06 LC 33
1115
House
Bill 1011
By:
Representatives Buckner of the
130th,
Walker of the
107th,
and Mosley of the
178th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 5A of Title 31 of the Official Code of Georgia Annotated, relating
to the Department of Community Health, so as to provide for a pilot program to
test and evaluate a system of coverage for costs associated with the prevention
and treatment of lymphedema; to provide for program eligibility; to provide for
coverage requirements; to provide for data collection; to provide for duration
of the pilot program; to provide for an evaluation report on the pilot program;
to provide for automatic repeal; 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
5A of Title 31 of the Official Code of Georgia Annotated, relating to the
Department of Community Health, is amended by adding a new Code section to the
end of such chapter to read as follows:
"31-5A-7.
(a)
The department shall establish a pilot program to test and evaluate a system of
coverage for costs associated with the prevention and treatment of lymphedema, a
chronic condition requiring lifelong management. Such pilot program shall
include a component for the system of medical assistance established pursuant to
Article 7 of Chapter 4 of Title 49 and for the state
employeeś
health insurance plan established pursuant to Article 1 of Chapter 18 of Title
45. The purpose of such pilot program shall be to identify costs to the state
and measure health benefits to the pilot participants in order to determine
whether to provide such coverage on a permanent basis to all Medicaid recipients
and all state employees with state health coverage.
(b)
The pilot program shall include a minimum number of participants from each
coverage program to effectuate statistically significant data in which to make
the determination referenced in subsection (a) of this Code section. Any person
who is eligible to be a recipient of medical assistance under Article 7 of
Chapter 4 of Title 49 or who is eligible for and has elected coverage under the
state
employeeś
health insurance plan established pursuant to Article 1 of Chapter 18 of Title
45 shall be eligible to participate in the pilot program. The department may
establish procedures for determining which recipients may become participants in
a pilot program. Priority of participation in the pilot program shall be given
to those with the greatest medical need with regard to lymphedema, the greatest
financial need, or both.
(c)
To the extent funding is available, the pilot program shall provide coverage for
the following, if ordered by a physician, for patients diagnosed with
lymphedema:
(1)
A maximum of 20 treatment sessions per year with a nationally certified
lymphedema therapist. Such sessions shall not count against any other annual or
lifetime limit of physical, speech, occupational, or other therapy sessions;
(2)
Two sets of compression garments per year. A set shall include two compression
garments, one to be used for daytime wear and one to be used for nighttime wear;
and
(3)
Other treatments or medical devices, as determined by the
department.
(d)
The department shall produce and maintain records and data relating to the pilot
program to assist in the evaluation of the program. The department shall
solicit and collect input from physicians, physical therapists, certified
lymphedema therapists, and other health care providers on the operation of the
pilot program.
(e)
The department shall take whatever action is necessary to begin operation of a
pilot program no later than July 1, 2006, including enrolling individual
participants. The pilot program shall continue to operate until June 30,
2011.
(f)
No later than January 1, 2011, the department shall contract with an independent
organization with expertise in the area of health care and policy to produce a
report regarding the evaluation and results of the pilot program. Such report
shall include:
(1)
Costs to the state to provide coverage for lymphedema prevention and treatment
to recipients of medical assistance under Article 7 of Chapter 4 of Title 49 and
to individuals receiving health care coverage under the state
employeeś
health insurance plan established pursuant to Article 1 of Chapter 18 of Title
45;
(2)
Health benefits to participants in the pilot program resulting from prevention
and treatment; and
(3)
A recommendation as to whether such coverage should be extended on a permanent
basis to all Medicaid recipients and all state employees with state health
coverage.
Such
report shall be completed and submitted to the General Assembly no later than
December 31, 2011.
(g)
This Code section shall be automatically repealed on December 31,
2011."
SECTION
2.
This
Act shall become effective upon its approval by the Governor or upon its
becoming law without such approval.
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.