Georgia Administrative Code

(1) Funds appropriated by the General Assembly to the Department pursuant to O.C.G.A. § 31-8-156 shall be used for the purposes stated in Rule and shall be used to match federal funds which are available for such purposes. (2) The Department shall provide for public notice of the…

All Department records related to the Indigent Care Trust Fund shall be open for public inspection in accordance with the Open Records Act, O.C.G.A. § 50-18-70et seq.

Except where inconsistent with O.C.G.A., Title 31, Chapter 4 8, Articles 6, 6A, and 6B (Indigent Care Trust Fund), the provisions of O.C.G.A., Title 49, Chapter 4, Article 7 (Georgia Medical Assistance Act of 1977) shall apply to the Department in carrying out the purposes of the…

In accordance with Title XIX of the Social Security Act, 42 U.S.C. § 1396p, the State of Georgia has defined a process to recover the cost of medical assistance payments from the estates of deceased Members. The Official Code of Georgia gives the state the authority to recover th…

(1) "Authorized representative" means a guardian or a person designated by the Member to act on his or her behalf during the Member's life. (2) "Creditor" means an entity (person or institution) to whom an obligation is owed because a Member received something of value in exchang…

(1) If a debt is due pursuant to this section from the estate of a Member, the administrator of the nursing facility, intermediate care facility for individuals with intellectual disabilities, or medical institution in which the Member resided at the time of their death, the Medi…

(1) These regulations shall be construed and applied to further the intent of the Legislature to supplement Medicaid funds that are used to provide medical services to eligible persons. Estate recovery shall be accomplished by the Department or its agent filing a statement of cla…

(1) After receipt of notice of the death of an affected Member, the Department will file a claim against the estate for the full value of the Medicaid benefits paid on behalf of the Member. (2) No action to recover a debt due by the deceased Member shall be commenced against the …

(1) The administrator of the program may present an affidavit to a financial institution requesting that the financial institution release account proceeds to recover the cost of services correctly provided to a Member. The affidavit shall include the following information: (a) T…

(1) The basis for authority to impose liens is based on the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). The TEFRA lien law provides that the agency can place a Lien on the available real estate of a Member who enters a nursing home and is "permanently institutionali…

(1) Hardship waivers will be submitted to the program administrator for review. The denial of a hardship waiver may be appealed as provided under the Administrative Procedures Act, O.C.G.A. § 50-13-1 et. seq. The waiver is limited to the period in which the undue hardship exists.…

As used in Chapter 111-3-9: (1) "Board" means the Board of Community Health, the body created under O.C.G.A. § 31-2-3, appointed by the Governor, that establishes the general policy to be followed by the Department of Community Health. (2) "Department" means the Department of Com…

(1) There is established within the Trust Fund a Segregated Account for revenues raised through the imposition of the Provider Payment. Any Provider Payment assessed pursuant to this Chapter shall be deposited into the Segregated Account. No other funds shall be deposited into th…

(1) The Department shall collect the Provider Payments imposed pursuant to this Chapter. All revenues raised pursuant to this Chapter shall be deposited into the Segregated Account. Such funds shall be dedicated and used for the sole purpose of obtaining federal financial partici…

Upon the adoption by the Board, Chapter 111-3-9 shall become effective on July 1, 2013.

(1) "Active" means that the Employee is receiving compensation or is on Approved Leave of Absence Without Pay through a department, school system, Local Employer, agency, authority, board, commission, county department of family and children services, county department of health,…

(1) Functions, Duties and Responsibilities of the Board of Community Health. The Board shall provide policy direction for the operation of the State Health Benefit Plan. Other responsibilities as defined by law are: (a) Establish and Design Plan. The Board is authorized to establ…

(1) Applicability. All Members who become eligible for Coverage under the SHBP shall be enrolled or permitted to change Coverage election only in accordance with these regulations. All Employing Entities covered by the Acts shall administer the SHBP in accordance with these regul…

(1) Active Employees. Employees who are actively at work or on approved leave of absence and have not terminated their employment may participate in the SHBP if classified as the following: (a) Full-Time. 1. State Employees who work a minimum of thirty (30) hours per weeks are co…

(1) Upon Employment. The Employee's Coverage under the SHBP shall become effective on the first of the month following employment for the full preceding calendar month if the Employee has not terminated employment on or before that date. Coverage for a transferring Employee shall…

(1) Open Enrollment Period and Retiree Option Change Period. The Open Enrollment period and Retiree Option change period shall be a minimum period of fifteen (15) days and shall begin no earlier than October 1 and shall end no later than November 15 of each year. The Commissioner…

(1) Employee. Employees are permitted to continue the current Coverage under conditions outlined by State law. Application for Extended Coverage must be made to the Administrator within thirty-one (31) calendar days following Coverage termination as an Active Employee or Extended…

(1) Extended Beneficiary. Persons who lose coverage under the Plan and who meet requirements as specified in these regulations or as specified by federal law are eligible to continue Coverage in the enrolled Option, without evidence of insurability. An Extended Beneficiary shall …

(1) Termination from Employment. Termination from employment includes resignation, abandonment of job, release from job, forfeiture of job, and all other types of termination. Health benefit Coverage shall terminate at the end of the month following the month of the last date of …

(1) Creation of Benefit Schedule. The Board is authorized to establish benefit schedules for Options to be included in a health benefit plan for eligible persons as defined in Georgia law. Benefit schedules shall comply with applicable state and federal law. Benefit schedules sha…

(1) Filing Claims. The Administrator shall coordinate the procedures for filing claims with the TPA. Such procedures may not establish a liability period greater than the maximum liability period set forth below. Claim forms shall be designed and printed for the Member's and prov…

(1) Functions, Duties and Responsibilities of the Board of Community Health. The Board shall establish the Georgia Retiree Health Benefit Fund (GRHBF). The Board in its official capacity shall be the GRHBF's trustee. The Board shall annually review Other Post Employment Benefits …

These rules are adopted and published pursuant to the Official Code of Georgia Annotated (O.C.G.A.) § 49-6-80et seq., the "Adult Day Center for Aging Adults Licensure Act."

These rules shall be known as the Rules and Regulations for Adult Day Centers. The purposes of these rules are to provide for licensing and inspection of adult day centers which provide adult day care services and/or adult day health services to three or more adults, and to estab…

These rules and regulations shall not apply to the following: (1) Individuals or organizations operating an adult day center without receiving compensation as a condition of the participant's receiving such services; (2) Individuals or organizations that provide services for comp…

(1) In these rules, unless the context otherwise requires, the words and phrases set forth herein shall mean the following: (a) "Abuse" means any intentional or grossly negligent act or series of acts or intentional or grossly negligent omission to act which causes injury to a pa…

(1) Unless exempted in section , no person, partnership, entity, corporation, or association, whether operated for profit or not for profit, shall operate an adult day center without first obtaining a valid license from the Department. (2) A license issued under these rules shall…