Mandated Benefits in Louisiana
- Attention deficit/hyperactivity disorder (ADHD)
- Cleft lip and palate
- Hearing-impaired interpreter
- Pap test
- Mammography examinations
- Prostate cancer screenings
- Children’s immunizations
- Bone-mass measurement for osteoporosis
- Diabetes
- Reconstructive breast surgery following mastectomy
- Drugs used in the treatment of cancer
- Inpatient anesthesia for dental services
- Cancer clinical trials
- Severe mental illness
- Low-protein food products for inherited metabolic diseases
- Correctable medical conditions resulting in infertility
- Ambulance transportation
- Hospital length of stay for newborns and mothers
- Routine gynecological care
- Parity in annual and lifetime limits for mental health services
- Emergency medical services
- Hearing aids for minor children
- Colorectal cancer screening
- Prosthetic services and devices
- Autism spectrum disorders
- Covered services performed by registered nurse first assistants
- Covered services performed by chiropractors
- Covered services in ambulatory surgical centers
- Covered services performed by dentists
- Covered services performed by licensed marriage and family therapists
- Alcoholism and drug abuse (mandated option)
- Speech and language pathology therapy, physical therapy, rehabilitative services, and occupational therapy (mandated option)
Federal Mandates
- Maternity-related services (for employers with more than fifteen employees)
- Minimum hospital stay of forty-eight hours for delivery (ninety-six hours for Cesarean delivery)
- Parity of medical/surgical and mental health benefits (for employers with more than fifty employees)
- Breast reconstruction and other related services following mastectomy
Effect of state health insurance legislation on small employers
When a state legislature enacts a change to health insurance law, federal rules limit the effect of such legislation. The Employee Retirement Income Security Act (ERISA), administered by the U.S. Department of Labor, preempts the application of state law to self-insured, private employer-sponsored health benefit plans. The result of ERISA preeption is that many state laws including, but not limited to mandated benefits, apply mostly to small employers. These small businesses make up only about one-third of the total health insurance market and represent the sector that is most sensitive to rising costs. Moreover, mandates create an additional incentive for employers to self-insure, thus diminishing even further the number of employees who actually receive the benefit.
The Lewin Report
Click here to review the often-cited study by The Lewin Group detailing the relationship between rising health care costs and the number of uninsured. The Lewin Group is a national health care and human services consulting firm with more than 35 years of experience in the field.
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