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Georgia Statutes, Title 33

Georgia/Statutes

← All Georgia coverage

Title 33

73 chapters · 1,492 sections in this title.

All chapters in Title 331,492 Ch 24, INSURANCE GENERALLY134 Ch 14, DOMESTIC STOCK AND MUTUAL INSURERS78 Ch 11, INVESTMENTS72 Ch 23, LICENSING62 Ch 37, INSURERS REHABILITATION AND LIQUIDATION59 Ch 9, REGULATION OF RATES, UNDERWRITING RU…49 Ch 15, FRATERNAL BENEFIT SOCIETIES38 Ch 5, REGULATION OF UNAUTHORIZED INSURERS37 Ch 41, CAPTIVE INSURANCE COMPANIES34 Ch 20, HEALTH CARE PLANS33 Ch 3, AUTHORIZATION AND GENERAL REQUIREMEN…32 Ch 2, DEPARTMENT AND COMMISSIONER31 Ch 17, RECIPROCAL INSURERS31 Ch 21, HEALTH MAINTENANCE ORGANIZATIONS31

29 sections·Filtered byTitle 33✕Ch 20A✕

O.C.G.A. § 33-20A-1 Short title
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This article shall be known and may be cited as the ‘‘Patient Protection Act of 1996.’’ History. — Code 1981, § 33-20A-1, enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 350, § 2.
O.C.G.A. § 33-20A-2 Legislative ﬁndings
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(a) The General Assembly ﬁnds and declares that it is a vital government concern that the citizens of the State of Georgia have access to quality health care services and that informed consumers will be better able to identify and select plans that offer quality health care servi…
O.C.G.A. § 33-20A-3 Deﬁnitions
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As used in this article, the term: (1) ‘‘Emergency services’’ or ‘‘emergency care’’ means those health care services that are provided for a condition of recent onset and sufficient severity, including, but not limited to, severe pain, that would lead a prudent layperson, possess…
O.C.G.A. § 33-20A-4 Certiﬁcation requirements; review and recertiﬁcation; sanctions for failure to meet requirements; alternative methods for certiﬁcation
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(a) In addition to other requirements of law, prior to offering a managed care plan to any resident in Georgia, a managed care entity must ﬁrst obtain a certiﬁcate from the Commissioner of Insurance indicating that such managed care plan meets the requirements of this article. Th…

O.C.G.A. § 33-20A-5 Standards for certiﬁcation

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The Commissioner shall establish standards for the certiﬁcation of qualiﬁed managed care plans that conduct business in this state. Such standards must include the following provisions: (1) Disclosure to enrollees and prospective enrollees. (A) A managed care entity shall disclos…

O.C.G.A. § 33-20A-6 Financial incentive programs prohibited; capitated payment arrangement allowed

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(a) A managed care plan may not use a ﬁnancial incentive or disincentive program that directly or indirectly compensates a health care provider or hospital for ordering or providing less than medically necessary and appropriate care to his or her patients or for denying, reducing…

O.C.G.A. § 33-20A-7 Penalizing provider for discussing necessary or appropriate care with patient prohibited; penalty for providing records and assistance prohibited; penalty for violations

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(a) No health care provider may be penalized for considering, studying, or discussing medically necessary or appropriate care with or on behalf of his or her patient. (b) No health care provider may be penalized by a managed care plan for providing testimony, evidence, records, o…

O.C.G.A. § 33-20A-7.1 Application; managed care plan’s liability following precertiﬁcation; availability of personnel for precertiﬁcation procedure

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(a)(1) The provisions of this chapter shall apply to any managed care plan offered pursuant to Article 1 of Chapter 18 of Title 45 and to any managed care plan offered by any managed care entity. (2) When an enrollee, provider, facility, or home health care provider calls during …

O.C.G.A. § 33-20A-8 Conﬁdentiality and accuracy of patient records

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Each managed care plan shall establish procedures to safeguard the privacy of individually identiﬁable patient information and to maintain accurate and timely records for patients. History. — Code 1981, § 33-20A-8, enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 350, § 2.

O.C.G.A. § 33-20A-9 Emergency services requirements; restrictive formulary requirements

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Every managed care plan shall include provisions that: (1)(A) In the event that a patient seeks emergency services and if necessary in the opinion of the emergency health care provider responsible for the patient’s emergency care and treatment and warranted by his or her evaluati…

O.C.G.A. § 33-20A-9.1 Legislative intent; consumer choice option; provisions; increased expenses; covered beneﬁts; forms

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(a) It is the intent of the General Assembly to allow citizens to have the right to choose their own health care providers and hospitals with as few mandates from government and business as possible. It is also the intent to allow these choices with minimal additional cost to any…

O.C.G.A. § 33-20A-30 Short title

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This article shall be known and may be cited as the ‘‘Patient’s Right to Independent Review Act.’’ History. — Code 1981, § 33-20A-30, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

O.C.G.A. § 33-20A-31 Deﬁnitions

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As used in this article, the term: (1) ‘‘Department’’ means the Department of Community Health established under Chapter 2 of Title 31. (2) ‘‘Eligible enrollee’’ means a person who: (A) Is an enrollee or an eligible dependent of an enrollee of a managed care plan or was an enroll…

O.C.G.A. § 33-20A-32 Right to appeal

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An eligible enrollee shall be entitled to appeal to an independent review organization when: (1) The eligible enrollee has received notice of an adverse outcome pursuant to a grievance procedure or the managed care entity has not complied with the requirements of Code Section 33-…

O.C.G.A. § 33-20A-33 Minimum expense of treatment prior to review

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Except where required pursuant to Code Section 51-1-49, a proposed treatment must require the expenditure of a minimum of $500.00 to qualify for independent review. History. — Code 1981, § 33-20A-33, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

O.C.G.A. § 33-20A-34 Representatives for enrollee; cost of review; cooperation

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(a) The parent or guardian of a minor who is an eligible enrollee may act on behalf of the minor in requesting independent review. The legal guardian or representative of an incapacitated eligible enrollee shall be authorized to act on behalf of the eligible enrollee in requestin…

O.C.G.A. § 33-20A-35 Request for independent review

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(a) In the event that the outcome of the grievance procedure under Code Section 33-20A-5 is adverse to the eligible enrollee, the managed care entity shall include with the written notice of the outcome of the grievance procedure a statement specifying that any request for indepe…

O.C.G.A. § 33-20A-36 Additional information required for independent review

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(a) Within three business days of receipt of notice from the department of assignment of the application for determination to an independent review organization, the managed care entity shall submit to that organization the following: (1) Any information submitted to the managed …

O.C.G.A. § 33-20A-37 Effect of favorable determinations

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(a) A decision of the independent review organization in favor of the eligible enrollee shall be ﬁnal and binding on the managed care entity and the appropriate relief shall be provided without delay. A managed care entity bound by such decision of an independent review organizat…

O.C.G.A. § 33-20A-38 Organizational and employee liability

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Neither an independent review organization nor its employees, agents, or contractors shall be liable for damages arising from determinations made pursuant to this article, unless an act or omission thereof is made in bad faith or through gross negligence, constitutes fraud or wil…

O.C.G.A. § 33-20A-39 Certiﬁcation of independent review organizations; conﬂict of interest; quality assurance mechanism; copies of nonproprietary information

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(a) The department shall certify independent review organizations that meet the requirements of this Code section and any regulations promulgated by the department consistent with this article. The department shall deem certiﬁed any independent review organization meeting standar…

O.C.G.A. § 33-20A-40 Determining medical necessity or whether a treatment is experimental

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(a) For the purposes of this article, in making a determination as to whether a treatment is medically necessary and appropriate, the expert reviewer shall use the deﬁnition provided in paragraph (7) of Code Section 33-20A-31. (b) For the purposes of this article, in making a det…

O.C.G.A. § 33-20A-41 Rules and regulations

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The department shall provide necessary rules and regulations for the implementation and operation of this article. History. — Code 1981, § 33-20A-41, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

O.C.G.A. § 33-20A-42 Grievance procedures and hearings for Medicaid care management members

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Medicaid care management members shall, after ﬁrst exhausting the grievance procedure of the managed care plan providing health care beneﬁts pursuant to Article 7 of Chapter 4 of Title 49 or Article 13 of Chapter 5 of Title 49, be afforded the fair hearing rights provided pursuan…

O.C.G.A. § 33-20A-60 Deﬁnitions

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As used in this article, the term: (1) ‘‘Agent’’ shall not include an agent or agency as deﬁned in Code Section 33-23-1. (2) ‘‘Carrier’’ means an accident and sickness insurer, fraternal beneﬁt society, health care corporation, health maintenance organization, provider sponsored …

O.C.G.A. § 33-20A-61 Physician contracts

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(a) Every physician contract entered into, amended, extended, or renewed after July 1, 2002, by a carrier shall contain a speciﬁc provision which shall provide that, in the event that an insurance carrier, plan, network, panel, or any agent thereof should terminate a physician’s …

O.C.G.A. § 33-20A-62 Payment

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(a) No carrier, plan, network, panel, or any agent thereof may conduct a postpayment audit or impose a retroactive denial of payment on any claim by any claimant relating to the provision of health care services that was submitted within 90 days of the last date of service or dis…

O.C.G.A. § 33-20A-10 INDEX PATIENT PROTECTION ACT OF 1996 —Cont’d Short title, §33-20A-1

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PERMITS. Insurance representatives. Transferability of permits, §33-23-24. PATIENT PROTECTION AND AFFORDABLE CARE ACT. Waiver of provisions, request by governor, §33-1-26. PERSONAL INJURY PROTECTION. Motor vehicle insurance. Accident reparations, §§33-34-1 to

O.C.G.A. § 33-20A-70 Prescription costs in state funded health care plans

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Joint committee to study, §33-20A-70. GENERIC DRUGS. Pharmacy beneﬁts managers. Multi-source generic drug pricing,