§ 33-21A-1. Short Title
This chapter shall be known and may be cited as the “Medicaid Care Management Organizations Act.” History. Code 1981, § 33-21A-1 , enacted by Ga. L. 2008, p. 704, § 1/HB 1234.
§ 33-21A-10. New and Renewal Agreements With Care Management Organizations and Health Care Providers
On and after May 13, 2008, the Department of Community Health shall include provisions in all new or renewal agreements with a care management organization, which require the care management organization to comply with all provisions of this chapter. On and after May 13, 2008, a care management organization shall not include any provisions in […]
§ 33-21A-11. Hospital Statistical and Reimbursement Reports From Care Management Organizations; Penalty
Upon request by a hospital provider related to a specific fiscal year, a care management organization shall, within 30 days of the request, provide that hospital with an HS&R report for the requested fiscal year. Any care management organization which violates this Code section by not providing the requested report within 30 days shall be […]
§ 33-21A-12. Federal Law, Rule and Regulations Control
To the extent any provision in this chapter is inconsistent with applicable federal law, rule, or regulation, the applicable federal law, rule, or regulation shall govern. History. Code 1981, § 33-21A-12 , enacted by Ga. L. 2008, p. 704, § 1/HB 1234.
§ 33-21A-13. Coverage for Mental Health and Substance Abuse Disorders; Role of Commissioner of Community Health; Parity Violations
As used in this Code section, the term: “Addictive disease” has the same meaning as in Code Section 37-1-1. “Generally accepted standards of mental health or substance use disorder care” means evidence based independent standards of care and clinical practice that are generally recognized by health care providers practicing in relevant clinical specialties such as […]
§ 33-21A-14. Minimum Medical Loss Ratio Standard; Remittance Directions; Required Website Information
The intent of this Code section is to implement the state option in subdivision (j) of 42 C.F.R. Section 438.8. As used in this Code section, the term “medical loss ratio reporting year” or “MLR reporting year” shall have the same meaning as that term is defined in 42 C.F.R. Section 438.8. Beginning July 1, […]
§ 33-21A-2. Definitions
As used in this chapter, the term: “Care management organization” means an entity that is organized for the purpose of providing or arranging health care, which has been granted a certificate of authority by the Commissioner of Insurance as a health maintenance organization pursuant to Chapter 21 of this title, and which has entered into […]
§ 33-21A-3. Certificate of Authority Required; Setting of Rates; Authority of Commissioners
A care management organization shall be required to obtain a certificate of authority as a health maintenance organization pursuant to Chapter 21 of this title prior to providing or arranging health care for members pursuant to a contract with the Department of Community Health. On and after the date of issuance of its certificate of […]
§ 33-21A-4. Reimbursement for Emergency Health Care Services
In particular, but without limitation, a care management organization shall not: Deny or inappropriately reduce payment to a provider of emergency health care services for any evaluation, diagnostic testing, or treatment provided to a recipient of medical assistance for an emergency condition; or Make payment for emergency health care services contingent on the recipient or […]
§ 33-21A-5. Requirements Relating to Critical Access Hospitals
A critical access hospital must provide notice to a care management organization and the Department of Community Health of any alleged breaches in its contract by such care management organization. If a critical access hospital satisfies the requirement of subsection (a) of this Code section, and if the Department of Community Health concludes, after notice […]
§ 33-21A-6. Coverage for Newborn Infants Until Discharged From Inpatient Care
Each care management organization shall pay for health care services provided to a newborn infant who is born to a mother who is a member currently enrolled with that care management organization until such time as the newborn is finally discharged from all inpatient care to a home environment subject to approval by the federal […]
§ 33-21A-7. Bundling of Provider Complaints and Appeals
In reviewing provider complaints or appeals related to denial of claims, a care management organization shall allow providers to consolidate complaints or appeals of multiple claims that involve the same or similar payment or coverage issues, regardless of the number of individual patients or payment claims included in the bundled complaint or appeal. Each care […]
§ 33-21A-8. Participation by Dentists
Except as provided in subsection (b) of this Code section, no care management organization or agent of such care management organization shall deny any dentist from participating in the Medicaid and PeachCare for Kids dental program administered by such care management organization if: Such dentist has obtained a license to practice in this state and […]
§ 33-21A-9. Submission and Payment of Claims
If a provider submits a claim to a responsible health organization for services rendered within 72 hours after the provider verifies the eligibility of the patient with that responsible health organization, the responsible health organization shall reimburse the provider in an amount equal to the amount to which the provider would have been entitled if […]