SB460: SB460 Department of Community Health; determine and verify eligibility of Medicaid applicants and Medicaid recipients and to manage Medicaid enrollment; provide

26 LC 52 0973 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 of1 Georgia Annotated, relating to the Department of Community Health, Department of Human2 Services, and public assistance, respectively, so as to provide for the Department of3 Community Health to determine and verify eligibility of Medicaid applicants and Medicaid4 recipients and to manage Medicaid enrollment; to transfer certa in powers, functions, and5 duties from the Department of Human Services to the Department of Community Health; to6 provide for the Department of Community Health to administer, expend, and disburse funds;7 to provide for cooperation and continuity of care and services; to provide for consent to8 disclosure of certain information; to provide for the Departmen t of Community Health to9 request and review information for changes in circumstances that may affect ineligibility;10 to provide for notice; to provide for removal of ineligible Medicaid recipients; to provide for11 referral for prosecution; to provide for related matters; to provide for a state plan amendment12 or waiver request; to provide for an effective date; to repeal conflicting laws; and for other13 purposes.14 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:15 S. B. 460 - 1 - 26 LC 52 0973 SECTION 1.16 Chapter 2 of Title 31 of the Official Code of Georgia Annotated, relating to Department of17 Community Health, is amended in Code Section 31-2-1, relating t o legislative intent and18 grant of authority, by revising paragraph (1) as follows:19 "(1) Serve as the lead planning agency for all health issues in the state to remedy the20 current situation wherein the responsibility for health care policy, purchasing, planning,21 and regulation is spread among many different agencies; and achieve determinations of22 Medicaid eligibility for inmates to attain services at long-term care facilities when he or23 she is being considered for parole; determine and verify eligib ility for Medicaid24 applicants and Medicaid recipients; and use data analytics, aud its, screenings,25 investigations, and prosecutions to manage Medicaid enrollment to prevent fraud, waste,26 and abuse;"27 SECTION 2.28 Said chapter is further amended in paragraph (1) of subsection (a) of Code Section 31-2-4,29 relating to powers, duties, functions, and responsibilities, divisions, directors, and contracts30 for health benefits, by adding a new subparagraph to read as follows:31 "(C) On and after July 1, 2027, the powers, functions, and duties of the Department of32 Human Services relating to the Medicaid program, Medicaid eligibility determinations,33 and Medicaid enrollment shall be performed and exercised by the Department of34 Community Health pursuant to paragraph (1) of Code Section 31-2-1."35 SECTION 3.36 Chapter 2 of Title 49 of the Official Code of Georgia Annotated, relating to the Department37 of Human Services, is amended in Code Section 49-2-1, relating to department created,38 transfer from Department of Human Resources, commissioner, and kinship care enforcement39 administrator, by revising subsection (a) as follows:40 S. B. 460 - 2 - 26 LC 52 0973 "(a)(1) There is created a Department of Human Services. The powers, functions, and41 duties of the Department of Human Resources as they existed on June 30, 2009, except42 for those relating to the Division of Mental Health, Developmen tal Disabilities, and43 Addictive Diseases, the Division of Public Health, and the Office of Regulatory Services,44 unless specifically transferred or reassigned to the Department of Community Health or45 the Department of Behavioral Health and Developmental Disabilities, are transferred to46 the Department of Human Services effective July 1, 2009, and the Department of Human47 Resources shall be reconstituted as the Department of Human Services effective July 1,48 2009.49 (2) On and after July 1, 2027, the powers, functions, and duti es of the Department of50 Human Services relating to the Medicaid program, Medicaid eligibility determinations,51 and Medicaid enrollment shall be performed and exercised by the Department of52 Community Health pursuant to subparagraph (a)(1)(C) of Code Section 31-2-4."53 SECTION 4.54 Said chapter is further amended by revising Code Section 49-2-5, relating to department is55 institution of state, and power to disburse state, county, and federal funds, as follows:56 "49-2-5.57 The department is declared to be an institution of the state for which the powers of taxation58 over the whole state may be exercised, and the department is empowered and authorized59 to administer, expend, and disburse funds appropriated to it an d allocated to it by the60 General Assembly, the respective counties of the state, and the United States, through its61 appropriate agencies and instrumentalities for the purpose of distributing old-age benefits62 and all other benefits as provided in this title; provided, however, that, on and after July 1,63 2027, the Department of Community Health is empowered and authorized to administer,64 expend, and disburse such funds for the purpose of administering the Medicaid program,65 including Medicaid eligibility determinations and Medicaid enrollment management."66 S. B. 460 - 3 - 26 LC 52 0973 SECTION 5.67 Said chapter is further amended by revising subparagraph (b)(1) (A) and paragraph (5) of68 subsection (b) of Code Section 49-2-6, relating to powers and duties, as follows:69 "(A) All categories of public assistance established under Code Section 49-4-3;70 provided, however, that, on and after July 1, 2027, the Departm ent of Community71 Health shall administer and supervise the Medicaid program, including, but not limited72 to, Medicaid eligibility determinations and Medicaid enrollment management;"73 "(5) Act as the agent of the federal government in welfare matters of mutual concern in74 conformity with this title and the administration of any federal funds granted to the state75 to aid in the furtherance of any functions of the department; provided, however, that, on76 and after July 1, 2027, the Department of Community Health shal l administer and77 supervise the Medicaid program, including, but not limited to, Medicaid eligibility78 determinations and Medicaid enrollment management;"79 SECTION 6.80 Said chapter is further amended by revising Code Section 49-2-1 0, relating to state81 appropriations and state, county, and federal welfare funds are for public purpose, as follows:82 "49-2-10.83 For the purpose of carrying out the duties and obligations of t he department for84 performance of welfare services of the state, for administrativ e costs, for matching such85 federal funds as may be available for all of the aforesaid serv ices, for the purpose of86 establishing an equalization fund to be used in assisting those counties which may be87 unable otherwise to bear their proportionate share of the expenses of administration and of88 dispensing the benefits provided for under this title, and for dispensing all of the benefits89 provided for under this title, the General Assembly shall make appropriations out of the90 general fund of the state or otherwise for the various and sepa rate activities of the91 department. All funds appropriated or allocated to the departm ent or to the county92 S. B. 460 - 4 - 26 LC 52 0973 departments by the General Assembly, the fiscal authorities of the respective counties, and93 by the federal government through its appropriate agencies and instrumentalities are94 declared to be funds provided for a public purpose; and all appropriations provided for in95 this Code section and hereafter may be expended and distributed by the department for the96 purposes provided for under this title; provided, however, that, on and after July 1, 2027,97 the Department of Community Health shall expend and distribute such funds as they98 pertain to the Medicaid program, including, but not limited to, Medicaid eligibility99 determinations and Medicaid enrollment management."100 SECTION 7.101 Said chapter is further amended in Code Section 49-2-11, relati ng to acceptance and102 disbursement of federal aid, compliance with conditions, and us e of appropriations for103 matching funds, by revising subsection (f) as follows:104 "(f) Notwithstanding subsections (a) through (e) of this Code section, the The Department105 of Community Health shall be the single state agency for the ad ministration of the state106 medical assistance plan, and on and after July 1, 2027, shall determine and verify Medicaid107 eligibility and manage Medicaid enrollment."108 SECTION 8.109 Chapter 4 of said title, relating to public assistance, is amended by revising paragraph (2) of110 Code Section 49-4-2, relating to definitions, as follows:111 "(2) 'Public assistance' means payment in or by money, medical care, remedial care, goods,112 or services to or for the benefit of needy persons under any ca tegories that may be113 established pursuant to this article; provided, however, that, on and after July 1, 2027, such114 term shall not include medical assistance provided for under the Medicaid program."115 S. B. 460 - 5 - 26 LC 52 0973 SECTION 9.116 Said chapter is further amended in Code Section 49-4-3, relatin g to establishment of117 categories of public assistance and powers and duties in administration of article, by adding118 a new subsection to read as follows:119 "(c) On and after July 1, 2027, all powers, functions, and duties relative to administration120 of and eligibility determinations for the Medicaid program shal l be transferred from the121 department to the Department of Community Health; provided, how ever, that the122 department shall provide for maximum cooperation with the Depar tment of Community123 Health to ensure continuity of care and services provided under the Medicaid program."124 SECTION 10.125 Said chapter is further amended in Code Section 49-4-142, relat ing to Department of126 Community Health established, adoption, administration, modific ation of state plan, drug127 application fees, and personal needs allowance, by revising subsection (a) as follows:128 "(a) The Department of Community Health established under Chapt er 2 of Title 31129 department is authorized to adopt and administer a state plan for medical assistance in130 accordance with Title XIX of the federal Social Security Act, as amended (Act of July 30,131 1965, P.L. 89-97, 79 Stat. 343, as amended), provided such stat e plan is administered132 within the appropriations made available to the department. The department is authorized133 to establish the amount, duration, scope, and terms and conditi ons of eligibility for and134 receipt of such medical assistance as it may elect to authorize pursuant to this article. The135 department shall regularly and systematically review eligibility determinations. Further,136 the department is authorized to establish such rules and regulations as may be necessary137 or desirable in order to execute the state plan and to receive the maximum amount of138 federal financial participation available in expenditures made pursuant to the state plan;139 provided, however, that the department shall establish reasonable procedures for notice to140 interested parties and an opportunity to be heard prior to the adoption, amendment, or141 S. B. 460 - 6 - 26 LC 52 0973 repeal of any such rule or regulation. The department is autho rized to enter into such142 reciprocal and cooperative arrangements with other states, persons, and institutions, public143 and private, as it may deem necessary or desirable in order to execute the state plan."144 SECTION 11.145 Said chapter is further amended by adding a new Code section to read as follows:146 "49-4-143.1.147 (a) Except as prohibited by federa l law, the department shall determine and verify all148 conditions of eligibility for medical assistance before authorization of medical assistance149 for a Medicaid applicant and during regular reevaluation of a M edicaid recipient's150 eligibility for medical assistance.151 (b) By applying for medical assistance, an individual consents to the disclosure of152 information about the identity, age, residence, citizenship, em ployment, applications for153 employment, income, wages, assets, and resources of the individ ual or available to the154 individual that are in the possession of state and federal agencies. Such consent shall be155 effective to authorize any state and federal agencies to release such information requested156 by the department.157 (c) The department shall regularly request and review information concerning Medicaid158 recipients that may indicate a change in circumstances that aff ect eligibility. Any159 information indicating fraud, waste, or abuse shall be referred to prosecution pursuant to160 Code Sections 49-4-15 and 49-4-146.1 and Article 7B of this chapter.161 (d) Medicaid applicants who are determined by the department t o be ineligible shall be162 promptly informed of such ineligibility in accordance with federal guidelines. Medicaid163 recipients who are determined by the department to be ineligibl e shall be subject to164 disenrollment and removal in accordance with federal notice req uirements. The165 department shall inform any ineligible Medicaid applicants or Medicaid recipients of any166 S. B. 460 - 7 - 26 LC 52 0973 appeals processes and the availability of discounted or reduced cost healthcare coverage167 or healthcare services from other sources.168 (e) The department shall enter into any data sharing agreement s or memorandums of169 understanding with any governmental agencies to effectuate the provisions of this Code170 section. The department is authorized to contract with vendors to process applications,171 verify data, or manage technical systems to support the provisions of this Code section."172 SECTION 12.173 If necessary to implement the provisions of this Act, the Department of Community Health174 shall submit a Medicaid state plan amendment or waiver request to the Centers for Medicare175 and Medicaid Services of the United States Department of Health and Human Services.176 SECTION 13.177 This Act shall become effective upon its approval by the Governor or upon its becoming law178 without such approval.179 SECTION 14.180 All laws and parts of laws in conflict with this Act are repealed.181 S. B. 460 - 8 -