HB1374: HB1374 Insurance; methods of payment to healthcare providers; provide certain requirements

26 HB 1374/AP House Bill 1374 (AS PASSED HOUSE AND SENATE) By: Representatives Hawkins of the 27th, Stephens of the 164th, Jasperse of the 11th, Newton of the 127th, and Clark of the 100th A BILL TO BE ENTITLED AN ACT To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to1 insurance generally, so as to provide for certain requirements concerning methods of2 payment to healthcare providers; to provide for definitions; to provide for notification; to3 provide for the avoidance of additional fees; to prohibit contr actual waivers of certain4 statutory requirements; to amend Part 1 of Article 3 of Chapter 5 of Title 50 of the Official5 Code of Georgia Annotated, relating to general authority, duties, and procedures relative to6 state purchasing, so as to revise provisions for the award of c ontracts to prequalified7 suppliers; to clarify competitive bidding requirements and proc edures with respect to8 prequalified suppliers; to provide for a report to the General Assembly; to prohibit the9 renewal or extension of contracts under certain circumstances; to require the commissioner10 of administrative services to adopt rules, regulations, and procedures; to provide for related11 matters; to repeal conflicting laws; and for other purposes.12 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:13 H. B. 1374 - 1 - 26 HB 1374/AP PART I14 SECTION 1-1.15 Chapter 24 of Title 33 of the Official Code of Georgia Annotate d, relating to insurance16 generally, is amended by revising Code Section 33-24-59.24, rel ating to restrictions on17 payment methods prohibited, waiver of provisions prohibited, and enforcement, as follows:18 "33-24-59.24.19 (a) As used in this chapter Code section, the term:20 (1) 'Care management organization' means an entity that is organized for the purpose of21 providing or arrangi ng health care healthcare, which has been granted a certificate of22 authority by the Commissioner as a health maintenance organization pursuant to Chapter23 21 of this title, and which has entered into a contract with the Department of Community24 Health to provide or arrange health care healthcare services on a prepaid, capitated basis25 to members.26 (2) 'Credit card payment' means a type of electronic funds tra nsfer in which a health27 insurance plan or health insurer or its contracted vendor issue s a single-use series of28 numbers associated with the payment of health care healthcare services performed by a29 health care healthcare provider and chargeable to a predetermined dollar amount,30 whereby the health care healthcare provider is responsible for processing the payment by31 a credit card terminal or Internet internet portal. Such term shall include virtual or online32 credit card payments, whereby no physical credit card is presen ted to the health care33 healthcare provider and the single-use credit card expires upon payment processing.34 (3) 'Electronic funds transfer' means an electronic funds tran sfer through the federal35 Health Insurance Portability and Accountability Act of 1996, P. L. 104-191, standard36 automated clearing-house network.37 H. B. 1374 - 2 - 26 HB 1374/AP (4) 'Express acceptance' means a clear and direct agreement to the terms of payment38 method, communicated explicitly by the health benefit plan to the healthcare provider,39 in writing, signifying acceptance of the payment method.40 (4)(5) 'Healthcare 'Health care provider' means any physician, dentist, podiatrist,41 pharmacist, optometrist, psychologist, registered optician, lic ensed professional42 counselor, physical therapist, chiropractor, hospital, or other entity or person that is43 licensed or otherwise authorized in this state to furnish health care healthcare services.44 (6) 'Healthcare provider's agent' means a third-party firm or individual contracted by a45 healthcare provider to handle administrative tasks, particularly billing, insurance claims,46 and payment processing, acting on the healthcare provider's beh alf for financial47 transactions and often providing value-added services like data management or portal48 access. Such term shall also refer to a recruiter who acts as an agent for healthcare49 providers seeking jobs or healthcare practices seeking to hire healthcare providers,50 guiding them through hiring and contract negotiation.51 (5)(7) 'Healthcare 'Health care services' means the examination or treatment of persons52 for the prevention of illness or the correction or treatment of any physical or mental53 condition resulting from illness, injury, or other human physical problem and includes,54 but is not limited to:55 (A) Hospital services which include the general and usual services and care, supplies,56 and equipment furnished by hospitals;57 (B) Medical services which include the general and usual services and care rendered58 and administered by doctors of medicine, doctors of dental surg ery, and doctors of59 podiatry; and60 (C) Other health care healthcare services which include appliances and supplies;61 nursing care by a registered nurse or a licensed practical nurse; care furnished by such62 other licensed practitioners; institutional services including the general and usual care,63 services, supplies, and equipment furnished by health care healthcare institutions and64 H. B. 1374 - 3 - 26 HB 1374/AP agencies or entities other than hospitals; physiotherapy; ambulance services; drugs and65 medications; therapeutic services and equipment including oxyge n and the rental of66 oxygen equipment; hospital beds; iron lungs; orthopedic service s and appliances67 including wheelchairs, trusses, braces, crutches, and prostheti c devices including68 artificial limbs and eyes; and any other appliance, supply, or service related to health69 care healthcare.70 (6)(8) 'Health insurance plan' means any hospital or medical insuran ce policy or71 certificate; health plan contract or certificate; qualified hig her deductible health plan;72 health maintenance organization subscriber contract; any contract providing benefits for73 dental care whether such contract is pursuant to a medical insurance policy or certificate;74 stand-alone dental plan, health maintenance provider contract, managed health care75 healthcare plan, self-insured plan, or otherwise; or any health insurance plan established76 pursuant to Article 1 of Chapter 18 of Title 45.77 (7)(9) 'Health insurer' means any entity or person engaged as an indemnitor, surety, or78 contractor that issues insurance, annuity or endowment contracts, subscriber certificates,79 or other contracts of insurance by whatever name called. Health care Healthcare plans80 under Chapter 20A of this title and health maintenance organizations are health insurers81 within the meaning of this chapter.82 (b) No Any health insurance plan issued, amended, or renewed on or after January 1, 201983 2027, between a health insurer or its contracted vendor or a care management organization84 and a health care healthcare provider for the provision of health care healthcare services85 to a plan enrollee shall not contain restrictions on methods of payment from the health86 insurer or its vendor or the care management organization to th e health care healthcare87 provider in which the only acceptable payment method is a credi t card payment or any88 other form of payment that requires fees or similar charges.89 H. B. 1374 - 4 - 26 HB 1374/AP (c) If initiating or changing payments to a health care provid er using electronic funds90 transfer payments, including virtual credit card payments, a health insurance plan, health91 insurer or its contracted vendor, or care management organization shall:92 (1) Notify the health care provider if any fees are associated with a particular payment93 method; and94 (2) Advise the provider of the available methods of payment an d provide clear95 instructions to the health care provider as to how to select an alternative payment method.96 (c) A health insurance plan or its contracted vendor or a care management organization97 may initiate or change payment methodology to a healthcare prov ider using electronic98 funds transfer payments, including virtual credit card payments, only if:99 (1) The health insurance plan notifies the healthcare provider if any fees are associated100 with a particular payment method;101 (2) The health insurance plan advises the healthcare provider of the available methods102 of payment and provides clear instructions to the healthcare provider as to how to select103 an alternative payment method that does not impose fees or simi lar charges on the104 provider; and105 (3) The healthcare provider or the healthcare provider's agent , through express106 acceptance, accepts a payment for the claim using a credit card or electronic funds107 transfer payment method.108 (d) A healthcare provider's selected form of claim payment methodology remains effective109 until such time as the healthcare provider chooses an alternative method of payment or by110 making an election in a new contract.111 (e) A health insurance plan or its contracted vendor or a care management organization112 that initiates or changes payments to a healthcare provider thr ough an electronic funds113 transfer in accordance with 45 C.F.R. Section 162.1602, as effective on January 1, 2026,114 shall not charge a fee solely to transmit the payment to a heal thcare provider unless the115 healthcare provider has consented to the fee.116 H. B. 1374 - 5 - 26 HB 1374/AP (f) A healthcare provider or the healthcare provider's agent m ay charge reasonable fees117 when transmitting an automated clearing-house network payment r elated to transaction118 management, data management, portal services, and other value-added services in addition119 to the bank transmittal.120 (g) Any electronic funds transfer or remittance advice transaction under this Code section121 shall be the transmission of any of the following from a health insurance plan to a122 healthcare provider:123 (1) Payment;124 (2) Information about the transfer of funds;125 (3) Payment processing information;126 (4) Explanation of benefits; or127 (5) Remittance advice.128 (d)(h) The provisions of this Code section shall not be waived by co ntract, and any129 contractual clause in conflict with the provisions of this Code section or that purports to130 waive any requirements of this Code section are void.131 (e)(i) Violations of this Code section shall be subject to enforceme nt by the132 Commissioner."133 PART II134 SECTION 2-1.135 Part 1 of Article 3 of Chapter 5 of Title 50 of the Official Co de of Georgia Annotated,136 relating to general authority, duties, and procedures relative to state purchasing, is amended137 by revising Code Section 50-5-68, relating to prequalification of prospective suppliers, as138 follows:139 H. B. 1374 - 6 - 26 HB 1374/AP "50-5-68.140 (a) Prospective suppliers may be prequalified for particular type s of supplies, services,141 goods, materials, and equipment at the discretion of the Depart ment of Administrative142 Services. Solicitation mailing lists of potential contractors shall include, but shall not be143 limited to, such prequalified suppliers. The award of contracts, however, may shall not be144 conditioned upon prequalification; provided, however, that preq ualification may be145 included among evaluation factors and criteria used in making an award.146 (b)(1) The provisions of subsection (a) of this Code section s hall not be construed or147 applied to abrogate the competitive bidding requirements and procedures provided for in148 Code Sections 50-5-67 and 50-5-69.149 (2) The commissioner of administrative services shall adopt ru les, regulations, and150 procedures to ensure and clarify that the discretion of the Department of Administrative151 Services to prequalify prospective suppliers for particular typ es of supplies, services,152 goods, materials, and equipment does not extend and shall not be exercised to abrogate153 or frustrate the competitive bidding requirements and procedures provided for in Code154 Sections 50-5-67 and 50-5-69. Such rules, regulations, and procedures shall ensure that155 the application of such competitive bidding requirements and pr ocedures shall not be156 obviated solely on the basis that a prospective supplier is prequalified for a particular type157 of supply, service, good, material, or equipment.158 (3) By November 1, 2026, the commissioner of administrative services shall prepare a159 report of the rules, regulations, and procedures that have been adopted in compliance with160 paragraph (2) of this subsection. Such report shall be submitted in writing to the Speaker161 of the House of Representatives, the President of the Senate, and the chairpersons of the162 House Committee on Appropriations and the Senate Appropriations Committee."163 SECTION 2-2.164 Said part is further amended by adding a new Code section to read as follows:165 H. B. 1374 - 7 - 26 HB 1374/AP "50-5-69.1.166 (a) No contract for any purchase that was effectuated without competitive bidding solely167 because the contract price did not exceed a threshold amount re quired for competitive168 bidding as set forth under this part shall be subsequently renewed or extended at any time169 for a contract price that exceeds such threshold amount.170 (b) The commissioner of administrative services shall adopt ru les, regulations, and171 procedures necessary to carry out the intent of this Code section.172 (c) Nothing in this Code section shall apply to or affect the laws, rules, and regulations173 governing emergency purchases."174 PART III175 SECTION 3-1.176 All laws and parts of laws in conflict with this Act are repealed.177 H. B. 1374 - 8 -