SB 461: Department of Human Services; the single state agency responsible for the administration of the state Medicaid program; provide

Senate Bill 461

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 Human Services to be the single state agency responsible for the administration of the state Medicaid program; to transfer certain powers, functions, and duties from the Department of Community Health to the Department of Human Services; to revise definitions; to provide for transition; to provide for conforming changes; 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;"

SECTION 2.

Said chapter is further amended in Code Section 31-2-4, relating to powers, duties, functions, and responsibilities, divisions, directors, and contracts for health benefits, by adding a new subsection to read as follows:

"(e) On and after July 1, 2027, the powers, functions, and duties of the Department of Community Health relating to the administration of the state Medicaid program, including, but not limited to, the requirements provided for in paragraphs (11) and (12) of subsection (d) of this Code section, shall be performed and exercised by the Department of Human Services."

SECTION 3.

Said chapter is further amended in Code Section 31-2-15, relating to streamlining and expediting credentialing and billing processes for state medical plans, by revising subsection

(a) as follows:

"(a) As used in this Code section, the term 'state medical plan' means the state health benefit plan under Article 1 of Chapter 18 of Title 45, the medical assistance program under Article 7 of Chapter 4 of Title 49, the PeachCare for Kids Program under Article 13 of Chapter 5 of Title 49, and any other health benefit plan or policy administered by or on behalf of the state."

SECTION 4.

Said chapter is further amended in Code Section 31-2-18, relating to reporting on state health plans, by revising subsection (a) as follows:

"(a) As used in this Code section, the term 'state health plan' means:

(1) The medical assistance program provided pursuant to Article 7 of Chapter 4 of Title 49 Reserved;

(2) The PeachCare for Kids Program provided pursuant to Article 13 of Chapter 5 of Title 49;

(3) The state employees' health insurance plan established pursuant to Article 1 of Chapter 18 of Title 45;

(4) The health insurance plan for public school teachers established pursuant to Subpart 2 of Part 6 of Article 17 of Chapter 2 of Title 20; and

(5) The health insurance plan for public school employees established pursuant to Subpart 3 of Part 6 of Article 17 of Chapter 2 of Title 20; and

(6) The health benefit plan established for members, employees, and retirees of the Board of Regents of the University System of Georgia pursuant to Code Section 31-2-4."

SECTION 5.

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 Community Health relating to the Medicaid program shall be performed and exercised by the Department of Human Services."

SECTION 6.

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 Department of Community Health On and after July 1, 2027, the department shall be the single state agency for the administration of the state medical assistance plan."

SECTION 7.

Chapter 4 of said title is amended in Code Section 49-4-141, relating to definitions, by revising paragraphs (2), (3), and (4) as follows:

"(2) 'Board' means the Board of Community Health established under Chapter 2 of Title 31 Human Services.

(3) 'Commissioner' means the commissioner of the department human services.

(4) 'Department' means the Department of Community Health established under Chapter 2 of Title 31 Human Services."

SECTION 8.

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) and adding a new subsection to read as follows:

"(a) The Until June 30, 2027, the Department of Community Health established under Chapter 2 of Title 31 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. On and after July 1, 2027, the department is authorized to adopt and administer such state plan for medical assistance, 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. 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." "(e) The department, in cooperation with the Department of Community Health, shall take all necessary steps to implement and facilitate the transition of the administration of the Medicaid program from the Department of Community Health to the department in accordance with the provisions of this Code section."

SECTION 9.

Said chapter is further amended by revising Code Section 49-4-143, relating to power of Board of Community Health and Board of Medical Assistance abolished, as follows:

"49-4-143.

The Board of Community Health established under Chapter 2 of Title 31 board is empowered to establish the general policy to be followed by the department. The Board of Medical Assistance which existed June 30, 1999, is abolished July 1, 1999, and no person shall be appointed to such board on or after July 1, 1999."

SECTION 10.

Said chapter is further amended by revising Code Section 49-4-144, relating to chief administrative officer and powers and duties, as follows:

"49-4-144.

The commissioner of community health established under Chapter 2 of Title 31 shall be the chief administrative officer of the department and, subject to the general policy established by the board, shall supervise, direct, account for, organize, plan, administer, and execute the functions vested in the department."

SECTION 11.

Said chapter is further amended by revising Code Section 49-4-146, relating to time for action on claim, as follows:

"49-4-146.

The Until June 30, 2027, the Department of Community Health, within three months of receiving a claim submitted on or after July 1, 1978, shall pay or deny the claim. The department, within three months of receiving a claim submitted on or after July 1, 2027, shall pay or deny the claim."

SECTION 12.

Said chapter is further amended in Code Section 49-4-147.2, relating to Department of Community Health not eligible to obtain nor liable for interest on orders, judgments, and liquidated or unliquidated amounts and exceptions, by revising subsection (a) as follows: "(a) Notwithstanding the provisions of Code Section 49-4-141, as used in this Code section the term 'department' means the Department of Community Health Human Services or its officers, agents, or employees solely in their capacity as such officers, agents, or employees."

SECTION 13.

Said chapter is further amended in Code Section 49-4-154, relating to powers and duties retained by Department of Human Resources (Department of Community Health), by revising subsection (b) and adding a new subsection to read as follows: "(b) The Until June 30, 2027, the Department of Human Resources (now known as the Department of Community Health for these purposes) shall retain, in accordance with terms of the state plan, the functions, and all tangible things and employees relating thereto, of:

(1) Establishing and maintaining certain standards for certain institutions and agencies seeking to become or remain providers and shall finally determine and certify whether such institutions and agencies meet such standards;

(2) Determining and certifying the eligibility of certain applicants for and recipients of medical assistance; and

(3) Prescribing regulations to require that applicants for medical assistance be given clear and easily understandable notice that all books, papers, records, and memoranda of the provider relating to the provision of medical assistance to the applicant will be made available, upon request, to the commissioner of medical assistance or his representative and that, by accepting medical assistance, the applicant thereby consents to the providing of such books, papers, records, and memoranda to the commissioner of medical assistance or his representative.

(c) On and after July 1, 2027, the department shall assume, in accordance with the terms of the state plan, the powers, functions, and duties, and all tangible things and employees relating to the administration of the medical assistance program, as provided in paragraphs (1) through (3) of subsection (b) of this Code section."

SECTION 14.

Said chapter is further amended by revising Code Section 49-4-155, relating to Department of Community Health to succeed to existing rules, regulations, policies, procedures, and administrative orders, as follows:

"49-4-155.

(a) Beginning July 1, 2027, the department shall succeed to all the rules, regulations, policies, procedures, and administrative orders of the Department of Community Health that relate to the administration of the Medicaid program and are in effect on June 30, 2027, and shall further succeed to any rights, privileges, entitlements, obligations, and duties of the Department of Community Health that relate to the administration of the Medicaid program and are in effect on June 30, 2027.

(b) The Department of Community Health shall succeed to all the rules, regulations, policies, procedures, and administrative orders of the Department of Human Resources (now known as the Department of Human Services) transferred to the Department of Medical Assistance pursuant to the previously existing provisions of this Code section and that are in effect on June 30, 1999, and shall further succeed to any rights, privileges, entitlements, obligations, and duties of the Department of Human Resources (now known as the Department of Human Services) that are in effect on June 30, 1999, to which the Department of Medical Assistance succeeded pursuant to the previously existing provisions of Code Section 49-4-156."

SECTION 15.

Said chapter is further amended by replacing "Department of Community Health" with "department" where such term occurs in:

(1) Code Section 49-4-147, relating to enforcement of liens, claims, or offsets against assistance;

(2) Code Section 49-4-148, relating to recovery of assistance from third party liable for sickness, injury, disease, or disability;

(3) Code Section 49-4-149, relating to lien of Department of Community Health against third parties, subrogation to recipients' insurance claims, and assignment of recipients' claims;

(4) Code Section 49-4-149.1, relating to plan for family supplementation of Medicaid payments upon federal removal of restrictions or waiver;

(5) Code Section 49-4-150, relating to regulations as to maintenance and use of records and use of information;

(6) Code Section 49-4-151, relating to obtaining information for investigations and audits;

(7) Code Section 49-4-152, relating to research and demonstration projects, pilot projects to provide health care coverage and essential health care services, and pharmacy assistance programs; and

(8) Code Section 49-4-153, relating to hearings and appeals and judicial review.

SECTION 16.

Said chapter is further amended by replacing "commissioner of community health" with "commissioner" where such term occurs in:

(1) Code Section 49-4-147, relating to enforcement of liens, claims, or offsets against assistance;

(2) Code Section 49-4-148, relating to recovery of assistance from third party liable for sickness, injury, disease, or disability;

(3) Code Section 49-4-150, relating to regulations as to maintenance and use of records and use of information; and

(4) Code Section 49-4-153, relating to hearings and appeals and judicial review.

SECTION 17.

Said chapter is further amended by replacing "Board of Community Health" with "board" where such term occurs in:

(1) Code Section 49-4-150, relating to regulations as to maintenance and use of records and use of information; and

(2) Code Section 49-4-153, relating to hearings and appeals and judicial review.

SECTION 18.

If necessary to implement the provisions of this Act, the Department of Human Services 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 19.

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

SECTION 20.

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