07 LC 28
3547ER
House
Bill 597
By:
Representatives Harbin of the
118th
and Sims of the
119th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Part 1 of Article 6 of Chapter 9 of Title 34 of the Official Code of
Georgia Annotated, relating to medical attention, so as to require the
promulgation of standards for the exemption of certain medical providers and
treatments from the workers´ compensation fee schedule; to require that
certain kinds of medical services shall not be subject to any fee schedule but
shall be limited by usual, customary, and reasonable charge levels; to provide
for related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Part
1 of Article 6 of Chapter 9 of Title 34 of the Official Code of Georgia
Annotated, relating to medical attention, is amended by revising Code Section
34-9-205, relating to board approval of physician´s fees, hospital, and
other charges, by adding a new subsection as follows:
"(d)
Any and all fee schedule exemptions provided by the board shall be made pursuant
to written guidelines and standards promulgated by the board, which guidelines
and standards exempt designated types of medical care and treatment by reference
to the Diagnostic Related Groupings by which such care and treatment are
characterized. Such exemptions shall not be limited to or based on the fact
that a hospital or other medical facility, to which any exemption is provided,
may provide only one type of medical care or service, such as freestanding
rehabilitation or long-term acute care hospitals. The primary consideration for
the provision of any such exemptions shall be the type of injury sustained by
the patient, particularly including those injuries whose level of acuteness may
vary widely, or injuries that, by their nature, regularly and routinely involve
additional complications in the treatment thereof, which complications primarily
result from the effect of a burn injury on the patient, such that ultimately the
level of medical care and services required to treat such patients, as well as
the charges resulting therefrom, may both vary widely and be very unpredictable.
There is hereby specifically exempted from any medical fee schedule promulgated
by the board pursuant to any legislative authority any and all medical care and
treatment which is provided in hospitals that specialize in the treatment of
acute care burn injuries and maintain not less than 20 patient beds dedicated to
the care and treatment of patients who have sustained such burn injuries. The
fee schedule exemption for such burn treatment facilities, as provided in this
subsection, shall not apply to the facility, or the medical care rendered
therein, at large but shall be limited to the treatment at such facilities of
those patients whose initial injury was a burn injury and whose initial
inpatient hospitalization for such burn injury resulted in a discharge diagnosis
of one of the following Diagnostic Related Groupings, to wit: 504, 506, 507,
509, 510, 511, 541 or 542. Notwithstanding any fee schedule exemption
established by the board, or as otherwise herein provided, an insurer obligated
to pay for such exempt care shall negotiate reimbursement with the medical
provider of such exempt services; provided, however, that, in the absence of any
successful negotiated resolution of such charges, the insurer´s obligation
to pay such medical charges arising from such exempt care shall be measured by
the level of charges for such care that prevails within the State of Georgia for
the supplies, pharmaceuticals, services, and all other such care required to
treat such patients."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.