07 HB 505/AP
House
Bill 505 (AS PASSED HOUSE AND SENATE)
By:
Representative Butler of the
18th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Title 49 of the Official Code of Georgia Annotated, relating to social
services, so as to change certain provisions relating to recovery of assistance
from third parties liable for sickness, injury, disease, or disability; to
expand certain obligations of insurers, managed health care entities, and
pharmacy benefit managers; to authorize the Department of Human Resources to
charge fees relating to the licensure of adult day centers; to provide for
related matters; to provide for effective dates; to provide for a contingency;
to repeal conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Title
49 of the Official Code of Georgia Annotated, relating to social services, is
amended by revising subsection (b) of Code Section 49-4-148, relating to
recovery of assistance from third parties liable for sickness, injury, disease,
or disability, as follows:
"(b)
All insurers, as defined in Code Section 33-24-57.1, including but not limited
to group health plans as defined in Section 607(1) of the federal Employee
Retirement Security Act of
1974,
and
managed care entities as defined in Code Section 33-20A-3, which offer health
benefit plans, as defined in Code Section 33-24-59.5,
pharmacy
benefit managers, as defined in Code Section 26-4-110.1, and any other parties
that are, by statute, contract, or agreement, legally responsible for payment of
a claim for a health care item or service
shall comply with this subsection.
Those
insurers
Such entities
set forth in this subsection
shall:
(1)
Cooperate with the department in determining whether a person who is a recipient
of medical assistance may be covered under that
insurer´s
entity´s
health benefit plan and eligible to receive benefits thereunder for the medical
services for which that medical assistance was provided
and respond to
any inquiry from the state regarding a claim for payment for any health care
item or service submitted not later than three years after such item or service
was provided;
(2)
Accept the department´s authorization for the provision of medical services
on behalf of a recipient of medical assistance as the
insurer´s
entity´s
authorization for the provision of those services;
and
(3)
Comply with the requirements of Code Section 33-24-59.5, regarding the timely
payment of claims submitted by the department for medical services provided to a
recipient of medical assistance and covered by the health benefit plan, subject
to the payment to the department of interest as provided in that Code section
for failure to
comply.;
(4)
Provide the department, on a quarterly basis, eligibility and claims payment
data regarding applicants for medical assistance or recipients for medical
assistance;
(5)
Accept the assignment to the department or a recipient of medical assistance or
any other entity of any rights to any payments for such medical care from a
third party; and
(6)
Agree not to deny a claim submitted by the department solely on the basis of the
date of submission of the claim, type or format of the claim, or a failure to
present proper documentation at the point-of-sale which is the basis of the
claim, if:
(A)
The claim is submitted to the department within three years from when the item
or service was furnished; and
(B)
Any action by the department to enforce its rights with respect to such claim
commenced within six years of the department´s submission of the
claim.
The
requirements of paragraphs (2) and (3) of this subsection shall only apply to a
health benefit plan which is issued, issued for delivery, delivered, or renewed
on or after April 28, 2001."
SECTION
2.
Said
title is further amended by adding a new Code section to read as
follows:
"49-6-86.
The
department shall be authorized to charge reasonable application fees, license
fees, renewal fees, or other similar fees relating to the licensure of adult
day centers in an amount established by the board pursuant to rules and
regulations. The board shall take into consideration input from consumers,
providers of adult day health services, and advocates during the rulemaking
process to establish such fees. If so appropriated by the General Assembly, the
fees shall be used to support the licensing, inspecting, and monitoring of adult
day centers. Fees may be refunded by the department for good cause, as
determined by the department."
SECTION
3.
Section
2 of this Act shall become effective only if funds are specifically appropriated
for the purposes of this Act in an appropriations act making specific reference
to this Act and shall become effective when funds so appropriated become
available for expenditure. For all other purposes, this Act shall become
effective on July 1, 2007.
SECTION
4.
All
laws and parts of laws in conflict with this Act are repealed.