HB1502: HB1502 Community Health, Department of; contracts with care management organizations for the provision of healthcare services for Medicaid or PeachCare for Kids recipients; establish requirements

26 LC 60 0299 House Bill 1502 By: Representatives Kelley of the 16th, Williamson of the 112th, and Douglas of the 78th A BILL TO BE ENTITLED AN ACT To amend Article 7 of Chapter 4 of Title 49 of the Official Cod e of Georgia Annotated,1 relating to medical assistance generally, so as to establish requirements for the Department2 of Community Health relative to contracts with care management organizations for the3 provision of healthcare services for Medicaid or PeachCare for Kids recipients; to provide4 for definitions; to provide for an effective date and applicabi lity; to provide for related5 matters; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Article 7 of Chapter 4 of Title 49 of the Official Code of Geor gia Annotated, relating to9 medical assistance generally, is amended by adding a new Code section to read as follows:10 "49-4-159.5.11 (a) As used in this Code section, the term:12 (1) 'Care management organization' shall have the same meaning as set forth in Code13 Section 33-21A-2.14 H. B. 1502 - 1 - 26 LC 60 0299 (2) 'Existing contracts' means all contracts in effect on the effective date of this Code15 section, between the department and one or more care management organizations to16 provide or arrange healthcare services on a prepaid, capitated basis to a member.17 (3) 'Member' means a Medicaid or PeachCare for Kids recipient who is currently18 enrolled in a care management organization plan.19 (b)(1) Upon the expiration of the existing contracts and subject to the requirements set20 forth in paragraphs (2) and (3) of this subsection, the departm ent shall publish on its21 website a request for applications from care management organizations to contract with22 the department to provide or arrange healthcare services to mem bers. The department23 shall contract with each care management organization that subm its an application in24 response to such request and meets the minimum standards established by the department25 pursuant to subsection (d) of this Code section.26 (2) Not later than 60 days before the department issues a requ est for applications in27 accordance with paragraph (1) of this subsection, the department shall publish notice of28 and make available for public review and comment such request for applications and any29 related, nonprivileged documents, including, but not limited to , the proposed contract. 30 The department shall provide interested persons a reasonable op portunity to submit31 comments on such request for applications in writing or orally at one or more public32 forums.33 (3) Not later than 30 days before the department issues a requ est for applications, the34 department shall post on its website:35 (A) A summary of comments received from interested persons under paragraph (2) of36 this subsection; and37 (B) The department's response to such comments.38 (4) The department shall take all steps reasonably necessary to extend existing contracts39 as needed until new contracts are entered into in accordance with this subsection.40 H. B. 1502 - 2 - 26 LC 60 0299 (c) Any procurement for a care management organization pending without a final contract41 with the department on the effective date of this Code section shall be automatically42 cancelled.43 (d) The department shall establish minimum quality and performance standards to evaluate44 the applications of care management organizations submitted pursuant to subsection (b) of45 this Code section. In adopting such standards, the department shall consider:46 (1) Cost efficiency, quality of care, and experience of care;47 (2) The size and quality of a care management organization's provider network; and48 (3) The care management organization's past experience in providing similar services in49 this or other states.50 (e) Each member shall be permitted to select from any plan offered by a care management51 organization which the department has contracted with and which offers healthcare services52 in the member's region for which the member is eligible.53 (f) The department shall:54 (1) Evaluate by July 1, 2027, and annually thereafter, each ca re management55 organization by region against the quality and performance standards established pursuant56 to subsection (d) of this Code section;57 (2) Publish on its public website and in a format that is easily understood by a member58 of the general public the results of such evaluations;59 (3) Establish and publish an aggregate benchmark under which a care management60 organization may not be recertified until corrective actions are taken;61 (4) Reevaluate and recertify that a care management organization is reasonably capable62 of fulfilling the terms of its contract in accordance with all applicable federal and state63 laws for the regions under which the department has entered into a contract:64 (A) Five years after a care management organization initially enters into a contract65 with the department to provide healthcare services in a region; and66 (B) Every three years thereafter.67 H. B. 1502 - 3 - 26 LC 60 0299 (g)(1) A care management organization who, pursuant to this Co de section, either has68 not been awarded a contract with the department for failure to meet to the minimum69 standards established by the department pursuant to subsection (d) of this Code section70 or whose contract has been terminated shall be entitled to a he aring before the71 department. In such cases, the department shall give written notice of either the denial72 of application or termination of contract to the affected care management organization,73 including the reasons of the department for denial or terminati on. Should the care74 management organization desire to contest the initial decision of the department, it must75 give written notice of appeal to the commissioner of community health within 14 days76 after the date on which the notice of denial or notice of termi nation was transmitted to77 such care management organization. A hearing shall be schedule d and commenced78 within 20 days after the date on which the commissioner receives the notice of appeal;79 and the commissioner or his or her designee or designees shall r e n d e r a f i n a l80 administrative decision as soon as practicable thereafter.81 (2) Any care management organization which is aggrieved or adv ersely affected by a82 final decision of the commissioner may seek judicial review thereof by filing a petition83 w i t h i n 3 0 d a y s a f t e r t h e s e r v i c e o f t h e f i n a l d e c i s i o n o f t h e commissioner or, if a84 rehearing is requested, within 30 days after the decision thereon. Copies of the petition85 shall be served upon the commissioner and all parties of record. The petition shall state86 the nature of the petitioner's interest, the facts showing that the petitioner is aggrieved by87 the decision, and any grounds upon which the petitioner contends that the decision should88 be reversed or modified. Judicial review of the commissioner's decision shall be89 reviewable in the Superior Court of Fulton County in the same m anner and under the90 same standards as are applicable to those contested cases which are reviewable pursuant91 to Code Section 50-13-19.92 (h) If a care management organization that has contracted with the department pursuant93 to subsection (b) of this Code section fails to comply with the terms of the contract or with94 H. B. 1502 - 4 - 26 LC 60 0299 any requirement set forth in this Code section and to make substantial efforts to mitigate95 or cure such noncompliance, as determined by the department, in addition to any remedies96 available under the contract, the department may:97 (1) Require that the care management organization submit and comply with a corrected98 action plan;99 (2) Suspend default enrollment of members to the care management organization in one100 or more regions; or101 (3) Terminate the contract.102 (i) This Code section shall be the exclusive means by which the department may enter into103 contracts with a care management organization to provide or arrange healthcare services104 for a member."105 SECTION 2.106 This Act shall become effective upon its approval by the Governor or upon its becoming law107 without such approval, and shall apply to all contracts entered into by the department with108 a care management organization to provide or arrange healthcare services to a member.109 SECTION 3.110 All laws and parts of laws in conflict with this Act are repealed.111 H. 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