Ga. Comp. R. & Regs. R. 120-2-80-.04 - Modification of Operation of Plan after Certification
(1) A managed care
entity shall file supporting documentation for any substantial modification of
its managed care plan or plans with the Commissioner. Such documentation shall
describe changes in operations and update any previous filings made by the
managed care entity for the affected managed care plan or plans. Substantial
modification includes, but is not limited to, the following:
(a) Broad substitution, merger or other
change in hospital, physician network or ancillary services provider or
network;
(b) Changes in
subcontracting providers for utilization review or administrative services;
or
(c) Other changes affecting the
content, rules or procedures of any of the above entities.
(2) All proposed substantial modifications
which are voluntary must be submitted for the Commissioner's approval at least
sixty (60) days prior to proposed changes, and must clearly indicate the
nature, level and scope of changes. Managed care entities may not adopt
substantial modifications which are voluntary prior to receiving approval from
the Commissioner.
(3) Modifications
reflecting changes not under the control of the managed care entity should be
filed with the Commissioner as soon as possible.
Notes
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