SB276: SB276 Recovery of Medical Assistance from Third Party; certain provisions to comply with federal law; revise

Georgia law lets the Department of Community Health recover Medicaid costs from insurers, health plans, and other third parties who are legally responsible for paying a person's medical bills. This bill amends that law (O.C.G.A. § 49-4-148) to bring it in line with federal requirements. The bill adds a new rule saying insurers and other liable third-party payers cannot refuse to pay for a healthcare item or service solely because it was not authorized in advance by the payer; the department's own authorization counts instead. It also adds a requirement that these payers respond to a state inquiry about the status of a claim within 60 days of receiving it. The bill renumbers the existing list of insurer obligations to fit in these two new requirements and keeps rules limiting them to health plans issued or renewed on or after April 28, 2001.

• Prohibits insurers and other third-party payers from refusing to pay a Medicaid-related healthcare claim solely because the item or service lacked prior authorization from the payer.
• Requires third-party payers to respond to a Department of Community Health inquiry about a claim's status within 60 days of receiving it.
• Keeps in place existing duties for insurers, including cooperating with the state on eligibility checks and providing quarterly eligibility and claims data.
• Applies the prior-authorization and response-time rules only to health benefit plans issued, delivered, or renewed on or after April 28, 2001.

Health insurers, managed care entities, pharmacy benefits managers, group health plans, and other parties legally responsible for paying medical claims are directly affected, as is the Department of Community Health, which administers Medicaid recovery from these third parties on behalf of Medicaid recipients.

Medicaid recipients whose care is also covered by private insurance could see fewer payment disputes if insurers can no longer reject claims over missing prior authorization once the state has already approved the service. The 60-day response deadline also gives the state a clearer timeline for resolving claim disputes with insurers.

• Section 1 revises subsection (b) of O.C.G.A. § 49-4-148, which lists the duties of insurers and other third-party payers regarding Medicaid recovery.
• Adds new paragraph (2) language barring refusal to pay solely because a healthcare item or service was not previously authorized by the third-party payer.
• Adds new paragraph (3) requiring a response to a department inquiry about a claim's status within 60 days of receiving it.
• Renumbers the remaining existing duties (timely payment compliance, quarterly data reporting, assignment of payment rights, and rules on claim submission timing) as paragraphs (4) through (7).
• Clarifies that the prior-authorization and 60-day response rules apply only to health plans issued or renewed on or after April 28, 2001.
• Section 2 repeals any conflicting laws.

1. 2025-05-14Effective Date 2025-07-01
2. 2025-05-14Act 297
3. 2025-05-14Senate Date Signed by Governor (Senate)
4. 2025-04-07Senate Sent to Governor (Senate)
5. 2025-03-18House Passed/Adopted (House)
6. 2025-03-18House Third Readers (House)
7. 2025-03-13House Committee Favorably Reported (House)
8. 2025-03-11House Second Readers (House)

• Drew Echols (R, SD-049)Primary sponsor
• Brian Strickland (R, SD-042)
• Bo Hatchett (R, SD-050)
• Chuck Hufstetler (R, SD-052)
• Blake Tillery (R, SD-019)
• Ben Watson (R, SD-001)
• Timothy Bearden (R, SD-030)
• John Kennedy (R, SD-018)
• Kay Kirkpatrick (R, SD-032)
• Shawn Still (R, SD-048)
• Matthew Gambill (R, HD-015)

1. PassedSenate voteMarch 6, 2025

   54 yea, 1 nay (0 not voting, 1 absent)

   Passage: Senate Vote #166

2. PassedHouse voteMarch 18, 2025

   168 yea, 2 nay (5 not voting, 5 absent)

   Passage: House Vote #284

• Medicaid
• health insurance regulation
• prior authorization
• third-party liability