05 LC 9 1551
Senate
Bill 81
By: Senators Hudgens of the 47th, Carter of the 13th, Kemp of the 46th, Grant of the 25th and Meyer von Bremen of the 12th
By: Senators Hudgens of the 47th, Carter of the 13th, Kemp of the 46th, Grant of the 25th and Meyer von Bremen of the 12th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 2 of Chapter 1 of Title 31 of the Official Code of Georgia
Annotated, known as the "Patient Access to Eye Care Act" and further relating to
the blindness education, screening, and treatment program, and Article 1 of
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
insurance generally, so as to recodify the provisions relating to patient access
to eye care as a portion of Title 33, the "Georgia Insurance Code"; to provide
for enforcement by the Commissioner of Insurance and the powers of the
Commissioner related thereto; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Article
2 of Chapter 1 of Title 31 of the Official Code of Georgia Annotated, known as
the "Patient Access to Eye Care Act" and further relating to the blindness
education, screening, and treatment program, is amended by striking Code
Sections 31_1_20, 31_1_21, and 31_22, relating to a short title, definitions,
and health care insurers providing benefit plans including eye care, and
inserting in their place the following:
"31_1_20.
This
article shall be known and may be cited as the 'Patient Access to Eye Care
Act.'
Reserved.
31_1_21.
As
used in this article, the term:
(1)
'Covered person' means an individual enrolled in a health benefit plan or an
eligible dependent thereof.
(2)
'Covered services' means those health care services which a health care insurer
is obligated to pay for or provide to a covered person under a health benefit
plan.
(3)
'Eye care' shall mean those health care services and materials related to the
care of the eye and related structures and vision care services which a health
care insurer is obligated to pay for or provide to covered persons under the
health benefit plan.
(4)
'Health benefit plan' means any public or private health plan, program, policy,
or agreement implemented in this state which provides health benefits to covered
persons, including but not limited to payment and reimbursement for health care
services.
Reserved.
31_1_22.
(a)
A health care insurer providing a health benefit plan which includes eye care
benefits shall:
(1)
Not set professional fees or reimbursement for the same eye care services as
defined by established current procedural terminology codes in a manner that
discriminates against an individual eye care provider or a class of eye care
providers;
(1.1)
Not preclude a covered person who seeks eye care from obtaining such service
directly from a provider on the health benefit plan provider panel who is
licensed to provide eye care;
(2)
Not promote or recommend any class of providers to the detriment of any other
class of providers for the same eye care service;
(3)
Ensure that all eye care providers on a health benefit plan provider panel are
included on any publicly accessible list of participating providers for the
plan;
(4)
Allow each eye care provider on a health benefit plan provider panel, without
discrimination between classes of eye care providers, to furnish covered eye
care services to covered persons to the extent permitted by such provider´s
licensure;
(5)
Not require any eye care provider to hold hospital privileges or impose any
other condition or restriction for initial admittance to a provider panel not
necessary for the delivery of eye care upon such providers which would have the
effect of excluding an individual eye care provider or class of eye care
providers from participation on the health benefit plan; and
(6)
Include optometrists and ophthalmologists on the health benefit plan provider
panel in a manner that ensures plan enrollees timely access and geographic
access.
(b)
Nothing in this Code section shall preclude a covered person from receiving eye
care or other covered services from the covered person´s personal physician
in accordance with the terms of the health benefit plan.
(c)
A person adversely affected by a violation of this Code section by a health care
insurer may bring an action in a court of competent jurisdiction for injunctive
relief against such insurer and, upon prevailing, in addition to any injunctive
relief that may be granted, shall recover from such insurer damages of not more
than $100.00 and attorney´s fees and
costs.
Reserved."
SECTION
2.
Article
1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating
to insurance generally, is amended by adding at the end thereof a new Code
Section 33_24_59.12 to read as follows:
"33_24_59.12.
(a)
This Code section shall be known and may be cited as the 'Patient Access to Eye
Care Act.'
(b)
As used in this Code section, the term:
(1)
'Covered person' means an individual enrolled in a health benefit plan or an
eligible dependent thereof.
(2)
'Covered services' means those health care services which a health care insurer
is obligated to pay for or provide to a covered person under a health benefit
plan.
(3)
'Eye care' means those health care services and materials related to the care of
the eye and related structures and vision care services which a health care
insurer is obligated to pay for or provide to covered persons under the health
benefit plan.
(4)
'Health benefit plan' means any public or private health plan, program, policy,
or agreement implemented in this state which provides health benefits to covered
persons, including but not limited to payment and reimbursement for health care
services.
(5)
'Health care insurer' means an entity, including but not limited to insurance
companies, hospital service nonprofit corporations, nonprofit medical service
corporations, health care corporations, health maintenance organizations, and
preferred provider organizations, authorized by the state to offer or provide
health benefit plans, programs, policies, subscriber contracts, or any other
agreements of a similar nature which compensate or indemnify health care
providers for furnishing health care services.
(c)
A health care insurer providing a health benefit plan which includes eye care
benefits shall:
(1)
Not set professional fees or reimbursement for the same eye care services as
defined by established current procedural terminology codes in a manner that
discriminates against an individual eye care provider or a class of eye care
providers;
(2)
Not preclude a covered person who seeks eye care from obtaining such service
directly from a provider on the health benefit plan provider panel who is
licensed to provide eye care;
(3)
Not promote or recommend any class of providers to the detriment of any other
class of providers for the same eye care service;
(4)
Ensure that all eye care providers on a health benefit plan provider panel are
included on any publicly accessible list of participating providers for the
plan;
(5)
Allow each eye care provider on a health benefit plan provider panel, without
discrimination between classes of eye care providers, to furnish covered eye
care services to covered persons to the extent permitted by such provider´s
licensure;
(6)
Not require any eye care provider to hold hospital privileges or impose any
other condition or restriction for initial admittance to a provider panel not
necessary for the delivery of eye care upon such providers which would have the
effect of excluding an individual eye care provider or class of eye care
providers from participation on the health benefit plan; and
(7)
Include optometrists and ophthalmologists on the health benefit plan provider
panel in a manner that ensures plan enrollees timely access and geographic
access.
(d)
Nothing in this Code section shall preclude a covered person from receiving eye
care or other covered services from the covered person´s personal physician
in accordance with the terms of the health benefit plan.
(e)
A person adversely affected by a violation of this Code section by a health care
insurer may bring an action in a court of competent jurisdiction for injunctive
relief against such insurer and, upon prevailing, in addition to any injunctive
relief that may be granted, shall recover from such insurer damages of not more
than $100.00 and attorney´s fees and costs.
(f)
Nothing in this Code section requires a health benefit plan to include eye care
benefits.
(g)
The Commissioner is authorized to enforce this Code section and, in doing so, to
exercise the powers granted to the Commissioner by Code Section 33_2_24 and any
other provisions of this
title."
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.