08 LC 37
0688S
The
Senate Health and Human Services Committee offered the following substitute to
HB 279:
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating
to public assistance, so as to establish notice requirements of the Department
of Community Health or its agents or contractors for medically necessary
services for children with disabilities; to provide for definitions; to provide
certain requirements relating to denial of approval for requested services and
appeals; 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.
Chapter
4 of Title 49 of the Official Code of Georgia Annotated, relating to public
assistance, is amended by adding a new article to read as follows:
"ARTICLE
7C
49-4-169.
As
used in this article, the term:
(1)
'Department' means the Department of Community Health.
(2)
'EPSDT Program' means the federal Medicaid Early Periodic Screening,
Diagnostic, and Treatment Program contained in 42 U.S.C.S. Sections 1396a and
1396d.
(3)
'Medically necessary services' means services which are deemed necessary by a
physician or other health care provider pursuant to the EPSDT Program to
diagnose, correct, or ameliorate defects and physical and mental illnesses and
conditions, whether or not such services are covered under the state
plan.
49-4-169.1.
The
department or its agents or contractors shall give notice to affected Medicaid
recipients of the following information in cases where services are
denied:
(1)
The medical procedure or service for which the department or its agents or
contractors are refusing to grant prior approval;
(2)
Any additional information needed from the recipient´s medical provider
which could change the decision of the department or its agents or contractors;
and
(3)
The specific reason used by the department or its agents or contractors to
determine that the procedure is not medically necessary to the Medicaid
recipient, including facts pertinent to the individual case."
SECTION
2.
This
Act shall become effective upon its approval by the Governor or upon its
becoming law without such approval.
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.