Definitions

As used in this subpart, the term: 751 20-2-910 (1) “Board” means the Board of Community Health established under Chapter 2 of Title 31. (2) “Commissioner” means the commissioner of community health established under Chapter 2 of Title 31. (3) “Public school employee” means an “employee” as defined in paragraph (20) of Code Section 47-4-2. Such term also means and includes classroom aides, paraprofessionals, and noncertified administrative and clerical personnel. It is specifically provided, however, that such term shall not include any emergency or temporary employee or any other employee who works in a position otherwise covered by such term less than 60 percent of the time required to carry out the duties of such position. Such term also means and includes any person, other than an employee in a professionally certificated capacity or position, employed not less than half time and compensated in a charter school in this state established pursuant to either Article 31 or Article 31A of this chapter if such charter school elects to participate in the health insurance plan established pursuant to this subpart upon initial approval of its charter or, if such charter school is an existing charter school, upon renewal of its charter, upon notice by the health insurance plan provided in this part, or upon the expiration of its current health care plan. Notwithstanding this definition or any other provision of this subpart, the board may, by regulation, make available to employees who work 17 ½ hours or more per week such benefits as are required to be made available to such employees by regulations of the United States Internal Revenue Service or any other federal authority. (4) “Qualified entity” means any person, association, corporation, or other legal entity with which the board is authorized under Chapter 18 of Title 45 to contract. History. Ga. L. 1975, p. 1194, § 1; Ga. L. 1980, p. 1538, § 1; Ga. L. 1982, p. 896, § 1; Ga. L. 1983, p. 3, § 16; Ga. L. 1989, p. 1146, § 1; Ga. L. 1999, p. 296, § 26; Ga. L. 2008, p. 612, § 2/HB 1277; Ga. L. 2009, p. 453, § 1-7/HB 228; Ga. L. 2021, p. 256, § 4/SB 59. The 2021 amendment, effective July 1, 2021, rewrote paragraph (3). Editor’s notes. Georgia Laws 1982, p. 896, § 1, effective July 1, 1982, amended Ga. L. 1975, p. 1194, § 1, as amended, the basis for this Code section, by adding a provision regarding the applicability of the term “public school employee” to emergency or temporary employees. However, the 1982 Act did not specifically amend this Code section. Furthermore, since Ga. L. 1975, p. 1194, § 1 stood repealed on November 1, 1982 (see Code Section 1-1-10(a)(2)), the 1982 amendment was of no effect after that date. The provisions of Ga. L. 1982, p. 896, § 1 were substantially reenacted by Ga. L. 1983, p. 3, § 16, and codified as an amendment to this Code section. 752 20-2-911 ELEMENTARY & SECONDARY EDUC. 20-2-911 20-2-911. Board to establish plan; rules and regulations; extent of coverage; recommendations to General Assembly for schedule of maximum fees for hospitals and practitioners. (a) The board is authorized to establish a health insurance plan for public school employees of this state and to adopt and promulgate rules and regulations for its administration, subject to the limitations contained in this subpart. Such plan may provide for group hospitalization, surgical, and medical insurance against the financial costs of hospitalization, surgery, and medical treatment and care and may also include, among other things, prescribed drugs, medicines, prosthetic appliances, hospital inpatient and outpatient service benefits, and medical expense indemnity benefits, including major medical benefits. (b) The board shall investigate fees of hospitals, pharmacists, and practitioners of the healing arts and present recommendations to the General Assembly by not later than January 15, 1991, for a schedule of maximum fees for hospitals and practitioners of the healing arts. The recommended fees for hospitals shall be determined based upon a statistical analysis of the peer groups adjusted for the intensity of the case mix for hospitals of same licensure classification or subclassification (e.g., general, pediatric, psychiatric, rehabilitation, etc.) and of similar services in the same geographic area. The recommended fee schedule shall not be at the average of the usual and customary charges if the board determines that the average represents an unreasonably high or low charge. (c) The recommended fees for practitioners of the healing arts and pharmacists shall be determined based upon a statistical analysis of the peer groups for such practitioners and pharmacists of the same licensure classification (e.g., internists, family practitioners, cardiologists, neurosurgeons, etc.) and of similar services in the same geographic area. The recommended fee schedule shall not be at the average of the usual and customary charges if the board determines that the average represents an unreasonably high or low charge. (d) The recommendations shall include an analysis of all hospitals, pharmacists, and practitioners accepting assignment of benefits for such services not to exceed the amount authorized by the fee schedule. The board shall publish in print or electronically a list of practitioners who accept assignment of benefits under the plan. (e) The recommendations shall include an analysis of the impact of practitioners agreeing to provide medical or surgical services at a reduced rate for members of the health insurance plan and of pharmacists and hospitals agreeing to provide hospital services, medical equipment, or pharmaceuticals at a reduced rate for members of the 753 20-2-913 health insurance plan. The board shall publish in print or electronically a list of practitioners of the healing arts, pharmacists, and hospitals that offer a reduced rate for members and the rate at which those services, equipment, or pharmaceuticals have been offered. History. Ga. L. 1975, p. 1194, § 2; Ga. L. 1990, p. 1924, § 2; Ga. L. 1991, p. 94, § 20; Ga. L. 2010, p. 838, § 10/SB 388; Ga. L. 2012, p. 775, § 20/HB 942.