Rules and Regulations of the State of Georgia
 

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  • 1. In the address bar, type about:config and press Enter.
  • 2. Click "I'll be careful, I promise" if a warning message appears.
  • 3. In the search box, search for javascript.enabled
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  1. On web browser menu click "Tools" and select "Internet Options"
  2. In the "Internet Options" window select the "Security" tab.
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  • 1. a) Click on "Menu", hover mouse on the "Settings" then hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
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<xmp>.</xmp> <form name="form1" method="post" action="120-2-92?urlRedirected=yes&amp;data=admin&amp;lookingfor=120-2-92" id="form1"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTY5ODkwOTM2Nw8WAh4Ec3BhbQIFFgJmD2QWAgIFDw8WAh4EVGV4dAUFNCArIDFkZGQPvJCDcW4djbLiqwcwPmpXTOAVwg==" /> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="EEBB6393" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWCAKUoK7JDALniKOhBALV5cpNAoa5iIEFAoznisYGAsrv5u0MAsrv4u0MAsrv3u0MgrTExsqblsLWLt8/LdsPwVXtPfA=" /> <div class='popup'> <div class='cnt223'> <div style="margin-bottom:6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif"/> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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A health maintenance organization which is accredited on a continuing basis by an organization on the Approved Accrediting Organizations List and meeting the other requirements of this regulation shall be deemed to have satisfied the requirements of O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-21-3&amp;title=33#" target="_newtab">33-21-3</a>(b.1).</P> <h2><a href="/GAC/120-2-92-.02" name="120-2-92-.02" title="120-2-92-.02">Rule 120-2-92-.02 Qualifications for Approved Accreditation Organizations</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An organization may become an approved accrediting organization for purposes of this regulation when it meets the following requirements: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization has been in existence for a minimum of 10 years. An organization in existence for less than 10 years may petition the Commissioner for a waiver of this requirement;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization is not owned or operated by a health maintenance organization and performs its accrediting functions independently from the control of health maintenance organizations;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization operates on a national basis;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization's board of directors is comprised of diverse health care, business and consumer interests, including but not limited to representatives of the medical profession, hospital industry, consumers, and health maintenance organizations;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization has a process for regularly reviewing its own accreditation standards for health maintenance organizations;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization has provisions to perform regular on-site reviews of health maintenance organizations;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The organization establishes standards for performance and uses those standards to examine and measure the performance of health maintenance organizations in the following areas: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Quality Assurance and Improvement</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Member Satisfaction</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Appeals Processes</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)4.">4.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Clinical Oversight</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)5.">5.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Provider Credentialing</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)6.">6.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Utilization Review</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)7.">7.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Delegation Oversight</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)8.">8.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Confidentiality of Member Information</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(g)9.">9.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Access to Services.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A copy of the organization's standards for accreditation must be made available to the Department of Insurance upon request. Revisions to such standards shall also be communicated to the Department. Such standards may be reviewed by the Department of Insurance on a triennial basis. The Department may request additional standards to be included within any approved organization's standards for accreditation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In each accreditation review, the organization must utilize a physician experienced in health maintenance organization quality assurance management;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(1)(j)">(j)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Upon request, the Department may review the accreditation review files for a licensed health maintenance organization.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.02(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An organization seeking approval as an accrediting organization shall submit evidence to the Commissioner of its compliance with the standards in subparagraph (1) of this section. Upon submission of such evidence, the Commissioner, in his or her discretion, may include the organization on the Approved Accrediting Organizations List.</td> </tr> </table> <h2><a href="/GAC/120-2-92-.03" name="120-2-92-.03" title="120-2-92-.03">Rule 120-2-92-.03 Certification Pursuant to Accreditation by a National Accrediting Organization</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.03(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A health maintenance organization seeking certification for purposes of O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-21-3&amp;title=33#" target="_newtab">33-21-3</a>(b.1) through proof of accreditation by a national accreditation organization shall: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.03(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Submit to the Commissioner a copy of the certificate of provisional or final accreditation issued by a national accreditation agency qualified under this regulation; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.03(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Submit evidence that its services are reasonably available and accessible in its service area or proposed service area according to its written standards for establishing and measuring appropriate member access to health care services.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.03(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of subparagraph (1)(a) of this section, a health maintenance organization may submit proof of accreditation of a company with which it is formally affiliated, provided that the affiliated company supervises or performs the services for the Georgia health maintenance organization using the same standards and procedures for which it has received accreditation by an Approved Accrediting Organization.</td> </tr> </table> <h2><a href="/GAC/120-2-92-.04" name="120-2-92-.04" title="120-2-92-.04">Rule 120-2-92-.04 Loss of Accreditation, Review and Action by the Commissioner of Insurance</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.04(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A health maintenance organization shall notify the Commissioner of Insurance of the loss of accreditation within 15 days of such occurrence.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.04(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Upon receipt of notice of a health maintenance organization's accreditation, the Commissioner of Insurance shall notify the Commissioner of the Department of Human Resources.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-92-.04(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner of Insurance may investigate and review specific issues relating to access and availability at any time.</td> </tr> </table> <h2><a href="/GAC/120-2-92-.05" name="120-2-92-.05" title="120-2-92-.05">Rule 120-2-92-.05 Severability</a></h2> <P>If any provision of this regulation or its application to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of the provision to other persons or circumstances shall not be affected.</P> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/120-2-92-.01" name="120-2-92-.01" title="120-2-92-.01">Rule 120-2-92-.01 Approved Accrediting Organizations List</a></li><li><a href="/GAC/120-2-92-.02" name="120-2-92-.02" title="120-2-92-.02">Rule 120-2-92-.02 Qualifications for Approved Accreditation Organizations</a></li><li><a href="/GAC/120-2-92-.03" name="120-2-92-.03" title="120-2-92-.03">Rule 120-2-92-.03 Certification Pursuant to Accreditation by a National Accrediting Organization</a></li><li><a href="/GAC/120-2-92-.04" name="120-2-92-.04" title="120-2-92-.04">Rule 120-2-92-.04 Loss of Accreditation, Review and Action by the Commissioner of Insurance</a></li><li><a href="/GAC/120-2-92-.05" name="120-2-92-.05" title="120-2-92-.05">Rule 120-2-92-.05 Severability</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 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