06 LC 33
1105
Senate
Bill 476
By:
Senators Miles of the 43rd, Jones of the 10th, Butler of the 55th, Thomas of the
2nd, Seay of the 34th and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 5 of Title 49 of the Official Code of Georgia Annotated, relating
to programs and protection for children and youth, so as to enact the
"PeachKids—Health Insurance for All Georgia Children Act"; to provide for
a short title; to provide for definitions; to provide for the creation of the
PeachKids health care insurance plan; to provide for eligibility, health care
services, and payment of premiums and copayments; to provide for contracted
services; to provide for health care provider enrollment; to provide for
application for funding sources; to provide for rules and regulations; to
provide for construction; to provide for an annual report; 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
5 of Title 49 of the Official Code of Georgia Annotated, relating to programs
and protection for children and youth, is amended by adding a new article to
read as follows:
∀ARTICLE
13A
49-5-275.
This
article shall be known and may be cited as the 'PeachKids—Health Insurance
for All Georgia Children Act.'
49-5-276.
The
General Assembly finds that a large proportion of children in Georgia do not
currently have access to affordable or adequate health care. Without access to
health care, a
child́s
ability to reach his or her full physical and educational potential is hindered.
The General Assembly finds and declares the provision of adequate health
insurance coverage to be in the public interest and further declares the
establishment of the program pursuant to this article to be a desirable and
economical means of increasing access to affordable and adequate health
care.
49-5-277.
As
used in this article, the term:
(1)
'Department' means the Department of Community Health.
(2)
'Medicaid' means medical assistance provided under Article 7 of Chapter 4 of
this title, the 'Georgia Medical Assistance Act of 1977.'
(3)
'PeachCare' means the PeachCare for Kids Program created by Code Section
49-5-273.
(4)
'PeachKids' or 'program' means the PeachKids health care insurance plan created
by Code Section 49-5-278.
49-5-278.
(a)
There is created the PeachKids health care insurance plan to provide health care
insurance for children in families with income at or above 235 percent of the
federal poverty level.
(b)
Children who meet all of the following criteria shall be eligible for PeachKids
which shall be administered by the department:
(1)
Children from birth through 18 years of age in families with a family income at
or above 235 percent of the federal poverty level;
(2)
Children who are not eligible for medical assistance under Medicaid, PeachCare,
or medicare;
(3)
Children who are residents of the State of Georgia and citizens of the United
States of America; and
(4)
Children who have not been covered by health insurance for the immediate
previous six months, unless the child is less than six months of age or the
child́s
parent has been involuntarily separated from his or her employment or his or her
employer has discontinued health insurance coverage as an employee
benefit.
Children
of families whose annual income has increased to prohibit their participation in
Medicaid or PeachCare shall be entitled to enroll in PeachKids without penalty
or waiting period.
(c)
PeachKids shall offer substantially the same health care services and coverage
available to children under PeachCare.
(d)
The department shall require payment of premiums for participation in PeachKids
as follows:
(1)
Forty dollars per month per child up to a total family maximum of $80.00 for
children in families with a family income determined to be under $100,000.00 per
year;
(2)
Sixty dollars per month per child for children in families with a family income
determined to be between $100,000.00 and $114,999.00 per year;
(3)
Seventy dollars per month per child for children in families with a family
income determined to be between $115,000.00 and $129,999.00 per
year;
(4)
Eighty dollars per month per child for children in families with a family income
determined to be between $130,000.00 and $149,999.00 per year; and
(5)
Ninety dollars per month per child for children in families with a family income
determined to be $150,000.00 or more per year.
(e)
The department shall set copayment requirements for participants for services
provided under PeachKids which shall not exceed the following:
(1)
Ten dollars for each visit to a health care provider who is not a specialist and
5 percent of the cost of a prescription drug for families earning less than
$100,000.00 per year;
(2)
Twenty dollars for each visit to a health care provider who is not a specialist
and 15 percent of the cost of a prescription drug for families earning between
$100,000.00 and $114,999.00 per year; and
(3)
Twenty-five dollars for each visit to a health care provider who is not a
specialist and 20 percent of the cost of a prescription drug for families
earning more than $114,999.00 per year.
(f)
The department, through the Department of Administrative Services or any other
appropriate entity, may contract for any or all of the following: collection of
premiums, processing of applications, outreach, data services, and evaluation,
if such contracting achieves administrative or service cost efficiency. The
department, and other state agencies as appropriate, shall provide necessary
information to any entity that has contracted with the department for services
related to the administration of the PeachKids plan.
(g)
Any health care provider who is enrolled in the Medicaid program shall be deemed
to be enrolled in the program.
(h)
The department is encouraged to apply for any public, nonprofit, or private
funding which may be available to subsidize the cost of PeachKids to the
state.
(i)
The department may promulgate such rules and regulations as it deems necessary
to effectuate this article.
(j)
Nothing in this article shall be interpreted in a manner so as to preclude the
department from contracting with licensed health maintenance organizations or
provider sponsored health care corporations for coverage of program services and
eligible children. The department may require enrollment in a health maintenance
organization or provider sponsored health care corporation as a condition of
receiving coverage under the program.
(k)
The department shall publish an annual report, copies of which shall be provided
to the Governor and the General Assembly, setting forth the number of
participants in the program, the health care services provided, the amount of
money paid to providers, and other pertinent information with respect to the
administration of the
program.∀
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.