SB 464 — HEALTH CARE: Provides relative to coverage for severe obesity treatment. (gov sig) (EN NO IMPACT See Note)

SLS 26RS-1124 ENGROSSED Regular Session ENROLLED SENATE BILL NO.

464 BY SENATOR BARROW HEALTHAN CARE.ACT To amend and reenact R.S.

Provides relative to coverage for severe obesitytreatment.

(gov sig) AN ACT To amend and reenact R.S.

18021 shall submit to the Department of Insurance an estimate, produced by a member of PagetheAmericanAcademyofActuariesandinaccordancewithgenerallyaccepted 1actuarial principles and methodologies, of 4the Coding:cost to provide the benefits required by this Section for calendar year 2028, and subsequent years thereafter.Unless otherwise modified by thecommissioner, such estimateshall include all cost elements including expected volumes of services per member-month, the assumed population, and both an aggregate and per-member per-month estimate.

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SLS 26RS-1124 ENGROSSED SB NO.

464 theAmericanAcademyofActuariesandinaccordancewithgenerallyacceptedENROLLED actuarial(2) principlesThe andLouisiana methodologies,Department of theHealth costshall toevaluate providebariatric thesurgery, benefitspre-operative requiredpsychological byscreening thisand Sectioncounseling, forbehavior calendarmodification, yearnutritional 2028,counseling, and subsequentpost-operative yearsfollow-up, thereafter.Unlessoverview, otherwisemodifiedand bycounseling thecommissioner,of suchdietary, estimateexercise,andlifestylechangesforcoveragebytheEssentialHealthBenefits shallBenchmark includePlan allduring costits elementsnext includingreview expected volumes of services per member-month, the assumedEssential population,Health andBenefits bothBenchmark anPlan. aggregate and per-member per-month estimate.

(2)NolaterthanDecember1,2026,and Theannually Louisianathereafter,theDepartment Department of HealthInsurance shall evaluatepublish bariatrican surgery,estimated pre-operativecost psychologicalfor screeningthe andstate counseling,to behaviordefray modification,the nutritionalcost counseling, and post-operative follow-up, overview, and counseling of dietary,exercise,andservices lifestylechangesrequired forcoveragebytheEssentialHealthBenefitsby Benchmarkthis PlanSection duringas itsrequired nextby reviewof42 theU.S.C. Essential Health Benefits Benchmark Plan.

Nolaterthan December1,2026,and annually thereafter,theDepartment of Insurance shall publish an estimated cost for the state to defray the cost of services required by this Section as required by 42 U.S.C.

(3) No later than July 1, 2027, and annually thereafter, the Department of Insurance shall notify all health insurance issuers and all health plans of the fundingratioandtheminimumcoveragestandardforthisSection.Thefunding ratioshallbecalculatedbyratioshall dividingbe thosesumscalculated appropriatedbydividing bythelegislaturethose sumsappropriatedbythelegislature to be spent to defray the cost of services required by this Section by the estimatedcostneededtodefraythosecostsaspublishedpursuanttoParagraphestimatedcostneededtodefraythosecostsaspublished pursuanttoParagraph (2) of this Subsection.

(4) Beginning on January 1, 2028, for any plan year during which the publishedfundingratiomeetsorexceeds1.0,nohealthinsuranceissuersubject to this Section shall apply a numerical cap to the services required under this Section.Foranyplanyearduringwhichthepublishedfundingratioislessthan 1.0,a1.0, healtha insuranceissuersubjecttothishealthinsurance Sectionmayapplyissuersubjecttothis anumericalcapSectionmayapplyanumericalcap Pageto 2the services required under this Section of 4no Coding:fewer than the product of the minimum coverage standard times the number of member-months from the most recent plan year, rounded up to the nearest whole number.

(5) Any numerical cap implemented by the health insurance issuer pursuanttoParagraph(4)ofthisSubsectionshallbeclearlystatedinthehealth insuranceplandocumentsandshallbedescribedusingtheactualnumericalcap and not by reference to a formula.

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SLS 26RS-1124 ENGROSSED SB NO.

464 toENROLLED the services required under this Section of2. no fewer than the product of the minimum coverage standard times the number of member-months from the most recent plan year, rounded up to the nearest whole number.

(5) Any numerical cap implemented by the health insurance issuer pursuanttoParagraph(4)ofthisSubsectionshallbeclearlystatedinthehealth insuranceplandocumentsandshallbedescribedusingtheactualnumericalcap and not by reference to a formula.

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ThePRESIDENT originalOF instrumentTHE andSENATE theSPEAKER followingOF digest,THE whichHOUSE constitutesOF noREPRESENTATIVES partGOVERNOR ofOF theTHE legislativeSTATE instrument,OF wereLOUISIANA preparedAPPROVED: bySenate Legislative Services.

ThePage keyword,3 summary, and digest do not constitute part of the3 lawCoding: or proof or indicia of legislative intent.

[R.S.

1:13(B) and 24:177(E)] DIGEST SB 464 Engrossed 2026 Regular Session Barrow Present law requires a health insurance issuer offering health coverage plans in La.

that provides hospital, medical, or surgical benefits for individuals covered under a respective plan to provide coverage for medically necessary expenses for diseases and conditions caused by severe obesity and treatment.

Present law further applies present law only to a health insurance issuer offering health coverageplansin La.to theextentthatservicesarecoveredbytheEssentialHealthBenefits Benchmark Plan selected by the state in accordance with applicable federal regulations.

Proposed law repeals present law applicability.

Proposed law provides that no laterthan Aug.

1, 2026, and annuallythereafter,eachinsurer offering a health coverage plan that meets the definition of a "qualified health plan" shall submit to the Dept.

of Insurance an estimate of the cost to provide the benefits for calendar year 2028, and subsequent years thereafter.

Proposed law provides that no later than Dec.

1, 2026, and annuallythereafter, the Dept.

of Insurance shall publish an estimated cost for the state to defray the cost of covering the services.

Proposed law provides that no later than July 1, 2027, and annually thereafter, the Dept.

of Insurance shall notify all health insurance issuers and all health plans of the funding ratio calculated by the department along with the minimum coverage standard for the year.

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Words which are struck through are deletions from existing law;

words in boldface type and underscored are additions.

SLS 26RS-1124 ENGROSSED SB NO.

464 Proposed law provides that, beginning on Jan.

1, 2028, for any plan year during which the published fundingratiomeetsorexceeds1.0,nohealthinsuranceissuersubjecttoproposed law shall apply a numerical cap to the services.

Proposedlawprovidesthatforanyplanyearduringwhichthepublishedfundingratioisless than 1.0, a health insurance issuer may apply a numerical cap to the services of no fewer than the product of the minimum coverage standard times the number of member-months from the most recent plan year, rounded up to the nearest whole number.