reglab/statecodes huggingface dataset:
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 4 - AID TO THE DISABLED (§§ 49-4-80 — 49-4-86) › Section 49-4-85 - Payment of assistance after recipient moves to another county

Any recipient who moves to another county in this state shall be entitled, with the approval of the Department of Human Services, to receive assistance in the county to which he has moved; and the county department of the county from which he has moved shall transfer all necessary records relating to the recipient to the county department of the county to which he has moved. The county from which the recipient has moved shall pay the assistance for a period of two months, after which time the county to which he has moved shall pay the assistance, if he remains otherwise eligible.
Amended by 2009 Ga. Laws 102,§ 2-2, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 4 - AID TO THE DISABLED (§§ 49-4-80 — 49-4-86) › Section 49-4-86 - Claims to assistance subject to amendments or repeals

All assistance granted under this article shall be deemed to be granted and to be held subject to any amending or repealing Act that may hereafter be passed; and no recipient shall have any claim for compensation, or otherwise, by reason of his assistance being affected in any way by any amending or repealing Act.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 5 - [RESERVED] AID TO FAMILIES WITH DEPENDENT CHILDREN (§ 49-4-100) › Section 49-4-100 - through 49-4-119 - [Reserved]

Reserved. Repealed by Ga. L. 1997, p. 1021, § 5, effective April 22, 1997.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 6 - [RESERVED] MEDICAL ASSISTANCE FOR AGED (§ 49-4-120) › Section 49-4-120 - through 49-4-128 - [Reserved]

Reserved. Repealed by Ga. L. 1999, p. 296, § 16, effective July 1, 1999.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-140 - Short title

The short title for this article shall be the "Georgia Medical Assistance Act of 1977."
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-141 - Definitions

As used in this article, the term:
(1)
"Applicant for medical assistance" means a person who has made application for certification as being eligible, generally, to have medical assistance paid in his or her behalf pursuant to the state plan and whose application has not been acted upon favorably.
(2)
"Board" means the Board of Community Health established under Chapter 2 of Title 31.
(3)
"Commissioner" means the commissioner of the department.
(4)
"Department" means the Department of Community Health established under Chapter 2 of Title 31.
(5)
"Medical assistance" means payment to a provider of a part or all of the cost of certain items of medical or remedial care or service rendered by the provider to a recipient of medical assistance, provided such items are rendered and received in accordance with such provisions of Title XIX of the federal Social Security Act of 1935, as amended, regulations promulgated pursuant thereto by the secretary of health and human services, all applicable laws of this state, the state plan, and regulations of the department which are in effect on the date on which the items are rendered.
(6)
"Provider of medical assistance" means a person or institution, public or private, which possesses all licenses, permits, certificates, approvals, registrations, charters, and other forms of permission issued by entities other than the department, which forms of permission are required by law either to render care or to receive medical assistance in which federal financial participation is available and which meets the further requirements for participation prescribed by the department and which is enrolled, in the manner and according to the terms prescribed by the department, to participate in the state plan.
(7)
"Recipient of medical assistance" means a person who has been certified eligible, pursuant to the state plan, to have medical assistance paid in his or her behalf.
(8)
"State plan" means all documentation submitted by the commissioner in behalf of the department to and for approval by the secretary of health and human services, pursuant to Title XIX of the federal Social Security Act, as amended (Act of July 30, 1965, P.L. 89-97, Stat. 343, as amended).
(9)
"Third party" means an individual, institution, corporation, or public or private agency, other than the department, that is legally liable to pay all or any part of the medical costs incurred by a recipient of medical assistance on account of any sickness, injury, disease, or disability to such a recipient.
Amended by 2009 Ga. Laws 102,§ 1-7, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-142.1 - Legislative notification of request for waiver

On and after May 3, 2006, neither the department, the board, nor any other representative of the state shall submit any request to the United States Department of Health and Human Services Centers for Medicare and Medicaid Services for a waiver pursuant to Section 1115 of the federal Social Security Act without legislative notification. This shall apply only to waivers that relate to Medicaid modernization, Medicaid transformation, or a Medicaid reform model that would affect 20,000 or more individuals in the Georgia Medicaid population. The legislative notification required under this Code section shall be by Act of the General Assembly or the adoption of a joint resolution of the General Assembly.
Amended by 2007 Ga. Laws 18,§ 49, eff. 5/11/2007.
Added by 2006 Ga. Laws 760,§ 1, eff. 5/3/2006.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-142.2 - Expansion of Medicaid eligibility through an increase in the income threshold

On and after July 1, 2014, neither the department, the board, nor any other representative of the state shall expand Medicaid eligibility under this article through an increase in the income threshold without prior legislative approval; provided, however, that this shall not apply to any increase resulting from a cost-of-living increase in the federal poverty level. The legislative approval required under this Code section shall be by Act of the General Assembly or the adoption of a joint resolution of the General Assembly.
Added by 2014 Ga. Laws 534,§ 2, eff. 7/1/2014.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-142.3 - Waiver request to federal government on income threshold for Medicare and Medicaid services

The department shall be authorized to submit a waiver request, on or before June 30, 2020, to the United States Department of Health and Human Services Centers for Medicare and Medicaid Services pursuant to Section 1115 of the federal Social Security Act, which may include an increase in the income threshold up to a maximum of 100 percent of the federal poverty level. Further, upon approval of the waiver, the department shall be authorized to take all necessary steps to implement the terms and conditions of the waiver without any further legislative action.
Added by 2019 Ga. Laws 4,§ 2-1, eff. 3/27/2019.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-142.4 - Comprehensive review of provider reimbursement rates; development of proposed rate models, documentation, and policy changes

(a)
Beginning Fiscal Year 2024, and at least every four years thereafter, the department shall conduct a comprehensive review of provider reimbursement rates for home and community based services covered by the New Options Waiver (NOW) program, the Comprehensive Supports Waiver Program (COMP), the Independent Care Waiver Program (ICWP), the Georgia Pediatric Program (GAPP), and the Elderly and Disabled Waiver Program (EDWP). Such review shall be conducted on all waiver services and shall include input from the public, service providers, and other stakeholders.
(b)
Based on the comprehensive review conducted pursuant to subsection (a) of this Code section, the department shall develop proposed rate models, related documentation, and associated policy changes to the policies and procedures of each waiver program. In addition, the department shall provide the projected fiscal impact of implementing such proposed rate models. Such proposed rate models, related documentation, associated policy changes, and the projected fiscal impact shall be submitted to the board, the Department of Behavioral Health and Developmental Disabilities, and the General Assembly.
Added by 2022 Ga. Laws 853,§ 1, eff. 7/1/2022.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-142.5 - Waiver request allowing Medicaid reimbursement

(a)
No later than December 31, 2022, the department shall submit a waiver request to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to authorize private institutions for mental disease (IMDs) to qualify for Medicaid reimbursement for mental health and substance use disorder treatment.
(b)
Upon approval of such waiver, the department shall take all necessary steps to provide for payment of such care at private IMDs with Medicaid funds.
Added by 2022 Ga. Laws 853,§ 1, eff. 7/1/2022.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-143 - Power of Board of Community Health; Board of Medical Assistance abolished

The Board of Community Health established under Chapter 2 of Title 31 is empowered to establish the general policy to be followed by the department. The Board of Medical Assistance which existed June 30, 1999, is abolished July 1, 1999, and no person shall be appointed to such board on or after July 1, 1999.
Amended by 2009 Ga. Laws 102,§ 1-7, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-144 - Chief administrative officer; powers and duties

The commissioner of community health established under Chapter 2 of Title 31 shall be the chief administrative officer of the department and, subject to the general policy established by the board, shall supervise, direct, account for, organize, plan, administer, and execute the functions vested in the department.
Amended by 2009 Ga. Laws 102,§ 1-7, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-145 - Time limitations on claims for assistance; form of claims

Claims for medical assistance must be submitted not more than six months after the month in which the service is rendered and shall be in the form prescribed by the commissioner, except that the commissioner may, where he finds that delay in submission of claims was caused by circumstances beyond the control of the provider, extend the period for submission of certain claims for a period not to exceed 12 months after the month in which the service was rendered; provided, however, that such limitations shall not apply to claims timely filed pursuant to Title XVIII of the federal Social Security Act of 1935, as amended, and reimbursements of such claims may be authorized by the department so long as federal financial participation in such reimbursements is available.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-146 - Time for action on claim

The Department of Community Health, within three months of receiving a claim submitted on or after July 1, 1978, shall pay or deny the claim.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-146.3 - Civil forfeiture of property and proceeds obtained through Medicaid fraud

(a)
As used in this Code section, the term:
(1)
"Civil forfeiture proceeding" shall have the same meaning as set forth in Code Section
9-16-2
.
(2)
"Medicaid fraud" means:
(A)
A violation of Code Section
49-4-146.1
; or
(B)
A violation relating to the obtaining of medical assistance benefits or payments under this article of any provision of:
(i)
Chapter 8 of Title 16, relating to offenses involving theft;
(ii)
Code Section
16-10-20
, relating to false statements and writings, concealment of facts, and fraudulent documents in matters within jurisdiction of state or political subdivisions; or
(iii)
Code Section
16-10-21
, relating to conspiracy to defraud the state or its political subdivisions.
(3)
"Proceeds" shall have the same meaning as set forth in Code Section
9-16-2
.
(4)
"Property" shall have the same meaning as set forth in Code Section
9-16-2
.
(b)
Any property which is directly or indirectly obtained by a person or entity through or as a result of Medicaid fraud in the provision of services or equipment under this article and any proceeds shall be subject to civil forfeiture proceedings in accordance with Chapter 16 of Title 9. This Code section shall not apply to cases involving alleged fraud by Medicaid recipients in obtaining medical assistance benefits.
Amended by 2015 Ga. Laws 98,§ 3-29, eff. 7/1/2015.
Amended by 2001 Ga. Laws 191, § 36, eff. 7/1/2001.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-147 - Enforcement of liens, claims, or offsets against assistance

Medical assistance payable by virtue of this article shall be subject to any claim, lien, or offset of this state against the payee and to any claim of the United States of America made against the payee pursuant to a federal statute, but such moneys shall not otherwise be subject to execution, levy, garnishment, or any other legal process; and no transfer or assignment of such at law or in equity shall be enforceable against the State of Georgia, the Department of Community Health, or the commissioner of community health; but medical assistance moneys, having been paid, are subject to all such actions and process.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-147.1 - Claims by department against estate of Medicaid recipients

(a)
In accordance with applicable federal law and regulations, including those under Title XIX of the federal Social Security Act, the department may make claim against the estate of a Medicaid recipient for the amount of any medical assistance payments made on such person's behalf by the department. A claim shall be made against the estate of a deceased Medicaid recipient only if at the time of application for medical assistance the applicant received written notice that the medical assistance costs could be recovered from the applicant's estate and the applicant signed a written acknowledgment of receipt of such notice, the estate is otherwise subject to recovery, and if no hardship or other exemption exists. The commissioner shall waive such claim if he or she determines enforcement of the claim would result in substantial and unreasonable hardship to dependents of the individual against whose estate the claim exists.
(b)
The estate recovery program established pursuant to this Code section shall not be effective any earlier than May 3, 2006. In no event shall the department make claims against the estate of a Medicaid recipient for the amount of any medical assistance payments made on such person's behalf prior to May 3, 2006.
(c)
The commissioner shall delay execution of a claim against the estate where the dependents or heirs agree to pay the full amount of the claim in reasonable installments.
(d)
To prevent substantial and unreasonable hardship, the commissioner shall waive any claim against the first $25,000.00 of any estate. No later than July 1, 2018, the department shall submit to the United States Department of Health and Human Services Centers for Medicare and Medicaid Services an amendment to the state plan reflecting the provisions of this subsection. In the event that such amendment to the state plan is not approved, this subsection shall stand repealed in its entirety.
Amended by 2018 Ga. Laws 355,§ 1, eff. 7/1/2018.
Amended by 2006 Ga. Laws 760,§ 3, eff. 5/3/2006.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-147.2 - Department of Community Health not eligible to obtain nor liable for interest on orders, judgments, and liquidated or unliquidated amounts; exceptions

(a)
Notwithstanding the provisions of Code Section
49-4-141
, as used in this Code section the term "department" means the Department of Community Health or its officers, agents, or employees solely in their capacity as such officers, agents, or employees.
(b)
Notwithstanding the provisions of Code Section
7-4-12
,
7-4-15
,
7-4-16
, or
13-6-13
, or any other statute or judicial construction thereof authorizing interest, the department shall not be eligible to obtain nor be liable for interest on orders, judgments, liquidated amounts, or unliquidated amounts unless such interest is:
(1)
Required by federal law or regulations;
(2)
Interest on penalties as required by Code Section
49-4-146.1
;
(3)
Interest as required by Code Section
49-4-148
; or
(4)
Incurred by a failure to pay the penalty which may be transferred to the Indigent Care Trust Fund under Code Section
31-8-153.1
within 30 days after the penalty is imposed, in which event interest shall be paid from the thirty-first day following such imposition at the same rate as interest on penalties under Code Section
49-4-146.1
.
Amended by 2001 Ga. Laws 382, § 7, eff. 4/28/2001.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-149.1 - Plan for family supplementation of Medicaid payments upon federal removal of restrictions or waiver

If the federal government removes restrictions upon family supplementation of Medicaid payments or approves a waiver allowing this supplementation, the Department of Community Health shall submit to the Health and Human Services Committee of the Senate and the Health and Human Services Committee of the House of Representatives a plan for this supplementation, which submission shall be made within 30 days after the earlier of the date the restrictions are removed or the date the waiver is approved.
Added by 2005 Ga. Laws 13,§ 5, eff. 4/7/2005.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-150 - Regulations as to maintenance and use of records; use of information

The Board of Community Health is directed to prescribe regulations governing the custody, use, and preservation of the records, papers, files, and communications of the Department of Community Health relating to applicants for and recipients of medical assistance. Except as otherwise provided in Code Section
49-4-151
, such regulations shall provide safeguards restricting the use or disclosure of information concerning applicants for or recipients of medical assistance to purposes directly connected with the administration of the state plan. No person who obtains information by virtue of any such regulations shall use such information for commercial or political purposes, and any person seeking such information shall certify to the commissioner of community health, in writing, that the information obtained will not be used for commercial or political purposes.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-151 - Obtaining information for investigations and audits

(a)
The commissioner, for the purposes of investigating the nature, amount, and extent of services provided to a recipient of medical assistance or auditing information submitted to the department concerning a provider's entitlement to an amount of medical assistance, is authorized, personally or by his duly authorized representative, to administer oaths and to examine and copy books, papers, records (medical, business, or otherwise), or memoranda of a provider or of any other person possessed of information relating to reimbursable costs claimed by a provider or otherwise relating to the amount of medical assistance to which a provider is entitled. The commissioner may compel such examinations by means of subpoenas issued to require the custodian of such items to produce them for examination. A subpoena may be served by any sheriff, by his deputy, or by any other person not less than 18 years of age. Proof may be shown by return of certificate endorsed on a copy of the subpoena. Subpoenas may also be served by registered or certified mail or statutory overnight delivery, and the return receipt shall constitute prima-facie proof of service. If any person shall fail to obey a subpoena issued and served under this subsection, then upon application of the commissioner, the superior court of the county in which such custodian was required to appear may issue an order requiring such custodian to comply with the subpoena and to produce the subpoenaed documentation. Furthermore, if any provider shall fail to obey a subpoena issued and served under this subsection with respect to any matter concerning a claim for medical assistance, that claim for medical assistance shall not be reimbursed by the Department of Community Health; and, if already reimbursed, the amount of medical assistance reimbursed shall be deducted from any amount of medical assistance which may then be or thereafter become payable to such provider.
(b)
In the course of conducting investigations and audits, the Department of Community Health may request from any governmental department, board, commission, bureau, or agency information and assistance pertinent thereto. The Department of Community Health shall be entitled to have access to all such pertinent information which is within the custody of any governmental department, board, commission, bureau, or agency.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-151.1 - Errors or omissions in reporting; right to hearing; exclusion

(a)
Any clerical or record-keeping error, including but not limited to a typographical error, scrivener's error, or computer error; any unintentional error or omission in billing, coding, or required documentation; or any isolated instances of incomplete documentation by a provider of medical assistance regarding reimbursement for medical assistance may not in and of itself constitute fraud or constitute a basis to recoup payment for medical assistance provided, so long as any such errors or instances do not result in an improper payment. An improper payment includes any payment that was made to an ineligible recipient, payment for noncovered services, duplicate payments, payments for services not received, payments that are for the incorrect amount, and instances when the department is unable to discern whether a payment was proper because of insufficient or lack of documentation. The department or its agents shall not recoup the cost of medical assistance if such error, omission, or incomplete documentation has been resolved in accordance with subsection (b) of this Code section; provided, however, that recoupment shall be allowed to the extent that the error, omission, or incomplete documentation resulted in an improper payment, though recoupment shall be limited to the amount improperly paid.
(b)
A provider of medical assistance shall be allowed 30 calendar days following receipt by the provider of a preliminary audit review report in which to submit records or documents to correct an error or omission or to complete documentation identified in such review report; provided, however, that the department or its agents, in the discretion of the department, may reject the submission of a corrected record or document if the submission would result in an improper payment, or the provider demonstrates a pattern of repeated errors, omissions, or incomplete documentation. The department shall be authorized to establish rules and regulations delineating what constitutes a pattern of repeated errors, omissions, or incomplete documentation taking into consideration the type of provider; frequency of audits; volume of claims submitted by a provider; type of error, omission, or incomplete documentation; and other pertinent factors.
(c)
A provider of medical assistance shall be afforded the right to a hearing in accordance with Code Section
49-4-153
for any attempted withholding of reimbursement or recoupment by the department or its agents relating to an error, omission, incomplete documentation, or improper payment relating to the provision of medical assistance.
(d)
This Code section shall not apply to criminal or civil investigations which involve fraud, willful misrepresentation, reckless disregard, or abuse conducted by the Attorney General's Medicaid Fraud Control Unit or other law enforcement agencies.
Added by 2017 Ga. Laws 68,§ 2, eff. 7/1/2017.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-152 - Research and demonstration projects; pilot projects to provide health care coverage and essential health care services; pharmacy assistance programs

Subject to the availability of funds, the Department of Community Health is authorized to enter into agreements with and submit applications to departments and agencies of the government of the United States for purposes of accepting grants, receiving matching funds, and administering such grants and funds for research and demonstration projects pursuant to Title XI, XVIII, XIX, or XXI of the federal Social Security Act of 1935, as amended, or any other provision of federal law, without regard to the factor of state wideness and such other factors as may be required to be waived by the terms of the federal grant. Notwithstanding any other provision of law and subject to the availability of funds, the department is authorized to establish pilot projects to provide health care coverage and access to essential health care services or benefits to the uninsured and underinsured, including but not limited to pharmacy assistance programs.
Amended by 2001 Ga. Laws 382, § 9, eff. 4/28/2001.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-152.2 - Rebates for sole-source and multiple-source drugs included in Controlled Medical Assistance Drug List

(a)
The department is authorized to negotiate and enter into agreements directly with manufacturers and distributors whose prescription drug products are sold in the state for sole-source and multiple-source drugs to be paid for under the state plan for eligible recipients under this article. Such agreements shall provide for a periodic rebate of a negotiated percentage of the total product cost to be paid by the manufacturer or distributor of a specific product covered under the state plan.
(b)
Prescription drug products shall be included in the Controlled Medical Assistance Drug List only upon satisfaction and completion of the application and approval process established by the department. Those products for which a rebate has been successfully negotiated shall automatically be included in the Controlled Medical Assistance Drug List for a period of time conterminous with the negotiated rebate.
(c)
If there has been a failure to negotiate or renew a rebate agreement for a specific prescription drug product, the pharmaceutical manufacturer or distributor of that product shall disclose to the department its most favorable pricing arrangements available to state and nonstate government purchasers of such products. If the department determines that the product needs to be included in the Controlled Medical Assistance Drug List, the department shall establish the amount of the rebate for such product based upon the price information provided by the manufacturer or distributor. The determination as to whether a product should be included in the Controlled Medical Assistance Drug List shall be based upon the product's efficacy, cost, medical necessity, and safety.
(d)
The provisions of this Code section shall be construed in conformity with Code Section
49-4-157
.
Amended by 2013 Ga. Laws 33,§ 49, eff. 2/24/2013.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-152.3 - Reuse of unit dosage drugs

(a)
As used in this Code section, the term:
(1)
"Long-term care facility" or "facility" means an intermediate care home, skilled nursing home, or intermingled home subject to regulation as such by the Department of Community Health.
(2)
"Unit dosage drug" means any dangerous drug regulated under Chapter 13 of Title 16 which is individually packaged to contain only one dosage of such drug and which includes on such packaging the brand or generic name, strength, lot number, and expiration date of such drug.
(b)
Unit dosage drugs may be returned to the dispensing pharmacy for reuse. The department and the State Board of Pharmacy shall promulgate regulations which permit the reuse of prescribed but unused unit dosage drugs for a resident of a long-term care facility other than the resident for whom the drug was originally prescribed, but only when:
(1)
The cost of those drugs has been paid for or reimbursed under this article; and
(2)
The drugs are unused because the resident for whom the drugs were originally prescribed:
(A)
Has died;
(B)
Has had such resident's prescription changed so as no longer to require those drugs; or
(C)
Otherwise no longer needs those drugs.
The consent of the resident for whom the unused drugs were originally prescribed shall not be required for such reuse of prescribed unit doses. Such reuse shall only be authorized by a resident of a long-term care facility for whom the specific dosage of that unused drug has been prescribed when payment or reimbursement for that drug for that resident is otherwise permitted under this article. Nothing in this Code section shall require a pharmaceutical manufacturer to provide a rebate based on the reuse of any unused unit dosage drug.
Amended by 2009 Ga. Laws 102,§ 1-4, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-152.4 - Department contracts to require refund of prescription drug rebates

The department shall provide that any department contract with a provider of medical assistance which is renewed or executed on or after July 1, 1997, shall require a refund to the department of any prescription drug rebate, as established in this article or in federal law in Section 1927 of Title XIX of the Social Security Act, as amended, obtained by the provider for prescription drugs furnished to recipients of medical assistance pursuant to that contract.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-152.5 - Restocking fees

In the provision of medical assistance pursuant to this article, the department shall allow for the payment and coverage of appropriate restocking fees incurred by a pharmacy which receives and dispenses unused over-the-counter and prescription drugs pursuant to Article 10 of Chapter 8 of Title 31.
Amended by 2016 Ga. Laws 471,§ 3, eff. 7/1/2016.
Amended by 2009 Ga. Laws 8,§ 49, eff. 4/14/2009.
Added by 2006 Ga. Laws 468,§ 2, eff. 7/1/2006.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-152.6 - Medicaid coverage for mood disorders prescriptions

(a)
The department shall provide Medicaid coverage for any prescription drug prescribed to an adult patient and determined by a duly licensed practitioner in this state to be medically necessary for the treatment and prevention of mood disorders with psychotic symptoms, including, but not limited to, bipolar disorders, schizophrenia and schizotypal, or delusion disorders if:
(1)
During the preceding year, the patient was prescribed and unsuccessfully treated with a preferred or generic drug; or
(2)
The patient has previously been prescribed and obtained prior approval for the nonpreferred prescribed drug.
(b)
If necessary to implement the provisions of this Code section, the department shall submit a Medicaid state plan amendment or waiver request to the United States Department of Health and Human Services.
Added by 2022 Ga. Laws 587,§ 6-5, eff. 7/1/2022.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-154 - Powers and duties retained by Department of Human Resources (Department of Community Health)

(a)
The status, position, and rights of persons transferred from the Department of Human Resources (now known as the Department of Community Health for these purposes) to the Department of Medical Assistance pursuant to Ga. L. 1977, p. 384 shall not be affected by the transfer, in and of itself; and such persons shall retain, inter alia, all rights of rank or grade; rights to vacation, sick pay, and leave; rights under any retirement plan; and any other rights under any law or administrative policy.
(b)
The Department of Human Resources (now known as the Department of Community Health for these purposes) shall retain, in accordance with terms of the state plan, the functions, and all tangible things and employees relating thereto, of:
(1)
Establishing and maintaining certain standards for certain institutions and agencies seeking to become or remain providers and shall finally determine and certify whether such institutions and agencies meet such standards;
(2)
Determining and certifying the eligibility of certain applicants for and recipients of medical assistance; and
(3)
Prescribing regulations to require that applicants for medical assistance be given clear and easily understandable notice that all books, papers, records, and memoranda of the provider relating to the provision of medical assistance to the applicant will be made available, upon request, to the commissioner of medical assistance or his representative and that, by accepting medical assistance, the applicant thereby consents to the providing of such books, papers, records, and memoranda to the commissioner of medical assistance or his representative.
Amended by 2009 Ga. Laws 102,§ 1-54, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-155 - Department of Community Health to succeed to existing rules, regulations, policies, procedures, and administrative orders

The Department of Community Health shall succeed to all the rules, regulations, policies, procedures, and administrative orders of the Department of Human Resources (now known as the Department of Human Services) transferred to the Department of Medical Assistance pursuant to the previously existing provisions of this Code section and that are in effect on June 30, 1999, and shall further succeed to any rights, privileges, entitlements, obligations, and duties of the Department of Human Resources (now known as the Department of Human Services) that are in effect on June 30, 1999, to which the Department of Medical Assistance succeeded pursuant to the previously existing provisions of Code Section
49-4-156
.
Amended by 2009 Ga. Laws 102,§ 1-55, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-156 - [Comprehensive Health Coverage Commission]

(a)
There is created the Comprehensive Health Coverage Commission. The commission shall be attached to the Department of Community Health for administrative purposes only as provided by Code Section
50-4-3
.
(b)
The commission shall consist of nine members, who shall be appointed no later than July 1, 2024, as follows:
(1)
The chairperson, who shall be a subject matter expert on health policy, and shall not be an employee of the State of Georgia, to be appointed by the Governor;
(2)
Three nonlegislative members to be appointed by the Speaker of the House of Representatives;
(3)
Three nonlegislative members to be appointed by the President of the Senate;
(4)
One nonlegislative member to be appointed by the minority leader of the Senate; and
(5)
One nonlegislative member to be appointed by the minority leader of the House of Representatives.
(c)
Members of the commission shall not be registered lobbyists in the State of Georgia.
(d)
Members of the commission shall serve without compensation.
(e)
The purpose of the commission shall be to advise the Governor, the General Assembly, and the Department of Community Health, as the administrator of the state medical assistance program, on issues related to access and quality of healthcare for Georgia's low-income and uninsured populations. The commission shall be tasked with reviewing the following:
(1)
Opportunities related to reimbursement and funding for Georgia healthcare providers, including premium assistance programs;
(2)
Opportunities related to quality improvement of healthcare for Georgia's low-income and uninsured populations; and
(3)
Opportunities to enhance service delivery and coordination of healthcare among and across state agencies.
(f)
Subject to appropriations, the commission shall contract with experts and consultants to produce a semiannual report on its findings for the Governor and the General Assembly. The commission shall provide its initial report to the Governor and the General Assembly no later than December 1, 2024.
(g)
The commission shall stand abolished on December 31, 2026, unless extended by the General Assembly prior to such date.
Added by 2024 Ga. Laws 384,§ 12, eff. 4/19/2024.
Repealed by 2010 Ga. Laws 376,§ 1, eff. 7/1/2010.
Added by 2005 Ga. Laws 399,§ 3, eff. 5/10/2005.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-156.1 - Reimbursement for services rendered under Article 5 of Chapter 6 of this title

It is the intention of the General Assembly that the Department of Community Health be authorized to take those actions necessary to provide reimbursement under this article for services rendered under Article 5 of Chapter 6 of this title, relating to community care for the elderly.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-157 - Construction of this article with federal act

It is the intention of the General Assembly that this article be construed consistently with Title XIX of the federal Social Security Act of 1935, as amended, and so as to authorize the Department of Community Health, within the appropriations provided to it, to administer the state plan in a manner so as to receive the maximum amount of federal financial participation available in expenditures made under the state plan.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-159 - Medicaid coverage for lactation and postpartum care

(a)
The department shall provide Medicaid coverage for:
(1)
Lactation care and services, as defined in paragraph (5) of Code Section
43-22A-3
, to pregnant and lactating women and to children who are breastfeeding or receiving their mother's milk; and
(2)
Postpartum care for mothers for a period of one year following the date the pregnancy ends.
(b)
If necessary to implement the provisions of this Code section, the department shall submit a Medicaid state plan amendment or waiver request to the United States Department of Health and Human Services.
Amended by 2022 Ga. Laws 870,§ 1, eff. 7/1/2022.
Added by 2020 Ga. Laws 473,§ 1, eff. 7/16/2020.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-159.1 - State plan amendment to implement express lane eligibility in Medicaid and the PeachCare for Kids Program; enrollment and renewal

(a)
No later than June 30, 2022, the department shall submit a state plan amendment to the federal Department of Health and Human Services to implement express lane eligibility in accordance with section 1902(e)(13) of the federal Social Security Act to determine whether a child meets one or more of the eligibility criteria for and enroll the child in Medicaid and the PeachCare for Kids Program. Such state plan amendment shall include, but not be limited to, reliance on a finding made by the Division of Family and Children Services of the Department of Human Services in determining eligibility of applicants for the federal Supplemental Nutrition Assistance Program and other programs as identified by the department and the Division of Family and Children Services of the Department of Human Services.
(b)
Upon approval of a state plan amendment, the Division of Family and Children Services of the Department of Human Services shall employ express lane eligibility by evaluating data received from applicants for the federal Supplemental Nutrition Assistance Program and other programs, as identified by the department and the Division of Family and Children Services of the Department of Human Services, to determine eligibility for Medicaid and the PeachCare for Kids Program and to provide for automatic enrollment and renewal of eligible children in Medicaid and the PeachCare for Kids Program.
Added by 2021 Ga. Laws 178,§ 1, eff. 7/1/2021.
2023 CODE OF GEORGIA › Title 49 - SOCIAL SERVICES (§§ 49-1-1 — 49-10-7) › Chapter 4 - PUBLIC ASSISTANCE (§§ 49-4-1 — 49-4-193) › Article 7 - MEDICAL ASSISTANCE GENERALLY (§§ 49-4-140 — 49-4-159.3) › Section 49-4-159.2 - [Multiple versions] [Repealed Effective 12/31/2025] Remote maternal health clinical services; reporting; termination

(a)
(1)
As used in this Code section, the term "remote maternal health clinical services" means the use of digital technology:
(A)
To collect medical and other forms of health data from a patient and electronically transmitting that information securely to a healthcare provider in a different location for interpretation and recommendation; and
(B)
Through a device that is compliant with the federal Health Insurance Portability and Accountability Act of 1996 and approved by the federal Food and Drug Administration.
(2)
Such term includes a device that:
(A)
Performs remote fetal monitoring, including maternal heart rate, fetal heart rate, amniotic fluid, placenta location, fetal presentation, tone, and movement;
(B)
Measures physiological data, including blood pressure, pulse, pulse oximetry, weight, blood glucose levels, or other such data determined to be medically necessary;
(C)
Uses remote non-stress test technology;
(D)
Uses remote ultrasound technology; or
(E)
Uses Doppler effect technology.
(b)
No later than October 31, 2025, the department shall submit a detailed written report on the provision of remote maternal health clinical services for Fiscal Year 2024 and Fiscal Year 2025 to recipients of medical assistance who meet eligibility criteria established by the department to the Governor, Lieutenant Governor, Speaker of the House of Representatives, and the chairpersons of the House Committee on Health, the Senate Health and Human Services Committee, the House Committee on Appropriations, and the Senate Appropriations Committee.
(c)
This Code section shall stand repealed by operation of law on December 31, 2025.
Added by 2023 Ga. Laws 231,§ 3, eff. 7/1/2023.