HB 545 - Essential Rural Provider Access Act; enact
Georgia House of Representatives - 1995/1996 Sessions
HB 545 - Essential Rural Provider Access Act; enact
Page Numbers - 1/ 2/ 3/ 4/ 5/ 6
1. Cox 160th 2. Coleman 142nd 3. Royal 164th
4. Hart 116th 5. Greene 158th 6. Bates 179th
House Comm: Ins / Senate Comm: /
House Vote: Yeas Nays Senate Vote: Yeas Nays
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House Action Senate
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2/2/95 Read 1st Time
2/3/95 Read 2nd Time
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Code Sections amended: 31-7-310, 31-7-312, 31-7-313, 31-7-314, 31-7-315,
31-7-316
HB 545 LC 22 1505
A BILL TO BE ENTITLED
AN ACT
1- 1 To amend Chapter 7 of Title 31 of the Official Code of
1- 2 Georgia Annotated, relating to the regulation and
1- 3 construction of hospitals and other health care facilities,
1- 4 so as to provide for the definition and designation of
1- 5 essential rural providers; to provide for legislative
1- 6 findings and intent; to provide for definitions; to impose
ded d , th d A @ d zA @ d A @ d HA @ d A @ d A @ d }A
1- 8 providers; to authorize essential rural providers to enter
1- 9 into certain payment arrangements with the Department of
1-10 Medical Assistance to provide Medicaid services; to require
1-11 the commissioner of human resources to adopt qualifications
1-12 and standards to be met by such providers wishing to
1-13 participate in health benefit plans; to provide that certain
1-14 essential rural providers shall not be denied the
1-15 opportunity to become participating providers in health care
1-16 plans; to provide for good faith negotiations between
1-17 providers and insurers; to require written notice of an
1-18 insurer's reasons for rejecting or terminating an essential
1-19 rural provider and an opportunity to conform to a
1-20 qualification or standard; to authorize the commissioner of
1-21 human resources to adopt rules and regulations; to provide
1-22 for automatic repeal; to repeal conflicting laws; and for
1-23 other purposes.
1-24 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
1-25 Chapter 7 of Title 31 of the Official Code of Georgia
1-26 Annotated, relating to the regulation and construction of
1-27 hospitals and other health care facilities, is amended by
1-28 inserting at the end thereof the following:
"ARTICLE 14
1-29 31-7-310. (Index)
1-30 This article shall be known and may be cited as the
1-31 'Essential Rural Provider Access Act.'
-1- (Index)
LC 22 1505
2- 1 31-7-311. (Index)
2- 2 It is the intent of the General Assembly to encourage the
2- 3 continued existence and availability of certain health
2- 4 care providers in rural areas of the state so as to
2- 5 promote and preserve the provision of primary care to the
2- 6 residents of such rural areas. The General Assembly finds
2- 7 that a severe shortage of health care providers currently
2- 8 exists in many rural areas, and those providers which do
2- 9 exist continue to do so under serious financial hardship.
2-10 The General Assembly further finds that rural health care
2-11 providers are being arbitrarily excluded from
2-12 participating in certain health benefit plans and that,
2-13 should such practice continue, these providers will be
2-14 irreparably harmed and forced either to discontinue their
2-15 services or relocate to urban areas, thereby further
2-16 exacerbating the shortage which already exists. The
2-17 General Assembly therefore concludes that certain steps
2-18 must be taken to promote the continued existence and
2-19 expansion of rural health care providers in order to
2-20 preserve the availability of primary health care services
2-21 to Georgia's rural citizens.
2-22 31-7-312. (Index)
2-23 As used in this article, the term:
2-24 (1) 'Essential rural provider' means any hospital,
2-25 federally qualified health center, rural health clinic,
2-26 pharmacy, nursing home, or physician, as such terms are
2-27 defined in this Code section, which is located in a
2-28 rural area and which complies with the provisions of
2-29 Code Section 31-7-313.
2-30 (2) 'Federally qualified health center' means a facility
2-31 which is located in a rural area and which meets the
2-32 definition of a federally qualified health center as
2-33 described in Section 1395x(aa)(4) of Title 42 of the
2-34 United States Code Annotated as such title, section, and
2-35 constituent parts existed on January 1, 1995.
2-36 (3) 'Health benefit plan' means the health insurance
2-37 policy or subscriber agreement between a covered person
2-38 or policyholder and a health care insurer which defines
2-39 the covered services and benefit levels available.
2-40 (4) 'Health care insurer' means an insurer, a fraternal
2-41 benefit society, a health care plan, a nonprofit medical
2-42 service corporation, a nonprofit hospital service
-2- (Index)
LC 22 1505
3- 1 corporation, or a health maintenance organization
3- 2 authorized to sell accident and sickness insurance
3- 3 policies, subscriber certificates, or other contracts of
3- 4 insurance by whatever name called under Title 33.
3- 5 (5) 'Health care services' means services rendered or
3- 6 products sold by an essential rural provider within the
3- 7 scope of such provider's license or legal authorization.
3- 8 (6) 'Hospital' means any building or facility licensed
3- 9 by the department as a hospital under this chapter
3-10 which:
3-11 (A) Operates no more than 100 beds;
3-12 (B) Provides 24 hour emergency care as well as a range
3-13 of health care services sufficient to support the
3-14 practice of a primary care physician;
3-15 (C) For at least one of the immediately preceding two
3-16 fiscal years, derived at least 50 percent of its
3-17 patient revenues from medicare, Medicaid, or any
3-18 combination of medicare and Medicaid; and
3-19 (D) Is either:
3-20 (i) Located in a rural area and in a county in which
3-21 no other medical-surgical hospital is located; or
3-22 (ii) Is designated as a disproportionate share
3-23 hospital by the Department of Medical Assistance.
3-24 (7) 'Nursing home' means any building or facility
3-25 licensed by the department as a nursing home under this
3-26 chapter which is located in a rural area and in a county
3-27 in which no other nursing home is located.
3-28 (8) 'Pharmacy' means any business located in a rural
3-29 area which operates as a licensed pharmacy in accordance
3-30 with Part 4 of Article 2 of Chapter 4 of Title 26.
3-31 (9) 'Physician' means any person who is licensed to
3-32 practice medicine by the Composite State Board of
3-33 Medical Examiners pursuant to Chapter 34 of Title 43
3-34 whose primary office for the treatment of patients is
3-35 located in a rural area and who practices as a primary
3-36 care physician.
3-37 (10) 'Primary care physician' means a physician as
3-38 defined by this Code section who practices as a family
3-39 physician, general internist, pediatrician, general
3-40 surgeon, obstetrician, or gynecologist.
-3- (Index)
LC 22 1505
4- 1 (11) 'Rural area' means any county having a population
4- 2 of less than 30,000 according to the United States
4- 3 decennial census of 1990 or any future such census.
4- 4 (12) 'Rural health clinic' means a facility which is
4- 5 located in a rural area and which meets the definition
4- 6 of a rural health clinic as described in Section
4- 7 1395x(aa)(2) of Title 42 of the United States Code
4- 8 Annotated, as such title, section, and constituent parts
4- 9 existed on January 1, 1995.
4-10 31-7-313. (Index)
4-11 In order to qualify as an essential rural provider under
4-12 this article, a provided must:
4-13 (1) Participate in the medicare and Medicaid programs;
4-14 (2) Adopt and comply with a policy for the provision of
4-15 health care services to indigent and charity patients
4-16 which meets such reasonable requirements as may be
4-17 established by the commissioner; and
4-18 (3) Have in effect sufficient referral agreements with
4-19 other essential rural providers in the same county and
4-20 with other providers to demonstrate its ability to meet
4-21 the health care needs of those citizens residing in such
4-22 rural area.
4-23 31-7-314. (Index)
4-24 (a) This Code section shall apply to any essential rural
4-25 provider which is willing to render health care services
4-26 covered by a health benefit plan under one of the
4-27 following:
4-28 (1) The same payment terms applicable to other
4-29 participating providers in the plan; or
4-30 (2) Such payment terms as may be mutually agreed upon by
4-31 such provider and a health care insurer.
4-32 (b) No essential rural health provider shall be denied the
4-33 opportunity to become a participating provider in such
4-34 plan, provided such provider meets the reasonable and
4-35 nondiscriminatory qualifications and standards established
4-36 by the commissioner of human resources pursuant to Code
4-37 Section 31-7-315. In the event an essential rural
4-38 provider requests the opportunity to become a
4-39 participating provider in any health benefit plan, the
4-40 health care insurer shall conduct reasonable and good
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LC 22 1505
5- 1 faith negotiations with such essential rural provider to
5- 2 determine whether it meets the applicable qualifications
5- 3 and standards established by the commissioner. If the
5- 4 requesting essential rural provider does meet such
5- 5 qualifications and standards, the health care insurer
5- 6 shall approve such provider as a participating provider
5- 7 for purposes of such plan. Nothing in this Code section
5- 8 shall be deemed to prevent a health care insurer from
5- 9 voluntarily approving any provider as a participating
5-10 provider in any health benefit plan.
5-11 (c) Notwithstanding the provisions of Title 33 or any
5-12 other law to the contrary, any essential rural provider
5-13 shall be authorized to contract with the Department of
5-14 Medical Assistance to provide covered health care services
5-15 to Medicaid beneficiaries on a prepaid capitation basis or
5-16 other basis satisfactory to such department.
5-17 31-7-315. (Index)
5-18 No later than the effective date of this article, the
5-19 commissioner of human resources shall adopt and publish
5-20 reasonable and nondiscriminatory qualifications and
5-21 standards to be met by an essential rural provider in
5-22 order to become a participating provider in any health
5-23 benefit plan pursuant to subsection (b) of Code Section
5-24 31-7-314. In no event shall such qualifications and
5-25 standards require an essential rural provider to be
5-26 accredited by any national, regional, or state
5-27 accreditation body, nor shall they impose upon an
5-28 essential rural provider any obligation or requirement
5-29 which could not reasonably be met by similar rural
5-30 providers in like surrounding circumstances.
5-31 31-7-316. (Index)
5-32 To reject or terminate an essential rural provider from
5-33 serving as a participating provider in a health plan, the
5-34 health care insurer shall:
5-35 (1) Inform the provider in writing of the basis for such
5-36 rejection or termination, referring to the specific
5-37 qualification or standard which the provider failed to
5-38 meet; and
5-39 (2) Afford the provider a reasonable opportunity to
5-40 conform to such qualification or standard.
-5- (Index)
LC 22 1505
6- 1 31-7-317. (Index)
6- 2 The commissioner of human resources shall promulgate rules
6- 3 and regulations necessary or appropriate to the
6- 4 administration and enforcement of this article no later
6- 5 than September 1, 1995."
SECTION 2.
6- 6 This article shall be automatically repealed on July 1,
6- 7 2001.
SECTION 3.
6- 8 All laws and parts of laws in conflict with this Act are
6- 9 repealed.
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Robert E. Rivers, Jr., Clerk of the House
Last Updated on 01/02/97