RS 802 - Powers and duties; Office of Group Benefits
A.(1) The Office of Group Benefits shall have the powers and privileges of a corporation and shall exercise all powers, duties, functions, and responsibilities provided or authorized for it by law. It shall directly exercise all powers, duties, functions, and responsibilities provided or authorized for it which are in the nature of policymaking, rulemaking, licensing, regulation, enforcement, or adjudication and shall directly exercise all advisory powers, duties, and functions provided to it by law.
(2) The office shall administer and implement all programs provided or authorized for it by law which relate to rulemaking, licensing, regulation, enforcement, and adjudication and shall be subject to the provisions of the Administrative Procedure Act, including provisions relative to adjudication proceedings.
(3) The office shall exercise its powers, duties, functions, and responsibilities and shall administer and implement the programs authorized in this Section.
B. In addition, the office shall have the following powers and duties:
(1) To adopt and promulgate rules and regulations for the administration, operation, and management of programs and benefit plans offered through the Office of Group Benefits, which shall not be inconsistent with the provisions of this Chapter or other applicable laws.
(2) To prepare and submit a budget in accordance with the provisions of Parts I and II of Chapter 1 of Subtitle I of Title 39 of the Louisiana Revised Statutes of 1950.
(3) To designate a depository for operating and other monies under its control, which shall be fully guaranteed and shall be subject to the provisions of R.S. 49:321 and Chapter 1-A of Subtitle I of Title 39 of the Louisiana Revised Statutes of 1950.
(4) To appoint an independent consulting actuary.
(5) To do and perform all things necessary or incident to the powers, duties, and functions vested in it.
(6) To establish benefit plans, under the direction of the commissioner of administration, for the life, health, and other benefit programs offered through the office. This duty shall include the responsibility to ensure, to the greatest extent practicable, that the plans for benefits and coverages available for employees in all parts of the state are comparable with respect to coverages offered.
(7) Subject to the board's review and recommendation, to establish premium rates, under the direction of the commissioner of administration and in consultation with actuaries for the life, health, and other benefit programs offered through the office. The commissioner of administration, the chief executive officer of the Office of Group Benefits, and the Policy and Planning Board shall also use any official information developed, gathered, and presented to the parties by the Group Benefits Estimating Conference in the development of premium rates.
(8)(a) To negotiate contracts under the provisions of Chapter 17 of Subtitle III of Title 39 of the Louisiana Revised Statutes of 1950, in the best interests of the office and its covered persons. The Office of Group Benefits is specifically authorized to negotiate and contract directly with the following:
(i) Health maintenance organizations as defined by R.S. 22:242(7).
(ii) A group purchaser as defined in R.S. 40:2202(3).
(iii) A preferred provider organization.
(iv) A health care provider or providers for formation of a preferred provider organization as defined by R.S. 40:2202(5).
(b) The office is specifically authorized to negotiate and contract directly for the following:
(i) Provision of basic health care services and other health care services to the program's covered persons.
(ii) Any other health care plan or systems, including but not limited to any health care service, delivery system, benefits programs, insurance, or any other plan or programs that may be authorized by law.
(c) For the purposes of this Paragraph, the basic health care services provided under a contract for a preferred provider organization or a health maintenance organization shall be those services which are covered under the Office of Group Benefits Schedule of Benefits. Nothing herein shall prohibit the office from adopting rules or regulations to prevent or prohibit adverse selection between programs offered by the office.
(d) Any such contract shall be subject to review and final approval by the appropriate standing committees of the legislature having jurisdiction over review of agency rules by the Office of Group Benefits as designated by R.S. 49:968(B)(21)(c), or the subcommittees on oversight of such standing committees, and the office of state procurement of the division of administration.
(9) To administer or provide for the administration of an Internal Revenue Service qualified cafeteria plan. The plan shall be developed, negotiated, and implemented by the office subject to approval of the appropriate standing committees of the legislature having jurisdiction over review of agency rules of the Office of Group Benefits as designated by R.S. 49:968(B)(21)(c) or the subcommittee on oversight of such standing committees. The provisions of Chapter 17 of Subtitle III of Title 39 of the Louisiana Revised Statutes of 1950 shall not apply.
(10) To authorize small debts owed to the Office of Group Benefits to be canceled from the financial records. For purposes of this Paragraph, a small debt shall be any debt owed to the Office of Group Benefits in an amount less than fifty-one dollars.
(11) To procure and negotiate internal auditing service contracts in accordance with the provisions of Chapter 17 of Subtitle III of Title 39 of the Louisiana Revised Statutes of 1950.
(12) To procure and negotiate pharmacy benefit manager contracts through the use of a reverse auction pursuant to R.S. 39:1600(D) and 1600.1 when it has been determined by the division of administration to be in the best interest of the state.
C. Notwithstanding any other provision of law to the contrary, the Office of Group Benefits may establish health reimbursement accounts, health savings accounts, and similar accounts as authorized by federal law.
D.(1) Notwithstanding any other provision of this Section to the contrary, any new plan of benefits or the annual plan of benefits submitted under the direction of the commissioner of administration for the life, health, or other benefit programs offered through the Office of Group Benefits or any professional, personal, and social services contracts other than contracts for legal services or actuarial services negotiated through the Office of Group Benefits under the provisions of Chapter 17 of Subtitle III of Title 39 of the Louisiana Revised Statutes of 1950 as provided in Subsection A and Paragraph (B)(8) of this Section or any contracts in connection therewith shall be subject to review and final approval by the Joint Legislative Committee on the Budget.
(2) Additionally, any adjustments to such contracts in the amount of one million dollars or more shall require the review and approval of the oversight committees before the modified contracts may be implemented. Such adjustments shall indicate the fiscal impact to the plan of benefits as well as the rate structure, if any, over the subsequent three years or maximum contract period.
Acts 2001, No. 1178, §5, eff. June 29, 2001; Acts 2004, No. 890, §2; Acts 2007, No. 479, §1, eff. July 19, 2007; Acts 2008, No. 415, §2, eff. Jan. 1, 2009; Acts 2014, No. 864, §§4 and 5; Acts 2015, No. 146, §2, eff. Jan. 1, 2016; Acts 2018, No. 603, §1; Acts 2021, No. 102, §3.