SB 460: Department of Community Health; determine and verify eligibility of Medicaid applicants and Medicaid recipients and to manage Medicaid enrollment; provide

Senate Bill 460

By: Senators Tillery of the 19th, Robertson of the 29th, Walker III of the 20th and Watson of the 1st

A BILL TO BE ENTITLED

AN ACT

To amend Chapter 2 of Title 31 and Chapters 2 and 4 of Title 49 of the Official Code of Georgia Annotated, relating to the Department of Community Health, Department of Human Services, and public assistance, respectively, so as to provide for the Department of Community Health to determine and verify eligibility of Medicaid applicants and Medicaid recipients and to manage Medicaid enrollment; to transfer certain powers, functions, and duties from the Department of Human Services to the Department of Community Health; to provide for the Department of Community Health to administer, expend, and disburse funds; to provide for cooperation and continuity of care and services; to provide for consent to disclosure of certain information; to provide for the Department of Community Health to request and review information for changes in circumstances that may affect ineligibility; to provide for notice; to provide for removal of ineligible Medicaid recipients; to provide for referral for prosecution; to provide for related matters; to provide for a state plan amendment or waiver request; to provide for an effective date; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Chapter 2 of Title 31 of the Official Code of Georgia Annotated, relating to Department of Community Health, is amended in Code Section 31-2-1, relating to legislative intent and grant of authority, by revising paragraph (1) as follows:

"(1) Serve as the lead planning agency for all health issues in the state to remedy the current situation wherein the responsibility for health care policy, purchasing, planning, and regulation is spread among many different agencies; and achieve determinations of Medicaid eligibility for inmates to attain services at long-term care facilities when he or she is being considered for parole; determine and verify eligibility for Medicaid applicants and Medicaid recipients; and use data analytics, audits, screenings, investigations, and prosecutions to manage Medicaid enrollment to prevent fraud, waste, and abuse;"

SECTION 2.

Said chapter is further amended in paragraph (1) of subsection (a) of Code Section 31-2-4, relating to powers, duties, functions, and responsibilities, divisions, directors, and contracts for health benefits, by adding a new subparagraph to read as follows: "(C) On and after July 1, 2027, the powers, functions, and duties of the Department of Human Services relating to the Medicaid program, Medicaid eligibility determinations, and Medicaid enrollment shall be performed and exercised by the Department of Community Health pursuant to paragraph (1) of Code Section 31-2-1."

SECTION 3.

Chapter 2 of Title 49 of the Official Code of Georgia Annotated, relating to the Department of Human Services, is amended in Code Section 49-2-1, relating to department created, transfer from Department of Human Resources, commissioner, and kinship care enforcement administrator, by revising subsection (a) as follows:

"(a)(1) There is created a Department of Human Services. The powers, functions, and duties of the Department of Human Resources as they existed on June 30, 2009, except for those relating to the Division of Mental Health, Developmental Disabilities, and Addictive Diseases, the Division of Public Health, and the Office of Regulatory Services, unless specifically transferred or reassigned to the Department of Community Health or the Department of Behavioral Health and Developmental Disabilities, are transferred to the Department of Human Services effective July 1, 2009, and the Department of Human Resources shall be reconstituted as the Department of Human Services effective July 1, 2009.

(2) On and after July 1, 2027, the powers, functions, and duties of the Department of Human Services relating to the Medicaid program, Medicaid eligibility determinations, and Medicaid enrollment shall be performed and exercised by the Department of Community Health pursuant to subparagraph (a)(1)(C) of Code Section 31-2-4."

SECTION 4.

Said chapter is further amended by revising Code Section 49-2-5, relating to department is institution of state, and power to disburse state, county, and federal funds, as follows:

"49-2-5.

The department is declared to be an institution of the state for which the powers of taxation over the whole state may be exercised, and the department is empowered and authorized to administer, expend, and disburse funds appropriated to it and allocated to it by the General Assembly, the respective counties of the state, and the United States, through its appropriate agencies and instrumentalities for the purpose of distributing old-age benefits and all other benefits as provided in this title; provided, however, that, on and after July 1, 2027, the Department of Community Health is empowered and authorized to administer, expend, and disburse such funds for the purpose of administering the Medicaid program, including Medicaid eligibility determinations and Medicaid enrollment management."

SECTION 5.

Said chapter is further amended by revising subparagraph (b)(1)(A) and paragraph (5) of subsection (b) of Code Section 49-2-6, relating to powers and duties, as follows: "(A) All categories of public assistance established under Code Section 49-4-3; provided, however, that, on and after July 1, 2027, the Department of Community Health shall administer and supervise the Medicaid program, including, but not limited to, Medicaid eligibility determinations and Medicaid enrollment management;" "(5) Act as the agent of the federal government in welfare matters of mutual concern in conformity with this title and the administration of any federal funds granted to the state to aid in the furtherance of any functions of the department; provided, however, that, on and after July 1, 2027, the Department of Community Health shall administer and supervise the Medicaid program, including, but not limited to, Medicaid eligibility determinations and Medicaid enrollment management;"

SECTION 6.

Said chapter is further amended by revising Code Section 49-2-10, relating to state appropriations and state, county, and federal welfare funds are for public purpose, as follows:

"49-2-10.

For the purpose of carrying out the duties and obligations of the department for performance of welfare services of the state, for administrative costs, for matching such federal funds as may be available for all of the aforesaid services, for the purpose of establishing an equalization fund to be used in assisting those counties which may be unable otherwise to bear their proportionate share of the expenses of administration and of dispensing the benefits provided for under this title, and for dispensing all of the benefits provided for under this title, the General Assembly shall make appropriations out of the general fund of the state or otherwise for the various and separate activities of the department. All funds appropriated or allocated to the department or to the county departments by the General Assembly, the fiscal authorities of the respective counties, and by the federal government through its appropriate agencies and instrumentalities are declared to be funds provided for a public purpose; and all appropriations provided for in this Code section and hereafter may be expended and distributed by the department for the purposes provided for under this title; provided, however, that, on and after July 1, 2027, the Department of Community Health shall expend and distribute such funds as they pertain to the Medicaid program, including, but not limited to, Medicaid eligibility determinations and Medicaid enrollment management."

SECTION 7.

Said chapter is further amended in Code Section 49-2-11, relating to acceptance and disbursement of federal aid, compliance with conditions, and use of appropriations for matching funds, by revising subsection (f) as follows:

"(f) Notwithstanding subsections (a) through (e) of this Code section, the The Department of Community Health shall be the single state agency for the administration of the state medical assistance plan, and on and after July 1, 2027, shall determine and verify Medicaid eligibility and manage Medicaid enrollment."

SECTION 8.

Chapter 4 of said title, relating to public assistance, is amended by revising paragraph (2) of Code Section 49-4-2, relating to definitions, as follows:

"(2) 'Public assistance' means payment in or by money, medical care, remedial care, goods, or services to or for the benefit of needy persons under any categories that may be established pursuant to this article; provided, however, that, on and after July 1, 2027, such term shall not include medical assistance provided for under the Medicaid program."

SECTION 9.

Said chapter is further amended in Code Section 49-4-3, relating to establishment of categories of public assistance and powers and duties in administration of article, by adding a new subsection to read as follows:

"(c) On and after July 1, 2027, all powers, functions, and duties relative to administration of and eligibility determinations for the Medicaid program shall be transferred from the department to the Department of Community Health; provided, however, that the department shall provide for maximum cooperation with the Department of Community Health to ensure continuity of care and services provided under the Medicaid program."

SECTION 10.

Said chapter is further amended in Code Section 49-4-142, relating to Department of Community Health established, adoption, administration, modification of state plan, drug application fees, and personal needs allowance, by revising subsection (a) as follows: "(a) The Department of Community Health established under Chapter 2 of Title 31 department is authorized to adopt and administer a state plan for medical assistance in accordance with Title XIX of the federal Social Security Act, as amended (Act of July 30, 1965, P.L. 89-97, 79 Stat. 343, as amended), provided such state plan is administered within the appropriations made available to the department. The department is authorized to establish the amount, duration, scope, and terms and conditions of eligibility for and receipt of such medical assistance as it may elect to authorize pursuant to this article. The department shall regularly and systematically review eligibility determinations. Further, the department is authorized to establish such rules and regulations as may be necessary or desirable in order to execute the state plan and to receive the maximum amount of federal financial participation available in expenditures made pursuant to the state plan; provided, however, that the department shall establish reasonable procedures for notice to interested parties and an opportunity to be heard prior to the adoption, amendment, or repeal of any such rule or regulation. The department is authorized to enter into such reciprocal and cooperative arrangements with other states, persons, and institutions, public and private, as it may deem necessary or desirable in order to execute the state plan."

SECTION 11.

Said chapter is further amended by adding a new Code section to read as follows:

"49-4-143.1.

(a) Except as prohibited by federal law, the department shall determine and verify all conditions of eligibility for medical assistance before authorization of medical assistance for a Medicaid applicant and during regular reevaluation of a Medicaid recipient's eligibility for medical assistance.

(b) By applying for medical assistance, an individual consents to the disclosure of information about the identity, age, residence, citizenship, employment, applications for employment, income, wages, assets, and resources of the individual or available to the individual that are in the possession of state and federal agencies. Such consent shall be effective to authorize any state and federal agencies to release such information requested by the department.

(c) The department shall regularly request and review information concerning Medicaid recipients that may indicate a change in circumstances that affect eligibility. Any information indicating fraud, waste, or abuse shall be referred to prosecution pursuant to Code Sections 49-4-15 and 49-4-146.1 and Article 7B of this chapter.

(d) Medicaid applicants who are determined by the department to be ineligible shall be promptly informed of such ineligibility in accordance with federal guidelines. Medicaid recipients who are determined by the department to be ineligible shall be subject to disenrollment and removal in accordance with federal notice requirements. The department shall inform any ineligible Medicaid applicants or Medicaid recipients of any appeals processes and the availability of discounted or reduced cost healthcare coverage or healthcare services from other sources.

(e) The department shall enter into any data sharing agreements or memorandums of understanding with any governmental agencies to effectuate the provisions of this Code section. The department is authorized to contract with vendors to process applications, verify data, or manage technical systems to support the provisions of this Code section."

SECTION 12.

If necessary to implement the provisions of this Act, the Department of Community Health shall submit a Medicaid state plan amendment or waiver request to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

SECTION 13.

This Act shall become effective upon its approval by the Governor or upon its becoming law without such approval.

SECTION 14.

All laws and parts of laws in conflict with this Act are repealed.