantypesthatahealthbenefitplan, vision benefit plan, or vision benefit discount plan sells, administers, or offers, including but not limited to individually purchased plans and employer-sponsored plans.

§1809.8.

acceptance as participating eye care provider A.A.Aninsurerorvisionbenefitmanagershallincludeallofthefollowing on its website:

An insurer or vision benefit manager must include on their website:

B.Aninsurer'sorvisionbenefitmanager'sapplicationforinclusionandPage credentialing16 as a participating eye care provider in the health benefit plan, vision benefit plan, or vision benefit discount plan shall only require standardized information specified in the current version of the33 LouisianaCoding: Standardized Credentialing Application Form or the current format used by the Council for Affordable Quality Healthcare credentialing application.

C.Aninsurer'sorvisionbenefitmanager'sapplicationforinclusionand credentialingasaparticipatingeyecareproviderinthehealthinsurancebenefit plan, vision benefit plan, or vision benefit discount plan must impose the same application requirements on each eye care provider.

D.

Not later than the thirtieth business day after the date the insurer or vision benefit manager receives an application from an eye care provider for inclusion as a participating provider in the health benefit plan, vision benefit Page 17 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 plan,orvisionbenefitdiscountplan,theinsurerorvisionbenefitmanagershallENROLLED informtheapplicantofalldefectsandreasonsknownatthetimebytheinsurerB.Aninsurer'sorvisionbenefitmanager'sapplicationforinclusionand credentialing as a participating eye care provider in the health benefit plan, vision benefit plan, or vision benefit managerdiscount plan shall only require standardized information specified in the eventcurrent thatversion of the applicationLouisiana isStandardized deemedCredentialing toApplication beForm notor correctlythe completed.current format used by the Council for Affordable Quality Healthcare credentialing application.

C.Aninsurer'sorvisionbenefitmanager'sapplicationforinclusionand credentialingasaparticipatingeyecareproviderinthehealthinsurancebenefit plan, vision benefit plan, or vision benefit discount plan shall impose the same application requirements on each eye care provider.

D.

Not later than the thirtieth business day after the date the insurer or vision benefit manager receives an application from an eye care provider for inclusion as a participating provider in the health benefit plan, vision benefit plan,orvisionbenefitdiscountplan,theinsurerorvisionbenefitmanagershall informtheapplicantofalldefectsandreasonsknownatthetimebytheinsurer or vision benefit manager in the event that the application is deemed to be not correctly completed.

Not laterthanlater than the ninetieth business day after the date the insurer or vision benefit manager receives an application from an eye care provider for inclusion as a participating provider in the health benefit plan, vision benefit plan,orvisionbenefitdiscountplan,theinsurerorvisionbenefitmanagershall complete the credentialing determination of the eye care provider, approve or disapprove the application of the eye care provider, and deliver electronically aPage proposed17 participatingof provider33 contractCoding: as provided for in this Section for acceptance and signature to the approved eye care provider.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED a proposed participating provider contract as provided for in this Section for acceptance and signature to the approved eye care provider.

If the application for inclusion and credentialing as a participating provider is denied by the insurer or vision benefit manager, the eye care provider mustshall be allowed a reasonable period of time in which to appeal the decision to the insurer or vision benefit manager and provide in the appeal evidence that supports the reconsideration of the denied application.

The insurer or vision benefit managers shall consider, and render a decision on the Pageeye 18care provider's appeal submission within thirty days of 35the Coding:date of receipt of the submission by the insurer or vision benefit manager.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 eye care provider's appeal submission within thirty days of the date of receipt of the submission by the insurer or vision benefit manager.

An insurer orvisionor vision benefit manager, concurrentwith the electronic delivery of the proposed participating provider contract to the approved eye careprovider,mustprovidethename,emailaddress,andphonenumberofthecareprovider,shall provide thename,email address, and phone numberof the representative of the insurer or vision benefit manager to allow the approved eye care provider the opportunity to:to do all of the following:

(1)Contacttherepresentativebeforesigning(1)Contacttherepresentativebeforesigningthecontractoragreement. thecontractoragreement.

(2)DiscusstheproposedcontractwiththerepresentativebeforesigningPage the18 contractof or33 agreement.Coding:

(3)Electronically send the representativemodifications totheproposed contract or agreement before signing the contract.

L.

In the event that the approved eye care provider sends the representative of the insurer or vision benefit manager modifications to the proposedparticipatingprovidercontract,theinsurerorvisionbenefitmanager must respond to the submission of the approved eye care provider within five business days.

Each subsequent response made by the insurer, vision benefit manager, or approved eye care provider to the other party shall be responded to within five business days by the receiving party.

Page 19 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 M.ENROLLED (2)Discusstheproposedcontractwith therepresentativebeforesigning the contract or agreement.

(3) Electronically send the representativemodifications totheproposed contract or agreement before signing the contract.

L.

In the event that the approved eye care provider sends the representative of the insurer or vision benefit manager modifications to the proposedparticipatingprovidercontract,theinsurerorvisionbenefitmanager shall respond to the submission of the approved eye care provider within five business days.

Each subsequent response made by the insurer, vision benefit manager, or approved eye care provider to the other party shall be responded to within five business days by the receiving party.

M.

N.N.Notlater than the twentieth business day after the datetheapproved eye care provider signs a participating provider contract, the insurer or vision benefitmanagershall include thecredentialedand approved eyecareprovider as a participating provider in the health benefit plan, vision benefit plan, or visionbenefitdiscount plan, and list theeyecareproviderwithoutlimitationin all of the plan directories that are available to enrollees and the public.

Notlaterthan thetwentieth business day afterthe date the approved eye care provider signs a participating provider contract, the insurer or vision benefitmanagershall includethecredentialedandapproved eyecareprovider as a participating provider in the health benefit plan, vision benefit plan, or visionbenefitdiscountplan,and list theeyecareproviderwithoutlimitationin all of the plan directories that are available to enrollees and the public.

P.Theearliestthataneyecareprovidermaysubmitanotherapplication toPage an19 insurer or vision benefit manager after a previous disapproval of an33 applicationCoding: is one hundred eighty calendar days from the date of the previous application.

Q.Aninsurerorvisionbenefitmanagershallallowaneyecareprovider to become a participating provider in the network of a health benefit plan, vision benefit plan, or vision benefit discount plan if the eye care provider:

(1)Meetsthecredentialingrequirementsof theinsurerorvision benefit manager.

(2) Agrees in writing to the applicable provider agreement.

R.Aninsurerorvisionbenefitmanagershallallowalleyecareproviders Page 20 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 whoENROLLED practiceto underan ainsurer singleor Employervision Identificationbenefit Numbermanager orafter Taxa Identificationprevious Numberdisapproval toof becomean participatingapplication providersis inone thehundred networkeighty ofcalendar adays healthbenefitplan,visionbenefitplan,orvisionbenefitdiscountplanifoneeyefrom carethe providerdate practicingof inthe thatprevious practice:application.

(1)MeetsthecredentialingrequirementsofQ.Aninsurerorvisionbenefitmanagershallallowaneyecareprovider theinsurerorvisionto become a participating provider in the network of a health benefit manager.plan, vision benefit plan, or vision benefit discount plan if theeye careprovider does all of the following:

(1)Meetsthecredentialingrequirementsof theinsurerorvisionbenefit manager.

R.Aninsurerorvisionbenefitmanagershallallowalleyecareproviders who practice under a single Employer Identification Number or Tax Identification Number to become participating providers in the network of a healthbenefitplan,visionbenefitplan,orvisionbenefitdiscountplanifoneeye care provider practicing in that practice does all of the following:

(1)Meetsthecredentialingrequirementsof theinsurerorvisionbenefit manager.

(2) Agrees in writing to the applicable provider agreement.

An insurer or vision benefit manager shall not exclude an eye care providerfromapplying toorbecomingaparticipatingproviderinthenetwork of a health benefit plan, vision benefit plan, or vision benefit discount plan because of:of any of the following:

§1809.8.T.

TransparencyAn andinsurer disclosureor requirementsvision forbenefit insurersmanager andshall visionnot benefitdeny managersparticipation A.to Page 20 of 33 Coding:

An insurer or vision benefit manager shall disclose the following information publicly on its internet website and with all documents and document packages, including but not limited to proposals, responses to requests for proposals, sales documents, enrollment documents, benefit plan documents, purchaser contracts, enrollee contracts, and provider agreements that are presented to purchasers, potential purchasers, enrollees, potential enrollees, participating eye care providers, potential participating providers, andstateagencieswithjurisdictional,regulatory,orenforcementauthorityover its business:

Page 21 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 (1)ENROLLED Itsanyeyecareprovideremployed legalbyorunder namecontractwithafederallyqualified andhealth entitycenter type.or rural health clinic, based on the practice setting, ownership structure, participation through the federally qualified health center or rural healthclinic,ordesignationasafederallyqualifiedhealthcenterorruralhealth clinic.

§1809.9.

Transparency and disclosure requirements for insurers and vision benefit managers A.Aninsurerorvisionbenefitmanagershalldiscloseallofthefollowing information publicly on its internet website and with all documents and document packages, including but not limited to proposals, responses to requests for proposals, sales documents, enrollment documents, benefit plan documents, purchaser contracts, enrollee contracts, and provider agreements that are presented to purchasers, potential purchasers, enrollees, potential enrollees, participating eye care providers, potential participating providers, andstateagencieswithjurisdictional,regulatory,orenforcementauthorityover its business:

(1) Its legal name and entity type.

(7)Page All21 federalof and33 stateCoding: litigation in which the company is, or has been, a party to in the current year and during the preceding five years.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED (7) All federal and state litigation in which the company is, or has been, a party to in the current year and during the preceding five years.

All information required to be disclosed by an insurer or vision benefit manager in Subsection A of this Section shall be conveyed in plain language and typed with a minimum of ten point font size and prominently displayed:displayed in all of the following:

(2) In a separately created document titled "Required Transparency Information forPatients,Doctors,and Purchasers"thatshall beincluded with all documents and document packages, including but not limited to proposals, Pageresponses 22to ofrequests 35for Coding:proposals, benefit plan documents, sales documents, enrollment documents, purchaser contracts, enrollee contracts, and provider agreements.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 responses to requests for proposals, benefit plan documents, sales documents, enrollment documents, purchaser contracts, enrollee contracts, and provider agreements.

Any proposed amendments to existing provider agreements, fee schedules,providerhandbooks,providermanuals,orrelatedpolicydocumentsPage by22 anof insurer33 orCoding: vision benefit manager delivered to a participating eye care provider shall be:

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED schedules,providerhandbooks,providermanuals,orrelatedpolicydocuments by an insurer or vision benefit manager delivered to a participating eye care provider shall be all of the following:

An insurer or vision benefit manager shall maintain:maintain all of the following:

(2) The ability for an eye care provider to leave voice messages at all Pagetimes. 23 of 35 Coding:

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 times.

H.Aninsurerorvisionbenefitmanagershallacknowledgereceiptofan electronicPage mail23 message within one hour by use of a33 returnCoding: electronic mail message with a communication tracking number and shall respond to the substantive questions orcommunications of theelectronicmail messagewithin seventy-two hours in writing by use of a return electronic mail message.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED electronic mail message within one hour by use of a return electronic mail message with a communication tracking number and shall respond to the substantive questions or communications of theelectronicmail messagewithin seventy-two hours in writing by use of a return electronic mail message.

Upon request by a state agency with jurisdictional, regulatory, or enforcement authority over its business, insurers and vision benefit managers Pageshallsubmitallinformationrelatedtoahealthbenefitplan,visionbenefitplan, 24orvisionbenefitdiscountplan,includingbutnotlimitedtoproposals,responses oftorequestsforproposals,benefitplan 35documents,salesdocuments,enrollment Coding:documents, purchaser contracts, enrollee contracts, provider agreements, and marketing and advertising activities for review.

Words§1809.10. which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 shallsubmitallinformationrelatedtoahealthbenefitplan,visionbenefitplan, orvisionbenefitdiscountplan,includingbutnotlimitedtoproposals,responses torequestsforproposals, benefitplandocuments,salesdocuments,enrollment documents, purchaser contracts, enrollee contracts, provider agreements, and marketing and advertising activities for review.

§1809.9.

An insurer or vision benefit manager shall not change or alter a contract or agreement, including terms, reimbursements, or fee schedules, entered into with a participating eye care provider unless the insurer or vision benefit manager complies with all of the following requirements at least ninety days before the date of the proposed change would take effect:

(2) A face-to-face or virtual meeting is required to discuss proposed changes,Page if24 requestedof by33 theCoding: eye care provider.

(3) The eye care provider shall either agree or not agree in writing to proposed changes.

If the changes in the contract or agreement are not agreed to by the eye care provider then the current agreement shall continue and the insurer or vision benefit manager may not remove the eye care provider from a network panel or plan for not accepting the proposed changes to a contract or agreement.

(4)Anewagreementisrequiredtobeestablishedandagreedupon after threeor more material changes, are made to an existing agreement between an eye care provider and an insurer or vision benefit manager.

(5)Any proposed amendmenttoanexistingcontractoragreementshall bepresentedtotheparticipatingeyecareproviderinamannerconducivetothe provider's review.

Proposed changes will be enumerated in a cover letter and Page 25 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 clearlyENROLLED markedchanges, asif trackedrequested changesby within the bodyeye ofcare theprovider. applicable contract or agreement.

B.Acontractoragreementbetweenaninsurerorvisionbenefitmanager(3) andThe an eye care provider shall noteither containagree anyor provisionnot requiringagree anin optometristwriting to acceptproposed achanges. reimbursement payment in the form of a virtual credit cardoranyotherpaymentmethodwhereinaprocessingfee,administrativefee, percentageamount, ordollaramount is assessedfor the providertoreceivethe reimbursement payment.

If the changes in the contract or agreement are not agreed to by the eye care provider then the current agreement shall continue and the insurer or vision benefit manager may not remove the eye care provider from a network panel or plan for not accepting the proposed changes to a contract or agreement.

(4)Anewagreementisrequiredtobeestablished andagreeduponafter threeor more material changes, are made to an existing agreement between an eye care provider and an insurer or vision benefit manager.

(5)Anyproposedamendmenttoan existing contractoragreementshall bepresentedtotheparticipatingeyecareproviderinamannerconducivetothe provider's review.

Proposed changes will be enumerated in a cover letter and clearly marked as tracked changes within the body of the applicable contract or agreement.

B.Acontractoragreementbetweenaninsurerorvisionbenefitmanager and an eye care provider shall not contain any provision requiring an optometrist to accept a reimbursement payment in the form of a virtual credit cardoranyotherpaymentmethodwhereinaprocessingfee,administrativefee, percentageamount, ordollar amount is assessedforthe provider toreceivethe reimbursement payment.

Termination of any contract or agreement shall be permissible only in thetheevent event of a material breach, wherein the eye careprovider fails toremedyto theallegedremedy breachtheallegedbreach to the reasonablesatisfactionofreasonable satisfactionof theinsurerorvision benefit manager within thirty days of receipt of written notice specifying the alleged breach.

It shall be prohibited for an insurer or vision benefit manager to requireaneyecareprovidertoestablishasecurityinterestinallorpartoftheir property and assets, including assets pertaining to their practice, in a sum equivalent to the funds owed to the insurer or vision benefit manager at termination.Page 25 of 33 Coding:

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED termination.

F.Aninsurerorvisionbenefitmanagershallnotretaliateinanymanner against an eye care provider for discussing, or attempting in good faith to negotiate,thetermsnegotiate,thetermsand andprovisionsofaprovideragreementwiththeinsurerorprovisionsofaprovideragreementwiththeinsureror vision benefit manager.

PageG.Aninsurerorvisionbenefitmanagershallnotretaliateinanymanner 26against an eyecareprovider for filing a complaint against the insurer or vision benefit manager with any state agency with jurisdictional, regulatory, or enforcement authority over the business of 35the Coding:insurer or vision benefit manager.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 G.Aninsurerorvisionbenefitmanagershallnotretaliateinanymanner against an eyecareprovider for filing a complaint against the insurer or vision benefit manager with any state agency with jurisdictional, regulatory, or enforcement authority over the business of the insurer or vision benefit manager.

§1809.10.§1809.11.

No contract or agreement between an insurer or vision benefit manager and an eye care provider shall restrict or limit, either directly or indirectly, the eye care provider's choice or use of sources and suppliers of covered or uncovered services or materials, including the choice or use of opticallaboratories,providedoptical bytheeyecareprovidertoanenrollee.Anysuchlaboratories,providedbytheeyecareprovidertoanenrollee.Anysuch contractuallanguage,policies,orproceduressetbytheinsurerorvisionbenefit manager in violation of the foregoing shall be void and unenforceable.

B.Page 26 of 33 Coding:

An insurer or vision benefit manager shall not directly or indirectly:

(1) Control or attempt to control the professional judgment, manner of practice, or practice of an eye care provider.

(2)Employ an eyecareprovidertoprovide acoveredserviceorcovered material.

(3) Withhold or recoup payment to an eye care provider for covered servicesorcoveredmaterialsprovidedforanenrolleeiftheenrolleewasshown to be eligible on the date that the covered services or covered materials were provided.

(4) Reimburse an eye care provider a different amount for covered services or covered materials because of the eye care provider's choice of:

Page 27 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 (a)ENROLLED OpticalB. laboratory.

(b)An Sourceinsurer or vision benefit manager shall not directly or indirectly do any of supplierthe of:following:

(1) Control or attempt to control the professional judgment, manner of practice, or practice of an eye care provider.

(2)Employ an eye careprovidertoprovide acoveredserviceorcovered material.

(3) Withhold or recoup payment to an eye care provider for covered servicesorcoveredmaterialsprovidedforanenrolleeiftheenrolleewasshown to be eligible on the date that the covered services or covered materials were provided.

(4) Reimburse an eye care provider a different amount for covered services or covered materials because of the eye care provider's choice of any of the following:

(a) Optical laboratory.

(b) Source of supplier of any of the following:

(5) Restrict, limit, or influence an eye care provider's choice of sources orPage suppliers27 of services33 orCoding: materials, including optical laboratories used by the eye care provider to provide services or materials to the enrollee.

(6)Restrict,limit,orinfluenceaneyecareprovider'schoiceofelectronic health record software, electronic medical record software, or practice management software.

(7) Restrict, limit, or influence an eye care provider's choice of third-party claim filing service, billing service, or electronic data interchange clearinghouse company.

(8) Restrict or limit an eye care provider's access to an enrollee's completeplan coverageinformation,including in-networkandout-of-network coverage details.

(9) Apply a chargeback to an enrollee or eye care provider if the Page 28 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 chargebackENROLLED is for a covered product or servicesuppliers forof whichservices the insurer or visionmaterials, benefitincluding manageroptical doeslaboratories notused incurby the costeye care provider to produce,provide deliver,services or providematerials to the enrolleeenrollee. or eye care provider.

(6)Restrict,limit,orinfluenceaneyecareprovider'schoiceofelectronic health record software, electronic medical record software, or practice management software.

(7) Restrict, limit, or influence an eye care provider's choice of third-party claim filing service, billing service, or electronic data interchange clearinghouse company.

(8) Restrict or limit an eye care provider's access to an enrollee's completeplancoverageinformation,including in-networkandout-of-network coverage details.

(9) Apply a chargeback to an enrollee or eye care provider if the chargeback is for a covered product or service for which the insurer or vision benefit manager does not incur the cost to produce, deliver, or provide to the enrollee or eye care provider.

(12) Require an eye care provider to disclose or report an enrollee's glasses prescription, contact lens prescription, ophthalmic device measurements, facial photograph, or unique anatomical measurements as condition to file a claim, adjudicate a claim, or receive reimbursement for a claim, unless the information inis needed for the vision benefit manager to manufacture,orcausetobemanufactured,acoveredproductthatissubmitted on the applicable claim.

(13) Require an eye care provider to disclose any enrollee information, otherthaninformationPage identified28 onof theversionof33 theHealthInsuranceClaimCoding: FormapprovedbytheNationalUniformClaimCommitteeasofMarch1,2023, or its approved successor, as a condition to file a claim, adjudicate a claim, or receive reimbursement for a claim unless the information is needed for the visionbenefitmanagertomanufacture,orcausetobemanufactured,acovered product that is submitted on the applicable claim.

C.

An insurer or vision benefit manager shall not solicit patients or referrals for supplies on behalf of itself or its affiliates by identifying participating eye care providers in an inaccurate or otherwise misleading manner, in any list of participating providers, or in any communications to purchasers or enrollees.

All communications which distinguish between Page 29 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 participatingENROLLED eyeotherthan careinformation providers,identified on theversionoftheHealthInsuranceClaim FormapprovedbytheNationalUniformClaimCommitteeasofMarch1,2023, or whichits otherwiseapproved claimsuccessor, professionalas superioritya orcondition theto performancefile ofa claim, adjudicate a professionalclaim, serviceor inreceive reimbursement for a superiorclaim manner,unless basedonthefollowingcharacteristics,shallbereadilysubjecttoverificationbythe information is needed for the Departmentvisionbenefitmanagertomanufacture,orcausetobemanufactured,acovered ofproduct Insurance:that is submitted on the applicable claim.

C.

An insurer or vision benefit manager shall not solicit patients or referrals for supplies on behalf of itself or its affiliates by identifying participating eye care providers in an inaccurate or otherwise misleading manner, in any list of participating providers, or in any communications to purchasers or enrollees.

All communications which distinguish between participating eye care providers, or which otherwise claim professional superiority or the performance of a professional service in a superior manner, based on any of the following characteristics, shall be readily subject to verification by the Department of Insurance:

(2)(2)The The dollar amount, volume amount, orpercentusageor percentusage amount of any material, product, or good purchased by the participating eye care provider.

(3)The(3)Thebrand,source,manufacturer,orsupplierofacoveredserviceor brand, source,manufacturer,orsupplierofacoveredserviceor covered material utilized by the participating eye care provider.

§1809.11.§1809.12.

An insurer or vision benefit manager shall not use extrapolation to completeanauditofaparticipatingeyecareprovider.Anyadditionalcompleteanauditofaparticipatingeyecareprovider.Anyadditionalpayment payment due to a participating eye care provider or any refund due to the insurer or vision benefit manager shall not be based on an extrapolation, but shall be basedPage on29 theof actual33 overpaymentCoding: or underpayment, as determined after an investigation by the insurer or vision benefit manager, and participating eye careproviderhasbeenafforded,andhasexhausted,allopportunitiestoappeal the insurer or vision benefit manager's findings, as set forth in the provider manual, policy document, or applicable law.

B.

For purposes of this Section, "extrapolation" means a mathematical formula, process, or technique used by a vision benefit manager, or the vision benefitmanager'sagent,in theaudit of an optometristtoestimateaudit results or findings for a larger batch or group of claims not reviewed by the vision benefit manager.

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SLS 26RS-490 REENGROSSED SB NO.

404 §1809.12.ENROLLED based on the actual overpayment or underpayment, as determined after an investigation by the insurer or vision benefit manager, and participating eye careproviderhasbeenafforded,andhasexhausted,allopportunitiestoappeal the insurer or vision benefit manager's findings, as set forth in the provider manual, policy document, or applicable law.

PrivateB. right of action;

eyeFor carepurposes providersof Anythis eyecareproviderSection, adversely"extrapolation" affectedbymeans a violationmathematical offormula, thisprocess, Partmayor bringtechnique anactioninacourtofcompetentjurisdictionused forinjunctiveby reliefagainsta the insurer or vision benefit managermanager, and,or uponthe prevailing,vision inbenefitmanager'sagent,in additiontheaudit toof suchan injunctiveoptometristtoestimateaudit relief,results shallor recoverfindings monetaryfor damages,a includinglarger butbatch notor limitedgroup to direct, indirect, special, and punitive damages and penalties, of noclaims morenot thanreviewed tenby thousandthe dollarsvision forbenefit eachmanager. violation, plus attorney fees and costs.

Private right of action;

eye care providers Any eye careprovider adversely affectedby aviolation of this Part may bringanactionin a courtof competentjurisdictionforinjunctivereliefagainst the insurer or vision benefit manager and, upon prevailing, in addition to such injunctive relief, shall recover monetary damages, including but not limited to direct, indirect, special, and punitive damages and penalties, of no more than ten thousand dollars for each violation, plus attorney fees and costs.

§1809.14.

Notwithstanding any other provision of law, including any law that purports to be the sole body of law governing the insurer, an insurerinsurershall shall comply with this Part,totheextentnotPart,to preemptedbythe federalextent law.not preempted byfederallaw.

§1809.14.§1809.15.

The department may:may do any of the following:

(1)Bringanaction,issueorders,andimposeremediesauthorizedbythis PartPage against30 anyof insurer33 orCoding: vision benefit manager.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED Part against any insurer or vision benefit manager.

The Department of Insurance shall:shall do all of the following:

(1) Provide a mechanism for aggrieved individuals, whether actively or Pageformerlyenrolledwithaparticularvisioncareplan,tosubmitcomplaintstothe 31department offor 35review, Coding:investigation, and as appropriate, discipline under applicable law.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 formerlyenrolledwithaparticularvisioncareplan,tosubmitcomplaintstothe department for review, investigation, and as appropriate, discipline under applicable law.

(4) Be entitled to seek an injunction against an insurer or vision benefit manager in a court of competent jurisdiction if the insurer or vision benefit manager:manager does any of the following:

The attorney general shall:shall do all of the following:

(1) Enforce the provisions of this Part concerning discount card plans, usingPage powers31 grantedof to33 theCoding: attorney general pursuant to this Title and the Unfair Trade Practices and Consumer Protection Law, R.S.

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SB NO.

404 ENROLLED using powers granted to the attorney general pursuant to this Title and the Unfair Trade Practices and Consumer Protection Law, R.S.

§1809.15.§1809.16.

PageB. 32 of 35 Coding:

Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 B.

No insurer or vision benefit manager shall construe re-credentialing asre-contractingwithaparticipatingeyecareprovider.Aprovidercontractor agreement shall be a distinctly separate document from any credentialing materials and shall be signed by theeyecareproviderand theinsurerortheinsurer or vision benefit manager.

SectionPage 4.32 of 33 Coding:

This Act shall become effective upon signature bythe governor or, if not signedbythegovernor,uponexpirationofthetimeforbillstobecomelawwithoutsignature by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana.

If vetoed bythe governorand subsequentlyapprovedbythe legislature, this Act shall become effective on the dayfollowing such approval.

Page 33 of 35 Coding:

SLS 26RS-490 REENGROSSED SB NO.

404 TheENROLLED originalSection instrument4. and the following digest, which constitutes no part of the legislative instrument, were prepared bySenate Legislative Services.

TheThis keyword,Act summary,shall andbecome digesteffective doupon notsignature constitutebythe partgovernor ofor, if not signedbythegovernor,uponexpirationofthetimeforbillstobecomelawwithoutsignature by the lawgovernor, oras proofprovided orby indiciaArticle III, Section 18 of legislativethe intent.Constitution of Louisiana.

[R.S.If vetoed bythe governorand subsequentlyapprovedbythe legislature, this Act shall become effective on the dayfollowing such approval.

1:13(B)PRESIDENT andOF 24:177(E)]THE DIGESTSENATE SBSPEAKER 404OF ReengrossedTHE 2026HOUSE RegularOF SessionREPRESENTATIVES McMathGOVERNOR PresentOF lawTHE providesSTATE forOF requirementsLOUISIANA andAPPROVED: prohibitions for medical eye care or vision care benefits provided by or available through a health benefit plan, health maintenance organization,preferredproviderorganization,managedcareorganization, accountablecare organization,orcontractofinsuranceoranymedicalhospitalservicecontractthatarewithin the lawful scope of practice of a dulylicensed optometrist.

ProposedlawexpandstheapplicabilityofPage present33 law to vision benefitplans,vision benefit discount plans, and anyagent acting on behalf of anyplan33 orCoding: entitythat offersan agreement or contract of insurance that provides medical eye care or vision care benefits.

Proposed law provides that proposed law shall be cited as the "Louisiana Vision Plan Transparencyand Fair Practice Act".

Proposedlawprovidesthatproposedlawshall not beconstruedto expandorlimitthescope of practice of anyhealthcare provider.

Proposed law provides that proposed law does not applyto medical benefits provided byan insurer under a health benefit plan that is not a vision benefit plan or vision discount plan.

Proposed law provides for legislative findings and definitions relative to eye care providers and services, vision benefit managers, and vision benefit plans.

Proposedlawprovidesforrequirementsandprohibitionsrelativetocoveredandnoncovered services and fee schedules in contracts or agreements between insurers or vision benefit managers and eye care providers.

Proposedlawprovidesforrequirementsandprohibitions foreyecareproviderparticipation and credentialing by an insurer or vision benefit manager.

Proposed lawprovidesfortransparencyand disclosure requirementsfor insurers and vision benefit managers.

Proposedlawestablishesrequirementsforamendingcontractsandagreementsbetweeneye care providers and insurers or vision benefit managers.

Proposed law prohibits an insurer or vision benefit manager from using extrapolation to complete an audit of a participating eye care provider.

Proposed law establishes a private right of action for any eye care provider adversely affected by a violation of proposed law, including injunctive relief and monetary damages of up to $10,000 for each violation, plus attorneyfees and costs.

Proposed law provides for the authority of the Dept.

of Insurance and the attorney general to enforce the provisions of proposed law.

Proposedlawprovidesfortheapplicability,severability,andeffectivenessofproposedlaw.

Effective upon signature of the governor or lapse of time for gubernatorial action.

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Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-490 REENGROSSED SB NO.

404 (Amend R.S.

22:997;

adds R.S.

22:1809-1809.15) Summary of Amendments Adopted by Senate Committee Amendments Proposed bySenate Committee on Health and Welfare to the original bill 1.

Adds provision that proposed law does not change the scope of practice of any healthcare provider.

Senate Floor Amendments to engrossed bill 1.

Adds provision relative to the applicability of proposed law.

2.

Makes technical changes.

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