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Georgia Commons

Título 33. INSURANCE

Capítulo 20A. MANAGED HEALTH CARE PLANS

29 secciones · 33-20A-1 a 33-20A-70

Legible por máquinas https://georgiacommons.org/code/33-20A.md · https://georgiacommons.org/code/index.md · MCP https://mcp.georgiacommons.org/mcp

Artículo 1. PATIENT PROTECTION

  1. 33-20A-1Short title.
  2. 33-20A-2Legislative findings.
  3. 33-20A-3Definitions.
  4. 33-20A-4Certification requirements; review and recertification; sanctions for failure to meet requirements; alternative methods for certification.
  5. 33-20A-5Standards for certification.
  6. 33-20A-6Financial incentive programs prohibited; capitated payment arrangement allowed.
  7. 33-20A-7Penalizing provider for discussing necessary or appropriate care with patient prohibited; penalty for providing records and assistance prohibited; penalty for violations.
  8. 33-20A-7.1Application; managed care plan’s liability following precertification; availability of personnel for precertification procedure.
  9. 33-20A-8Confidentiality and accuracy of patient records.
  10. 33-20A-9Emergency services requirements; restrictive formulary requirements.
  11. 33-20A-9.1Legislative intent; consumer choice option; provisions; increased expenses; covered benefits; forms.
  12. 33-20A-10Chapter inapplicable to workers’ compensation provisions.

Artículo 2. PATIENT’S RIGHT TO INDEPENDENT REVIEW

  1. 33-20A-30Short title.
  2. 33-20A-31Definitions.
  3. 33-20A-32Right to appeal.
  4. 33-20A-33Minimum expense of treatment prior to review.
  5. 33-20A-34Representatives for enrollee; cost of review; cooperation.
  6. 33-20A-35Request for independent review.
  7. 33-20A-36Additional information required for independent review.
  8. 33-20A-37Effect of favorable determinations.
  9. 33-20A-38Organizational and employee liability.
  10. 33-20A-39Certification of independent review organizations; conflict of interest; quality assurance mechanism; copies of nonproprietary information.
  11. 33-20A-40Determining medical necessity or whether a treatment is experimental.
  12. 33-20A-41Rules and regulations.
  13. 33-20A-42Grievance procedures and hearings for Medicaid care management members.

Artículo 3. MANAGED HEALTH CARE PLANS

  1. 33-20A-60Definitions.
  2. 33-20A-61Physician contracts.
  3. 33-20A-62Payment.

Artículo 4. JOINT COMMITTEE TO STUDY PRESCRIPTION COSTS IN STATE FUNDED HEALTH CARE PLANS

  1. 33-20A-70Creation; members; meetings; duties; cooperation by the Department of Community Health; members’ expenses; repealer.Derogada