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 to
recovery of medical assistance from third party liable for sickness, injury, disease, or
disability, so as to revise certain provisions to comply with federal law; to bar liable
third-party payers from refusing payment solely because a healthcare item or service did not
receive prior authorization; to require a third-party payer to respond to an inquiry from the
Department of Community Health regarding a healthcare claim within 60 days; to provide
for related matters; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Code Section 49-4-148 of the Official Code of Georgia Annotated, relating to recovery of
medical assistance from third party liable for sickness, injury, disease, or disability, is
amended by revising subsection (b) as follows:
"(b) All insurers, as defined in Code Section 33-24-57.1, including but not limited to group
health plans as defined in Section 607(1) of the federal Employee Retirement Security Act
of 1974, managed care entities as defined in Code Section 33-20A-3, which offer health
benefit plans, as defined in Code Section 33-24-59.5, pharmacy benefits managers, as
defined in Code Section 33-64-1, and any other parties that are, by statute, contract, or
agreement, legally responsible for payment of a claim for a <del>health care</del> <ins>healthcare</ins> item or
service shall comply with this subsection. Such entities set forth in this subsection shall:
(1) Cooperate with the department in determining whether a person who is a recipient
of medical assistance may be covered under that entity's health benefit plan and eligible
to receive benefits thereunder for the medical services for which that medical assistance
was provided and respond to any inquiry from the state regarding a claim for payment for
any <del>health care</del> <ins>healthcare</ins> item or service submitted not later than three years after such
item or service was provided;
(2) Accept the department's <del>authorization for the provision of medical services</del> <ins>payment
for a healthcare item or service</ins> on behalf of a recipient of medical assistance as the
<del>entity's</del> <ins>third-party payer's</ins> authorization for the provision of those services <ins>and shall not
refuse to pay for a healthcare item or service solely on the basis that the third-party payer
did not previously authorize such item or service;
(3) Respond to a department inquiry regarding the status of a claim for payment for any
healthcare item or service within 60 days of receiving the inquiry;
</ins> <del>(3)(4)</del> Comply with the requirements of Code Section 33-24-59.5, regarding the timely
payment of claims submitted by the department for medical services provided to a
recipient of medical assistance and covered by the health benefit plan, subject to the
payment to the department of interest as provided in that Code section for failure to
comply;
<del>(4)(5)</del> Provide the department, on a quarterly basis, eligibility and claims payment data
regarding applicants for medical assistance or recipients for medical assistance;
<del>(5)(6)</del> Accept the assignment to the department or a recipient of medical assistance or
any other entity of any rights to any payments for such medical care from a third party;
and
<del>(6)(7)</del> Agree not to deny a claim submitted by the department solely on the basis of the
date of submission of the claim, type or format of the claim, or a failure to present proper
documentation at the point-of-sale which is the basis of the claim, if:
(A) The claim is submitted to the department within three years from when the item
or service was furnished; and
(B) Any action by the department to enforce its rights with respect to such claim
commenced within six years of the department's submission of the claim.
The requirements of paragraphs (2) and <del>(3)</del> <ins>(4)</ins> of this subsection shall only apply to a
health benefit plan which is issued, issued for delivery, delivered, or renewed on or after
April 28, 2001."
SECTION 2.
All laws and parts of laws in conflict with this Act are hereby repealed.