--- title: SB 276. Recovery of Medical Assistance from Third Party; certain provisions to comply with federal law; revise collection: bills id: 2025-2026/sb276 cite_as: SB 276, 2025-2026 Regular Session (Ga.) canonical_url: https://georgiacommons.org/bills/2025-2026/sb276 md_url: https://georgiacommons.org/bills/2025-2026/sb276.md text_url: https://georgiacommons.org/bills/2025-2026/sb276/text source_url: https://www.legis.ga.gov/legislation/70919 date: 2025-05-14 status: passed corpus_version: bills-2026-08-28 license: Public record of the Georgia General Assembly, via LegiScan; see about.md publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice. up: https://georgiacommons.org/bills/2025-2026.md previous: https://georgiacommons.org/bills/2025-2026/sb275.md next: https://georgiacommons.org/bills/2025-2026/sb277.md index: https://georgiacommons.org/bills/index.md omitted: votes and history omitted_chars: 953 omitted_url: https://georgiacommons.org/bills/2025-2026/sb276.md?full=1 bill_number: SB 276 session: 2025-2026 Regular Session session_slug: 2025-2026 chamber: Senate bill_type: bill status_date: 2025-05-14 last_action: Effective Date 2025-07-01 sponsors: - Drew Echols - Brian Strickland - Bo Hatchett - Chuck Hufstetler - Blake Tillery - Ben Watson - Timothy Bearden - John Kennedy - Kay Kirkpatrick - Shawn Still - Matthew Gambill text_version: Enrolled has_text: true legiscan_url: https://legiscan.com/GA/bill/SB276/2025 upstream_id: 1986188 summaries_model: claude-sonnet-5 topic_tags: - Medicaid - health insurance regulation - prior authorization - third-party liability --- # SB 276. Recovery of Medical Assistance from Third Party; certain provisions to comply with federal law; revise ## Text 25 LC 52 0780 Senate Bill 276 By: Senators Echols of the 49th, Strickland of the 42nd, Hatchett of the 50th, Hufstetler of the 52nd, Tillery of the 19th and others AS PASSED A BILL TO BE ENTITLED AN ACT To amend Code Section 49-4-148 of the Official Code of Georgia Annotated, relating to1 recovery of medical assistance from third party liable for sick ness, injury, disease, or2 disability, so as to revise certain provisions to comply with f ederal law; to bar liable3 third-party payers from refusing payment solely because a healthcare item or service did not4 receive prior authorization; to require a third-party payer to respond to an inquiry from the5 Department of Community Health regarding a healthcare claim within 60 days; to provide6 for related matters; to repeal conflicting laws; and for other purposes.7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:8 SECTION 1.9 Code Section 49-4-148 of the Official Code of Georgia Annotated , relating to recovery of10 medical assistance from third party liable for sickness, injury , disease, or disability, is11 amended by revising subsection (b) as follows:12 "(b) All insurers, as defined in Code Section 33-24-57.1, including but not limited to group13 health plans as defined in Section 607(1) of the federal Employee Retirement Security Act14 of 1974, managed care entities as defined in Code Section 33-20 A-3, which offer health15 benefit plans, as defined in Code Section 33-24-59.5, pharmacy benefits managers, as16 S. B. 276 - 1 - 25 LC 52 0780 defined in Code Section 33-64-1, and any other parties that are , by statute, contract, or17 agreement, legally responsible for payment of a claim for a health care healthcare item or18 service shall comply with this subsection. Such entities set forth in this subsection shall:19 (1) Cooperate with the department in determining whether a person who is a recipient20 of medical assistance may be covered under that entity's health benefit plan and eligible21 to receive benefits thereunder for the medical services for which that medical assistance22 was provided and respond to any inquiry from the state regarding a claim for payment for23 any health care healthcare item or service submitted not later than three years after such24 item or service was provided;25 (2) Accept the department's authorization for the provision of medical services payment26 for a healthcare item or service on behalf of a recipient of medical assistance as the27 entity's third-party payer's authorization for the provision of those services and shall not28 refuse to pay for a healthcare item or service solely on the basis that the third-party payer29 did not previously authorize such item or service;30 (3) Respond to a department inquiry regarding the status of a claim for payment for any31 healthcare item or service within 60 days of receiving the inquiry;32 (3)(4) Comply with the requirements of Code Section 33-24-59.5, regarding the timely33 payment of claims submitted by the department for medical servi ces provided to a34 recipient of medical assistance and covered by the health benef it plan, subject to the35 payment to the department of interest as provided in that Code section for failure to36 comply;37 (4)(5) Provide the department, on a quarterly basis, eligibility and claims payment data38 regarding applicants for medical assistance or recipients for medical assistance;39 (5)(6) Accept the assignment to the department or a recipient of med ical assistance or40 any other entity of any rights to any payments for such medical care from a third party;41 and42 S. B. 276 - 2 - 25 LC 52 0780 (6)(7) Agree not to deny a claim submitted by the department solely on the basis of the43 date of submission of the claim, type or format of the claim, or a failure to present proper44 documentation at the point-of-sale which is the basis of the claim, if:45 (A) The claim is submitted to the department within three year s from when the item46 or service was furnished; and47 (B) Any action by the department to enforce its rights with re spect to such claim48 commenced within six years of the department's submission of the claim.49 The requirements of paragraphs (2) and (3) (4) of this subsection shall only apply to a50 health benefit plan which is issued, issued for delivery, delivered, or renewed on or after51 April 28, 2001."52 SECTION 2.53 All laws and parts of laws in conflict with this Act are hereby repealed.54 S. B. 276 - 3 - ## Summaries written by Georgia Commons The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary. Senate Bill 276 changes Georgia's law on recovering Medicaid costs from third-party insurers, barring them from denying claims just because a service lacked prior authorization and setting a 60-day deadline to respond to state inquiries. ### Plain-language summary 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. ### What it does - 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. ### Who it affects 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. ### Why it matters 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. ### Key provisions - 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. ## Status - Status: Passed (2025-05-14) - Last action: Effective Date 2025-07-01 (2025-05-14) - Sponsors: Drew Echols, Brian Strickland, Bo Hatchett, Chuck Hufstetler, Blake Tillery, Ben Watson, Timothy Bearden, John Kennedy, Kay Kirkpatrick, Shawn Still, Matthew Gambill - Official page: https://www.legis.ga.gov/legislation/70919 > The history, votes, and amendments (953 characters) are at https://georgiacommons.org/bills/2025-2026/sb276.md?full=1