reglab/housing_qa huggingface dataset:
GA Code § 33-21-20.1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-20.1. Regulation of Hmos by Commissioner of Community Health

 All health maintenance organizations meeting the requirements of subsection (b.1) of Code Section 33-21-3 shall not be subject to regulation by the commissioner of community health.Upon the Commissioner's determination that a health maintenance organization no longer meets the requirements of subsection (b.1) of Code Section 33-21-3, the Commissioner shall immediately notify the commissioner of community health and such health maintenance organization shall be subject to regulation by the commissioner of community health until such time as it again meets the requirements of subsection (b.1) of Code Section 33-21-3 as determined by the Commissioner.    (Code 1981, §33-21-20.1, enacted by Ga. L. 2004, p. 493, § 7; Ga. L. 2009, p. 453, § 1-40/HB 228; Ga. L. 2019, p. 386, § 2/SB 133.)    The 2019 amendment,  effective July 1, 2019, rewrote the first sentence, which formerly read: "On May 13, 2004, all health maintenance organizations meeting the requirements of subsection (b.1) of Code Section 33-21-3 shall not be subject to regulation by the commissioner of human resources (now known as the commissioner of community health for these purposes).", and, in the second sentence, substituted "Commissioner's" for "Commissioner of Insurance's" at the beginning, deleted a semicolon following "community health" in the middle, and deleted "of Insurance" following "Commissioner" at the end.
GA Code § 33-21-21 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-21. Authority of Commissioner of Community Health to Contract for Making of Recommendations Required by Chapter; Acceptance of Recommendations

 The commissioner of community health, in carrying out his obligations under subsection (b) of Code Section 33-21-3, paragraph (4) of subsection (a) of Code Section 33-21-5, and subsection (b) of Code Section 33-21-17, may contract with qualified persons to make recommendations concerning the determinations required to be made by him. Such recommendations may be accepted in full or in part by the commissioner of community health.   (Code 1933, § 56-3626, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 2009, p. 453, § 1-6/HB 228.)
GA Code § 33-21-22 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-22. Applications, Filings, and Reports to Be Treated as Public Documents

 All applications, filings, and reports required under this chapter shall be treated as public documents.   (Code 1933, § 56-3624, enacted by Ga. L. 1979, p. 1148, § 1.)
GA Code § 33-21-23 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-23. Confidentiality of Medical Information; Claim of Privileges by Organizations

  Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from the person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except:   To the extent that it may be necessary to carry out the purposes of this chapter;   Upon the express consent of the enrollee or applicant;   Pursuant to statute or court order for the production of evidence;   The discovery of evidence; or   In the event of claim or litigation between the person and the health maintenance organization wherein such data or information is pertinent.     A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished the information to the health maintenance organization is entitled to claim.    (Code 1933, § 56-3625, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 2019, p. 386, § 3/SB 133.)    The 2019 amendment,  effective July 1, 2019, substituted the present provisions of subsection (a) for the former provisions, which read: "Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from the person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter; or upon the express consent of the enrollee or applicant; or pursuant to statute or court order for the production of evidence or the discovery of evidence; or in the event of claim or litigation between the person and the health maintenance organization wherein such data or information is pertinent."
GA Code § 33-21-24 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-24. Rehabilitation, Liquidation, or Conservation of Organizations

 Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the Commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies. The Commissioner may apply for an order directing him to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more grounds set forth in Chapter 37 of this title, relating to the rehabilitation, liquidation, or conservation of insurers or when in his opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this state.   (Code 1933, § 56-3618, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 10.)
GA Code § 33-21-25 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-25. Organization and Operation of Health Maintenance Organizations by Insurers or Health Care Corporations

 Notwithstanding any other law which may be inconsistent with this Code section, an insurer or a health care corporation licensed in this state may directly or through a subsidiary or affiliate organize and operate a health maintenance organization.   (Code 1933, § 56-3615, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 11; Ga. L. 1995, p. 745, § 2.5; Ga. L. 2017, p. 164, § 13/HB 127.)
GA Code § 33-21-26 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-26. Untrue or Misleading Statements; Deceptive Evidence of Coverage; Cancellation or Nonrenewal of Enrollees

  No health maintenance organization or representative of a health maintenance organization may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of this Code section:   A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health benefits plan;   A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which the statement is made or the item of information is communicated, the statement or item of information may be reasonably understood by a reasonable person not possessing special knowledge regarding health care coverage as indicating any benefit or advantage or the absence of any exclusion, limitation, or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health benefits plan, if the benefit or advantage or absence of limitation, exclusion, or disadvantage does not in fact exist; and   An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person not possessing special knowledge regarding health benefits plans and evidences of coverage for the health benefits plan to expect benefits, services, charges, or other advantages which the evidence of coverage does not provide or which the health benefits plan issuing the evidence of coverage does not regularly make available for enrollees covered under evidence of coverage.     The provisions of Chapter 6 of this title applicable to insurers shall apply to health maintenance organizations in this chapter and, for the purpose of determining whether a violation of Chapter 6 of this title has occurred, an "enrollee" as defined in this chapter shall be deemed to be an insured or a policyholder as used in Chapter 6 of this title, whichever is applicable.   An enrollee may not be canceled or nonrenewed except for the failure to pay the charge for such coverage or for such other reasons as may be promulgated by the Commissioner.    (Code 1933, § 56-3613, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 12.)
GA Code § 33-21-28 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-28. Applicability of Provisions of Title and of Other Laws to Health Maintenance Organizations and Representatives

  Except as otherwise provided by law, all provisions of this title which are not in conflict with this chapter shall apply to health maintenance organizations and all other persons subject to this chapter, and specifically, the requirements and restrictions of Code Sections 33-20A-6, 33-20A-7, 33-20A-8, and 33-20A-9.1 shall apply to health maintenance organizations and all other persons subject to this chapter.   Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.   Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from the provision of Chapter 34 of Title 43, relating to the practice of medicine.    (Code 1933, § 56-3623, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1999, p. 342, § 6.)   Code Commission notes.   - Pursuant to Code Section 28-9-5, in 1999, "33-20A-7.1" was deleted following "33-20A-7" in subsection (a).   Law reviews.   - For note on 1999 amendment to this Code section, see 16 Ga. St. U.L. Rev. 163 (1999).   JUDICIAL DECISIONS    Applicability of O.C.G.A. § 33-20-16. - "Any Willing Provider" (AWP) statute did not apply to a health maintenance organization (HMO) because: (1) the statute did not apply to for-profit corporations not statutorily defined as "surviving corporations," and (2) the HMO had never been an O.C.G.A. T. 33, C. 20 health care corporation, nor was the HMO an insurer's subsidiary any longer, so the HMO was not a surviving corporation, and O.C.G.A. § 33-21-28(a) barred applying the AWP statute to the HMO. Northeast Ga. Cancer Care, LLC v. Blue Cross & Blue Shield of Ga., Inc., 315 Ga. App. 521, 726 S.E.2d 714 (2012), cert. denied, No. S12C1322, 2012 Ga. LEXIS 1018 (Ga. 2012), cert. denied, No. S12C1413, 2012 Ga. LEXIS 1033 (Ga. 2012).   Exhuastion of remedies.    - Medical group's suit for a declaratory judgment as to the group's rights to participate in a health maintenance organization under Georgia's Any Willing Provider Statute, O.C.G.A. § 33-20-16, was procedurally barred by the failure to exhaust administrative remedies by first submitting the group's dispute to the Georgia Insurance Commissioner pursuant to O.C.G.A. § 33-20-30. Northeast Ga. Cancer Care, LLC v. Blue Cross & Blue Shield of Ga., Inc., 297 Ga. App. 28, 676 S.E.2d 428 (2009), cert. denied, No. S09C1241, 2009 Ga. LEXIS 805 (Ga. 2009).
GA Code § 33-21A-1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-1. Short Title

 This chapter shall be known and may be cited as the "Medicaid Care Management Organizations Act."    (Code 1981, §33-21A-1, enacted by Ga. L. 2008, p. 704, § 1/HB 1234.)
GA Code § 33-21A-3 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-3. Certificate of Authority Required; Setting of Rates; Authority of Commissioners

  A care management organization shall be required to obtain a certificate of authority as a health maintenance organization pursuant to Chapter 21 of this title prior to providing or arranging health care for members pursuant to a contract with the Department of Community Health. On and after the date of issuance of its certificate of authority as a health maintenance organization, a care management organization shall comply with all provisions relating to health maintenance organizations and all provisions relating to managed health care plans, with the exception of Code Section 33-20A-9.1.   The Commissioner of Insurance shall not have the authority to approve, disapprove, or set rates paid by the Department of Community Health to a care management organization or paid by a care management organization to a health care provider.   The Commissioner of Insurance shall not have the authority to approve, disapprove, or modify any plan offered by a care management organization or any contract between a care management organization and the Department of Community Health.   Nothing in this chapter shall be interpreted as altering the authority of the commissioner of community health.     (Code 1981, §33-21A-3, enacted by Ga. L. 2008, p. 704, § 1/HB 1234.)
GA Code § 33-21A-4 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-4. Reimbursement for Emergency Health Care Services

  In particular, but without limitation, a care management organization shall not:   Deny or inappropriately reduce payment to a provider of emergency health care services for any evaluation, diagnostic testing, or treatment provided to a recipient of medical assistance for an emergency condition; or   Make payment for emergency health care services contingent on the recipient or provider of emergency health care services providing any notification, either before or after receiving emergency health care services.     In processing claims for emergency health care services, a care management organization shall consider, at the time that a claim is submitted, at least the following criteria:   The age of the patient;   The time and day of the week the patient presented for services;   The severity and nature of the presenting symptoms;   The patient's initial and final diagnosis; and   Any other criteria prescribed by the Department of Community Health, including criteria specific to patients under 18 years of age.  A care management organization shall configure or program its automated claims processing system to consider at least the conditions and criteria described in this subsection for claims presented for emergency health care services. The Department of Community Health may develop and publish in print or electronically a list of additional standards to be used by care management organizations to maximize the identification and accurate payment of claims for emergency health care services.      If a provider that has not entered into a contract with a care management organization provides emergency health care services or post-stabilization services to that care management organization's member, the care management organization shall reimburse the noncontracted provider for such emergency health care services and post-stabilization services at a rate equal to the rate paid by the Department of Community Health for Medicaid claims that it reimburses directly.     (Code 1981, §33-21A-4, enacted by Ga. L. 2008, p. 704, § 1/HB 1234; Ga. L. 2010, p. 838, § 10/SB 388.)   Code Commission notes.   - Pursuant to Code Section 28-9-5, in 2008, a misspelling of "symptoms" was corrected in paragraph (b)(3).
GA Code § 33-21A-5 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-5. Requirements Relating to Critical Access Hospitals

  A critical access hospital must provide notice to a care management organization and the Department of Community Health of any alleged breaches in its contract by such care management organization.   If a critical access hospital satisfies the requirement of subsection (a) of this Code section, and if the Department of Community Health concludes, after notice and hearing, that a care management organization has substantively and repeatedly breached a term of its contract with a critical access hospital, the department is authorized to require the care management organization to pay damages to the critical access hospital in an amount not to exceed three times the amount owed. Notwithstanding the foregoing, nothing in this Code section shall be interpreted to limit the authority of the Department of Community Health to establish additional penalties or fines against a care management organization for failure to comply with the contract between a care management organization and the Department of Community Health.     (Code 1981, §33-21A-5, enacted by Ga. L. 2008, p. 704, § 1/HB 1234.)
GA Code § 33-21A-6 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-6. Coverage for Newborn Infants Until Discharged From Inpatient Care

  Each care management organization shall pay for health care services provided to a newborn infant who is born to a mother who is a member currently enrolled with that care management organization until such time as the newborn is finally discharged from all inpatient care to a home environment subject to approval by the federal Centers for Medicare and Medicaid Services. For a newborn infant whose mother is enrolled in a Medicaid program under which she receives Medicaid benefits directly from the Department of Community Health, the Department of Community Health shall pay for health care services provided to the newborn until such time as the newborn is finally discharged from all inpatient care to a home environment.   In the event a newborn is disenrolled from a care management organization and re-enrolled into the Medicaid fee-for-service program conducted directly by the Department of Community Health, the care management organization shall ensure the coordination of care for that child until the child has been appropriately discharged from the hospital and placed in an appropriate care setting.     (Code 1981, §33-21A-6, enacted by Ga. L. 2008, p. 704, § 1/HB 1234.)
GA Code § 33-21A-8 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-8. Participation by Dentists

  Except as provided in subsection (b) of this Code section, no care management organization or agent of such care management organization shall deny any dentist from participating in the Medicaid and PeachCare for Kids dental program administered by such care management organization if:   Such dentist has obtained a license to practice in this state and is an enrolled provider who has met all of the requirements of the Department of Community Health for participation in the Medicaid and PeachCare for Kids program; and     The licensed dentist will provide dental services to members pursuant to a state or federally funded educational loan forgiveness program that requires such services; provided, however, each care management organization shall be required to offer dentists wishing to participate through such loan forgiveness programs the same contract terms offered to other dentists in the service region who participate in the care management organization's Medicaid and PeachCare for Kids dental programs;   The geographic area in which the dentist intends to practice has been designated as having a dental professional shortage as determined by the Department of Community Health, which may be based on the designation of the Health Resources and Services Administration of the United States Department of Health and Human Services; or   Such care management organization fails to establish to the satisfaction of the Department of Community Health that a sufficient number of general dentists and specialists have contracted with the care management organization to provide covered dental services to members in the geographic region.       A care management organization may decline to contract with a dentist who meets the requirements of subsection (a) of this Code section if such dentist has had his or her license to practice dentistry sanctioned in any manner or fails to meet the credentialing criteria established by the care management organization. Any dentist denied on this basis shall be entitled to a hearing before an administrative law judge as set forth in subsection (e) of Code Section 49-4-153.   The Department of Community Health shall also provide a means for dentists to request an annual hearing to determine whether a condition described in subparagraph (B) or (C) of paragraph (2) of subsection (a) of this Code section exists. The department may compel the attendance of care management organizations or agents of care management organizations to attend such hearings. The department may request additional information as a result of the hearing, and it shall consider matters raised in the hearing when deciding whether a condition described in subparagraph (A) or (B) of paragraph (2) of subsection (a) of this Code section exists.     (Code 1981, §33-21A-8, enacted by Ga. L. 2008, p. 704, § 1/HB 1234.)
GA Code § 33-21A-9 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21A - Medicaid Care Management Organizations|§ 33-21A-9. Submission and Payment of Claims

  If a provider submits a claim to a responsible health organization for services rendered within 72 hours after the provider verifies the eligibility of the patient with that responsible health organization, the responsible health organization shall reimburse the provider in an amount equal to the amount to which the provider would have been entitled if the patient had been enrolled as shown in the eligibility verification process. After resolving the provider's claim, if the responsible health organization made payment for a patient for whom it was not responsible, then the responsible health organization may pursue a cause of action against any person who was responsible for payment of the services at the time they were provided but may not recover any payment made to the provider.   If a provider verifies the eligibility of a patient as set forth in subsection (a) of this Code section, and if a provider determines that a person other than the responsible health organization to which it has submitted a claim is responsible for Medicaid or PeachCare for Kids coverage of the patient at the time the service was rendered, the provider may submit the claim to the person that is responsible for Medicaid or PeachCare for Kids coverage and that person shall reimburse all medically necessary services, without application of any penalty for failure to file claims in a timely manner, for failure to obtain prior authorization, or for the provider not being a participating provider in the person's network, and the amount of reimbursement shall be that person's applicable rate for the service if the provider is under contract with that person or the rate paid by the Department of Community Health for the same type of claim that it pays directly if the provider is not under contract with that person.     (Code 1981, §33-21A-9, enacted by Ga. L. 2008, p. 704, § 1/HB 1234.)