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