07 LC 33
1867
House
Bill 625
By:
Representatives Manning of the
32nd,
Gardner of the
57th,
and Stephens of the
164th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Code Section 49-5-273 of the Official Code of Georgia Annotated, relating
to the creation and operation of the PeachCare for Kids Program, so as to enact
the "PeachCare for Kids Protection Act of 2007"; to provide legislative
findings; to revise the PeachCare for Kids Program to be designated in two parts
known as PeachCare A and PeachCare B; to provide that if sufficient federal
funds are not available for PeachCare, the program will be administered pursuant
to Title XIX of the Social Security Act; to provide that premiums to participate
in the program may be imposed by the department but are not mandatory; to
provide for related matters; 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.
This
Act shall be known and may be cited as the "PeachCare for Kids Protection Act of
2007."
SECTION
2.
The
General Assembly finds that Georgia´s PeachCare for Kids program serves a
vital state interest by providing high quality, secure health care for children
of Georgia´s working families. PeachCare has achieved national prominence
by successfully enrolling previously uninsured children consistent with the
goals of the State Child Health Insurance Program (SCHIP), as administered by
the federal Centers for Medicare and Medicaid Services. The General Assembly
finds, however, that delay by Congress in reauthorizing SCHIP and its funding
and changing the funding distribution formula has led to a shortfall in federal
funds supporting PeachCare. The General Assembly finds and declares that
PeachCare is essential to the health, education, and welfare of Georgia´s
children who would otherwise have no reliable access to health care. It is
essential that PeachCare continue uninterrupted without reducing access or
benefits for children. The General Assembly therefore intends to provide for
the proper use of federal Medicaid funds as a bridge until federal SCHIP funds
again become available by enacting limited changes in the PeachCare program to
provide for operation in the best interests of children and to prevent future
funding volatility.
SECTION
3.
Code
Section 49-5-273 of the Official Code of Georgia Annotated, relating to the
creation and operation of the PeachCare for Kids Program, is revised as
follows:
"49-5-273.
(a)
There is created the PeachCare for Kids Program to provide health care benefits
for children
in families
with income below 235 percent of the federal poverty level. Children
from birth through 18 years of age in
families with family incomes below 235 percent of the federal poverty level
and who are
not eligible for medical assistance under Medicaid shall be eligible for the
program, to.
Except as otherwise provided in this Code section, the program
shall be administered by the department
pursuant to federal law and subject to availability of funding.
(b)
Between the effective date of this Act and such time as the Governor determines
by executive order that sufficient federal funds through the State Child Health
Insurance Program (SCHIP) are again available, the entire PeachCare for Kids
Program shall be administered pursuant to Title XIX of the federal Social
Security Act.
(c)
At such time as the Governor makes the determination provided for in subsection
(b) of this Code section, PeachCare shall be designated in two parts, as
follows:
(1)
PeachCare A shall include children from birth to age one in families with
incomes at or below 200 percent of the federal poverty level, children ages one
through 18 with family incomes at or below 150 percent of the federal poverty
level, and children eligible under Title XIX of the federal Social Security Act
based on any other criteria. PeachCare A shall be administered pursuant to
Title XIX of the federal Social Security Act; and
(2)(A)
PeachCare B shall include children from birth through age 18 with family incomes
above 150 percent of the federal poverty level but below 235 percent of the
federal poverty level and who are not eligible for medical assistance under
Medicaid. PeachCare B shall be administered by the department pursuant to
federal law and subject to availability of funding.
(b)(B)
No entitlement to benefits for the children covered under
the program
or this article
PeachCare
B shall be created by the program, nor
shall this article or any rules or regulations adopted pursuant to this article
be interpreted to entitle any person to receive any health services or insurance
available under
this
program
PeachCare
B.
The program
PeachCare
B shall be established subject to the
availability of funds specifically appropriated by the General Assembly for this
purpose, as
may be supplemented by
and
federal matching funds as set forth in federal
law, to the
extent they are available. The department
shall operate
the
program
PeachCare
B consistent with administrative
efficiency and the best interests of children.
(c)(C)
The PeachCare
B program shall offer substantially the
same health care services available to children under
PeachCare
A
Georgia´s
Medicaid plan, but coverage for such services shall not be provided by an
expansion of eligibility for medical assistance under
Medicaid. However,
the
program
PeachCare
B shall exclude nonemergency
transportation and targeted case management services. The department shall
utilize appropriate medical management and utilization control procedures
necessary to manage care effectively and shall prospectively limit enrollment in
the program and modify the health care services benefits when the department has
reason to believe the cost of such enrollment or services may exceed the
availability of funding.
(d)(D)
The department may require copayments for services consistent with federal law;
provided, however, that no copayment shall be charged for preventive services
and no copayments or premiums shall be charged for any child under six years of
age. Preventive services include but are not limited to medically necessary
maintenance medication and monitoring for chronic conditions such as asthma and
diabetes.
(e)(E)
The department
shall
may
require payment of
reasonable
premiums for participation in
the
program
PeachCare
B. The premiums shall not exceed the
amounts permitted under Section 1916(b)(1) of the
federal
Social Security Act or federal law.
(f)(d)
The department
may
shall
provide for presumptive eligibility for all applicant children as allowed by
federal law and in a manner consistent with the provisions of this
article.
(g)(e)
The department shall provide for outreach for the purpose of enrolling children
in the program. Applications shall be accepted by mail or in person. All
necessary and appropriate steps shall be taken to achieve administrative cost
efficiency, reduce administrative barriers to application for and receipt of
services under the program, verify eligibility for the program and enforce
eligibility standards, and ensure that enrollment in the program does not
substitute for coverage under a group health insurance plan.
(h)(f)
Any health care provider who is enrolled in
the
Medicaid program
PeachCare A
shall be deemed to be enrolled in
the
program
PeachCare
B.
(g)
The department shall maximize use of available federal funds through the State
Child Health Insurance Program (SCHIP) by charging against Georgia´s
allotment first for children with incomes between 150 percent and 235 percent of
the federal poverty level and then for children with incomes between the
Medicaid income eligibility limits that were in effect as of January 1, 2007,
for children ages one through 18 and 150 percent of the federal poverty
level.
(i)(h)
The department shall file
a
plans under
Title XIX and Title XXI
plan to
carry out the program with the United
States Department of Health and Human Services Centers for Medicare and Medicaid
Services to
carry out PeachCare A and PeachCare B.
The department shall have the authority and flexibility to make such decisions
as are necessary to secure approval of
that
plan
the
plans consistent with this article. The
department shall provide a copy of the
plan
plans
to the General Assembly. The department shall operate this program consistent
with federal law
as defined in
Code Section 49-5-272 or within Title XIX of the federal Social Security Act, as
applicable.
(j)(i)
The department shall publish an annual report, a copy of which shall be provided
to the Governor, setting forth the number of participants in the program, the
health services provided, the amount of money paid to providers, and other
pertinent information with respect to the administration of the program. The
department shall not be required to distribute copies of the annual report to
the members of the General Assembly but shall notify the members of the
availability of the report in the manner which it deems to be most effective and
efficient.
(k)(j)
All state agencies shall cooperate with the department and its designated agents
by providing requested information to assist in the administration of the
program.
(l)(k)
The department, through the Department of Administrative Services or any other
appropriate entity, may contract for any or all of the following: the collection
of premiums, processing of applications, verification of eligibility, 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 which has
contracted with the department for services related to the administration of the
program upon request. For purposes of compliance with Code Section 34-8-125, a
request by any entity which has contracted with the department for services
related to the administration of the program shall be deemed to be a request by
a responsible official of the department and considered to be a request by the
department.
(m)(l)
Nothing in this article shall be interpreted in a manner so as to preclude the
department from contracting with licensed health maintenance organizations (HMO)
or provider sponsored health care corporations (PSHCC) for coverage of program
services and eligible children; provided, however, that such contracts shall
require payment of premiums and copayments in a manner consistent with this
article. The department may require enrollment in a health maintenance
organization (HMO) or provider sponsored health care corporation (PSHCC) as a
condition of receiving coverage under the program.
(n)(m)
The Department of Education and local boards of education shall cooperate with
and provide assistance to the department and its designated agents for the
purposes of identifying and enrolling eligible children in the
program."
SECTION
4.
This
Act shall become effective upon its approval by the Governor or upon its
becoming law without such approval.
SECTION
5.
All
laws and parts of laws in conflict with this Act are repealed.