On December 9, 2021, the Insurance and Safety Fire Commissioner issued Bulletin 21-EX-16 to remind all health insurers conducting business in the state that House Bill 454 goes into effect on January 1, 2022.

This legislation requires an insurer to reimburse a provider at in-network rates for 180 days (or through the end of the enrollee’s coverage period, if earlier), if a provider is listed as in-network in the insurer’s directory when the individual selects a health benefit plan, and the provider becomes out of network subsequent to open enrollment in the succeeding plan year. In such case, the provider must accept the insurer’s payment as payment in full. Certain exceptions apply.

This guidance is directed at insurers, but employers may want to be aware of the bulletin.

Bulletin 21-EX-16 »

Gov. Kemp recently signed HB 146, which provides paid parental leave to state and public-school employees. The law took effect on July 1, 2021.

Specifically, employees of the state government or local board of education are entitled to 120 hours of paid parental leave after the birth of a child, adoption of a child or placement of a child in foster care in their home. Generally, employees of these entities are eligible for the leave after six continuous months of employment. Hourly employees are required to work a minimum of 700 hours over the six-month period immediately preceding the requested paid parental leave date.

An employee can only qualify for the leave once per rolling twelve-month period but can take the time incrementally over such period. Unused leave does not carry over to the next twelve-month period nor does it have any cash value in the event of employment termination. Employers are prohibited from retaliating against employees for using leave to which they are entitled.

State government and local board of education employers should be aware of the new parental paid leave requirements. Under the law, these employers must produce rules for administering the leave that address whether the leave will run concurrently with other federal leave and documentation requirements. Counsel should be consulted for guidance.

HB 146 »

On December 3, 2020, the Insurance and Safety Fire Commissioner issued Directive 20-EX-9 to address high demand on inpatient hospital services as a result of the COVID-19 pandemic. The directive is issued to all licensed health insurers in the state.

The directive advises insurers to suspend preauthorization requirements for post-acute placements, including but not limited to skilled nursing facilities, home health, acute rehabilitation and long-term acute care. Under normal circumstances, it may take up to seven days for hospitals to receive the insurer’s authorization to move a patient to the next level of care. Insurers are now asked to respond to such discharge requests within 24 hours. The elimination of the typical delay is intended to alleviate the strain on hospital bed capacity and enable new admissions.

Additionally, insurers should provide hospitals with a current list of all in-network rehabilitation facilities, long-term acute care hospitals and skilled nursing facilities. Hospitals are expected to use their best efforts to transfer insureds to the in-network providers. An insurer can require the rehabilitation facility or long-term acute care hospital to provide notification of the admission.

The preauthorization suspension is effective for 60 days, subject to further evaluation as the COVID-19 situation is monitored.

Group health plan sponsors should be aware of these developments.

Directive 20-EX-9 »

On March 9, 2020, the Insurance and Safety Fire Commissioner issued Directive 20-EX-3 regarding coronavirus (COVID-19) preparedness. The directive is issued to all insurers authorized to write accident and health insurance and health benefit plans in the state.

The directive is released as part of the state’s response to the spread of the respiratory illness known as COVID-19 to the United States, including Georgia. The outlined measures are designed to assist individuals and entities in providing the necessary insurance-related services during the public health challenge.

Specifically, the directive is asking health insurers who provide coverage to state residents to consider options to reduce or remove cost and procedural barriers to COVID-19 testing and treatment. These entities should be prepared to provide accurate and timely coverage information to insureds. Additionally, the insurers are instructed to review their internal procedures, telemedicine and in-network services, and access to out-of-network providers to ensure these are adequate to address an increased need for services.

The memo is directed at insurers, who are requested to provide information as to the steps taken in response. Employers should be aware of these developments.

Directive 20-EX-3 »

On Aug. 11, 2015, Commissioner of Insurance Hudgens issued Directive 15-EX-3 related to patient access to eye care. The directive reinforces that insurers must allow covered persons to obtain eye services from providers who are otherwise licensed to provide such services. Some insurers have been limiting coverage to services performed or products sold by certain providers only. The directive points to the recent Georgia Supreme Court case of Spectera, Inc. v. Wilson (749 S.E.2d 704 (2013)). Based on that case, a provider may provide all the services for which he or she is licensed and may receive provider panel reimbursement from an insurer as long as the service is otherwise covered by the insurance policy. Although this directive is aimed at insurers, it is important for employers to be aware that insurers cannot restrict the access to eye care in this manner.

Directive 15-EX-3 »