06 LC 33
1436S
The
Senate Insurance and Labor Committee offered the following substitute to SB
438:
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia
Annotated, relating to the state
employeeś
health insurance plan, so as to provide time requirements for the credentialing
of hospitals, physicians, and other health care providers by a new third-party
administrator of the state
employeeś
health insurance plan; to provide for related matters; to provide for
applicability; 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.
Article
1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating
to the state
employeeś
health insurance plan, is amended by adding a new Code section to the end of
such article to read as follows:
"45-18-20.
(a)
At any time in which the board selects and enters into a contract with a new
third party to administer health benefits under this article, the new
third-party administrator shall be required to complete the credentialing
process on any hospital, physician, or other health care provider:
(1)
Within 30 days of receiving an application for reapproval of credentialing from
a hospital, physician, or other health care provider that had been approved and
credentialed by the third-party administrator immediately preceding the new
third-party administrator; and
(2)
Within 60 days of receiving an application for approval of credentialing from a
hospital, physician, or other health care provider that is to be newly approved
and credentialed by the third-party administrator.
The
board shall have the authority to grant, in its sole discretion, up to 15
additional days to the third-party administrator with respect to paragraphs (1)
and (2) of this Code section if the administrator can demonstrate due diligence
in its efforts to meet such time requirements. The requirements of this Code
section shall be included in the contract entered into between the board and the
third-party administrator.
(b)
This Code section shall apply to all plan years beginning on and after the
effective date of this Code section and shall also apply to the plan year in
effect as of the effective date of this Code section as it relates to any
hospital, physician, or other health care provider that has applied for but not
received a determination on credentialing. For purposes of such hospitals,
physicians, or other health care providers, the time requirements in subsection
(a) of this Code section shall begin on the later of the effective date of this
Code section or upon entering into a contract with the board and receipt of
application for credentialing by the third-party administrator.
(c)
For the plan year in effect as of the effective date of this Code section, the
third-party administrator shall approve payment for hospitals, physicians, and
other health care providers for services rendered by hospitals, physicians, and
other health care providers between the date of receipt by the third-party
administrator of the application for credentialing and the date of approval of
the credentialing application; provided, however, this shall not apply to any
services rendered prior to January 1, 2006. This subsection shall not be
construed to effect any impairment of a contract or contracts and shall only be
enforceable to the extent any contract or contracts are not
impaired."
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.