HB 1199

ENROLLED
 2026 Regular Session
  ACT No. 884
 HOUSE BILL NO. 1199
 BY REPRESENTATIVES JORDAN, CHASSION, AND LACOMBE AND SENATORS
  CARTER, EDMONDS, TALBOT, AND WHEAT
1AN ACT
2 To enact R.S. 22:1049.1, relative to health insurance; to require coverage for genetic testing
3for SCN2A associated disorders; to require coverage for medically necessary
4treatment of SCN2A associated medical conditions; to provide for definitions; to
5provide for medical necessity determinations; to provide for coverage standards; to
6provide for prior authorization and cost-sharing requirements; to provide for
7effectiveness; and to provide for related matters.
8 Be it enacted by the Legislature of Louisiana:
9Section 1. R.S. 22:1049.1 is hereby enacted to read as follows:
10§1049.1.     Requirements for coverage for genetic testing and treatment of
11SCN2A-associated medical conditions
12A. For the purpose of this Section, the following terms have the meanings
13ascribed to them:
14(1) "Genetic testing" means a laboratory method used to detect changes in
15genes, gene expression, or chromosomes in a person's cells or tissues. Genetic
16testing may be done to look for inherited changes in a person's genes that may be a
17sign that the person has an increased risk of developing a specific disease or
18condition or of having a child or other family member that is covered under the
19enrollee's policy with the disease or condition.
20(2) "Health coverage plan" means any hospital, health, or medical expense
21insurance policy, hospital or medical service contract, employee welfare benefit plan,
22contract or agreement with a health maintenance organization or a preferred provider
23organization, health and accident insurance policy, or any other insurance contract
24of this type, including a group insurance plan and the Office of Group Benefits
25programs.
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1(3) "Medically necessary treatment" means health services necessary for the
2diagnosis, treatment, cure, or alleviation of health conditions, illnesses, injuries, or
3diseases. These services must be necessary and appropriate to address the specific
4health issue or its associated symptoms, and must adhere to the generally accepted
5standards of medical care within the community.
6(4) "SCN2A" refers to a gene located on chromosome 2, which provides
7critical instructions for the synthesis of a sodium channel protein essential for
8neurotransmission in the brain. The SCN2A gene encodes a voltage-gated sodium
9channel that plays a pivotal role in the generation of neuronal action potentials.
10Pathogenic variants of the SCN2A gene are associated with a wide spectrum of
11neurodevelopmental disorders, which may include but are not limited to neonatal or
12infantile onset epilepsy, developmental delay, autism spectrum disorder, intellectual
13disability, and movement disorders.
14B. Any health coverage plan delivered, issued for delivery, renewed, or
15otherwise contracted for in this state on or after January 1, 2027, shall provide
16coverage for genetic testing to diagnose SCN2A-associated medical conditions when
17ordered by a treating physician or advanced practice provider and determined to be
18medically necessary by the health coverage plan.
19C. A health coverage plan shall provide coverage for medically necessary
20treatment of SCN2A-associated medical conditions, including but not limited to:
21(1) Anti-seizure medications and other pharmacologic therapies.
22(2) Rehabilitative and habilitative services, including physical, occupational,
23speech, and behavioral therapies.
24(3) Medically necessary durable medical equipment, assistive technology,
25and adaptive devices.
26(4) Nutritional, feeding, and gastrointestinal management services.
27(5) Any additional treatment determined to be medically necessary by the
28treating physician or advanced practice provider.
29D. Medical necessity shall be determined by the enrollee's treating physician
30or advanced practice provider. Any denial of coverage based on medical necessity
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1shall be in writing and shall include the reasons for denial and an explanation of how
2the request does not meet medical necessity standards. Denials may be appealed
3pursuant to R.S. 22:1121 et seq.
4E. A health coverage plan may require prior authorization for services
5covered under this Section if such procedures are applied in a nondiscriminatory
6manner and are no more restrictive than those applied to other benefits.
7F.   A health coverage plan may impose copayments, deductibles, or
8coinsurance amounts on benefits required by this Section. Such cost-sharing shall
9not be greater than that applied to other medical or surgical benefits under the plan.
10G. A health coverage plan shall not deny coverage for genetic testing or
11medically necessary treatment under this Section on the basis of disability,
12developmental status, or preexisting condition.
13H. Benefits required by this Section shall be considered rehabilitative or
14habilitative services and devices for purposes of any state or federal requirement for
15coverage of essential health benefits.
16I. The provisions of this Section do not apply to limited benefit health
17insurance policies or contracts.
18Section 2. This Act shall become effective upon signature by the governor or, if not
19 signed by the governor, upon expiration of the time for bills to become law without signature
20 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
21 vetoed by the governor and subsequently approved by the legislature, this Act shall become
22 effective on the day following such approval.
  SPEAKER OF THE HOUSE OF REPRESENTATIVES
  PRESIDENT OF THE SENATE
  GOVERNOR OF THE STATE OF LOUISIANA
 APPROVED:
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