reglab/housing_qa huggingface dataset:
GA Code § 33-46-1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-1. (Effective January 1, 2022.) Construction

 This chapter shall be construed liberally to promote consumer protection.    (Code 1981, §33-46-1, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)   Editor's notes.   - Ga. L. 2021, p. 629, § 1/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-1, relating to legislative purposes and intent, as present Code Section 33-46-3.
GA Code § 33-46-2 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-2. (Effective January 1, 2022.) Application

  This chapter applies to:   Private review agents;   Utilization review entities;   All health insurers and stand-alone dental plans that provide accident and sickness insurance products whether on an individual, group, or blanket basis as provided in this title;   All administrators of such products licensed in accordance with Article 2 of Chapter 23 of this title;   All pharmacy benefits managers;   All contracts entered into or renewed by the Department of Community Health with a contracted entity to provide healthcare coverage or services pursuant to the state health benefit plan; and   All contracts entered into or renewed by the Department of Community Health and care management organizations to provide or arrange for healthcare coverage or services on a prepaid, capitated basis to members.       (Code 1981, §33-46-2, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-2, relating to definitions, as present Code Section 33-46-4.
GA Code § 33-46-5 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-5. (Effective January 1, 2022.) Certification of Private Review Agents; Exemption

  A private review agent or utilization review entity may not conduct utilization review of healthcare provided in this state unless the Commissioner has granted the private review agent or utilization review entity a certificate pursuant to this chapter. No individual conducting utilization review shall require certification if such utilization review is performed within the scope of such person's employment with an entity already certified pursuant to this Code section.   The Commissioner shall issue a certificate to an applicant that has met all the requirements of this chapter and all applicable regulations of the Commissioner.   A certificate issued under this chapter is not transferable without the prior approval of the Commissioner.     (Code 1981, §33-46-3, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-5, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-3 as this Code section, and, in the first sentence of subsection (a), inserted "or utilization review entity" in two places and substituted "healthcare" for "health care".   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-5 as present Code Section 33-46-7.
GA Code § 33-46-7 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-7. (Effective January 1, 2022.) Certificate Application Fees; Information to Be Submitted With Application

  An applicant for a certificate shall submit an application on a form prescribed by the Commissioner and pay an application fee and a certificate fee as provided in Code Section 33-8-1. The application shall be signed and verified by the applicant.   In conjunction with the application, the private review agent or utilization review entity shall submit such information that the Commissioner requires, including but not limited to:   A utilization review plan;   The type and qualifications of the personnel either employed or under contract to perform the utilization review;   A copy of the materials designed to inform applicable patients and healthcare providers of the requirements of the utilization review plan; and   A signed attestation by the chief medical officer or chief executive officer of the applicant that such entity's utilization review activities comply with the standards required by this chapter.  The information provided must demonstrate to the satisfaction of the Commissioner that the applicant will comply with the requirements of this chapter.        (Code 1981, §33-46-5, enacted by Ga. L. 1990, p. 1088, § 1; Ga. L. 1992, p. 2725, § 33; Code 1981, §33-46-7, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-5 as this Code section; inserted "or utilization review entity" in subsection (b); deleted "and" at the end of paragraph (b)(2); in paragraph (b)(3), substituted "healthcare" for "health care" and substituted "; and" for a period; added paragraph (b)(4); and substituted "applicant" for "private review agent" in the ending undesignated language of subsection (b).   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-7 as present Code Section 33-46-9.
GA Code § 33-46-8 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-8. (Effective January 1, 2022.) Expiration and Renewal of Certificate

  A certificate shall expire on the second anniversary of its effective date unless the certificate is renewed for a two-year term as provided in this Code section.   Before the certificate expires but no sooner than 90 days prior to such expiration, a certificate may be renewed for an additional two-year term if the applicant:   Otherwise is entitled to the certificate;   Pays to the Commissioner the renewal fee as provided in Code Section 33-8-1;   Submits to the Commissioner:   A renewal application on the form that the Commissioner requires; and   Satisfactory evidence of compliance with any requirements established by the Commissioner for certificate renewal; and       Establishes and maintains a complaint system which has been approved by the Commissioner and which provides reasonable procedures for the resolution of written complaints initiated by covered persons or healthcare providers concerning utilization review;   Maintains records of such written complaints for five years from the time the complaints are filed and submits to the Commissioner a summary report at such times and in such format as the Commissioner may require; and   Permits the Commissioner to examine the complaints at any time.         (Code 1981, §33-46-6, enacted by Ga. L. 1990, p. 1088, § 1; Ga. L. 1992, p. 2725, § 34; Code 1981, §33-46-8, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-6 as this Code section and substituted "covered persons or healthcare providers" for "enrollees or health care providers" in subparagraph (b)(4)(A).   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-8 as present Code Section 33-46-10.
GA Code § 33-46-9 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-9. (Effective January 1, 2022.) Jurisdiction of Commissioner Over Private Review Agents and Utilization Review Entities

 Private review agents and utilization review entities shall be subject to the jurisdiction of the Commissioner in all matters regulated by this chapter and the Commissioner shall have such powers and authority with regard to private review agents and utilization review entities as provided in Code Sections 33-2-9 through 33-2-28 with regard to insurers.    (Code 1981, §33-46-7, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-9, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-7 as this Code section and inserted "and utilization review entities" in two places.   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-9 as present Code Section 33-46-11.
GA Code § 33-46-10 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-10. (Effective January 1, 2022.) Applicability of Chapter 39 of Title 33

 Private review agents and utilization review entities shall be subject to the provisions of Chapter 39 of this title.    (Code 1981, §33-46-8, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-10, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-8 as this Code section and inserted "and utilization review entities".   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-10 as present Code Section 33-46-12.
GA Code § 33-46-11 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-11. (Effective January 1, 2022.) Listings of Certificate Holders

 The Commissioner shall periodically, not less than once a year, provide a list of private review agents and utilization review entities issued certificates and the renewal date for those certificates to all hospitals and to any other individual or organization requesting such list.    (Code 1981, §33-46-9, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-11, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-9 as this Code section and inserted "and utilization review entities".   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-11 as present Code Section 33-46-13.
GA Code § 33-46-12 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-12. (Effective January 1, 2022.) Reporting Requirements

 The Commissioner shall establish such reporting requirements upon private review agents and utilization review entities as are necessary to determine if the utilization review programs are in compliance with the provisions of this chapter and applicable rules and regulations.    (Code 1981, §33-46-10, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-12, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-10 as this Code section and inserted "and utilization review entities".   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-12 as present Code Section 33-46-14.
GA Code § 33-46-13 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-13. (Effective January 1, 2022.) Adoption of Rules and Regulations

 The Commissioner shall adopt rules and regulations to implement the provisions of this chapter.    (Code 1981, §33-46-11, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-13, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-11 as this Code section.   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-13 as present Code Section 33-46-15.
GA Code § 33-46-14 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-14. (Effective January 1, 2022.) Exemptions From Certificate Requirements

 No certificate is required for utilization review by any Georgia licensed pharmacist or pharmacy while engaged in the practice of pharmacy, including but not limited to review of the dispensing of drugs, participation in drug utilization review, and monitoring patient drug therapy.    (Code 1981, §33-46-12, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-14, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-12 as this Code section.   Editor's notes.   - Ga. L. 2021, p. 629, § 2/SB 80, effective January 1, 2022, redesignated former Code Section 33-46-14 as present Code Section 33-46-16.
GA Code § 33-46-15 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-15. (Effective January 1, 2022.) Exemptions From Applicability of Chapter

  This chapter shall not apply to any contract with the federal government for utilization and review of patients eligible for hospital services under Title XVIII or XIX of the Social Security Act.   This chapter shall not apply to any private review agent or utilization review entity when such private review agent or utilization review entity is working under contract, or an extension or renewal thereof, with a licensed insurer operating under an agreement, providing administrative services pursuant to the provisions of subsection (b) of Code Section 33-20-17 to a healthcare benefit plan negotiated through collective bargaining as that term is defined in the federal National Labor Relations Act, as amended, if the original agreement was executed and in effect prior to January 1, 1990.   This chapter shall not apply to audits of the medical record for the purposes of verifying that healthcare services were ordered and delivered.     (Code 1981, §33-46-13, enacted by Ga. L. 1990, p. 1088, § 1; Code 1981, §33-46-15, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-13 as this Code section, inserted "or utilization review entity" in two places in subsection (b), and substituted "healthcare" for "health care" in subsections (b) and (c).   Code Commission notes.   - Pursuant to Code Section 28-9-5, in 1990, "Title" was substituted for "Titles" in subsection (a).
GA Code § 33-46-16 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 1 - General Provisions|§ 33-46-16. (Effective January 1, 2022.) Commissioner to Issue Annual Report

 The Commissioner shall issue an annual report to the Governor and the General Assembly concerning the conduct of utilization review in this state. Such report shall include a description of utilization review programs and the services they provide, an analysis of complaints filed against private review agents and utilization review entities by patients or providers, and an evaluation of the impact of utilization review programs on patient access to care. The Commissioner shall not be required to distribute copies of the annual report to legislators in the General Assembly but shall notify such legislators of the availability of the report in the manner which he or she deems to be most effective and efficient.    (Code 1981, §33-46-14, enacted by Ga. L. 1990, p. 1088, § 1; Ga. L. 2005, p. 1036, § 26/SB 49; Code 1981, §33-46-16, as redesignated by Ga. L. 2021, p. 629, § 2/SB 80.)    The 2021 amendment,  effective January 1, 2022, redesignated former Code Section 33-46-14 as this Code section, inserted "and utilization review entities" in the second sentence, and substituted "annual report to legislators in the General Assembly but shall notify such legislators" for "annual report to the members of the General Assembly but shall notify the members" in the third sentence.
GA Code § 33-46-20 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 2 - (Effective January 1, 2022.) Prior Authorizations|§ 33-46-20. (Effective January 1, 2022.) Prior Authorization Requirements Posted on Website; Statistical Reporting

  An insurer shall make any current prior authorization requirements readily accessible on its website to healthcare providers. Clinical criteria on which an adverse determination is based shall be provided to the healthcare provider at the time of the notification.   If an insurer intends either to implement a new prior authorization requirement or to amend an existing requirement, such insurer shall ensure that the new or amended requirement is not implemented unless such insurer's website has been updated to reflect such addition or change.   An insurer using prior authorization shall make aggregate statistics available per such insurer and per its plans regarding prior authorization approvals and denials on its website in a readily accessible format. The Commissioner shall determine the statistics required in order to comply with this Code section in accordance with applicable state and federal privacy laws. Such statistics shall include, but not be limited to, the following:   Approved or denied on initial request;   Reason for denial;   Whether appealed;   Whether approved or denied on appeal; and   Time between submission and response.       (Code 1981, §33-46-20, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)
GA Code § 33-46-21 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 2 - (Effective January 1, 2022.) Prior Authorizations|§ 33-46-21. (Effective January 1, 2022.) Insurer Responsibility for Compliance; Periodic Reviews; Evaluation of Adverse Determinations

  An insurer shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the insurer and for ensuring that all requirements of this chapter and applicable rules and regulations are met. The insurer also shall ensure that appropriate personnel have operational responsibility for the conduct of the insurer's utilization review program.   Whenever an insurer contracts with a private review agent or utilization review entity to perform services subject to this chapter or applicable rules and regulations, the Commissioner shall hold the insurer responsible for monitoring the activities of such private review agent or utilization review entity and for ensuring that the requirements of this chapter and applicable rules and regulations are met.   A private review agent or utilization review entity shall use documented clinical criteria that are based on sound clinical evidence and which are evaluated periodically to assure ongoing efficacy.   Qualified healthcare professionals shall administer the utilization review program and oversee utilization review decisions. An initial screening of prior authorization requests may be completed without providing the treating provider or other qualified healthcare professional with the opportunity to speak with a clinical peer of the private review agent or utilization review entity. Such an opportunity shall be provided, however, before an appeal. If a private review agent or utilization review entity questions the medical necessity of a healthcare service, such agent or entity shall notify the covered person's treating provider, or such provider's appropriately qualified designee familiar with the patient's case, that medical necessity is being questioned in accordance with the provisions of paragraph (5) of subsection (a) of Code Section 33-46-6.   An insurer shall provide covered persons and participating providers with access to its utilization review staff by telephone or through synchronous digital text or voice messaging or similar technology in accordance with state and federal privacy laws. A clinical peer shall evaluate the clinical appropriateness of adverse determinations.     (Code 1981, §33-46-21, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)
GA Code § 33-46-22 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 2 - (Effective January 1, 2022.) Prior Authorizations|§ 33-46-22. (Effective January 1, 2022.) Review of Appeals by Appropriate Healthcare Provider

 A private review agent or utilization review entity shall ensure that all appeals are reviewed by an appropriate healthcare provider who shall:    Possess a current and valid nonrestricted license or maintain other appropriate legal authorization;   Be currently in active practice in the same or similar specialty and who typically manages the medical condition or disease;   Be knowledgeable of, and have experience providing, the healthcare service under appeal;   Not have been directly involved in making the adverse determination; and   Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical or other records provided to the private review agent or utilization review entity by the covered person's healthcare provider, any relevant records provided to such agent or entity by a facility, and any medical or other literature provided to such agent or entity by the healthcare provider.     (Code 1981, §33-46-22, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)
GA Code § 33-46-23 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 2 - (Effective January 1, 2022.) Prior Authorizations|§ 33-46-23. (Effective January 1, 2022.) Restrictions on Authorizations When Service Timely Rendered

 If initial healthcare services are performed within 45 business days of approval of prior authorization, the insurer shall not revoke, limit, condition, or restrict such authorization, unless such prior authorization is for a Schedule II controlled substance or there is a billing error, fraud, material misrepresentation, or loss of coverage.    (Code 1981, §33-46-23, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)
GA Code § 33-46-24 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 2 - (Effective January 1, 2022.) Prior Authorizations|§ 33-46-24. (Effective January 1, 2022.) Medically Necessary Unanticipated Emergency or Urgent Healthcare Services

 Prior authorization shall not be required for unanticipated emergency healthcare services, urgent healthcare services, or covered healthcare services which are incidental to the primary covered healthcare service and determined by the covered person's physician or dentist to be medically necessary.    (Code 1981, §33-46-24, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)
GA Code § 33-46-25 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 46 - (Effective January 1, 2022.) Certification of Private Review Agents|Article 2 - (Effective January 1, 2022.) Prior Authorizations|§ 33-46-25. (Effective January 1, 2022.) Prior Authorization for Ambulance Transportation or Emergency Healthcare Services Prohibited

 An insurer cannot require prior authorization for emergency prehospital ambulance transportation or for the provision of emergency healthcare services.    (Code 1981, §33-46-25, enacted by Ga. L. 2021, p. 629, § 2/SB 80.)