reglab/housing_qa huggingface dataset:
GA Code § 33-20D-2 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20D - Rental Provider Network|§ 33-20D-2. Registration With Commissioner; Requirements; Fee; Approved List

  Any person who commences business as a rental preferred provider network shall register with the Commissioner within 30 days of commencing business in this state unless such person is licensed by the Commissioner as a health insurer. Each rental preferred provider network not licensed by the Commissioner on July 1, 2016, shall be required to register with the Commissioner no later than September 30, 2016, and shall be placed on an approved list maintained by the Commissioner.   Registration shall consist of the submission of the following information:   The official name of the rental preferred provider network, including any d/b/a designations used in this state;   The mailing address and main telephone number for the rental preferred provider network's main headquarters; and   The name and telephone number of the rental preferred provider network representative who shall serve as the primary contact with the department.     The information required by this Code section shall be submitted in written or electronic format, as prescribed by the Commissioner by rule or regulation.   The Commissioner may, pursuant to rule or regulation, collect a reasonable fee for the purpose of administering the registration process.   The Commissioner shall maintain an approved list of rental preferred provider networks.     (Code 1981, §33-20D-2, enacted by Ga. L. 2016, p. 319, § 1/SB 158.)
GA Code § 33-20D-4 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20D - Rental Provider Network|§ 33-20D-4. Rights and Responsibilities Imposed on Third Parties

  A third party, having itself been granted access to a network provider's health care services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third party shall be obligated to comply with the rights and responsibilities imposed on contracting entities pursuant to this chapter.   A third party that enters into a contract with another third party to access a network provider's health care services and contractual discounts pursuant to a provider network contract shall be obligated to comply with the rights and responsibilities imposed on third parties under this Code section.     (Code 1981, §33-20D-4, enacted by Ga. L. 2016, p. 319, § 1/SB 158.)
GA Code § 33-20D-5 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20D - Rental Provider Network|§ 33-20D-5. Exclusions

 This chapter shall not apply to:    Provider network contracts for services provided to Medicaid, medicare, the state health benefit plan under Article 1 of Chapter 18 of Title 45, or State Children's Health Insurance Program (SCHIP) beneficiaries;   Employers, church plans, or government plans receiving administrative services from a rental preferred provider network or its affiliates, or pharmacy benefits managers;   Circumstances where access to the provider network contract is granted to an entity operating under the same brand licensee program as the contracting entity;   The provision of any medical services for injuries covered under Chapter 9 of Title 34, relating to workers' compensation; or   Self-funded, employer sponsored health insurance plans regulated under the Employee Retirement Income Security Act of 1974, as codified and amended at 29 U.S.C. Section 1001, et seq.     (Code 1981, §33-20D-5, enacted by Ga. L. 2016, p. 319, § 1/SB 158.)
GA Code § 33-20D-6 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20D - Rental Provider Network|§ 33-20D-6. Penalties

 Any person or entity that is not duly licensed or that should be licensed by the department or that is not duly registered or that should be registered with the department pursuant to Code Section 33-20D-2 and acts as a rental preferred provider network, as defined in paragraph (7) of Code Section 33-20D-1, shall be subject to penalties set forth in subsection (g) of Code Section 33-2-24. The Commissioner shall have the authority, in addition to any other remedies and damages allowed by law, to seek to restrain or enjoin any person or entity, whether or not such person or entity is licensed or registered pursuant to this title, that is determined to be in violation of Code Section 33-20D-2 or 33-20D-3, and such person or entity shall be liable for attorney fees and litigation expenses incurred in the action to restrain or enjoin such violation.    (Code 1981, §33-20D-6, enacted by Ga. L. 2016, p. 319, § 1/SB 158.)   Code Commission notes.   - Pursuant to Code Section 28-9-5, in 2016, in the first sentence, "33-20D-2" was substituted for "33-20C-2" and "33-20D-1" was substituted for "33-20C-1" and, in the second sentence, "33-20D-2" was substituted for "33-20C-2" and "33-20D-3" was substituted for "33-20C-3".
GA Code § 33-20E-1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-1. Short Title

 This chapter shall be known and may be cited as the "Surprise Billing Consumer Protection Act."    (Code 1981, §33-20E-1, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-3 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-3. Exemption

  Nothing in this chapter shall be applicable to healthcare plans which are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq.   This chapter shall be applicable only to healthcare plans and state healthcare plans as defined in this chapter.     (Code 1981, §33-20E-3, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-5 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-5. Payment for Nonemergency Medical Services

  In accordance with Code Section 33-20E-7 and this chapter, an insurer that provides any benefits to covered persons with respect to nonemergency medical services shall pay for such services in the event that such services resulted in a surprise bill regardless of whether the healthcare provider furnishing nonemergency medical services is a participating provider with respect to nonemergency medical services.   In the event a covered person receives a surprise bill for the provision of nonemergency medical services from a nonparticipating medical provider, the nonparticipating provider shall collect or bill the covered person no more than such person's deductible, coinsurance, copayment, or other cost-sharing amount as determined by such person's policy directly and such insurer shall directly pay such provider the greater of:   The verifiable contracted amount paid by all eligible insurers subject to the provisions of this chapter for the provision of the same or similar services as determined by the department;   The most recent verifiable amount agreed to by the insurer and the nonparticipating provider for the provision of the same services during such time as such provider was in-network with such insurer; or   Such higher amount as the insurer may deem appropriate given the complexity and circumstances of the services provided.  Any amount that the insurer pays the nonparticipating provider under this subsection shall not be required to include any amount of coinsurance, copayment, or deductible owed by the covered person or already paid by such person.      For purposes of the covered person's financial responsibilities, the healthcare plan shall treat the nonemergency medical services received by the covered person from a nonparticipating provider pursuant to this Code section as if such services were provided by a participating provider, and shall include applying the covered person's cost-sharing for such services toward the covered person's deductible and maximum out-of-pocket limit applicable to services obtained from a participating provider under the healthcare plan.   All insurer payments made to providers pursuant to this Code section shall be in accord with Code Section 33-24-59.14. Such payments shall accompany notification to the provider from the insurer disclosing whether the healthcare plan is subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq.     (Code 1981, §33-20E-5, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-6 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-6. Denying or Restricting Benefits Based on Balance Billing; Notice to Insured

 No healthcare plan shall deny or restrict the provision of covered benefits from a participating provider to a covered person solely because the covered person obtained treatment from a nonparticipating provider leading to a balance bill. Notice of such protection shall be provided in writing to the covered person by the insurer.    (Code 1981, §33-20E-6, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-7 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-7. Surprise Bill Exclusion; Requirements

  Nothing in this chapter shall reduce a covered person's financial responsibilities in the event that such covered person chose to receive nonemergency medical services from an out-of-network provider. Such services shall not be considered a surprise bill for purposes of this chapter.   The covered person's choice described in subsection (a) of this Code section must:   Be documented through such covered person's written and oral consent in advance of the provision of such services; and   Occur only after such person has been provided with an estimate of the potential charges.     If during the provision of nonemergency medical services, a covered person requests that the attending provider refer such covered person to another provider for the immediate provision of additional nonemergency medical services, such referred provider shall be exempt from the requirements in subsection (b) of this Code section if the following requirements are satisfied:   The referring provider advises the covered person that the referred provider may be a nonparticipating provider and may charge higher fees than a participating provider;   The covered person orally and in writing acknowledges that he or she is aware that the referred provider may be a nonparticipating provider and may charge higher fees than a participating provider;   The written acknowledgment referenced in paragraph (2) of this subsection shall be on a document separate from other documents provided by the referring provider and shall include language to be determined by the Commissioner through rule and regulation; and   The referring provider records the satisfaction of the requirements in paragraphs (1), (2), and (3) of this subsection in the covered person's medical file.       (Code 1981, §33-20E-7, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-8 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-8. Payer Health Claims Data Base; Annual Updating of Website

  Subject to appropriation, the department shall provide for the maintenance of an all-payer health claims data base and maintain records of insurer payments which shall track such payments by a wide variety of healthcare services and by geographic areas of this state. Such appropriation must specifically reference the Surprise Billing Consumer Protection Act. The department shall update information in the all-payer health claims data base on no less than an annual basis and shall maintain such information on the department's website.   In the event that the appropriation described in subsection (a) of this Code section is not made, the department shall update information from such other verifiable data as the Commissioner shall determine appropriate on no less than an annual basis and shall maintain such information on the department's website.     (Code 1981, §33-20E-8, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)   Code Commission notes.   - Pursuant to Code Section 28-9-5, in 2020, "the Surprise Billing Consumer Protection Act" was substituted for "this Act" at the end of the second sentence of subsection (a).
GA Code § 33-20E-9 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-9. Arbitration of Payment Issues

  If an out-of-network provider concludes that payment received from an insurer pursuant to Code Section 33-20E-4 or 33-20E-5 or if an out-of-network facility concludes that payment received from an insurer pursuant to Code Section 33-20E-4 is not sufficient given the complexity and circumstances of the services provided, the provider or facility may initiate a request for arbitration with the Commissioner. Such provider or facility shall submit such request within 30 days of receipt of payment for the claim and concurrently provide the insurer with a copy of such request.   A request for arbitration may involve a single patient and a single type of healthcare service, a single patient and multiple types of healthcare services, multiple patients and a single type of healthcare service, or multiple substantially similar healthcare services in the same specialty on multiple patients.     (Code 1981, §33-20E-9, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)   Code Commission notes.   - Pursuant to Code Sectiton 28-9-5, in 2020, "Code Section 33-20E-4" was substituted for "Code Section 3-20E-4" in the middle of the first sentence of subsection (a).
GA Code § 33-20E-10 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-10. Dismissal or Arbitration Requests

 The Commissioner shall dismiss certain requests for arbitration if the disputed claim is:    Related to a healthcare plan that is not regulated by the state;   The basis for an action pending in state or federal court at the time of the request for arbitration;   Subject to a binding claims resolution process entered into prior to July 1, 2021;   Made against a healthcare plan subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq.; or   In accord with other circumstances as may be determined by department rule.     (Code 1981, §33-20E-10, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-11 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-11. Submission to Commissioner by Insurer of Data Pending Arbitration

 Within 30 days of the insurer's receipt of the provider's or facility's request for arbitration, the insurer shall submit to the Commissioner all data necessary for the Commissioner to determine whether such insurer's payment to such provider or facility was in compliance with Code Section 33-20E-4 or 33-20E-5. The Commissioner shall not be required to make such a determination prior to referring the dispute to a resolution organization for arbitration.    (Code 1981, §33-20E-11, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-12 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-12. Regulation; Contracting With Resolution Organizations

 The Commissioner shall promulgate rules implementing an arbitration process requiring the Commissioner to select one or more resolution organizations to arbitrate certain claim disputes between insurers and out-of-network providers or facilities. Prior to proceeding with such arbitration, the Commissioner shall allow the parties 30 days from the date the Commissioner received the request for arbitration to negotiate a settlement. The parties shall timely notify the Commissioner of the result of such negotiation. If the parties have not notified the Commissioner of such result within 30 days of the date that the Commissioner received the request for arbitration, the Commissioner shall refer the dispute to a resolution organization within five days. The department shall contract with one or more resolution organizations by July 1, 2021, to review and consider claim disputes between insurers and out-of-network providers or facilities as such disputes are referred by the Commissioner.    (Code 1981, §33-20E-12, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-13 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-13. Selection of Arbitrator

 Upon the Commissioner's referral of a dispute to a resolution organization, the parties shall have five days to select an arbitrator by mutual agreement. If the parties have not notified the resolution organization of their mutual selection before the fifth day, the resolution organization shall select an arbitrator from among its members. Any selected arbitrator shall be independent of the parties and shall not have a personal, professional, or financial conflict with any party to the arbitration. The arbitrator shall have experience or knowledge in healthcare billing and reimbursement rates. He or she shall not communicate ex parte with either party.    (Code 1981, §33-20E-13, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-14 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-14. Submission of Final Offers; Supporting Documentation

 The parties shall have ten days after the selection of the arbitrator to submit in writing to the resolution organization each party's final offer and each party's argument in support of such offer. The parties' initial arguments shall be limited to written form and shall consist of no more than 20 pages per party. The parties may submit documents in support of their arguments. The arbitrator may require the parties to submit such additional written argument and documentation as the arbitrator determines necessary, but the arbitrator may require such additional filing no more than once. Such additional written argument shall be limited to no more than ten pages per party. The arbitrator may set filing times and extend such filing times as appropriate. Failure of either party to timely submit the supportive documentation described herein may result in a default against the party failing to make such timely submission.    (Code 1981, §33-20E-14, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-15 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-15. Proposed Payment Amounts

 Each party shall submit one proposed payment amount to the arbitrator. The arbitrator shall pick one of the two amounts submitted and shall reveal that amount in the arbitrator's final decision. The arbitrator may not modify such selected amount. In making such a decision, the arbitrator shall consider the complexity and circumstances of each case, including, but not limited to, the level of training, education, and experience of the relevant physicians or other individuals at the facility who are licensed or otherwise authorized in this state to furnish healthcare services and other factors as determined by the Commissioner through rule. The arbitrator's final decision shall be in writing and shall describe the basis for such decision, including citations to any documents relied upon. Notwithstanding Code Section 33-20E-14, such decision shall be made within 30 days of the Commissioner's referral. Any default or final decision issued by the arbitrator shall be binding upon the parties and is not appealable through the court system.    (Code 1981, §33-20E-15, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-16 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-16. Payment of Expenses and Fees

 The party whose final offer amount is not selected by the arbitrator shall pay the amount of the verdict, the arbitrator's expenses and fees, and any other fees assessed by the resolution organization, directly to such resolution organization. In the event of default, the defaulting party shall also pay such moneys due directly to such organization. In the event that both parties default, the parties shall each be responsible for paying such organization one-half of all moneys due. Moneys due under this Code section shall be paid in full to the resolution organization within 15 days of arbitrator's final decision. Within three days of such organization's receipt of moneys due to the party whose final offer was selected, such moneys shall be distributed to such party.    (Code 1981, §33-20E-16, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-17 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-17. Referral of Parties for Violations

 Following the resolution of arbitration, the Commissioner may refer the decision of the arbitrator to the appropriate state agency or the governing entity with governing authority over such provider or facility if the Commissioner concludes that a provider or facility has either displayed a pattern of acting in violation of this chapter or has failed to comply with a lawful order of the Commissioner or the arbitrator. Such referral shall include a description of such violations and the Commissioner's recommendation for enforcement action. Such state agency or governing entity shall initiate an investigation regarding such referral within 30 days of receiving such referral and shall conclude the investigation within 90 days of receiving such referral.    (Code 1981, §33-20E-17, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-18 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-18. Limitation on Litigation When Arbitration Sought

 Once a request for arbitration has been filed with the Commissioner by a provider or facility under this chapter, neither such provider nor such facility nor the insurer in such dispute shall file a lawsuit in court regarding the same out-of-network claim.    (Code 1981, §33-20E-18, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-19 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-19. Quarterly Reporting by Resolution Organizations

 Each resolution organization contracted with by the department shall report to the department on a quarterly basis the results of all disputes referred to such organization as follows: the number of arbitrations filed, settled, arbitrated, defaulted, or dismissed during the previous calendar year and whether the arbitrators' decisions were in favor of the insurer or the provider or facility.    (Code 1981, §33-20E-19, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-20 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-20. Annual Reporting by Commissioner

 On or before July 1, 2022, and each July 1 thereafter, the Commissioner shall provide a written report to the House Committee on Insurance and the Senate Insurance and Labor Committee, or their successor committees, and shall post the report on the department's website summarizing the number of arbitrations filed, settled, arbitrated, defaulted, and dismissed during the previous calendar year; and a description of whether the arbitration decisions were in favor of the insurer or the provider or facility.    (Code 1981, §33-20E-20, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-21 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-21. Exclusion From Other Statutory Provisions

 The arbitration conducted under this chapter shall be subject to neither Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," nor Chapter 11 of Title 9, the "Georgia Civil Practice Act."    (Code 1981, §33-20E-21, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)