HB 1798 - Essential Rural Health Care Provider Access Act; enact

First Reader Summary

A BILL to amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to provide for legislative findings and intent; to create a new article to be known as the "Essential Rural Health Care Provider Access Act"; and for other purposes.

Murphy, Thomas B (18th) Hudson, Sistie G (120th) Powell, Alan T (23rd)
McCall, Tom (90th) Hudson, Newt (156th) Channell, R. M. (Mickey) (111th)
Status Summary HC: Rules SC: H&HS LA: 03/06/98 S - Read 1st Time (FSFA )
Page Numbers - 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8
Code Sections - 33-20B-1/ 33-20B-2/ 33-20B-3/ 33-20B-4/ 33-20B-5/ 33-20B-6/ 31-7-75.3
House Action Senate
2/26/98 Read 1st Time 3/6/98
2/27/98 Read 2nd Time
3/2/98 Favorably Reported
3/6/98 Read 3rd Time
3/6/98 Passed/Adopted
FSFA Comm/Floor Amend/Sub

HB 1798                                          HB 1798/FSFA 
 
      H. B. No. 1798 (FLOOR SUBSTITUTE)(AM) 
      By:  Representatives Murphy of the 18th, Hudson of the 
      120th and Powell of the 23rd 
 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Title 33 of the Official Code of Georgia Annotated, 
  1- 2  relating to insurance, so as to provide for legislative 
  1- 3  findings and intent; to create a new chapter to be known as 
  1- 4  the "Essential Rural Health Care Provider Access Act"; to 
  1- 5  provide for definitions; to provide for the designation of 
  1- 6  essential rural health care providers; to impose 
  1- 7  requirements for qualifications as essential rural health 
  1- 8  care providers; to provide that certain essential rural 
  1- 9  health care providers shall have the opportunity to become 
  1-10  participating providers in health care plans; to provide for 
  1-11  good faith negotiations between providers and health care 
  1-12  insurers; to provide for physicians in such plans; to 
  1-13  provide for certain exceptions for health maintenance 
  1-14  organizations and for considerations regarding certain 
  1-15  service areas; to provide for administration by the 
  1-16  Commissioner of Insurance; to provide for conditions for 
  1-17  denial, rejection, or termination of an essential rural 
  1-18  health care provider as a participating provider and an 
  1-19  opportunity to cure any deficiency; to provide for hearing, 
  1-20  appeal, and confidentiality of information; to amend Title 
  1-21  31 of the Official Code of Georgia Annotated, relating to 
  1-22  health, so as to provide for exemptions from certificate of 
  1-23  need requirements for certain rural hospitals; to provide 
  1-24  for changes in joint hospital authorities where a 
  1-25  participating unit is a rural county having less than a 
  1-26  specified population; to provide for powers of certain rural 
  1-27  hospital authorities; to provide for effective dates; to 
  1-28  repeal conflicting laws; and for other purposes. 
 
  1-29       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-30                           SECTION 1. 
 
  1-31  It is the intent of the General Assembly to encourage the 
  1-32  continued existence and availability of certain health care 
  1-33  providers in rural areas of the state so as to promote and 
  1-34  preserve the provision of primary care to the residents of 
  1-35  such rural areas.  The General Assembly finds that a severe 
 
 
 
                                 -1- 
 
 
 
  2- 1  shortage of health care providers currently exists in many 
  2- 2  rural areas, and those providers which do exist continue to 
  2- 3  do so under financial hardship.  The General Assembly 
  2- 4  further finds that rural health care providers are being 
  2- 5  arbitrarily excluded from participating in certain health 
  2- 6  benefit plans and that, should such practice continue, these 
  2- 7  providers will be harmed and forced either to discontinue 
  2- 8  their services or relocate to urban areas thereby further 
  2- 9  exacerbating the shortage which already exists.  The General 
  2-10  Assembly therefore concludes that certain steps must be 
  2-11  taken to promote the continued existence and expansion of 
  2-12  rural health care providers in order to preserve the 
  2-13  availability of primary health care services to Georgia's 
  2-14  rural citizens. 
 
  2-15                           SECTION 2. 
 
  2-16  Title 33 of the Official Code of Georgia Annotated, relating 
  2-17  to insurance, is amended by adding immediately following 
  2-18  Chapter 20A thereof a new chapter to read as follows: 
 
 
 
  2-19    33-20B-1. 
 
  2-20    This chapter shall be known and may be cited as the 
  2-21    'Essential Rural Health Care Provider Access Act.' 
 
  2-22    33-20B-2. 
 
  2-23    As used in this chapter, the term: 
 
  2-24      (1) 'Essential rural health care provider' means any 
  2-25      hospital, federally qualified health center, or rural 
  2-26      health clinic, as such terms are defined in this Code 
  2-27      section, which is located in a rural area and which 
  2-28      complies with the provisions of Code Section 33-20B-3. 
 
  2-29      (2) 'Federally qualified health center' means, for the 
  2-30      purposes of this Code section, a facility which meets 
  2-31      the definition of a federally qualified health center as 
  2-32      described in Section 1395x(aa)(4) of Title 42 of the 
  2-33      United States Code Annotated and which is located in a 
  2-34      rural area. 
 
  2-35      (3) 'Health benefit plan' or 'plan' means the health 
  2-36      insurance policy or subscriber agreement between a 
  2-37      covered person or policyholder and a health care insurer 
  2-38      which defines the covered services and benefit levels 
  2-39      available. 
 
 
 
                                 -2- 
 
 
 
  3- 1      (4) 'Health care insurer' means an insurer, a fraternal 
  3- 2      benefit society, a health care plan, a nonprofit medical 
  3- 3      service corporation, a nonprofit hospital service 
  3- 4      corporation, a health care corporation, a health 
  3- 5      maintenance organization, or any other entity authorized 
  3- 6      to sell accident and sickness insurance policies, 
  3- 7      subscriber certificates, or other contracts of health 
  3- 8      insurance by whatever name called under Title 33. 
 
  3- 9      (5) 'Health care services' means services rendered or 
  3-10      products sold by an essential rural health care provider 
  3-11      within the scope of such provider's license or legal 
  3-12      authorization. 
 
  3-13      (6) 'Hospital' means any building or facility licensed 
  3-14      by the department as a hospital under this chapter 
  3-15      which: 
 
  3-16        (A) Operates no more than 100 beds; 
 
  3-17        (B) Provides 24 hour emergency care as well as a range 
  3-18        of health care services sufficient to support the 
  3-19        practice of a primary care physician; and 
 
  3-20        (C) For at least one of the immediately preceding two 
  3-21        fiscal years, derived at least 40 percent of its 
  3-22        patient revenues from medicare, Medicaid, or any 
  3-23        combination of medicare and Medicaid. 
 
  3-24      (7) 'Physician' for purpose of this section only means 
  3-25      any person who is licensed to practice medicine by the 
  3-26      Composite State Board of Medical Examiners pursuant to 
  3-27      Chapter 34 of Title 43 who practices as a family 
  3-28      physician, general internist, pediatrician, general 
  3-29      practitioner, general surgeon, or 
  3-30      obstetrician/gynecologist and who has medical staff 
  3-31      privileges at a hospital as defined in paragraph (6) of 
  3-32      this Code section. 
 
  3-33      (8) 'Rural area' means any county having a population of 
  3-34      less than 35,000 according to the United States 
  3-35      decennial census of 1990 or any future such census. 
 
  3-36      (9) 'Rural health clinic' means a facility which is 
  3-37      located in a rural area and which meets the definition 
  3-38      of a rural health clinic as described in Section 
  3-39      1395x(aa)(2) of Title 42 of the United States Code 
  3-40      Annotated. 
 
 
 
 
                                 -3- 
 
 
 
  4- 1    33-20B-3. 
 
  4- 2    (a) Any essential rural health care provider shall have 
  4- 3    the opportunity to become a participating provider of 
  4- 4    health care services in a health benefit plan if such 
  4- 5    provider meets all of the following conditions: 
 
  4- 6      (1) Participates in the medicare and Medicaid programs; 
 
  4- 7      (2) Adopts and complies with a policy for the provision 
  4- 8      of health care services to indigent and charity 
  4- 9      patients; 
 
  4-10      (3) Is licensed, where required under law, and qualified 
  4-11      to render the services provided by the plan; 
 
  4-12      (4) Agrees to payment terms which are either: 
 
  4-13        (A) The same payment terms applicable to other similar 
  4-14        participating providers in the plan; or 
 
  4-15        (B) Such payment terms as may be mutually agreed upon 
  4-16        by such provider and a health care insurer; and 
 
  4-17      (5) Meets the reasonable and nondiscriminatory 
  4-18      qualifications and standards established by the plan. 
  4-19      Plan standards must comply with all applicable laws and 
  4-20      regulations, but such qualifications and standards may 
  4-21      not discriminate against essential rural health care 
  4-22      providers on the basis of geographic proximity to other 
  4-23      participating providers or corporate status. 
 
  4-24    (b) All essential rural health care providers within a 
  4-25    defined service area who meet the conditions established 
  4-26    in subsection (a) of this Code section shall be given the 
  4-27    opportunity to apply to become a participating provider in 
  4-28    a plan.  Provisions within a health benefit plan 
  4-29    applicable to providers in such plan shall be applied by 
  4-30    the health care insurer in a uniform and consistent manner 
  4-31    to similarly situated providers.  In the event an 
  4-32    essential rural health care provider requests the 
  4-33    opportunity to become a participating provider in any 
  4-34    health benefit plan, the health care insurer shall conduct 
  4-35    reasonable and good faith negotiations with such essential 
  4-36    rural health care provider to determine whether it meets 
  4-37    the applicable qualifications and standards established by 
  4-38    the plan in accordance with all applicable laws, rules, 
  4-39    and regulations as promulgated the Commissioner of 
  4-40    Insurance. 
 
 
 
 
                                 -4- 
 
 
 
  5- 1    (c) Health benefit plans shall include sufficient and 
  5- 2    reasonable numbers of physicians located in rural areas. 
 
  5- 3    (d) A health care insurer which is a health maintenance 
  5- 4    organization shall not be required to comply with this 
  5- 5    Code section within such health maintenance organization's 
  5- 6    service area if such area was approved by the commissioner 
  5- 7    of human resources or otherwise is deemed by the 
  5- 8    Commissioner of Insurance to have complied with the 
  5- 9    standards established by the commissioner of human 
  5-10    resources. When reviewing a health maintenance 
  5-11    organization's request to originate or expand an area of 
  5-12    service into a rural area, the commissioner of human 
  5-13    resources shall consider whether the health maintenance 
  5-14    organization has demonstrated its willingness to grant 
  5-15    reasonable consideration to essential rural health care 
  5-16    providers in the negotiating and contracting process. 
 
  5-17    33-20B-4. 
 
  5-18    To deny, reject, or terminate an essential rural health 
  5-19    care provider from serving as a participating provider in 
  5-20    a health benefit plan, the health care insurer shall: 
 
  5-21      (1) Inform the essential rural health care provider in 
  5-22      writing of the basis for such rejection or termination, 
  5-23      including a reference to any specific qualification or 
  5-24      standard established by the plan in accordance with all 
  5-25      applicable laws and regulations which the provider 
  5-26      failed to meet; and 
 
  5-27      (2) Where possible, afford the essential rural health 
  5-28      care provider a reasonable opportunity to cure the 
  5-29      deficiency which is the basis for such rejection or 
  5-30      termination. 
 
  5-31    33-20B-5. 
 
  5-32    Any essential rural health care provider which is denied, 
  5-33    rejected, or terminated from serving as a participating 
  5-34    provider in a health benefit plan shall have the right of 
  5-35    hearing and appeal before the Commissioner, or his or her 
  5-36    designee, if that provider believes there has been a 
  5-37    violation of  this chapter and of judicial appeal as 
  5-38    provided in Chapter 2 of Title 33.  To the extent 
  5-39    proprietary materials, trade secrets, rate data, or other 
  5-40    materials not generally known to the public are presented 
  5-41    at a hearing or an appeal, such information shall be 
  5-42    admissible but shall be sealed by the Commissioner and 
 
 
 
                                 -5- 
 
 
 
  6- 1    held as confidential and shall not be subject to Article 4 
  6- 2    of Chapter 18 of Title 50. 
 
  6- 3    33-20B-6. 
 
  6- 4    The administration of this chapter shall be through the 
  6- 5    Commissioner of Insurance." 
 
  6- 6                           SECTION 3. 
 
  6- 7  Title 31 of the Official Code of Georgia Annotated, relating 
  6- 8  to health, is amended by adding between paragraphs (14) and 
  6- 9  (15) of subsection (a) of Code Section 31-6-47, relating to 
  6-10  exemptions from certificate of need requirements, a new 
  6-11  paragraph to read as follows: 
 
  6-12      "(14.1) Services provided by a home health agency 
  6-13      through or on behalf of a medical-surgical hospital: 
 
  6-14        (A) Which is located in a county having a population 
  6-15        of 35,000 or less according to the United States 
  6-16        decennial census of 1990 or any future such census; 
 
  6-17        (B) Which is the only such hospital in that county; 
 
  6-18        (C) Which has a bed capacity of less than 100 beds; 
 
  6-19        (D) Which had combined revenues from Medicaid and 
  6-20        medicare which were greater than 40 percent of net 
  6-21        revenues the year in which those new institutional 
  6-22        health services were first provided; 
 
  6-23        (E) Which had gross revenues of less than $30 million 
  6-24        based upon the planning agency's 1995 report which 
  6-25        tabulated information required under Code Section 
  6-26        31-6-70; and 
 
  6-27        (F) Which provides those services only in the county 
  6-28        in which that hospital is located or in any other 
  6-29        county contiguous to such county in which that 
  6-30        hospital is located, which other county has no 
  6-31        hospital and has a population of 35,000 or less 
  6-32        according to the United States decennial census of 
  6-33        1990 or any future such census; 
 
  6-34      provided, that such services may not be provided until 
  6-35      such hospital applies to the planning agency for and 
  6-36      obtains an exemption, the planning agency conducts a 
  6-37      public hearing, within 45 days following such 
  6-38      application, in the county in which that hospital is 
  6-39      located regarding the provision of those services, and 
  6-40      the agency determines the hospital otherwise meets the 
 
 
                                 -6- 
 
 
 
  7- 1      requirements of this paragraph, whereupon that agency 
  7- 2      may then grant such exemption;" 
 
  7- 3                           SECTION 4. 
 
  7- 4  Said  title is further amended by striking subsection (d) of 
  7- 5  Code Section 31-7-72, relating to the creation of hospital 
  7- 6  authorities, and inserting in its place the following: 
 
  7- 7    "(d) Any two or more counties or any two or more 
  7- 8    municipalities or any county or municipality, or a 
  7- 9    combination of any county and any municipality, by a like 
  7-10    resolution or ordinance of their respective governing 
  7-11    bodies, may authorize the exercise of the powers provided 
  7-12    for in this article by an authority.  The membership of 
  7-13    such authority affected by like resolutions of the 
  7-14    respective governing bodies of any two or more of the 
  7-15    governing bodies of the participating units shall be not 
  7-16    less than five nor more than 15 members, the terms and 
  7-17    distribution of members between the participating units to 
  7-18    be provided for by the resolutions adopted by the 
  7-19    governing bodies of the participating units.  The 
  7-20    resolutions of the governing bodies of participating units 
  7-21    acting together for the creation of an authority may be 
  7-22    amended by the governing bodies of the participating units 
  7-23    from time to time.  Where the governing bodies of 
  7-24    participating units have acted together for the creation 
  7-25    of an authority under this subsection and where at least 
  7-26    one of those participating units is a county having a 
  7-27    population of 35,000 or less according to the United 
  7-28    States decennial census of 1990 or any future such census, 
  7-29    the method of filling vacancies upon such authority may be 
  7-30    changed only by local Act of the General Assembly and, 
  7-31    when so changed, shall be governed by that local Act." 
 
  7-32                           SECTION 5. 
 
  7-33  Said title is further amended by adding after Code Section 
  7-34  31-7-75.2 a new Code section to read as  follows: 
 
  7-35    "31-7-75.3. 
 
  7-36    A hospital authority which owns or operates a hospital 
  7-37    which is qualified to provide home health agency services 
  7-38    under the exemption provided in paragraph (14.1) of 
  7-39    subsection (a) of Code Section 31-6-47 shall be authorized 
  7-40    to exercise such powers under this article." 
 
 
 
 
 
                                 -7- 
 
 
 
  8- 1                           SECTION 6. 
 
  8- 2  Sections 1, 2, 3, and 5 of this Act shall become effective 
  8- 3  July 1, 1999.  The remaining provisions of this Act shall 
  8- 4  become effective upon its approval by the Governor or upon 
  8- 5  its becoming law without such approval. 
 
  8- 6                           SECTION 7. 
 
  8- 7  All laws and parts of laws in conflict with this Act are 
  8- 8  repealed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 -8- 

Clerk of the House
Robert E. Rivers, Jr., Clerk
Last Updated on 04/20/98

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