05 LC 28
2405
House
Bill 747
By:
Representatives Watson of the
91st,
Maxwell of the
17th,
Tumlin of the
38th,
and Manning of the
32nd
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 11 of Title 31 of the Official Code of Georgia Annotated, relating
to emergency medical services, so as to include providers of emergency
prehospital health care and emergency medical transportation within the
definition of emergency medical providers; to include the services of such
providers within the definition of emergency services; to amend Title 33 of the
Official Code of Georgia Annotated, relating to insurance, so as to include
providers of emergency prehospital health care and emergency medical
transportation within the definition of emergency medical providers; to prevent
insurers from penalizing covered persons for using certain ambulance services;
to include licensed ambulance services within the list of nonparticipating and
nonpreferred providers of health care services who are entitled to receive
payment of assigned benefits directly from an insurer; to provide for related
matters; to provide an effective date; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Chapter
11 of Title 31 of the Official Code of Georgia Annotated, relating to emergency
medical services, is amended by striking paragraphs (2) and (3) of Code Section
31-11-81, relating to definitions, and inserting in lieu thereof new paragraphs
(2) and (3) to read as follows:
"(2)
'Emergency medical provider' means any
provider of
emergency prehospital health care or emergency medical transportation licensed
or permitted by the Georgia Department of Human
Resources, hospital licensed or permitted
by the Georgia Department of Human Resources, hospital based service, or
physician licensed by the Composite State Board of Medical Examiners who
provides emergency services.
(3)
'Emergency services' means
emergency
prehospital health care, emergency medical transportation,
or health care services provided in a
hospital emergency facility to evaluate and treat any emergency
condition."
SECTION
2.
Said
chapter is further amended by striking subsection (b) of Code Section 31-11-82,
relating to evaluation of person with emergency condition, and inserting in lieu
thereof a new subsection (b) to read as follows:
"(b)
If,
in the opinion of the attending physician
or emergency
medical provider, the evaluation provided
under subsection (a) of this Code section warrants, he or she may initiate
appropriate intervention to stabilize the condition of the patient without
seeking or receiving prospective authorization by an insurer, a health
maintenance organization, or a private health benefit plan. No insurer, health
maintenance organization, or private health benefit plan may subsequently deny
payment for an evaluation, diagnostic testing, or treatment provided as part of
such intervention for an emergency
condition."
SECTION
3.
Title
33 of the Official Code of Georgia Annotated, relating to insurance, is amended
by striking subparagraph (A) of paragraph (1) of Code Section 33-20A-9, relating
to emergency services requirements, and inserting in lieu thereof a new
subparagraph (A) to read as follows:
"(1)(A)
In the event that a patient seeks emergency services and if necessary in the
opinion of the emergency health care provider responsible for the
patient́s
emergency care and treatment and warranted by his or her evaluation, such
emergency provider may initiate necessary intervention to stabilize the
condition of the patient without seeking or receiving prospective authorization
by the managed care entity or managed care plan. No managed care entity or
private health benefit plan may subsequently deny payment for an evaluation,
diagnostic testing, or treatment provided as part of such intervention for an
emergency condition. For purposes of this Code section, the term 'emergency
health care provider' includes without limitation an emergency services provider
and a licensed
or permitted provider of emergency prehospital health care or emergency medical
transportation."
SECTION
4.
Said
title is further amended by striking subsection (a) of Code Section 33-24-54,
relating to payments to nonparticipating or nonpreferred providers of health
care services, and inserting in lieu thereof a new subsection (a) to read as
follows:
"(a)
Notwithstanding any provisions of Code Sections 33-1-3, 33-1-5, and 33-24-17 and
Chapter 20 of this title or any other provisions of this title which might be
construed to the contrary, whenever an accident and sickness insurance policy,
subscriber contract, or self-insured health benefit plan, by whatever name
called, which is issued or administered by a person licensed under this title
provides that any of its benefits are payable to a participating or preferred
provider of health care services licensed under the provisions of Chapter 4 of
Title 26, or
of Chapter 11 of Title 31, or of Chapter
9, 11, 30, 34, 35, or 39 of Title 43 for services rendered, the person licensed
under this title shall be required to pay such benefits either directly to any
similarly licensed nonparticipating or nonpreferred provider who has rendered
such services, has a written assignment of benefits, and has caused written
notice of such assignment to be given to the person licensed under this title or
jointly to such nonparticipating or nonpreferred provider and to the insured,
subscriber, or other covered person; provided, however, that in either case the
person licensed under this title shall be required to send such benefit payments
directly to the provider who has the written assignment. When payment is made
directly to a provider of health care services as authorized by this Code
section, the person licensed under this title shall give written notice of such
payment to the insured, subscriber, or other covered
person."
SECTION
5.
Said
title is further amended by striking Code Section 33-30-24, relating to health
benefit plans providing incentives to use services of preferred providers, and
inserting in lieu thereof a new Code Section 33-30-24 to read as
follows:
"33-30-24.
Health
care insurers may issue health benefit plans which provide for incentives for
covered persons to use the health care services of preferred providers. Such
policies or subscriber certificates shall contain at least the following
provisions:
(1)
A provision that if a covered person receives emergency care for services
specified in the preferred provider arrangement and cannot reasonably reach a
preferred provider, that emergency care rendered during the course of the
emergency will be paid for in accordance with the terms of the health benefit
plan, at benefit levels at least equal to those applicable to treatment by
preferred providers for emergency care in an amount based on the usual,
customary, and reasonable charges in the area where the treatment is provided;
and
(2)
A provision which clearly identifies the differences in benefit levels for
health care services of preferred providers and benefit levels for health care
services of nonpreferred providers.
For
the purposes of this Code section, when a request for emergency care is made
through the emergency '911' communications system on behalf of a covered person
and the ambulance service licensed under Chapter 11 of Title 31 that was
dispatched in response to the request is not a preferred provider, for the
purposes of payment under the provisions of paragraph (1) of this Code section,
it shall be presumed that the covered person could not reasonably reach a
preferred
provider."
SECTION
6.
This
Act shall become effective upon its approval by the Governor or upon its
becoming law without such approval.
SECTION
7.
All
laws and parts of laws in conflict with this Act are repealed.