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.