06 HB1257/SCSFA/2
SENATE
SUBSTITUTE TO HB
1257
AS PASSED SENATE
AS PASSED SENATE
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 revise certain definitions; to change
certain provisions relating to evaluation of a person with an emergency
condition and initiation of intervention without prospective authorization; to
amend Title 33 of the Official Code of Georgia Annotated, relating to insurance,
so as to change certain provisions relating to emergency services requirements;
to change certain provisions relating to payments to nonparticipating and
nonpreferred providers of health care services; to change certain provisions
relating to health benefit plans providing incentives to use services of
preferred providers; to exempt certain change of address filings by agents,
subagents, counselors, and adjusters from a fee; to provide for certain
qualifications for a
counseloŕs
license; to provide for the maintenance by the Commissioner of Insurance of the
address of the place of business of agents, subagents, counselors, and
adjusters; to provide for related matters; 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, in their entirety and inserting in lieu
thereof the following:
"(2)
'Emergency medical provider' means any
provider of
emergency medical transportation licensed or permitted by the Georgia Department
of Human Resources, any hospital licensed
or permitted by the Georgia Department of Human Resources,
any
hospital based service, or
any
physician licensed by the Composite State Board of Medical Examiners who
provides emergency services.
(3)
'Emergency services' means
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 in Code Section 31-11-82, relating to evaluation of a
person with an emergency condition and initiation of intervention without
prospective authorization, by striking subsection (b) in its entirety and
inserting a new subsection (b) to read as follows:
"(b)
If in the opinion of the attending physician
or licensed
ambulance service personnel acting under the medical direction of an ambulance
service medical director as defined in Code Section
31-11-60.1 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, in its entirety and inserting in lieu
thereof the following:
"(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
ambulance service providing 911 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, in its entirety 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 9, 11, 30, 34, 35, or 39 of Title 43
or of Chapter
11 of Title 31 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 adding to the end of Code Section 33-30-24, relating
to health benefit plans providing certain incentives, the
following:
"For
purposes of this Code section, when a request for emergency care is made through
the emergency 9-1-1 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 purposes of payment under paragraph
(1) of this Code section, it shall be presumed that the covered person could not
reasonably reach a preferred
provider."
SECTION
6.
Said
title is further amended by striking subparagraph (AA) of paragraph (6) of Code
Section 33-8-1, relating to fees and charges generally, and inserting in lieu
thereof a new subparagraph (AA) to read as follows:
|
"(AA)
Amendment of filings
|
25.00
|
|
Provided,
however, that the Commissioner, in his or her discretion, may exempt from such
fee change of address filings done off line by agents, subagents, counselors,
and adjusters.
|
|
|
(AA.1)
Change of address filings done on line by agents, subagents, counselors, and
adjusters
|
No
charge"
|
SECTION
7.
Said
title is further amended by striking paragraph (6) of subsection (a) of Code
Section 33-23-5, relating to qualifications and requirements for license, and
inserting in lieu thereof a new paragraph (6) to read as follows:
"(6)
If applying for a license as counselor, the applicant must show that he or she
either
has had five
yearś
experience
acting as
either
as
an agent, subagent, or adjuster or in some other phase of the insurance business
or has
sufficient teaching or educational qualifications or
experience
which,
in the opinion of the
Commissioner,
has qualified the applicant to act as such counselor; and the applicant shall
pass such examination as shall be required by the Commissioner
unless the
applicant is exempted by the Commissioner, based on the
applicant́s
experience and qualifications and pursuant to a regulation adopted by the
Commissioner;".
SECTION
8.
Said
title is further amended by striking Code Section 33-23-25, relating to place of
business, and inserting a new Code Section 33-23-25 to read as
follows:
"33-23-25.
Every
licensed agent, subagent, counselor, and adjuster shall have and maintain in
this state or, if a nonresident licensee, in the state of domicile, a place of
business accessible to the public. The place of business shall be that wherein
the licensee principally conducts transactions pursuant to the license. The
address of the place of business shall
appear on
all licenses of the resident licensee
be maintained
by the Commissioner. All resident and
nonresident licensees shall promptly notify the Commissioner in writing within
30 days of any change in the business
address."
SECTION
9.
All
laws and parts of laws in conflict with this Act are repealed.