Georgia 2025-2026 Regular Session

Georgia Senate Bill SB276 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		25 LC 52 0780
2	2		Senate Bill 276
3	3		By: Senators Echols of the 49th, Strickland of the 42nd, Hatchett of the 50th, Hufstetler of
4	4		the 52nd, Tillery of the 19th and others
5		-	AS PASSED
	5	+	AS PASSED SENATE
6	6		A BILL TO BE ENTITLED
7	7		AN ACT
8	8		To amend Code Section 49-4-148 of the Official Code of Georgia Annotated, relating to
9	9		1
10	10		recovery of medical assistance from third party liable for sickness, injury, disease, or2
11	11		disability, so as to revise certain provisions to comply with federal law; to bar liable3
12	12		third-party payers from refusing payment solely because a healthcare item or service did not4
13	13		receive prior authorization; to require a third-party payer to respond to an inquiry from the5
14	14		Department of Community Health regarding a healthcare claim within 60 days; to provide6
15	15		for related matters; to repeal conflicting laws; and for other purposes.7
16	16		BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:8
17	17		SECTION 1.9
18	18		Code Section 49-4-148 of the Official Code of Georgia Annotated, relating to recovery of10
19	19		medical assistance from third party liable for sickness, injury, disease, or disability, is11
20	20		amended by revising subsection (b) as follows:12
21	21		"(b) All insurers, as defined in Code Section 33-24-57.1, including but not limited to group13
22	22		health plans as defined in Section 607(1) of the federal Employee Retirement Security Act14
23	23		of 1974, managed care entities as defined in Code Section 33-20A-3, which offer health15
24	24		benefit plans, as defined in Code Section 33-24-59.5, pharmacy benefits managers, as16
25	25		S. B. 276
26	26		- 1 - 25 LC 52 0780
27	27		defined in Code Section 33-64-1, and any other parties that are, by statute, contract, or
28	28		17
29	29		agreement, legally responsible for payment of a claim for a health care
30	30		healthcare item or18
31	31		service shall comply with this subsection. Such entities set forth in this subsection shall:19
32	32		(1) Cooperate with the department in determining whether a person who is a recipient20
33	33		of medical assistance may be covered under that entity's health benefit plan and eligible21
34	34		to receive benefits thereunder for the medical services for which that medical assistance22
35	35		was provided and respond to any inquiry from the state regarding a claim for payment for23
36	36		any health care healthcare item or service submitted not later than three years after such24
37	37		item or service was provided;25
38	38		(2) Accept the department's authorization for the provision of medical services payment26
39	39		for a healthcare item or service on behalf of a recipient of medical assistance as the27
40	40		entity's third-party payer's authorization for the provision of those services and shall not28
41	41		refuse to pay for a healthcare item or service solely on the basis that the third-party payer29
42	42		did not previously authorize such item or service;30
43	43		(3) Respond to a department inquiry regarding the status of a claim for payment for any31
44	44		healthcare item or service within 60 days of receiving the inquiry;32
45	45		(3)(4) Comply with the requirements of Code Section 33-24-59.5, regarding the timely33
46	46		payment of claims submitted by the department for medical services provided to a34
47	47		recipient of medical assistance and covered by the health benefit plan, subject to the35
48	48		payment to the department of interest as provided in that Code section for failure to36
49	49		comply;37
50	50		(4)(5) Provide the department, on a quarterly basis, eligibility and claims payment data38
51	51		regarding applicants for medical assistance or recipients for medical assistance;39
52	52		(5)(6) Accept the assignment to the department or a recipient of medical assistance or40
53	53		any other entity of any rights to any payments for such medical care from a third party;41
54	54		and42
55	55		S. B. 276
56	56		- 2 - 25 LC 52 0780
57	57		(6)(7) Agree not to deny a claim submitted by the department solely on the basis of the43
58	58		date of submission of the claim, type or format of the claim, or a failure to present proper44
59	59		documentation at the point-of-sale which is the basis of the claim, if:45
60	60		(A) The claim is submitted to the department within three years from when the item46
61	61		or service was furnished; and47
62	62		(B) Any action by the department to enforce its rights with respect to such claim48
63	63		commenced within six years of the department's submission of the claim.49
64	64		The requirements of paragraphs (2) and (3) (4) of this subsection shall only apply to a50
65	65		health benefit plan which is issued, issued for delivery, delivered, or renewed on or after51
66	66		April 28, 2001."52
67	67		SECTION 2.53
68	68		All laws and parts of laws in conflict with this Act are hereby repealed.54
69	69		S. B. 276
70	70		- 3 -