Rule 350-1-.02. Department of Medical Assistance

1. (1) The Department of Medical Assistance was created by the General Assembly in 1977. The Department is authorized to:

   1. (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;
   2. (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;
   3. (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;
   4. (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. (2) The Department shall administer the State Plan for Medical Assistance in accordance with these Rules.

3. (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:

   1. (a) conditions of participation;
   2. (b) recordkeeping, claims submission, and payment requirements;
   3. (c) requirements for prior approval of services;
   4. (d) scope of services;
   5. (e) reimbursement methodology;
   6. (f) adverse actions the Department may take against a provider and the circumstances under which such actions may be taken; and
   7. (g) administrative review and hearing rights available to a provider.

Authority: Ga. L. 1977, pp. 384, 387; O.C.G.A. Sec. 49-4-142(a).

History. Original Rule was filed on April 11, 1978; effective May 1, 1978.

Repealed: ER. 350-1-0.1-.02 adopted. F. Oct. 5, 1989; eff. Sept. 29, 1989, the date of adoption, to remain in effect for 120 days or until adoption of a permanent Rule superseding said Emergency Rule, as specified by the Agency.

Repealed: Permanent Rule entitled "Department of Medical Assistance" adopted. F. Oct. 4, 1989; eff. Nov. 1, 1989, as specified by the Agency.