Legislation	Secretary of Senate	Members	Committees	Meetings	Home	House

SB 2 - Comprehensive Patient & Provider Health Care Relief Act of 1999 (PF)

Thomas, Nadine (10th)

Status Summary	SC:	I&L	HC:		FR:	01/15/99	LA:	01/15/99	S - Read 1st time

First Reader Summary

A bill to amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions relating to insurance generally, so as to enact the "Comprehensive Patient and Provider Health Care Relief Act of 1999"; to provide for liability for failure by a health care insurer to provide for medically necessary items or services.

Code Sections - 33-24-59.4

SB 2   99                                          LC 19 3975 
 
      SENATE BILL 2 
 
      By:  Senator Thomas of the 10th 
 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Article 1 of Chapter 24 of Title 33 of the Official 
  1- 2  Code of Georgia Annotated, relating to general provisions 
  1- 3  relating to insurance generally, so as to enact the 
  1- 4  "Comprehensive Patient and Provider Health Care Relief Act 
  1- 5  of 1999"; to provide for liability for failure by a health 
  1- 6  care insurer to provide for medically necessary items or 
  1- 7  services; to provide for reimbursement for medically 
  1- 8  necessary items or services rendered to an insured person; 
  1- 9  to provide for the right of an insured person to choose a 
  1-10  health care provider to render any medically necessary items 
  1-11  or services within this state; to offer certain tax 
  1-12  incentives; to provide for related matters; to repeal 
  1-13  conflicting laws; and for other purposes. 
 
  1-14       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-15                           SECTION 1. 
 
  1-16  Article 1 of Chapter 24 of Title 33 of the Official Code of 
  1-17  Georgia Annotated, relating to general provisions relating 
  1-18  to insurance generally, is amended by adding at the end 
  1-19  thereof a new Code Section 33-24-59.4 to read as follows: 
 
  1-20    "33-24-59.4. 
 
  1-21    (a) This Code section shall be known and may be cited as 
  1-22    the 'Comprehensive Patient and Provider Health Care Relief 
  1-23    Act of 1999.' 
 
  1-24    (b) It is the purpose of this Code section: 
 
  1-25      (1) To provide for liability for failure by any health 
  1-26      benefit provider to provide for medically necessary 
  1-27      items or services within this state; 
 
  1-28      (2) To provide for adequate reimbursement for medically 
  1-29      necessary items or services rendered to an insured 
  1-30      person by a health care provider within this state; 
 
 
 
 
 
                                 -1- 
 
 
 
  2- 1      (3) To provide an insured person the right to choose a 
  2- 2      health care provider to render any medically necessary 
  2- 3      items or services in this state; 
 
  2- 4      (4) To attract more health care providers to underserved 
  2- 5      areas of this state by providing for more reasonable 
  2- 6      compensation for services rendered to patients by such 
  2- 7      providers and to provide that payment for services 
  2- 8      rendered shall not be an arbitrary number set by a 
  2- 9      person or entity who is not rendering those services; 
  2-10      and 
 
  2-11      (5) To offer a tax incentive to any individual or entity 
  2-12      within this state who chooses to obtain comprehensive 
  2-13      medical health insurance through an indemnity insurer 
  2-14      that is licensed within this state. 
 
  2-15    (c) The General Assembly finds that where many health 
  2-16    benefit providers cover the costs of medically necessary 
  2-17    item or services, other insurers fail to ensure that 
  2-18    patients receive appropriate and medically necessary 
  2-19    health care items and services and therefore advocate to a 
  2-20    lesser principle of the best medical service that can be 
  2-21    rendered to the citizens of this state. 
 
  2-22    (d) As used in this Code section, the term: 
 
  2-23      (1) 'Health benefit provider' means any insurer, health 
  2-24      maintenance organization, health benefit plan, preferred 
  2-25      provider organization, employee benefit plan, or other 
  2-26      entity which provides for payment or reimbursement of 
  2-27      health care expenses, health care items or services, 
  2-28      disability payments, lost wage payments, or any other 
  2-29      benefits under a policy of insurance or contract with an 
  2-30      individual or group. 
 
  2-31      (2) 'Health care provider' means any primary care 
  2-32      physician or specialist duly licensed or legally 
  2-33      authorized to provide health care services in this 
  2-34      state. 
 
  2-35      (3) 'Medically necessary' means that which is determined 
  2-36      by a treating physician after consultation with the 
  2-37      patient to be required according to generally accepted 
  2-38      principles of good medical practice for diagnosis or 
  2-39      direct care and treatment of an illness or injury of the 
  2-40      patient. 
 
  2-41    (e) Any health benefit provider doing business in this 
  2-42    state which chooses to make determination of medical 
 
 
                                 -2- 
 
 
 
  3- 1    necessity for items or services shall do so only through 
  3- 2    consultation with a health care provider who is board 
  3- 3    certified in the same specialty for which that 
  3- 4    determination is being made.  The health benefit provider 
  3- 5    and the health care provider consultant shall make that 
  3- 6    determination with the full knowledge that they shall be 
  3- 7    held responsible wholly or in part for any adverse effect 
  3- 8    or injury to the public health, safety, and welfare.  Such 
  3- 9    adverse effect shall be considered a tort for which a 
  3-10    recovery may be had wholly or in part from the health 
  3-11    benefit provider and the health care consultant. 
 
  3-12    (f) Any nonfederal health benefit provider shall adjust 
  3-13    reimbursement for items or services rendered to patients 
  3-14    by health care providers to be no less than the number 
  3-15    which is four times the present reimbursement schedule for 
  3-16    medicare services or procedures.  Changes in the 
  3-17    reimbursement schedule below this level can be petitioned 
  3-18    for every four years through the office of the Insurance 
  3-19    Commissioner in collaboration with the Georgia Board for 
  3-20    Physician Workforce.  A public notice shall be made after 
  3-21    each determination. 
 
  3-22    (g) Any employer within this state that wishes to provide 
  3-23    indemnity or nonmanaged care health insurance for 75 or 
  3-24    fewer employees shall be granted the opportunity to do so. 
  3-25    A tax incentive of $500.00 per employee shall be granted 
  3-26    to such employer at the end of the tax year. 
 
  3-27    (h) Any individual or family of two or more members who 
  3-28    wishes to obtain indemnity or nonmanaged care health 
  3-29    insurance shall be granted the opportunity to do so.  A 
  3-30    tax incentive of $500.00 shall be granted to such 
  3-31    individual at the end of the tax year.  A tax incentive of 
  3-32    $1,000.00 shall be granted to such family at the end of 
  3-33    the tax year. 
 
  3-34    (i) Any employer with 75 or more employees that wishes to 
  3-35    obtain indemnity or nonmanaged care health insurance shall 
  3-36    be granted the opportunity to do so. A tax incentive of 
  3-37    $250.00 per employee shall be granted to such employer at 
  3-38    the end of the tax year." 
 
  3-39                           SECTION 2. 
 
  3-40  All laws and parts of laws in conflict with this Act are 
  3-41  repealed. 
 
 
 
 
                                 -3-