08 LC 33
2463/AP
House
Bill 1328 (AS PASSED HOUSE AND SENATE)
By:
Representatives Peake of the
137th,
Channell of the
116th,
and Lunsford of the
110th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Code Section 33-20A-9.1 of the Official Code of Georgia Annotated,
relating to consumer choice options offered by managed care plans, so as to
revise a provision relating to consumer choice options under the state
employees´ health insurance plan; to provide for related matters; to repeal
conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Code
Section 33-20A-9.1 of the Official Code of Georgia Annotated, relating to
consumer choice options offered by managed care plans, is amended by revising
subsection (c) as follows:
"(c)
Except for managed care plans offering a consumer choice option under
subparagraph (d)(2)(C) of this Code section, every managed care plan
offered
pursuant to Article 1 of Chapter 18 of Title 45
or offered by a managed care entity shall
offer a separate consumer choice option to enrollees at least annually with the
following provisions:
(1)
Every enrollee of a managed care plan shall have the right to nominate one or
more out of network health care providers or hospitals for use by that enrollee
and that enrollee´s eligible dependents, if:
(A)
Such health care provider or hospital is located within and licensed by the
state;
(B)
Such health care provider or hospital agrees to accept reimbursement from both
the plan and the enrollee at the rates and on the terms and conditions
applicable to similarly situated participating providers and hospitals. The
reimbursement rates for the plan may be proportionally reduced from those paid
to participating providers if the cost-sharing provisions in paragraph (3) of
subsection (d) of this Code section are utilized in the consumer choice
option;
(C)
Such health care provider or hospital agrees to adhere to the managed care
plan´s quality assurance requirements and to provide the plan with
necessary medical information related to such care; and
(D)
Such health care provider or hospital meets all other reasonable criteria as
required by the managed care plan of in network providers and hospitals;
and
(2)
Each nominated health care provider or hospital which meets the requirements of
subparagraphs (A), (B), (C), and (D) of paragraph (1) of this subsection shall
be reimbursed by the plan, subject to the agreement in subparagraph (B) of
paragraph (1) of this subsection, as though it belonged to the managed care
plan´s provider network. Such reimbursement shall be full and final payment
for the health care services provided to the enrollee and no health care
provider or hospital shall bill the enrollee for any portion of a payment
exclusive of the requirements of subparagraph (B) of paragraph (1) of this
subsection."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.