Title 33 — Title 33
0 chapters · 1,218 sections in this title.
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-10 Chapter inapplicable to workers’ compensation provisions
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Nothing in this article shall apply to Chapter 9 of Title 34, relating to workers’ compensation. History. — Code 1981, § 33-20A-10, enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 350, § 2. ARTICLE 2 PATIENT’S RIGHT TO INDEPENDENT REVIEW Editor’s notes. — Ga. L. 1999, p. 350…
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-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. 809 33-20A-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…
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 Experimental treatment
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Determining whether treatment is experimental, §33-20A-40. Favorable determination by independent review organization. Effect, §33-20A-37. Grievance procedure. Adverse outcome of grievance procedure. Request for independent review, §33-20A-35. 1276 INDEX MANAGED HEALTH CARE PLANS…
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 Consumer
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Insurance underwriting and rate risking, §33-24-90. Consumer choice option. Managed health care plan, §33-20A-9.1. Consumer driven health plan.
O.C.G.A. § 33-20A-4 Standards
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Establishment, §33-20A-5. Confidentiality of information. Patient records, §33-20A-8. Conflicts of interest. Patient’s right to independent review. Independent review organization, §33-20A-39. Consumer choice option, §33-20A-9.1. Definitions, §33-20A-3. Consumers’ health insurance p…
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. 33-20A-42. Grievance procedures and hearings for Medicaid c…
O.C.G.A. § 33-20A-42 Short title, §33-20A-30
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PERSONAL PROPERTY. Insurance companies. Authority to sell, assign, transfer, etc., §33-11-38. Time limit for disposal, §33-11-40.
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-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-7 Drugs
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Restrictive formulary for prescription drugs. Requirements, §33-20A-9. Emergency services. Defined, §33-20A-3. Requirements, §33-20A-9. Experimental treatment. Patient’s right to independent review. Determining whether treatment is experimental, §33-20A-40. Financial incentive pro…
O.C.G.A. § 33-20A-7.1 Defined, §33-20A-3
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Payment of benefits, §33-20A-62. Quality assurance program. Requirements, §33-20A-5. Records. Patient records. Confidentiality and accuracy, §33-20A-8. Retroactive denial of claims, §33-20A-62. Defined, §33-20A-60.
O.C.G.A. § 33-20A-70 Insurance
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Group insurance. Authorized, §33-24-34. Deduction of premiums from wages or salaries, §33-24-34. Effect upon rights under workers’ compensation act, §33-24-36. Participation by employees generally, §33-24-35. Withdrawal or retirement from group plan, §33-24-35. Wages. Group insur…
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. 33…
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 803 33-20A-9 responsible for the patient’s emergency care and treatment and warranted by his or…
O.C.G.A. § 33-20A-9.1 Consumer driven health plan
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Health care spending accounts and consumer driven health plans, §33-30B-3. Consumer insurance premium finance agreement. Service charges, §33-22-9. 1129 INDEX DEFINED TERMS —Cont’d Consumer report. Insurance information, §33-39-3. Consumer reporting agency. Insurance information, …