Bill Text: GA HB1407 | 2009-2010 | Regular Session | Comm Sub

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Bill Title: Medicaid and PeachCare for Kids; single administrator for dental services; provisions

Spectrum: Partisan Bill (Republican 4-0)

Status: (Vetoed) 2010-06-04 - Veto V15 [HB1407 Detail]

Download: Georgia-2009-HB1407-Comm_Sub.html

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10 LC 33 3709S

House Bill 1407 (COMMITTEE SUBSTITUTE)

By: Representatives Rogers of the 26th, Channell of the 116th, and Cooper of the 41st

A BILL TO BE ENTITLED
AN ACT

To amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for a single administrator for dental services for Medicaid recipients and PeachCare for Kids participants; to require the Department of Community Health to competitively bid out and contract with such single administrator; to provide for requirements for the single administrator; to provide for applicability; to provide for an amendment to the state plan if necessary; to provide for related matters; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, is amended by adding a new Code section to read as follows:

"49-4-158.

(a) Upon expiration, or termination prior to expiration, of the current term of a contract with a care management organization which covers dental services for recipients of medical assistance pursuant to this article and for participants in the PeachCare for Kids program pursuant to Article 13 of Chapter 5 of this title, the department shall enter into a contract with a single administrator to provide dental services for such recipients and participants. Such single administrator shall be selected through a competitive bidding process pursuant to Article 3 of Chapter 5 of Title 50. The single administrator shall be prohibited from outsourcing, subcontracting, or assigning any rights or obligations under its contract with the department. The single administrator shall be required to obtain a certificate of authority from the Commissioner of Insurance as a health maintenance organization pursuant to Chapter 21 of Title 33. The single administrator shall be compensated for dental services on a prepaid, capitated basis for recipients of medical assistance and PeachCare for Kids participants. The single administrator shall establish a dental provider fee schedule which is at least 85 percent of the maximum allowable payments for dental services as published by the department in Appendix B of the Policies and Procedures for Dental Services on January 1, 2010, and subject to annual review and adjustment by the department.

(b) A single administrator for dental services shall be in place and shall contract with willing dental providers upon the expiration, or termination prior to expiration, of the current term of all contracts with care management organizations which cover dental services for recipients of medical assistance pursuant to this article and for participants in the PeachCare for Kids program pursuant to Article 13 of Chapter 5 of this title. At such time, all dental services for such recipients shall be provided through a single administrator.

(c) The single administrator shall comply with and be subject to the provisions of subsection (e) of Code Section 49-4-153 in the same manner as a care management organization subject to such subsection. The single administrator shall be subject to and shall comply with the provisions of Code Section 33-21A-8 in the same manner as for care management organizations.

(d) The department shall submit any necessary modifications, if applicable, to the state plan for medical assistance filed pursuant to Code Section 49-4-12 in order to fulfill the requirements of this Code section."

SECTION 2.

All laws and parts of laws in conflict with this Act are repealed.