GA HB1317

Medicaid recipients and PeachCare for Kids participants must be allowed to immediately switch to a different health maintenance organization (HMO) if their current HMO terminates a contract with their health care provider, regardless of when their next annual enrollment opportunity occurs.

The Georgia Department of Community Health must provide adequate notice to affected enrollees, including information on which other HMOs have contracts with their provider, instructions on how to switch enrollment, and specific contact information for processing changes.

The legislative findings declare that contract disputes between HMOs and health care providers must not impede access to care for Medicaid and PeachCare members, particularly relationships with primary care providers, dentists, or specialists providing ongoing treatment.

The findings also state that continuing to pay an HMO a monthly capitation rate for a patient who lacks meaningful access to care due to a provider termination unjustly enriches the HMO at taxpayer expense.

Amends Code Sections 49-4-142 (Medicaid) and 49-5-273 (PeachCare for Kids) of the Official Code of Georgia Annotated to establish these new requirements.