06 LC 33
1326
House
Bill 1464
By:
Representatives Gardner of the
57th,
Manning of the
32nd,
Brown of the
69th,
Ashe of the
56th,
Oliver of the
83rd,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 5 of Title 49 of the Official Code of Georgia Annotated, relating
to programs and protection for children and youth, so as to enact the "PeachCare
for All Kids Act"; to repeal the "PeachCare for Kids Act"; to provide for a
short title; to provide for definitions; to provide for the creation of the
PeachCare for All Kids health care insurance plan; to provide for eligibility,
health care services, and payment of premiums and copayments; to provide for
accessing federal matching funds; to provide for health care provider
enrollment; to provide for rules and regulations; to provide for construction;
to provide for a study of adequacy of provider payments; to provide for an
annual report; to provide for related matters; to provide for an effective date;
to repeal conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Chapter
5 of Title 49 of the Official Code of Georgia Annotated, relating to programs
and protection for children and youth, is amended by striking Article 13,
relating to PeachCare for Kids, in its entirety and inserting in lieu thereof a
new article to read as follows:
"ARTICLE
13
49-5-270.
This
article shall be known and may be cited as the "PeachCare for All Kids
Act."
49-5-271.
The
General Assembly finds and declares:
(1)
All children need quality, timely health care in order to achieve maximum
physical and mental health, to benefit fully from their educational
opportunities, and to mature into the productive citizens
tomorroẃs
Georgia needs;
(2)
It is the right of every Georgia child to have such health care;
(3)
Lack of health insurance is associated with low utilization of appropriate
health services, poorer health, poorer school achievement, and lower lifetime
earnings;
(4)
At least 100,000 Georgia children are uninsured, and many others have unstable
or inadequate insurance;
(5)
While the United States spends more per person on health care than any other
country, a far higher proportion of our citizens are uninsured than in any other
economically developed country; we receive fewer doctor visits than citizens of
the nations that are our economic competitors, and we have poorer health
outcomes and life expectancy. That health coverage is ensured by the public
sector in other major nations but not in the United States puts Georgia
businesses at a competitive disadvantage in the emerging global
economy;
(6)
Employment based insurance has declined in Georgia and in the rest of the United
States as the burden of uncontrolled and unpredictable health spending has led
many businesses to end or reduce coverage and others to close their doors or
move offshore. Many people in Georgia who desire to pursue business
opportunities are constrained by the need to remain in particular employment to
retain health coverage;
(7)
The current Medicaid and PeachCare for Kids programs are tools the state can use
creatively to assure access to health care for all children and to improve the
statés
economy. Establishment of the PeachCare for All Kids program pursuant to this
article leverages state buying power while utilizing heretofore untapped federal
funds available to the state; and
(8)
Establishing PeachCare for All Kids in Georgia is in the public interest by
removing a persistent worry for families and serving as a major benefit for all
Georgia businesses as well as an incentive for others that may consider
relocating to this state.
49-5-272.
As
used in this article, the term:
(1)
'Department' means the Department of Community Health.
(2)
'PeachCare for All Kids' means the health care insurance plan created by Code
Section 49-5-273 and shall include PeachCare for All Kids A, PeachCare for All
Kids B, and PeachCare for All Kids C.
(3)
'PeachCare for All Kids A' means the PeachCare for All Kids health care
insurance plan created by subsection (c) of Code Section 49-5-273 for children
in families with incomes at or below 200 percent of the federal poverty
level.
(4)
'PeachCare for All Kids B' means the PeachCare for All Kids health care
insurance plan created by subsection (d) of Code Section 49-5-273 for children
in families ineligible for PeachCare for All Kids A due to income, but with
incomes below 400 percent of the federal poverty level.
(5)
'PeachCare for All Kids C' means the PeachCare for All Kids health care
insurance buy-in program created by subsection (e) of Code Section 49-5-273 for
children ineligible for PeachCare for All Kids A or PeachCare for All Kids
B.
49-5-273.
(a)
There is created the PeachCare for All Kids health care insurance plan to
provide health care insurance for Georgia children.
(b)
Children who meet the following criteria shall be eligible for PeachCare for All
Kids which shall be administered by the department:
(1)
Children from birth through 18 years of age; and
(2)
For PeachCare for All Kids A and PeachCare for All Kids B, children who are
residents of the State of Georgia and citizens of the United States of America
or who are immigrants in categories eligible for coverage as of January 1, 2006,
under Title XIX or Title XXI of the federal Social Security Act.
(c)
There is created PeachCare for All Kids A which shall be operated by the
department consistent with Article 7 of Chapter 4 of this title. No premiums
shall be charged to participants under PeachCare for All Kids A. For children
over age six with family incomes exceeding 150 percent of the federal poverty
level, the department may require a copayment by the participant not to exceed
$2.00 per visit to a physician or dentist and fifty cents per prescription
filled; provided, however, that no copayment shall be charged for preventive
services as defined by the department. A child shall not be denied service for
inability to pay the copayment.
(d)(1)
There is created PeachCare for All Kids B. To the extent permitted by federal
law and to the extent federal matching funds are available, the department shall
set income disregards for this plan so as to cover children in families with
incomes above the limit for PeachCare A, but below 400 percent of the federal
poverty level. PeachCare for All Kids B shall offer substantially the same
health care services and coverage available to children under PeachCare for All
Kids A except that it shall not cover nonemergency transportation.
(2)
The department may require premiums for participation in PeachCare for All Kids
B as follows:
(A)
For participants with family income at or between 200 percent and 250 percent of
the federal poverty level, a maximum of $30.00 per month per child up to a total
family maximum of $60.00; and
(B)
For participants with family income above 250 percent of the federal poverty
level, a sliding scale of premiums as determined by the department based on
ability to pay.
(3)
The department may set reasonable copayment requirements for participants for
services provided under PeachCare for All Kids B, provided that copayments are
not charged for preventive services as defined by the department.
(4)
To be eligible to enroll in PeachCare for All Kids B, a child may not have been
covered by health insurance for the previous three months unless the child is
less than three months of age, the
child́s
parent has been involuntarily separated from his or her employment or no longer
qualifies for health benefits, his or her employer has discontinued health
insurance coverage as an employee benefit, or there is other good cause as
defined by the department including, but not limited to, good cause related to a
child́s
special health needs. A family shall not be required to exhaust COBRA
continuation benefits prior to receiving benefits under this plan. A child who
loses financial eligibility for PeachCare for All Kids A shall not be required
to exhaust a waiting period to enter PeachCare for All Kids B.
(e)(1)
There is created PeachCare for All Kids C which shall be available to children
ineligible for PeachCare for All Kids A or PeachCare for All Kids B. It shall
offer substantially the same health care services and coverage available to
children under PeachCare for All Kids B.
(2)
Families may buy into PeachCare for All Kids C at a group rate to be determined
by the department. Coverage under PeachCare for All Kids C shall not be
subsidized by the state unless funds are specifically appropriated for this
purpose.
(3)
The department may set reasonable copayment requirements for participants for
services provided under PeachCare for All Kids C, provided that copayments are
not charged for preventive services as defined by the department.
(f)
The department shall submit amendments to its state plans under Title XIX and
Title XXI of the Social Security Act consistent with the requirements of this
article. The department shall submit claims to the federal government in such a
manner as to maximize the amount of federal matching funds received under Title
XXI of the Social Security Act.
(g)
The department, through the Department of Administrative Services or any other
appropriate entity, may contract for any or all of the following services:
collection of premiums, processing of applications, outreach, data services, and
evaluation, if such contracting achieves administrative or service cost
efficiency. The department, and other state agencies as appropriate, shall
provide necessary information to any entity engaged in the administration of the
PeachCare for All Kids plan.
(h)
Any health care provider who is enrolled in the Medicaid program shall be deemed
to be enrolled in PeachCare for All Kids.
(i)
The department may promulgate such rules and regulations as it deems necessary
to effectuate this article.
(j)
Nothing in this article shall be interpreted in a manner so as to preclude the
department from contracting with licensed health maintenance organizations or
provider sponsored health care corporations for coverage of program services and
eligible children. The department may require enrollment in a health
maintenance organization or provider sponsored health care corporation as a
condition of receiving coverage under the program.
(k)
Nothing in this article shall be interpreted in a manner so as to preclude an
employer or other person or entity from paying premiums for a
child́s
coverage under PeachCare for All Kids.
(l)
The department shall conduct a study to determine the provider payment rates
that would be sufficient to ensure adequate access to all covered services for
children eligible for PeachCare for All Kids. The study report shall include
recommendations on provider payment rate changes. The department shall publish
its report no later than December 1, 2006.
(m)
The department shall publish an annual report, copies of which shall be provided
to the Governor and the General Assembly, setting forth the number of
participants in the program, the health care services provided, the amount of
money paid to providers, and other pertinent information with respect to the
administration of the
program."
SECTION
2.
This
Act shall become effective on January 1, 2007.
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.