reglab/statecodes huggingface dataset:
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.06 - Investigations, Inspections and Plans of Correction

Current through Rules and Regulations filed through June 27, 2024
(1)
Authority to Investigate.
The department shall have the authority to make public or private
				investigations inside or outside this state. Such investigations may be
				initiated at any time, in the discretion of the department, and may continue
				during the pendency of any action initiated by the department pursuant to Rule
				111-8-25-.05 of this
				Chapter.
(2)
Consent to Entry
				and Access.
An application for a license or the issuance of the same by
				the department constitutes consent by the applicant or licensee and the owner
				of the premises for the department's representatives, after displaying
				identification to any facility staff, to enter the facility for the purpose of
				conducting an investigation or an inspection.
(a) Department representatives shall be
				allowed reasonable and meaningful access to the facility's premises, and
				information pertinent to licensure including staff and persons in care. The
				department shall have the authority to require the production of any documents
				related to the initial and continued licensing of any facility.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.07 - Immunity

Current through Rules and Regulations filed through June 27, 2024
For any action taken or any proceeding held under this
				  Chapter or under color of law, except for gross negligence or willful or wanton
				  misconduct, the department, when acting in its official capacity, shall be
				  immune from liability and suit to the same extent that any judge of any court
				  of general jurisdiction in this state would be immune.
O.C.G.A. Sec.
				  31-2-11.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.08 - Exemptions

Current through Rules and Regulations filed through June 27, 2024
In an administrative or legal proceeding under this Chapter,
				  a person claiming an exemption or an exception granted by law, rule,
				  regulation, or formal order has the burden of proving this exemption or
				  exception.
O.C.G.A. Sec.
				  31-2-11.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.09 - Applicability of Administrative Procedures Act

Current through Rules and Regulations filed through June 27, 2024
This Chapter and all sanction actions resulting from its
				  provisions shall be administered in accordance with Chapter 13 of Title 50 of
				  the Official Code of Georgia Annotated, the Georgia Administrative Procedure
				  Act. Any request for hearing in response to any sanction action undertaken
				  pursuant to this Chapter shall be in writing and shall be submitted to the
				  department no later than 10 calendar days from the date of receipt of any
				  notice of intent by the department to impose a sanction setting forth the
				  proposed sanction or sanctions and the basis therefore.
O.C.G.A. Secs.
				  31-2-11,
				  50-13-18.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.10 - Notice of Violations

Current through Rules and Regulations filed through June 27, 2024
(1) Where a nursing home or intermediate care
				home is required by the provisions of O.C.G.A. §
									31-7-3.2 to give notice of
				violations giving rise to the imposition of any sanction, the notice shall
				contain the information required by that code section and shall conform to the
				following requirements:
(a)
Size and
				Format of Notice.
The facility may post the Report of Licensure
				Inspection and Medicare/Medicaid Statement of Deficiencies, along with the
				notices by the department, the department's Division of Medical Assistance
				and/or the Center for Medicare and Medicaid Services of intent to impose any
				sanction. These may be posted in their original forms as the notice required by
				O.C.G.A. §
										31-7-3.2(a)and(b).
				If the facility chooses to post the notice of the agency taking the action and
				the Report of Licensure Inspection and Statement of Deficiencies, there shall
				be a conspicuous heading clearly visible from at least twenty feet away,
				calling the attention of the observer to them. As an alternative, the facility
				may post its own notice which accurately and thoroughly reflects the violations
				found which give rise to the sanctions imposed or proposed and which describes
				each sanction or notice of sanction issued by any of the above-described
				agencies. Any such notice shall be at least 11 1/2 inches by 17 1/2 inches in
				size. Words and letters shall be in bold print and shall be at least one
				centimeter in size;
(b)
Location of Notice.
The facility shall post the notice in a place
				readily accessible and continuously visible to persons in care and their
				representatives;
(c)
Timing
				of Notice.
The facility shall post the notices within fourteen days
				after it receives notification of the imposition of a sanction for a violation
				which requires the notice. The notices shall remain in place until the
				department has determined that cited violations no longer exist, at which time
				the notice may be removed; and
(d)
Mailing of Notices.
Where any person has made a written request
				for a copy of the notice or notices, the facility shall mail the same to the
				requester within 5 business days of receipt of the request when such request is
				accompanied by a postage paid self addressed envelope.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.11 - Applicability of Other Laws

Current through Rules and Regulations filed through June 27, 2024
The provisions of this Chapter shall be supplemental to and
				  shall not operate to prohibit the department from acting pursuant to those
				  provisions of law which may now or hereafter authorize remedial or disciplinary
				  grounds and action for the department. In cases where those other provisions of
				  law so authorize other disciplinary grounds and actions, but this Chapter
				  limits such grounds or actions, those other provisions shall
				  apply.
O.C.G.A. Sec.
				  31-2-11.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.12 - Inspection Warrants

Current through Rules and Regulations filed through June 27, 2024
In addition to the enforcement actions authorized by this
				  Chapter with respect to refusal to provide the department with access to a
				  facility, the department may make application to a court of competent
				  jurisdiction for an inspection warrant if its representatives are denied
				  meaningful access to the premises, staff, persons in care, and documents or
				  other information of a licensed facility or of a facility which the department
				  believes is required to have a license but which does not have one. Upon the
				  grant of such a warrant, the department may gain entry and meaningful access to
				  such facility, its staff, and persons in care therein, facility documents, and
				  other information deemed pertinent by the department to making a compliance
				  determination, unless the warrant specifically limits the entry or access
				  allowed to department representatives. This rule shall not be construed to
				  require the department to seek entry and be denied the same before it may apply
				  for an inspection warrant.
O.C.G.A. Secs.
				  31-2-11,
				  31-5-20
et
				  seq.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.13 - Injunctive Relief

Current through Rules and Regulations filed through June 27, 2024
The department may, without regard to the availability of
				  other remedies, including the remedies set forth in this Chapter, seek an
				  injunction against the continued operation of a facility without a license. The
				  department likewise may seek injunctive relief against the continued operation
				  of a facility in violation of licensing requirements.
O.C.G.A. Secs.
				  31-2-11,
				  31-5-9.
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 111-8-25 - GENERAL LICENSING AND ENFORCEMENT REQUIREMENTS › Rule 111-8-25-.14 - Severability

Current through Rules and Regulations filed through June 27, 2024
In the event that any rule, sentence, clause or phrase of any
				  of these rules and regulations may be construed by any court of competent
				  jurisdiction to be invalid, illegal, unconstitutional, or otherwise
				  unenforceable, such determination or adjudication shall in no manner affect the
				  remaining rules or portions thereof. The remaining rules or portions thereof
				  shall remain in full force and effect as if such rule or portions thereof so
				  determined, declared or adjudicated invalid or unconstitutional were not
				  originally part of these rules.
O.C.G.A. Sec.
				  31-2-11.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.01 - Definitions

Current through Rules and Regulations filed through June 27, 2024
Unless a different meaning is required by the context, the
				  following terms as used in these regulations shall have the meaning hereinafter
				  respectively ascribed to them:
(a)
				"Eye bank" means a facility which is maintained and operated for the
				extraction, removal, care, storage, preservation, and/or use of human eyes or
				parts thereof for purposes of sight preservation or restoration, medical
				education, instruction pertaining to sight preservation or restoration, or
				research.
(b) "Person" or "persons"
				means any individual, firm, partnership, corporation, trustee, association, or
				combination thereof.
(c)
				"Department" means the Georgia Department of Community Health.
(d) "Medical Director" means a physician who
				has specialized in the field of ophthalmology, is certified by the American
				Board of Ophthalmology and is responsible for the medical supervision of the
				eye bank.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.02 - Application

Current through Rules and Regulations filed through June 27, 2024
Any person or persons desiring to establish an eye bank shall
				  apply in writing to the Department for a permit. The application shall include
				  the following information:
(a) Name of
				hospital or medical school;
(b)
				Name and qualifications of medical director of the proposed eye bank;
(c) Name of the eye bank facility;
(d) Address of the eye bank;
(e) Brief description of equipment and
				facilities;
(f) Concise description
				of scope of service to be offered;
(g) Proof of tax-exempt and non-profit
				status.
O.C.G.A. §§
										31-2-4 and
				  31-23-1
et
				  seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.03 - Approval

Current through Rules and Regulations filed through June 27, 2024
(1) Upon compliance
				with all of the requirements for establishing an eye bank the governing
				authority for establishing said eye bank shall be issued a permit by the
				Department.
(2) It shall be
				unlawful to establish and operate an eye bank without a permit.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.04 - Inspection

Current through Rules and Regulations filed through June 27, 2024
Inspections of facilities, equipment and operational
				  procedures of the eye bank shall be made by the Department. If the eye bank is
				  found to be deficient in any point in these rules and regulations, notice of
				  these deficiencies will be given to the eye bank. Correction of such
				  deficiencies must be accomplished for continuation of
				  licensure.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.05 - National Standards

Current through Rules and Regulations filed through June 27, 2024
In addition to the requirements of these regulations, the eye
				  bank shall meet the current medical standards approved by the Eye Bank
				  Association of America.
O.C.G.A. §§
										31-2-4 and
				  31-23-1
et
				  seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.06 - Administration

Current through Rules and Regulations filed through June 27, 2024
(1) The eye bank
				shall be under the control of a hospital or medical school's governing
				authority. This control may be shared through contractual agreement with other
				charitable institutions.
(2) The
				eye bank shall have a medical director.
(3) The eye bank may receive gifts, donations
				and bequests for purposes stated under the law.
(4) The eye bank shall be
				non-profit.
(5) The eye bank shall
				offer, on an as-needed basis, an appropriate course in eye extractions for
				embalmers.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.07 - Records

Current through Rules and Regulations filed through June 27, 2024
(1) All records of
				the eye bank shall be confidential and shall be made available only to duly
				authorized persons.
(2) The
				following records shall be kept by each eye bank:
(a) donor record; the signed and witnessed
				duplicate donor card of every intended donor as well as the consent form for
				every eye received in the eye bank must be kept on file. The consent form shall
				be witnessed by two (2) persons of legal majority.
(b) history record; this shall be a record of
				the enucleation, identification and condition of the eye or eyes. It shall
				include a full medical history, the cause of death, time of death, recorded
				time of enucleation, and when available, gross and slit lamp examination of the
				enucleated eye.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.08 - Consent Requirements in Coroner or Medical Examiner Cases

Current through Rules and Regulations filed through June 27, 2024
(1) In any case in
				which a donor is having an autopsy performed, the following consent
				requirements shall be met prior to enucleation:
(a) A decedent who may provide a suitable eye
				for the transplant is under the jurisdiction of a coroner or medical examiner
				and an autopsy is required in accordance with O.C.G.A. §
										45-16-20
et seq.
;
				or the physician has been requested, as provided by law, to perform an autopsy
				on a decedent who may provide a suitable eye for the transplant:
(b) The express written consent to the
				removal of the eye is given by the next of kin of the decedent; and
(c) The removal of the eye will not interfere
				with the subsequent course of an investigation or autopsy.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.09 - Consent Requirements in Non-Coroner or Non-Medical Examiner Cases

Current through Rules and Regulations filed through June 27, 2024
Standard hospital and/or eye bank consent requirements shall
				  be met.
O.C.G.A. §§
										31-2-4
et seq.
,
				  31-7-1
et seq.
and
				  31-23-1.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.10 - Persons Authorized to Extract Eyes

Current through Rules and Regulations filed through June 27, 2024
Eye banks may authorize the following persons to perform eye
				  extractions:
(a) Any
				physician;
(b) any embalmer
				licensed by the state of Georgia who has completed a course in eye extraction
				approved by the Department;
(c) any
				technician trained by and authorized by the eye bank to perform
				extractions.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.11 - Medical and Surgical Procedures

Current through Rules and Regulations filed through June 27, 2024
Procedures involved in the enucleation, transportation, and
				  storage of eye tissue shall comply with the eye bank's policies for such
				  procedures. These procedures shall conform to the current prevailing medical
				  standards.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.12 - Shipment

Current through Rules and Regulations filed through June 27, 2024
(1) Shipping of
				eyes shall be the fastest and most convenient transportation methods.
(2) Eyes used for transplanting purposes
				shall be shipped in sturdy, insulated shipping containers that will maintain a
				maximum temperature of 4°C. for at least 36 hours.
(3) A shipping carton, for the transportation
				of eyes, shall be supplied to the participating physicians by the Eye Bank and
				shall contain for each donated eye:
(a) a
				sterile storage chamber with cotton balls.
(b) history record card;
(c) printed instructions for removal of
				eyes.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.13 - Publicity

Current through Rules and Regulations filed through June 27, 2024
All publicity, with the objective of informing and educating
				  the general public to take an active part in the eye donor program, all fund
				  raising activities, and the solicitation of donor eye pledges, must be done by
				  the most dignified means. Such activities shall conform to prevailing medical
				  ethics and at a minimum provide that:
(a) Eye tissue shall neither be bought nor
				sold.
(b) Eye tissue shall be
				distributed without discrimination based on race, creed, color, or national
				origin.
(c) Eye tissue shall be
				distributed only to qualified opthalmologists on a first come, first served
				basis, except in an emergency.
(d)
				The wishes of the immediate family shall be respected in carrying out the
				donor's eye pledge.
(e) The names
				of donor and recipient shall not be disclosed without written
				consent.
(f) Eye pledges shall be
				solicited in a dignified manner.
(g) Fund raising shall be ethically
				conducted.
(h) Eye banks shall not
				compete with one another.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.14 - Penalty

Current through Rules and Regulations filed through June 27, 2024
(1) It shall be
				unlawful:
(a) for any person to sell either
				his eyes or any parts thereof or the eyes or any parts thereof of another
				person or to receive any remuneration for the giving of a human eye or any part
				thereof;
(b) for the person or
				persons operating and maintaining any eye bank to sell any donated eye or
				donated part thereof or knowingly to extract, remove, or take possession of any
				human eye or part thereof for which any person received compensation or
				remuneration;
(c) for any person or
				persons to establish or operate any eye bank without approval of the Department
				or otherwise not in accordance with this chapter.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.15 - Waivers, Variances, Exemptions

Current through Rules and Regulations filed through June 27, 2024
(1) The Department upon petition may grant
				variances or waivers of specific rules and regulations as provided for in
				O.C.G.A. §
									31-2-7, when it has been shown
				that the rule or regulation is not applicable or to allow experimentation and
				demonstration of new and innovative approaches to delivery of
				services.
(2) The Department may
				exempt classes of facilities from regulation as provided for in O.C.G.A. §
									31-2-7, when regulation would not
				permit the purpose intended or the class of facilities is subject to similar
				requirements under other rules and regulations.
O.C.G.A. §§
										31-2-4
et seq.
and
				  31-23-1
et seq.
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 111-8-28 - EYE BANKS › Rule 111-8-28-.16 - Enforcement

Current through Rules and Regulations filed through June 27, 2024
The administration and enforcement of these rules and
				  regulations shall be as prescribed in O.C.G.A. §
									31-2-8 and as prescribed by the
				  Georgia Administrative Procedure Act, O.C.G.A. §
									50-13-1
et
				  seq.
O.C.G.A. §§
										31-2-4
et seq.
,
				  31-23-1
et seq.
and 50-13-1
et seq.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.01 - Introduction and Purpose

Current through Rules and Regulations filed through June 27, 2024
(1) The Department of Community Health is
				authorized by the Georgia Health Maintenance Organization Act of 1979, Ga. Laws
				of 1979, p. 1148, et seq., (Ga. Insurance Code Chapter 56-36) to promulgate
				rules and regulations necessary to establish and control the standards of
				health care which any Health Maintenance Organization (HMO)created under that
				Act shall be required to maintain. Before the Insurance Commissioner may issue
				a Certificate of Authority to operate an HMO, the Commissioner of the
				Department of Community Health must certify to the Insurance Commissioner that
				the standards of health care are met by the applicant HMO.
(2) The purpose of these rules and
				regulations is to establish the standards of health care which will be required
				by the Department of Community Health of HMOs. Minimum parameters of operation
				for the clinical staff and management of HMOs and components thereof will also
				be set. In recognition that HMOs are intended to be a cost effective
				alternative for the delivery of health care services, the Department is
				supportive of efforts to assure their availability to all citizens. It is the
				intent of the Department to assist the growth and development of HMO programs
				in Georgia and to aid in providing technical assistance needed for their
				efficient and effective utilization.
(3) HMOs are subject to review by the Office
				of Health Planning, pursuant to the Georgia Certificate of Need Law and 1122 of
				the Social Security amendment (where applicable). Evidence of completion of
				this review shall be Submitted to the Department of Community Health as a
				documentation requirement during the Certificate of Authority
				process.
(4) Copies of these rules
				and regulations shall be available within the HMO, and employees shall be fully
				informed and instructed with reference to their requirements.
Ga. L. 1964,
				  pp. 499, 507, 523; Ga. L. 1979, p. 1148
et seq.
; O.C.G.A.
				  §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.04 - Supplemental Health Services

Current through Rules and Regulations filed through June 27, 2024
(1) An HMO may provide or arrange for the
				provision of supplemental health services for which the enrollee has contracted
				and for which the required health manpower is available.
(2) An HMO must define the level and scope of
				each supplemental benefit to be offered, i.e., covered days of care, number of
				visits, or other specific units of service to be offered. Health service
				facilities, type of health professionals and range of specific services, and
				the capabilities made available under each benefit, shall be fully disclosed to
				enrollees and kept current and updated.
Ga. L. 1964,
				  pp. 499, 507, 523; Ga. L. 1979, p. 1148
et seq.
; O.C.G.A.
				  §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.05 - Health Services Information System

Current through Rules and Regulations filed through June 27, 2024
(1) The HMO and/or its providers shall
				establish and maintain an organized health services information system for the
				collection, processing, maintenance, storage and retrieval of information
				concerning health services received by HMO enrollees.
(2) An individual record shall be maintained
				within the system for each enrollee to include the following minimum data:
(a) Identification - name; address;
				identifying number; enrollment date; age and birthdate; sex; marital status;
				occupation; and telephone number;
(b) An initial health evaluation including a
				chronological record of past medical history, drug use profile, personal and
				social history, family history and results of physical examinations, including
				laboratory and x-ray reports;
(c) A
				health care plan which identifies enrollee problem(s) and need(s) and the
				service(s) that will be provided for the enrollee's health maintenance,
				including revisions as indicated;
(d) The chief complaint and purpose of each
				visit; clinical diagnosis or impression; studies ordered; treatment given;
				disposition, recommendations, and instruction to patient; and a progress note
				for each follow-up visit;
(e)
				Copies of all consultation and/or referral requests and responses from other
				health care providers within and without of the organization, which shall be
				entered into the health record within 14 calendar days following the completion
				of services by the provider; and
(f) Other records, such as laboratory, x-ray
				and other test reports, vision/hearing records, immunization records,
				prenatal/postnatal records, copies of discharge summaries from inpatient health
				facilities, etc.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.06 - Confidentiality of Medical Information

Current through Rules and Regulations filed through June 27, 2024
Any data or information pertaining to the diagnosis,
				  treatment, or health of any enrollee obtained from such person or from any
				  provider by any HMO shall be held in confidence and shall not be disclosed to
				  any person except to the extent that it may be necessary to carry out the
				  purposes of these regulations; or upon the express consent of the enrollee; or
				  pursuant to statute or court order for the production of evidence or the
				  discovery thereof or in the event of claim or litigation between such person
				  and the HMO wherein such data or information is pertinent. An HMO shall be
				  entitled to claim any statutory privileges against such disclosure which the
				  provider who furnished such information to the HMO is entitled to
				  claim.
Ga. L. 1979,
				  pp. 1148, 1171, 1172; O.C.G.A. §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.07 - Quality Assurance

Current through Rules and Regulations filed through June 27, 2024
(1) Program Planning and Evaluation. The HMO
				shall have a formal organized plan for an ongoing quality assurance program.
				The purpose of the quality assurance plan is to assure that the quality of
				health care services is continually monitored, reviewed and evaluated for
				appropriate resource utilization, cost containment, and improvement of
				healthcare delivery. The written plan shall be approved by the governing body
				and implemented under the direction of the medical director of the HMO or the
				medical group. At a minimum, the plan shall include:
(a) The role and responsibilities of the
				medical director;
(b) An
				organizational structure created for the purpose of monitoring, reviewing, and
				evaluating the quality of health care services provided and appropriate
				resource utilization and cost containment;
(c) Mechanisms to collect data; identify
				problem areas and make recommendations for changes or improvements; develop
				plans for correction of identified problems; and follow-up;
(d) Arrangements for routine reporting of
				results of quality assurance program activities to the governing body and
				administration;
(e) Provision for
				maintenance of minutes and records of quality assurance program activities;
				and
(f) A peer review process which
				will evaluate and document the internal quality assurance program and the
				professional standards and practices of the providers, and services
				provided.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.08 - Policies and Procedures of the HMO

Current through Rules and Regulations filed through June 27, 2024
The HMO shall have written policies and procedures governing
				  the provision of services which are based on the stated objectives of the HMO.
				  Policies and procedures shall be approved by the governing body and reviewed
				  and updated at least annually. All policies/procedures shall be available for
				  review by staff, enrollees, and providers. Policies and procedures shall
				  include the following subjects:
(a)
				Administrative Policies:
1. Advisory Panels.
				Enrollees shall be afforded an opportunity to participate in health care
				matters of policy and operation through the establishment of advisory panels,
				by the use of advisory referenda on major policy decision, or through the use
				of other mechanisms;
2. Complaint
				System. The HMO shall establish and maintain a complaint system approved by the
				Insurance Commissioner after consultation with the Commissioner;
3. Annual Report. The HMO shall annually,
				on/or before the first day of March, file with the Insurance Commissioner's
				Office an annual statement as of December 31st of the preceding year which has
				been certified by at least two principal officers of said HMO. This report
				shall include summary information and statistics relating to the quality of
				health care, cost of operations, the pattern of utilization of services,
				availability and accessibility to services, use of the complaint system, and
				such other matters as may be required by the Commissioner;
4. Separation of Medical Decisions. The HMO
				plan shall be able to demonstrate through its quality assurance program and
				utilization review process that medical decisions are not hindered by fiscal
				and administrative management;
5.
				Service Area. The HMO shall maintain a current, explicit, definition of its
				service area and a statement of any restrictions or limitations on out-of-area
				health care.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.09 - Statistical Information

Current through Rules and Regulations filed through June 27, 2024
(1) The HMO shall develop, compile, evaluate,
				and report statistics to the Department as requested relating to the cost of
				its operations, the pattern of utilization of its services, and the
				availability and accessibility of its services. The HMO shall provide the
				Department with full access to all operational and statistical data to enable
				the Department to verify the HMO's compliance.
(2) The annual statistical report shall
				contain the following information and shall be made on forms to be provided by
				the Commissioner. (Federally qualified HMO's may substitute for this annual
				statistical report, a copy of their four (4) most recent quarterly reports
				under the National Data Reporting Requirements).
(a) Enrollee statistics:
1. Number of employer contracts and total
				number of enrollees served by the contracts;
2. Number of subscriber contracts and total
				number of enrollees served by the contracts;
3. Number of enrollees at the beginning of
				the reporting year, and number of enrollees at the end of the reporting year,
				additions during the reporting year, losses during the reporting
				year;
4. Number of Medicaid and
				Medicare enrollees.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.10 - Examinations

Current through Rules and Regulations filed through June 27, 2024
(1) The HMO shall
				be available at all reasonable and/or scheduled operating hours for observation
				and examination by properly identified representatives of the Department. These
				examinations shall pertain to all matters relating to the quality of healthcare
				services of the HMO and all providers with whom such HMO has contracts,
				agreements, or other arrangements pursuant to its health benefits plan, as
				often as the Commissioner shall deem it necessary for the protection of the
				interests of the people of the State, but not less than once every five years.
				Such examinations may include any accounts, records, documents and files in the
				possession or control of the HMO, its officers, employees, representatives and
				providers, which relate to the subject of the examination. An HMO shall be
				entitled to claim any statutory privileges against such disclosure which the
				provider who furnished such information to the HMO is entitled to
				claim.
(2) The administrator or his
				representative shall accompany the Department representative on all tours of
				inspection and shall sign the completed checklist.
(3) Each HMO shall be periodically inspected
				to determine whether it is continuing to meet these requirements or is making
				satisfactory progress on approved plans of correction.
Ga. L. 1964,
				  pp. 499, 505, 507, 523; Ga. L. 1979, pp. 1148, 1164, 1165; O.C.G.A. §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.11 - Regulatory Process

Current through Rules and Regulations filed through June 27, 2024
Upon certification to the Insurance Commissioner's Office
				  that the HMO does not meet the requirements of Section 56-3603(1) (b) of the
				  HMO Act of Georgia; or the HMO is unable to fulfill its obligations to furnish
				  health care services as required under its health benefits plan(s); or the HMO
				  has violated any provision of the rules and regulations of the Department, the
				  HMO shall be subject to the regulatory process as prescribed by the HMO Act of
				  Georgia.
Ga. L. 1979,
				  pp. 1148, 1166, 1167, 1168; O.C.G.A. §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.12 - Enforcement

Current through Rules and Regulations filed through June 27, 2024
(1) Informal
				Procedure. If the Commissioner shall for any reason have cause to believe that
				any violation of these rules and regulations or of the Georgia Laws governing
				HMO's has occurred or is threatened, the Commissioner may give notice to the
				HMO and to its representatives, or to other persons who appear to be involved
				in the suspected violation, to arrange a conference with the alleged violators
				or their authorized representatives for the purpose of ascertaining the facts
				relating to each suspected violation. In the event it appears that any
				violation has occurred or is threatened, the conferees may determine an
				adequate and effective means of correcting or preventing such violation. The
				proceedings under this subsection may be conducted in the manner deemed
				appropriate by the Commissioner under the particular circumstances.
(2) Formal Regulatory Process. In the event
				the Department does not choose to use the informal procedure set out above, or
				if an HMO does not correct or prevent the alleged violations as required by the
				Commissioner when the Department finds an HMO does not meet the requirements of
				these regulations or an HMO is unable to fulfill its obligations to furnish
				health care services as required under its health benefits plan, the Department
				shall so certify to the Insurance Commissioner for enforcement proceeding by
				that Department.
Ga. L. 1979,
				  pp. 1170, 1171; O.C.G.A. §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.13 - Applicability of Regulations

Current through Rules and Regulations filed through June 27, 2024
These regulations are applicable only to HMO's and the
				  services provided therein, and do not modify or revoke any of the provisions of
				  other published rules of DCH.
Ga. L. 1964, p.
				  499
et seq
; Ga. L. 1979, p. 1148
et seq
.;
				  O.C.G.A. §
											33-21-1
et
				  seq
.
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 111-8-29 - RULES AND REGULATIONS FOR HEALTH MAINTENANCE ORGANIZATIONS › Rule 111-8-29-.14 - Severability

Current through Rules and Regulations filed through June 27, 2024
In the event that any rule, sentence, clause or phrase of any
				  of these rules and regulations may be construed by any court of competent
				  jurisdiction to be invalid, illegal, unconstitutional, or otherwise
				  unenforceable, such determination or adjudication shall in no manner affect the
				  remaining rules or portions thereof and such remaining rules or portions
				  thereof shall remain of full force and effect, as if such rule or portions
				  thereof so determined, declared or adjudged invalid or unconstitutional were
				  not originally a part hereof. It is the intent of the Board of Community Health
				  to establish rules and regulations that are constitutional and enforceable so
				  as to safeguard the health and well-being of the people of the
				  State.
Ga. L. 1979, p.
				  1172; O.C.G.A. §
											33-21-1
et
				  seq
.
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 111-8-31 - HOME HEALTH AGENCIES › Rule 111-8-31-.01 - Purpose

Current through Rules and Regulations filed through June 27, 2024
Under the authority of O.C.G.A. §
									31-7-150, the Department of
				  Community Health is authorized and required to establish the licensing
				  procedures and standards of operation for home health agencies operating in
				  this State. These rules and regulations are provided for this
				  purpose.
O.C.G.A. §
										31-7-150
et
				  seq.
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 111-8-31 - HOME HEALTH AGENCIES › Rule 111-8-31-.02 - Applications and Licenses

Current through Rules and Regulations filed through June 27, 2024
Each person, private or public organization, political
				  subdivision, or other governmental agency desiring to operate a home health
				  agency, as defined herein, must first apply for and obtain a license using the
				  forms furnished by the Department of Community Health. A license is not
				  assignable or transferable and is subject to suspension or revocation at any
				  time for failure to comply with these rules and regulations.
(a) Applications.
1. The governing body of the home health
				agency shall submit to the Department an application for a license of each
				agency and/or subunit. Such application(s) shall be signed by the executive
				officer of the governing body.
2.
				The application for a license shall be filed at least thirty (30) days prior to
				the anticipated date of opening and commencement of operation of a new home
				health agency.
3. Corporations
				shall submit a copy of their charter and the name and address of all owners
				with five percent or more of the stock and shall identify each corporate
				officer.
4. An application for a
				change in service(s) or service area(s) which is subject to review under
				O.C.G.A. §
										31-6-1
et seq.
and
				applicable rules shall be accompanied by a letter of approval from the Office
				of Health Planning within the Division of Healthcare Facility Regulation,
				Department of Community Health.
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 111-8-31 - HOME HEALTH AGENCIES › Rule 111-8-31-.03 - Certificate of Need Review

Current through Rules and Regulations filed through June 27, 2024
Home health agencies which are required by state laws to
				  obtain a certificate of need shall submit evidence that such requirements have
				  been met when applying for a license.
O.C.G.A. §§
										31-6-1
et seq.
and
				  31-7-155.
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 111-8-31 - HOME HEALTH AGENCIES › Rule 111-8-31-.04 - Exemptions

Current through Rules and Regulations filed through June 27, 2024
These rules and regulations shall not apply to services which
				  are provided under the following conditions:
(a) Persons who provide personal or
				paraprofessional health services, either with or without compensation when
				there is no claim that the service is provided as a part of a licensed home
				health agency;
(b) Persons who
				provide professional services for which they are duly licensed under
Georgia laws, when there is no claim that the service is
				  provided as a part of a licensed home health agency;
(c) Services provided under the provisions of
				any other license issued by the State of
Georgia when there is no claim that the service is provided
				  as a part of a licensed or certified home health agency;
(d) Any home health agency certified in a
				federal program for reimbursement of Medicare or Medicaid services shall be
				exempt from an additional on-site licensure inspection upon presentation of
				evidence of such certification.
O.C.G.A. §§
										31-2-7 and
				  31-7-150
et
				  seq.
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 111-8-31 - HOME HEALTH AGENCIES › Rule 111-8-31-.05 - Inspections

Current through Rules and Regulations filed through June 27, 2024
For the purpose of insuring compliance with these rules and
				  regulations, each home health agency shall be subjected to periodic inspections
				  by an authorized representative of the Department. Such inspections shall take
				  place during reasonable hours and, if possible, during scheduled operating
				  hours. The administrator or his representative shall accompany the Department
				  representative on tours of inspection and shall sign the completed
				  checklist.
O.C.G.A. §
										31-7-150
et
				  seq.