07 LC
29 2732ER
House
Bill 550
By:
Representative Lindsey of the
54th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia
Annotated, relating to medical assistance generally, so as to change certain
provisions relating to recovery of assistance from third parties liable for
sickness, injury, disease, or disability; to expand certain obligations of
insurers, managed health care entities, and pharmacy benefit managers; to
provide for related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Article
7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating
to medical assistance generally, is amended by revising subsection (b) of Code
Section 49-4-148, relating to recovery of assistance from third parties liable
for sickness, injury, disease, or disability, as follows:
"(b)
All insurers, as defined in Code Section 33-24-57.1, including but not limited
to group health plans as defined in Section 607(1) of the federal Employee
Retirement Security Act of
1974,
and
managed care entities as defined in Code Section 33-20A-3, which offer health
benefit plans, as defined in Code Section 33-24-59.5,
and pharmacy
benefit managers, as defined in Code Section
26-4-110.1, shall comply with this
subsection.
Those
insurers
Such
providers shall:
(1)
Cooperate with the department in determining whether a person who is a recipient
of medical assistance may be covered under that
insurer´s
provider´s
health benefit plan and eligible to receive benefits thereunder for the medical
services for which that medical assistance was provided
and respond to
any inquiry from the state regarding a claim for payment for any health care
item or service submitted not later than three years after such item or service
was provided;
(2)
Accept the department´s authorization for the provision of medical services
on behalf of a recipient of medical assistance as the
insurer´s
provider´s
authorization for the provision of those services;
and
(3)
Comply with the requirements of Code Section 33-24-59.5, regarding the timely
payment of claims submitted by the department for medical services provided to a
recipient of medical assistance and covered by the health benefit plan, subject
to the payment to the department of interest as provided in that Code section
for failure to
comply.;
(4)
Provide the department, on a quarterly basis, eligibility and claims payment
data regarding applicants for medical assistance or recipients for medical
assistance;
(5)
Accept the assignment to the department or a recipient of medical assistance or
any other entity of any rights to any payments for such medical care from a
third party; and
(6)
Agree not to deny a claim submitted by the department solely on the basis of the
date of submission of the claim, type or format of the claim, or a failure to
present proper documentation at the point-of-sale which is the basis of the
claim, if:
(A)
The claim is submitted to the department within three years from when the item
or service was furnished; and
(B)
Any action by the department to enforce its rights with respect to such claim
commenced within six years of the department´s submission of the
claim.
The
requirements of paragraphs (2) and (3) of this subsection shall only apply to a
health benefit plan which is issued, issued for delivery, delivered, or renewed
on or after April 28, 2001."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.