Ga. Comp. R. & Regs. R. 350-1-.02 - Department of Medical Assistance
(1) The Department of Medical Assistance was created by the
General Assembly in 1977. The Department is authorized to:
(a) adopt and administer a State Plan for medical assistance as
defined in paragraph (23) of Rule 350-1-.01, provided such State Plan is
administered within the appropriations made available to the Department;
(b) establish the amount, duration, scope, and terms and
conditions of eligibility for and receipt of such medical assistance as it may
elect to authorize pursuant to Article 7, Title 49 of the Official Code of
Georgia Annotated;
(c) establish such rules and regulations as may be necessary or
desirable to execute the State Plan and to receive the maximum amount of
federal financial participation available in expenditures made pursuant to the
State Plan;
(d) enter into such reciprocal and cooperative arrangements
with other states, persons, and institutions, public and private, as it may
deem necessary or desirable in order to execute the State Plan.
(2) The Department shall administer the State Plan for Medical
Assistance in accordance with these Rules.
(3) The Department shall publish the terms and conditions for
receipt of medical assistance in Policies and Procedures Manuals for each of
the categories of service authorized under the State Plan. A copy of the Manual
for each category of service shall be disseminated to each provider enrolled
for that category and to each prospective provider seeking to enroll for that
category. Such manuals shall be amended from time to time when the Department
finds it necessary or appropriate to do so. All such amendments shall be
disseminated to affected providers at the addresses at which they are then
registered with the Department. Amended provisions shall be effective as
specified by the Department at the time of dissemination. Each Manual shall
specify, at a minimum, the following:
(a) conditions of participation;
(b) recordkeeping, claims submission, and payment
requirements;
(c) requirements for prior approval of services;
(d) scope of services;
(e) reimbursement methodology;
(f) adverse actions the Department may take against a provider
and the circumstances under which such actions may be taken; and
(g) administrative review and hearing rights available to a
provider.
Notes
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