§ 33-46-24. Medically Necessary Unanticipated Emergency or Urgent Healthcare Services
Prior authorization shall not be required for unanticipated emergency healthcare services, urgent healthcare services, or covered healthcare services which are incidental to the primary covered healthcare service and determined by the covered person’s physician or dentist to be medically necessary. History. Code 1981, § 33-46-24 , enacted by Ga. L. 2021, p. 629, § 2/SB […]
§ 33-46-25. Prior Authorization for Ambulance Transportation or Emergency Healthcare Services Prohibited
An insurer cannot require prior authorization for emergency prehospital ambulance transportation or for the provision of emergency healthcare services. History. Code 1981, § 33-46-25 , enacted by Ga. L. 2021, p. 629, § 2/SB 80.
§ 33-46-26. Timely Notification of Prior Authorization or Adverse Determination
Effective January 1, 2022, until December 31, 2022, if an insurer requires prior authorization of a healthcare service, a private review agent or utilization review entity shall notify the covered person’s healthcare provider, or such provider’s appropriately qualified designee, of any prior authorization or adverse determination within 15 calendar days of obtaining all necessary information […]
§ 33-46-27. Notification Time for Prior Authorization or Adverse Determination
A private review agent or utilization review entity shall render a prior authorization or adverse determination concerning urgent healthcare services and notify such person’s healthcare provider, or such provider’s appropriately qualified designee, of that prior authorization or adverse determination no later than 72 hours after receiving all information needed to complete the review of the […]
§ 33-46-28. Honoring of Prior Authorizations
Upon receipt of information documenting a prior authorization from a covered person or from a covered person’s healthcare provider, a private review agent or utilization review entity, for at least the initial 30 days of such person’s new coverage, shall honor a prior authorization for a covered healthcare service granted to him or her from […]
§ 33-46-29. Noncompliance Resulting in Automatic Authorization
Each violation by a private review agent or utilization review entity of deadline or other requirements specified in this chapter shall result in the automatic authorization of healthcare services under review by such private review agent or utilization review entity if such noncompliance is related to such services. Notwithstanding the foregoing, noncompliance based on a […]
§ 33-46-30. Mandatory Compliance
With regard to the provision of healthcare services, each contract entered into or renewed by a managed care organization, each contract entered into or renewed by the Department of Community Health with a care management organization, and each contract entered into by the board of such organization with a contracted entity pursuant to the state […]
§ 33-46-31. Role of Commissioner; Compliance Enforced by Department of Community Health
The Commissioner shall not have the authority to approve, disapprove, or modify any plan offered by a care management organization or any contract between a care management organization and the Department of Community Health. Compliance with this chapter by care management organizations shall be enforced by the Department of Community Health. History. Code 1981, § […]
§ 33-46-32. Commissioner’s Authority Not Reduced
Nothing in this chapter shall be construed as reducing the authority of the commissioner of community health. History. Code 1981, § 33-46-32 , enacted by Ga. L. 2021, p. 629, § 2/SB 80.
§ 33-46-23.1. [Effective January 1, 2023] Prior Authorization of Prescription Medications for Chronic Conditions
As used in this Code section, the term: “Chronic condition” means a serious, long-term, physical, mental, or developmental disability or disease. “Ongoing medication therapy” means a clinical and evidence-based treatment that uses a prescribed medicine to prevent, diagnose, treat, or relieve the symptoms of a chronic condition and is continuing or expected to continue for […]