06 LC 33
1274
House
Bill 1364
By:
Representatives Sheldon of the
105th,
Walker of the
107th,
Cox of the
102nd,
Graves of the
137th,
and Carter of the
159th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Title 30 of the Official Code of Georgia Annotated, relating to
handicapped persons, so as to provide for assistance in matters relating to the
medicare prescription drug insurance plan; to provide a short title; to provide
for legislative findings; to provide for definitions; to provide for other
related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
This
Act shall be known and may be cited as the "Georgia Medicare Part D Authorized
Decision Makers Act."
SECTION
2.
The
General Assembly finds that:
(1) Some disabled adults and elder persons who need to purchase an insurance product to provide for their prescription drugs lack the capacity to do so on their own and have no authorized representative to do so on their behalf;
(2) Failure to enroll in the appropriate plan may lead to barriers to access to needed medications and can have a dire effect on the health and well-being of such disabled adults and elder persons;
(3) Certain individuals are appropriate to be authorized to act on behalf of such disabled adults and elder persons to choose a Medicare Part D prescription drug plan or a Medicare Advantage Plan, file drug coverage exceptions and appeals, and pursue grievances with Medicare Part D plan sponsors and the federal Centers for Medicare and Medicaid Services; and
(4) Legislative action is needed to meet the pharmaceutical needs of these disabled adults and elder persons.
(1) Some disabled adults and elder persons who need to purchase an insurance product to provide for their prescription drugs lack the capacity to do so on their own and have no authorized representative to do so on their behalf;
(2) Failure to enroll in the appropriate plan may lead to barriers to access to needed medications and can have a dire effect on the health and well-being of such disabled adults and elder persons;
(3) Certain individuals are appropriate to be authorized to act on behalf of such disabled adults and elder persons to choose a Medicare Part D prescription drug plan or a Medicare Advantage Plan, file drug coverage exceptions and appeals, and pursue grievances with Medicare Part D plan sponsors and the federal Centers for Medicare and Medicaid Services; and
(4) Legislative action is needed to meet the pharmaceutical needs of these disabled adults and elder persons.
SECTION
3.
Title
30 of the Official Code of Georgia Annotated, relating to handicapped persons,
is amended by adding a new chapter to read as follows:
"CHAPTER
5A
30-5A-1.
As
used in this chapter, the term:
(1)
'Authorized representative" means:
(A)
A staff member or volunteer of the state health insurance assistance program,
commonly known as 'Georgia Cares';
(B)
A case manager or care coordinator; and
(C)
An employee of any health care provider licensed by the Department of Human
Resources or of any community services provider funded by the Department of
Human Resources or the Department of Community Health.
(2)
'Case manager' or 'care coordinator' means an employee, contractor, or designee
of the Department of Human Resources or Department of Community Health that
provides case management services to those eligible, including but not limited
to: caseworkers for Medicaid eligibility, adult protective services, mental
health developmental disability and addictive diseases, the Service Options
Using Resources in a Community Environment Program, and the community care
services program.
(3)
'Eligible person' means an individual who is eligible to receive Medicare Part D
drug benefits.
(4)
'Enroll' and 'enrollment' means the act of enrolling an eligible person into a
Medicare Part D Prescription Drug Plan or Medicare Advantage Plan or the act of
changing plans.
(5)
'Incapable' means that the eligible
persońs
ability to receive and evaluate information effectively or communicate decisions
is impaired or diminished to such an extent that the person currently lacks the
capacity to make Medicare Part D decisions as determined by an authorized
representative.
(6)
'Legal representative' means:
(A)
A legal guardian or conservator appointed by a court of competent
jurisdiction;
(B)
A legal surrogate who is a duly appointed person authorized to act, within the
scope of the authority granted under the legal
surrogatés
appointment, such as through a statutory financial power of attorney or a
durable power of attorney for health care; and
(C)
Any other entity authorized in state or federal law or by order of a court of
competent jurisdiction.
(7)
'Medicare Part D' refers to the national prescription drug plan for all Medicare
beneficiaries created by Congress in the Medicare Modernization Act of 2003, P.
L. 108-173 and implemented January 1, 2006.
(8)
'Medicare Part D decision' means a decision to enroll in or disenroll from a
Medicare Part D plan or any other postenrollment decision.
(9)
'Medicare Part D Plan,' 'Medicare Prescription Drug Plan,' and 'Medicare
Advantage Plan' all mean a program under contract with the federal Centers for
Medicare and Medicaid Services to provide prescription drug insurance to people
enrolled in the medicare program.
(10)
'Postenrollment action' or 'postenrollment decision' means determining whether
and how to do any of the following within the Medicare Part D
program:
(A)
File a grievance;
(B)
Submit a complaint to the quality improvement organization;
(C)
Request and obtain a coverage determination, including exception requests and
requests for expedited procedures;
(D)
File and request an appeal and direct any part of the appeals process;
and
(E)
Disenroll from a Medicare Part D Plan.
30-5A-2.
(a)
If the eligible person is incapable and has a legal representative, the legal
representative shall be authorized to make Medicare Part D decisions within the
scope of his or her authority as a legal representative of the eligible
person.
(b)(1)
If the eligible person is incapable and does not have a legal representative, an
authorized representative may act on behalf of the eligible person solely for
the purpose of making Medicare Part D Decisions to the extent permitted by state
and federal law.
(2)
The authorized representative shall provide the eligible person a written copy
of the enrollment or disenrollment action taken that includes a statement that
if the eligible person does not agree with the action taken by the authorized
representative, the eligible person may reject the action of such person and
request the assistance of a different authorized representative. In addition to
providing the written information, this information may also be provided to the
eligible person orally or in some other appropriate manner.
(3)
Medicare Part D decisions made by an authorized representative shall be clearly
guided by the eligible
persońs
expressed wishes or in the eligible
persońs
best interest in selecting a drug benefit that will appropriately meet the
eligible
persońs
pharmaceutical needs.
(4)
An authorized representative shall not:
(A)
Receive monetary remuneration or any other compensation from a pharmacy or a
Medicare Part D plan based on Medicare Part D plan enrollment or postenrollment
activities;
(B)
Make Medicare Part D decisions for the sole benefit of a facility, pharmacy, or
plan; or
(C)
Serve as an agent of a Medicare Part D
plan."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.