Rule 120-2-110-.01. Definitions

1. (1) Pursuant to O.C.G.A. Section 33-24-59.27(c)(4) the Commissioner is responsible for promulgating rules and regulations which include definitions for the following terms:

   1. a) Risk adjusted hospital readmission rates;
   2. b) Absolute hospital readmission rates;
   3. c) Admission volume;
   4. d) Utilization volume;
   5. e) Risk adjusted rates of adverse events;
   6. f) Risk adjusted total cost of care; and

   7. g) Absolute relative total cost of care.

      We have researched the federal context of these programmatic terms under 42 CFR Parts 412, 413 and 476 and Title XVIII of the Social Security Act, Section 1801. We have determined that at the present time there are no official federal definitions set out for these terms. It is the intention of the Office of Commissioner of Insurance to establish definitions for these terms in keeping with currently developing federal guidance. At such time as federal guidance in this context develops, our Office will act to officially promulgate rule definitions consistent with federal guidance.

2. (2) Pursuant to O.C.G.A. Section 33-24-59.27(c)(5), the Office of Commissioner of Insurance will work with relevant Georgia governmental, business, and educational partners in development of an All-Payer Health Claims Database and supply Office of Commissioner of Insurance Website links and other information available to Insurers as it is developed and finalized for use in this State. At such time when the All-Payer Claims Database is developed the Department will promulgate final Regulations.

Authority: O.C.G.A. § 33-24-59.27.

History. Original Rule entitled "Definitions" adopted. F. Jan. 13, 2022; eff. Jan. 1, 2022, as specified by the Agency.