Georgia Code, Title 33, Chapter 20a, Article 2 - Patient's Right to Independent Review

• § 33-20a-30 - Short Title
  This article shall be known and may be cited as the "Patient's Right to Independent Review Act."
• § 33-20a-31 - Definitions
  As used in this article, the term: (1) "Department" means the Department of Community Health established under Chapter 2 of Title 31. (2) "Eligible...
• § 33-20a-32 - Right to Appeal
  An eligible enrollee shall be entitled to appeal to an independent review organization when: (1) The eligible enrollee has received notice of an adverse...
• § 33-20a-33 - Minimum Expense of Treatment Prior to Review
  Except where required pursuant to Code Section 51-1-49, a proposed treatment must require the expenditure of a minimum of $500.00 to qualify for independent
• § 33-20a-34 - Representatives for Enrollee; Cost of Review; Cooperation
  (a) The parent or guardian of a minor who is an eligible enrollee may act on behalf of the minor in requesting independent review....
• § 33-20a-35 - Request for Independent Review
  (a) In the event that the outcome of the grievance procedure under Code Section 33-20A-5 is adverse to the eligible enrollee, the managed care...
• § 33-20a-36 - Additional Information Required for Independent Review
  (a) Within three business days of receipt of notice from the department of assignment of the application for determination to an independent review organization,...
• § 33-20a-37 - Effect of Favorable Determinations
  (a) A decision of the independent review organization in favor of the eligible enrollee shall be final and binding on the managed care entity...
• § 33-20a-38 - Organizational and Employee Liability
  Neither an independent review organization nor its employees, agents, or contractors shall be liable for damages arising from determinations made pursuant to this article,...
• § 33-20a-39 - Certification of Independent Review Organizations; Conflict of Interest; Quality Assurance Mechanism; Copies of Nonproprietary Information
  (a) The department shall certify independent review organizations that meet the requirements of this Code section and any regulations promulgated by the department consistent...
• § 33-20a-40 - Determining Medical Necessity or Whether a Treatment is Experimental
  (a) For the purposes of this article, in making a determination as to whether a treatment is medically necessary and appropriate, the expert reviewer...
• § 33-20a-41 - Rules and Regulations
  The department shall provide necessary rules and regulations for the implementation and operation of this article.
• § 33-20a-42 - Grievance Procedures and Hearings for Medicaid Care Management Members
  Medicaid care management members shall, after first exhausting the grievance procedure of the managed care plan providing health care benefits pursuant to Article 7...

Last modified: October 14, 2016