Senate Bill No. by Senator Wheat aims to ensure that health coverage plans in Louisiana provide insurance coverage for medically necessary treatment related to acquired brain injuries. The bill mandates that all health coverage plans delivered or issued in the state must cover such treatments, as permitted by federal law. It prohibits any lifetime or unreasonable annual limitations on the number of treatment days or sessions and requires that limitations on rehabilitation services in inpatient facilities be separate from those for post-acute rehabilitation. Additionally, the bill stipulates that coverage for these treatments cannot have higher deductibles, coinsurance, or out-of-pocket limits than other similar benefits within the health coverage plan.

The bill also establishes that health coverage plans cannot deny coverage based solely on the treatment location, provided it meets clinical appropriateness and regulatory requirements. It requires that any adverse determinations regarding treatment preauthorization or utilization reviews be made by a clinical peer reviewer and allows for an expedited appeal process for such determinations. The legislation defines key terms related to acquired brain injuries and outlines that it will apply to new policies issued on or after January 1, 2027, with existing policies required to conform by January 1, 2028. The effective date for the bill is set for August 1, 2026.