reglab/statecodes huggingface dataset:
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-11 - HOSPITAL DIRECTED PAYMENT PROGRAM › Rule 111-3-11-.01 - Definitions

Current through Rules and Regulations filed through June 27, 2024
As used in this Chapter 111-3-11:
(1) "Board" means the Board of Community
				Health, the body created under O.C.G.A. §
									31-2-3, appointed by the Governor,
				that establishes the general policy to be followed by the Department of
				Community Health.
(2) "Care
				Management Organization" means a managed care organization defined in
				42 CFR §
										438.2 and O.C.G.A. §
									33-21A-2(1).
(3) "Department" means the Department of
				Community Health established under O.C.G.A. §
									31-2-3.
(4) "Directed Payment" means any payment made
				to hospitals by Care Management Organizations pursuant to their Medicaid
				managed care contracts with the Department as authorized under
				42 CFR §
										438.6(c).
(5) "Hospital" means an institution license
				pursuant to Chapter 7 of Title 31, which is primarily engaged in providing to
				inpatients, by or under the supervision of physicians, diagnostic services and
				therapeutic services for medical diagnosis, treatment, and care of injured,
				disabled, or sick persons or rehabilitation services for the rehabilitation of
				injured, disabled, or sick persons. Such term includes public, private,
				rehabilitative, geriatric, osteopathic, and other specialty hospitals but shall
				not include psychiatric hospitals, which shall have the same meaning as
				facilities as defined in paragraph (7) of O.C.G.A. §
									37-3-1, critical access hospitals
				as defined in paragraph (3) of O.C.G.A. §
									33-21A-2, or any state owned or
				state operated hospitals.
(6)
				"Non-Governmental Hospital" means a subclass of Hospitals, authorized to be
				defined by the Board pursuant to paragraph (a) of O.C.G.A. §
									31-8-179.2, that shall not include
				public, long term acute care, children's, rehabilitative, geriatric,
				osteopathic, and other specialty hospitals, psychiatric hospitals which shall
				have the same meaning as facilities as defined in paragraph (7) of O.C.G.A.
				§
									31-8-179.2, critical access
				hospitals as defined in paragraph (3) of O.C.G.A. §
									33-21A-2, or any state-owned or
				state-operated hospitals.
(7)
				"Provider Payment" means a payment assessed by the Department pursuant to this
				chapter for the privilege of operating a Non-Governmental Hospital.
(8) "Segregated Account" means an account for
				the dedication and deposit of Provider Payments which is established within the
				Trust Fund.
(9) "Trust Fund" means
				the Indigent Care Trust Fund created by Article 6 of Chapter 8 of Title
				31.
(10) "Waiver" means a waiver of
				the requirements for permissible health care related taxes, as provided for in
				42 C.F.R §
										433.68.
O.C.G.A. §
											31-8-179.3.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-11 - HOSPITAL DIRECTED PAYMENT PROGRAM › Rule 111-3-11-.03 - Use of Provider Payments

Current through Rules and Regulations filed through June 27, 2024
(1) The Department shall collect the Provider
				Payments imposed pursuant to this Chapter. All revenues raised pursuant to this
				Chapter shall be deposited into the Segregated Account. Such funds shall be
				dedicated and used for the sole purpose of obtaining federal financial
				participation for Directed Payments to Non-Governmental Hospitals from Care
				Management Organizations on behalf of Medicaid recipients pursuant to Article 7
				of Chapter 4 of Title 49. Directed Payments shall be exclusively used to
				provide Medicaid payments to Non-Governmental Hospitals based on each
				Non-Governmental Hospital's individual claims to Care Management
				Organizations.
(2) Revenues
				appropriated to the Department by the General Assembly pursuant to Article 6C
				of Chapter 8 of Title 31, shall be used to match federal funds that are
				available for the purpose for which such funds have been
				appropriated.
(3) The Department
				shall require the Care Management Organizations to remit any payments required
				under this Rule within ten (10) days of the Department's receipt of the
				Provider Payments pursuant to this Chapter.
O.C.G.A. §
											31-8-179.3.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-11 - HOSPITAL DIRECTED PAYMENT PROGRAM › Rule 111-3-11-.04 - Use of Directed Payments

Current through Rules and Regulations filed through June 27, 2024
(1) The Department may, in its sole
				discretion, create one or more directed payment programs in accordance with
				this Chapter.
(2) Non-Governmental
				Hospitals shall comply with Department requests to submit reports to the
				Department when necessary to comply with the requirements of
				42 CFR
				438.6(c)(2)(ii).
O.C.G.A. §
											31-8-179.3.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
(1) Act No. 397,
				Georgia Laws 1957, contains legislative authority for the creation of a
				"Hospital Care for the Indigent" program. The purpose of the program is "to
				assist counties in the purchase of hospital care for persons who are ill or
				injured, and who can be helped by treatment in a hospital, and who are
				financially unable to meet the full cost of hospital care from their own
				resources or from the resources of those upon whom they are legally
				dependent."
(2) This program is a
				State-County jointly financed and administered approach to providing hospital
				care for the medically indigent. However, participation in the program is
				voluntary with each county. The program will support the preservation of the
				professional freedom of physicians and the local control of hospitals.
				Furthermore, local program administration will be encouraged.
(3) Generally speaking, payment for hospital
				care is the responsibility of the individual and the local community. It is the
				intent of this program to supplement local action. Accordingly, the program
				should not be construed as replacing Federal, State, or local programs for the
				indigent. It is a basic program objective to provide financial means for the
				payment of hospital care for indigent patients who are hospitalized outside of
				their respective county or residency.
(4) The "Hospital Care for the Indigent"
				Program has been developed in close liaison with the Medical Association of
				Georgia, the Georgia Association of County Commissioners, the Georgia
				Association of Hospital Governing Boards, and the Georgia Hospital Association.
				Each of these organizations have representation on the Hospital Care Advisory
				Council.
(5) The Legislature
				delegated the administration of the program to the Department of Community
				Health. The purpose of this program is to assist counties in the purchase of
				hospital care for persons who are ill or injured and who can be helped by
				treatment in a hospital but are financially unable to meet the full cost of
				hospital care from their own resources or from the resources of those upon whom
				they are legally dependent.
Ga. L. 1933, p.
				  7., O.C.G.A. §
											31-8-1
				  (2009).
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.02 - Method for County Participation in the Program

Current through Rules and Regulations filed through June 27, 2024
(1) Procedure for County Participation:
(a) For a county to initiate participation in
				the Program, the governing authority of such county, by formal resolution or by
				contract agreement, must satisfy the provisions of
				111-3-12-.02(2).
(b) For continued participation in the
				Program, the county must comply with the Rules and Regulations governing the
				administration of the Program, and the governing authority of the county
				annually must adopt a renewal resolution or renew its contract agreement. The
				annual resolution or contract must satisfy the provisions of
				111-3-12-.02(2)
				and the required document must be filed with the Georgia Department of
				Community Health on or before the first day of April to assure participation
				for the entire ensuing fiscal year.
(c) The Georgia Department of Community
				Health shall make the determination, on a uniform state-wide basis, or whether
				a formal resolution, a contract agreement, or both shall be submitted by the
				county for participation in the Program.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.03 - Method of Allotment and Matching of State Funds

Current through Rules and Regulations filed through June 27, 2024
(1) Calculating the Allotment of State Funds:
(a) Within the one dollar ($1.00) per capita
				legal limitation, State funds shall be allotted to each participating county
				according to two factors: population and median income.
1. The population shall be the latest
				official decennial population count of the U.S. Census Bureau, adjusted to
				exclude military personnel and wards of State institutions.
2. The median income, which is an index of
				relative economic ability, shall be obtained from the most recent
				"Characteristics of Population" for Georgia as prepared by the U. S. Census
				Bureau in connection with its official decennial population count.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.04 - Method of Local Administration

Current through Rules and Regulations filed through June 27, 2024
(1) Supervision of Local Program:
(a) The governing authority of the county
				shall have the following Program role:
1. to
				determine whether the Program should be activated in the county and to
				establish the local budget needed;
2. to review and to adopt the County Program
				Plan;
3. to make an annual review
				of Program performance and to determine whether the Program is to be continued
				in its county.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.05 - Criteria for Determining Indigency

Current through Rules and Regulations filed through June 27, 2024
(1) General Statement on Determining
				Financial Eligibility:
(a) The Department of
				Community Health desires that each county have as much freedom as possible in
				determining the eligibility of its residents under the provisions of this
				Program.
(b) Recognizing the
				differences in the socio-economic level of the several counties, there shall be
				no rigid state-wide formula devised for determining indigency and medical
				indigency.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.06 - Criteria for Hospitalization

Current through Rules and Regulations filed through June 27, 2024
(1) Certification of Hospital Care:
(a) This Program shall provide essential
				hospitalization for the acutely ill or injured who are eligible otherwise under
				Program requirements and who are certified by the county of
				residency.
(b) Each Participating
				County has the option of including or excluding normal obstetrics as eligible
				under the Program.
(c) A standard
				application form shall be required for all patients who receive services under
				the Program.
(d) All applications
				for hospitalization under the Program must be initiated by a
				physician.
(e) Hospitalization
				under the Program for any one patient shall not exceed thirty days in any
				twelve-month period.
(f) The
				applicant's attending physician, in recommending hospitalization shall certify
				the following:
1. That the applicant is
				acutely ill or injured;
2. That in
				his professional judgment intensive care normally provided by a hospital is
				required;
3. That there is
				likelihood of substantial benefit from hospitalization;
4. That he has reason to believe that the
				applicant is indigent;
5. That he
				has reason to believe the applicant is NOT eligible for care under any other
				program.
(g) The
				applicant's attending physician in recommending hospitalization shall indicate,
				to the best of his judgment, the number of days of hospitalization required and
				the hospital providing the type of care needed by the applicant.
(h) The County Board of Health, or its
				authorized agent, shall make the final decision on the following matters:
1. Selection of the Hospital to be used by
				the applicant.
2. The number of
				hospitalization days which will be authorized.
(i) The County Board of Health, or its
				authorized agent, shall promptly notify the Georgia Department of Community
				Health regarding all hospital care authorized under the Program.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-12 - RULES AND REGULATIONS FOR HOSPITAL CARE FOR THE INDIGENT › Rule 111-3-12-.07 - Method for Approval of Participating Hospitals

Current through Rules and Regulations filed through June 27, 2024
(1) Procedure for Becoming a Participating
				Hospital:
(a) Prerequisite to any hospital
				becoming a Participating Hospital under the Program, the governing authority of
				the hospital must elect to participate in the Program.
(b) In expressing the desire of the hospital
				to participate in the Program, a responsible officer of the hospital shall
				complete a standard application form and shall submit such application to the
				Georgia Department of Community Health.
(c) A hospital once approved will continue as
				a Participating Hospital until it voluntarily withdraws or its approval is
				revoked.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-14 - AMBULANCE PROVIDER MATCHING PAYMENT PROGRAM › Rule 111-3-14-.01 - Definitions

Current through Rules and Regulations filed through June 27, 2024
As used in this Chapter 111-3-14:
(1) "Board" means the Board of Community
				Health, the body created under O.C.G.A. §
									31-2-3, appointed by the Governor,
				that establishes the general policy to be followed by the Department of
				Community Health.
(2) "Department"
				means the Department of Community Health established under O.C.G.A. §
									31-2-1.
(3) "Ambulance Service" for the purpose of
				this rule means a private entity performing services as defined in O.C.G.A.
				§
									31-11-2(4)(A),
				specifically, for providing emergency care and transportation on the public
				streets and highways of this state for a wounded, injured, sick, invalid, or
				incapacitated human being to or from a place where medical or hospital care is
				furnished, and where such private entity is licensed by the Department of
				Public Health and is a 911 responding ambulance provider, either designated as
				a 911 provider or providing services under a service delivery contract for a
				designated 911 provider.
(4) "Net
				Patient Revenue" means the total gross patient revenue of an Ambulance Service
				less contractual adjustments, charity care, bad debt, or any other
				write-offs.
(5) "Provider Matching
				Payment" means payment assessed by the Department pursuant to this Chapter on
				providers which operate a Private Ambulance Service.
(6) "Private Ambulance Service" means an
				Ambulance Service, as defined in this Chapter, other than:
(a) An Ambulance Service owned and operated
				by the Federal government
(b) An
				Ambulance Service owned and operated by a unit of State government
(c) An Ambulance Service owned and operated
				by a unit of Local (non-state) government
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-14 - AMBULANCE PROVIDER MATCHING PAYMENT PROGRAM › Rule 111-3-14-.03 - Use of Provider Payments

Current through Rules and Regulations filed through June 27, 2024
(1) The Department shall collect the Provider
				Matching Payments imposed pursuant to this Chapter. All revenues collected
				pursuant to this Chapter shall be deposited into the Segregated Account. Such
				funds shall be dedicated and used for the sole purpose of obtaining federal
				financial participation for medical assistance payments to Private Ambulance
				Service providers on behalf of Medicaid recipients pursuant to Article 7 of
				Chapter 4 of Title 49.
(2) Revenues
				appropriated to the Department by the General Assembly pursuant to Article 6C
				of Chapter 8 of Title 31, shall be used to match federal funds that are
				available for the purpose for which such funds have been
				appropriated.
O.C.G.A. §
											31-11-31.2.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-14 - AMBULANCE PROVIDER MATCHING PAYMENT PROGRAM › Rule 111-3-14-.04 - Effective Date

Current through Rules and Regulations filed through June 27, 2024
Upon the adoption by the Board, Chapter 111-3-14 shall become
				  effective on July 1, 2022.
O.C.G.A. §
											31-11-31.2.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.02 - Organizations

Current through Rules and Regulations filed through June 27, 2024
(1)
Functions,
				Duties and Responsibilities of the Board of Community Health.
The Board
				shall provide policy direction for the operation of the State Health Benefit
				Plan. Other responsibilities as defined by law are:
(a)
Establish and Design Plan
.
				The Board is authorized to establish a Health Insurance Plan for group medical
				insurance against the financial costs of hospitalizations and medical care. The
				Plan may also include, but is not required to include, prescription drugs,
				prosthetic appliances, hospital inpatient and outpatient Benefits, dental
				Benefits, vision care Benefits, and other types of medical Benefits. The Plan
				shall be designed to:
1. Provide reasonable
				hospital, surgical, and medical benefits with cost sharing of expenses for each
				such type to be incurred by the Enrolled Members, Dependents and the Plan,
				and
2. Include reasonable controls,
				which may include deductible and reinsurance provisions applicable to some or
				all of the benefits, to reduce unnecessary utilization of the various hospital,
				surgical and medical services to be provided and to provide reasonable
				assurance of financial stability in future years of the Plan.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.04 - Eligibility for Coverage

Current through Rules and Regulations filed through June 27, 2024
(1) Active Employees. Employees who are
				actively at work or on approved leave of absence and have not terminated their
				employment may participate in the SHBP if classified as the following:
(a)
Full-Time.
1. State Employees who work a minimum of
				thirty (30) hours per weeks are considered full-time.
2. A regular full-time Employee who receives
				a salary or wage payment from a state department, board, agency, commission,
				the general assembly, a community service board, or a local government or other
				organization to which the Department of Community Health provides SHBP coverage
				through a contract authorized by the Board of Community Health; except
				contingent workers of the Labor Department, specially classified Employees of
				the Jekyll Island State Park Authority, Employees working as an independent
				contractor or on a temporary, seasonal, or intermittent basis and Employees
				whose duties are expected to require less than nine (9) months of
				service.
3. A regular full-time
				Employee who receives a salary or wage payment from a state authority that
				participates in the Employees' Retirement System;
4. Part-time Employees of the General
				Assembly who had coverage prior to January 1981, and Administrative and
				clerical personnel of the General Assembly;
5. A full-time district attorney, assistant
				district attorney who was appointed pursuant to O.C.G.A. §
											15-18-14, or district attorneys'
				investigators appointed pursuant to O.C.G.A. §
											15-18-14.1 of the superior courts
				of this state;
6. A full-time
				Employee who receives a salary or wage payment from a county board of health or
				a county board of family and children services that receives financial
				assistance from the Department of Human Resources; except for sheltered
				workshop Employees;
7. Full-time
				secretaries and law clerks who are employed by district attorneys and judges
				and are employed under O.C.G.A. §§
											15-6-25 through
				15-6-28 and O.C.G.A. §§
											15-18-17 through
				15-18-19.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.06 - Changes in Coverage and Option

Current through Rules and Regulations filed through June 27, 2024
(1)
Open Enrollment Period and Retiree
				Option Change Period.
The Open Enrollment period and Retiree Option
				change period shall be a minimum period of fifteen (15) days and shall begin no
				earlier than October 1 and shall end no later than November 15 of each year.
				The Commissioner shall announce the dates of the periods each year. Eligible
				Employees, enrolled Retirees and Extended Beneficiaries shall be given an
				opportunity to make the changes in Coverage election as reflected in the
				following paragraphs.
(a)
Active
				Employees.
Eligible Active Employees, eligible Employees on Approved
				Leave of Absence Without Pay and Extended Beneficiaries shall be given an
				opportunity to enroll or change Coverage during the Open Enrollment
				period.
(b)
Retirees.
During the Retiree Option Change Period, enrolled Retirees shall be
				given an opportunity to change Coverage Option to any Option for which the
				Retiree is eligible.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.07 - Extended Coverage Under State Law

Current through Rules and Regulations filed through June 27, 2024
(1)
Employee.
Employees are
				permitted to continue the current Coverage under conditions outlined by State
				law. Application for Extended Coverage must be made to the Administrator within
				thirty-one (31) calendar days following Coverage termination as an Active
				Employee or Extended Beneficiary. Coverage election under Section
				111-4-1-.08, Extended Coverage Under
				Federal law, delays eligibility to enroll under State law provisions until the
				expiration of the Extended Beneficiary Coverage privileges, except as
				specifically stated in these provisions.
(a)
State Employee.
1. Any State
				Employee who resigns from employment or who is not re-elected on and after July
				1, 1978 and who has completed eight (8) or more years of service as an
				Employee, exclusive of Approved Leaves of Absence Without Pay for which health
				benefit Coverage may have been continued, under Section
				111-4-1-.04(1)(a)
				shall have the privilege of continuing Coverage.
2. Any State Employee who has been eligible
				for Coverage under this Plan for a period of ten (10) years, is discharged and
				is appealing the discharge to the State Personnel Board shall be entitled to
				continue Coverage for a period required for the State Personnel Board to render
				a decision but no longer than six (6) calendar months. The Premium for such
				Coverage will be the same amount as paid by the Active Employee through payroll
				Deduction/Reduction. The Employing Entity must notify the Member and the
				Administrator of the Member's eligibility to continue Coverage. Failure to pay
				the full Premium within the allotted time shall result in suspension of benefit
				payments and/or termination of Coverage and forfeit all eligibility for
				continued Coverage.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.09 - Termination of Coverage

Current through Rules and Regulations filed through June 27, 2024
(1)
Termination from Employment.
Termination from employment includes resignation, abandonment of job,
				release from job, forfeiture of job, and all other types of termination. Health
				benefit Coverage shall terminate at the end of the month following the month of
				the last date of employment that was transmitted to the Administrator unless
				continued under the provision of Extended Coverage. This date will normally be
				the end of the month following the month in which separation or termination of
				employment occurred.
(2)
Employment Layoff.
Employment layoff means that the Employer has
				formalized a reduction in staff plan and the Employee will no longer be
				employed by one of the Employing Entities. Health Benefit Coverage shall
				terminate at the end of the month following the month of the last date of
				employment that was transmitted to the Administrator, unless continued under
				the provisions of Extended Coverage. The Coverage termination date will
				normally be the end of the month following the month in which the layoff
				occurred.
(3)
Reduction of
				Hours.
A reduction in hours worked may result in loss of eligibility to
				continue health benefit Coverage.
(a) If for
				any reason the number of worked hours is reduced for a covered State Employee
				to less than thirty (30) hours per week, Coverage shall terminate at the end of
				the month following the month in which the reduced hours took effect; unless
				continued under the provisions of Extended Coverage.
(b) If for any reason the number of worked
				hours is reduced for a covered Teacher to less than half-time or a minimum of
				seventeen and one-half (17 1/2) hours per week, Coverage shall terminate at the
				end of the month following the month in which the reduced hours took effect;
				unless continued under the provisions of Extended Coverage.
(c) If for any reason the number of worked
				hours is reduced for a covered Public School Employee to less than sixty (60)
				percent of that required to perform the position duties, Coverage shall
				terminate at the end of the month following the month in which the reduced
				hours took effect; unless continued under the provisions of Extended Coverage.
				However, the sixty (60) percent cannot be less than twenty (20) hours if the
				Member is a participant in the Teachers Retirement System and less than fifteen
				(15) hours if the member is a participant in the Public School Employees
				Retirement System.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.11 - Claims

Current through Rules and Regulations filed through June 27, 2024
(1)
Filing
				Claims.
The Administrator shall coordinate the procedures for filing
				claims with the TPA. Such procedures may not establish a liability period
				greater than the maximum liability period set forth below. Claim forms shall be
				designed and printed for the Member's and providers' use when
				appropriate.
(2)
Maximum
				Liability Period.
All Claims of Benefits must be presented in writing to
				the Administrator or TPA in accordance with the procedures established by the
				Administrator and the TPA, which procedures may not permit payment of claims
				submitted after twenty-four (24) calendar months following the month of service
				in which the service was rendered. If any Claim for Benefits is presented to
				the Administrator or TPA after two (2) years from the date the service was
				rendered, benefits will not be owed or paid.
(3)
Unclaimed or Uncased Claim
				Checks.
All drafts issued on behalf of the Plan shall be void if not
				presented and accepted by the drawer's bank within six (6) calendar months of
				the date the draft was drawn. If the payee or Subscriber does not present the
				draft or request a reissue of the draft for a period of seven (7) years from
				the date the draft was drawn, the draft will be void and funds retained in the
				appropriate trust Fund.
O.C.G.A. Sec.
				  20-2-881,
				  20-2-884,
				  20-2-890,
				  20-2-911,
				  20-2-917,
				  45-18-2,
				  45-18-6,
				  45-18-11.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.12 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. Secs.
				  20-2-881,
				  20-2-890,
				  20-2-911,
				  20-2-917,
				  45-18-2,
				  45-18-11.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.13 - Georgia Retiree Health Benefit Fund

Current through Rules and Regulations filed through June 27, 2024
(1)
Functions, Duties and
				Responsibilities of the Board of Community Health.
The Board shall
				establish the Georgia Retiree Health Benefit Fund (GRHBF). The Board in its
				official capacity shall be the GRHBF's trustee. The Board shall annually review
				Other Post Employment Benefits (OPEB) liability. The Board shall determine
				Annual Required Contributions (ARC), which may not be the same as employer and
				employee contribution rates. The Board shall also determine annual employer and
				employee contribution rates. The Board shall collect employee and employer
				contributions and deposit the contributions into the GRHBF. The Board may
				utilize the investment services of the Employee Retirement System, Division of
				Investment Services to invest a portion of the GRHBF for long-term investments.
				No member of the Board or employee of the Department shall have any personal
				interest in the gains or profits from any investment made by the Board or use
				the assets of the GRHBF in any manner, directly or indirectly, except to make
				such payments as may be authorized by the Board or by the Commissioner as the
				executive officer of the Board.
(a)
Establish and Design Plan.
The Board is authorized to establish
				the GRHBF to collect employee and employer contributions for OPEB. The Board
				shall account for employee and employer contributions by each pension plan, as
				delineated at
				111-4-1-.01(50),
				separately.
(b)
Promulgate
				Regulations.
The Board is authorized to adopt and promulgate rules and
				regulations for the effective administration of the GRHBF.
(c)
Establish
Contributions
on
Behalf of Retirees.
The
				Board shall establish by Resolution, contributions by public school teacher
				retirees, retired public school employees, retired State employees, and any
				other Annuitant listed at
				111-4-1-.01(50) and
				shall deposit those contributions into the GRHBF. The Board shall consider the
				actuarial estimates of OPEB in establishing the contributions.
(d)
Establish Employer Rates.
The Board shall establish by Resolution, OPEB employer contribution rates and
				shall deposit those contributions into the GRHBF.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.01 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.02 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.03 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.04 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.05 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.06 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.07 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.08 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.09 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.10 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.11 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.12 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.13 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-5 - REPEALED › Subject 111-5-1 - REPEALED › Rule 111-5-1-.14 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. §
										31-2A-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
These rules are adopted and published pursuant to the
				  Official Code of Georgia Annotated (O.C.G.A.) §
									49-6-80
et seq.
,
				  the "Adult Day Center for Aging Adults Licensure Act."
O.C.G.A. §
										49-6-80.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.02 - Title and Purposes

Current through Rules and Regulations filed through June 27, 2024
These rules shall be known as the Rules and Regulations for
				  Adult Day Centers. The purposes of these rules are to provide for licensing and
				  inspection of adult day centers which provide adult day care services and/or
				  adult day health services to three or more adults, and to establish the minimum
				  standards for the operation of adult day centers. It is the intent of these
				  rules to promote, safeguard and protect the well-being of adults participating
				  in adult day care who need such services.
O.C.G.A. §
										49-6-80.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.03 - Exemptions

Current through Rules and Regulations filed through June 27, 2024
These rules and regulations shall not apply to the
				  following:
(1) Individuals or
				organizations operating an adult day center without receiving compensation as a
				condition of the participant's receiving such services;
(2) Individuals or organizations that provide
				services for compensation to only one or two participants;
(3) Programs which provide day habilitation
				and treatment services exclusively for developmentally disabled persons;
				and
(4) Respite care services
				programs, provided the program meets all parts of the definition for a respite
				care services program as outlined in section
				111-8-1-.04(hh).
O.C.G.A. §
										49-6-82.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.06 - License Requirements

Current through Rules and Regulations filed through June 27, 2024
(1) The governing body of each adult day
				center shall obtain a valid license from the Department prior to beginning
				operation. To be eligible for a license, the center must be in substantial
				compliance with the applicable rules and regulations.
(2) The adult day center's capacity shall be
				determined by the floor space available for participant activity, as described
				in 111-8-1-.10(1)(f),
				and the occupancy load determined by the local authority having jurisdiction
				over fire safety or the State Fire Marshal. The license shall state the maximum
				number of participants per day who may receive services at the center. Adult
				day centers shall schedule and provide services to participants in such a
				manner that it does not exceed its licensed capacity.
(3) The license shall be displayed in a
				prominent place on the premises where the adult day center programs are
				operated.
(4) Licenses are not
				transferable from one governing body to another or from one adult day center
				location to another.
(5) A license
				shall no longer be valid and shall be returned to the Department when the adult
				day center ceases to operate, changes locations, the ownership changes, the
				governing body is significantly changed, or the license is suspended or
				revoked. At such time a license is no longer valid, it shall be returned to the
				Department.
(6) Each change of
				ownership, change of location, addition of another location, change in name,
				change in the maximum number of participants per day or a change in the scope
				of services provided shall be reported to the Department along with an
				application from the proposed new owners or lessees for a new
				license.
O.C.G.A. §
										49-6-83.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.07 - Governing Body

Current through Rules and Regulations filed through June 27, 2024
(1) Each adult day center or mobile adult day
				center shall have a clearly identified governing body which shall be empowered
				and responsible for determining all policies and procedures and ensuring
				compliance with these rules and regulations.
(2) The governing body shall be responsible
				for compliance with the requirements of O.C.G.A. §§
									49-6-81 through
				49-6-86, and with applicable
				administrative rules and regulations of the Department, including but not
				limited to all applicable statutes, rules and regulations regarding disclosure
				of ownership.
(3) The governing
				body shall certify in its application the name of the Director who has been
				designated as responsible for the overall management of the center and for
				carrying out the rules and policies adopted by the governing body.
(4) The governing body shall notify the
				Department in writing immediately when there is a change in the
				Director.
(5) Each adult day center
				owned or operated by the same governing body shall have a designated Director
				who is available on-site during operating hours.
O.C.G.A. §
										49-6-81.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.09 - Disaster Preparedness, Fire Safety and Emergencies

Current through Rules and Regulations filed through June 27, 2024
(1) In a format
				provided by the Department, each center shall complete and submit for approval
				a disaster preparedness plan that contains a set of procedures for responding
				to internal and external disasters or emergency situations.
(2) The disaster preparedness plan shall
				identify the staff position responsible for implementing the plan, obtaining
				necessary emergency medical attention or intervention for participants, and
				coordinating with the local emergency management agency.
(3) A standardized format shall be used
				throughout the plan that clearly describes how the emergency procedures should
				be carried out for each potential disaster. The emergency procedures should
				answer the questions of "who, what, when, where, and how," and allow the center
				to be ready to act effectively and efficiently in an emergency
				situation.
(4) The plan shall
				contain a section that outlines the frequency of rehearsal and the procedures
				to be followed during rehearsal. Each aspect of the plan must be rehearsed on
				an annual basis.
(5) Each center
				shall forward a copy of the plan to the local emergency management
				agency.
(6) Each center shall
				review and update its disaster preparedness plan as needed, but at a minimum on
				an annual basis.
(7) Each center
				shall maintain the following records and make them available to authorized
				Department employees upon request:
(a) A copy
				of the disaster preparedness plan and any subsequent changes thereto, which
				shall also be available for immediate access by center staff;
(b) Records of rehearsals of the disaster
				preparedness plan to include the names of all participants, staff and
				volunteers participating in the rehearsals; and
(c) Records of incidences, which required
				implementation of the disaster preparedness plan, including a written incident
				report and a written critique of the performance under the plan.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-8 - HEALTHCARE FACILITY REGULATION › Subject 111-8-1 - RULES AND REGULATIONS FOR ADULT DAY CENTERS › Rule 111-8-1-.10 - Physical Plant Health and Safety Standards

Current through Rules and Regulations filed through June 27, 2024
(1)
General.
The adult day
				center shall be constructed, arranged, and maintained so as to provide
				adequately for the health, safety, access, and well-being of the participants.
(a) Each center shall have a standard
				telephone, not a pay telephone or cellular telephone, on the premises which is
				immediately accessible during the center's hours of operation. A list of
				emergency telephone numbers for fire, ambulance, police, poison control and 911
				shall be posted at each telephone.
(b) Each center shall provide adequate, safe
				and sanitary facilities appropriate for the services provided by the center and
				for the needs of the participants. All centers shall be accessible to and
				usable by physically disabled individuals and shall meet all applicable
				regulations for access for the handicapped.
(c) The adult day center shall be in
				compliance with all building codes and other applicable codes.
(d) Each center shall provide adequate
				lighting for participant activities and safety.
(e) Each center shall be adequately
				ventilated at all times by either mechanical or natural means to provide fresh
				air and the control of unpleasant odors.
(f) There shall be adequate floor space in
				the center to safely and comfortably accommodate the number of participants for
				all activities and services provided by the center. Centers shall provide at
				least 35 feet of usable floor space for each participant, exclusive of
				passageways, bathrooms, lockers, storage rooms, staff rooms, and other areas
				not used for participant activities.