§ 49-4-149. Lien of Department of Community Health Against Third Parties; Subrogation to Recipients’ Insurance Claims; Assignment of Recipients’ Claims
The Department of Community Health shall have a lien for the charges for medical care and treatment provided a medical assistance recipient upon any moneys or other property accruing to the recipient to whom such care was furnished or to his legal representatives as a result of sickness, injury, disease, disability, or death, due to […]
§ 49-4-149.1. Submission by Department of Plan for Family Supplementation of Medicaid Payments Upon Federal Removal of Restrictions
If the federal government removes restrictions upon family supplementation of Medicaid payments or approves a waiver allowing this supplementation, the Department of Community Health shall submit to the Health and Human Services Committee of the Senate and the Health and Human Services Committee of the House of Representatives a plan for this supplementation, which submission […]
§ 49-4-150. Regulations as to Maintenance and Use of Records; Certificate as to Use of Information
The Board of Community Health is directed to prescribe regulations governing the custody, use, and preservation of the records, papers, files, and communications of the Department of Community Health relating to applicants for and recipients of medical assistance. Except as otherwise provided in Code Section 49-4-151, such regulations shall provide safeguards restricting the use or […]
§ 49-4-151. Obtaining Information for Investigations and Audits
The commissioner, for the purposes of investigating the nature, amount, and extent of services provided to a recipient of medical assistance or auditing information submitted to the department concerning a provider’s entitlement to an amount of medical assistance, is authorized, personally or by his duly authorized representative, to administer oaths and to examine and copy […]
§ 49-4-151.1. Errors or Omissions in Reporting; Right to Hearing; Exclusion
Any clerical or record-keeping error, including but not limited to a typographical error, scrivener’s error, or computer error; any unintentional error or omission in billing, coding, or required documentation; or any isolated instances of incomplete documentation by a provider of medical assistance regarding reimbursement for medical assistance may not in and of itself constitute fraud […]
§ 49-4-152. Research and Demonstration Projects; Pilot Projects to Provide Health Care Coverage and Essential Health Care Services; Pharmacy Assistance Programs
Subject to the availability of funds, the Department of Community Health is authorized to enter into agreements with and submit applications to departments and agencies of the government of the United States for purposes of accepting grants, receiving matching funds, and administering such grants and funds for research and demonstration projects pursuant to Title XI, […]
§ 49-4-152.1. Medicaid Prescription Drug Bidding and Rebate Program
The General Assembly finds that the department frequently must pay more for prescription drugs furnished to recipients of medical assistance under this article than certain health care providers pay for the same products. In order to control more effectively the costs of such drugs, the department may establish a Medicaid Prescription Drug Bidding and Rebate […]
§ 49-4-145. Time Limitations on Claims for Assistance; Form of Claims
Claims for medical assistance must be submitted not more than six months after the month in which the service is rendered and shall be in the form prescribed by the commissioner, except that the commissioner may, where he finds that delay in submission of claims was caused by circumstances beyond the control of the provider, […]
§ 49-4-152.2. Rebates for Sole-Source and Multiple-Source Drugs Included in Controlled Medical Assistance Drug List
The department is authorized to negotiate and enter into agreements directly with manufacturers and distributors whose prescription drug products are sold in the state for sole-source and multiple-source drugs to be paid for under the state plan for eligible recipients under this article. Such agreements shall provide for a periodic rebate of a negotiated percentage […]
§ 49-4-146. Time for Action on Claim
The Department of Community Health, within three months of receiving a claim submitted on or after July 1, 1978, shall pay or deny the claim. History. Ga. L. 1977, p. 384, § 15A; Ga. L. 1999, p. 296, § 24.