GEORGIA

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The Georgia SBL became effective January 1, 2021. The relevant provisions include:

• An Arbitration process with a 30-day deadline to act.
• It now uses an All-Payor Claims Data Base (APCD)
• Permits consolidation of claims,

Georgia Code Titles 33, Section 33-20E.

According to CMS,

Georgia does [now] have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with Georgia Office of Insurance and Safety Fire Commissioner staff, CMS understands that OCGA 33-20E-8 is a specified state law that will apply for purposes of determining the out-of-network rate with respect to items and services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Georgia by nonparticipating providers, nonparticipating emergency facilities or nonparticipating providers of air ambulance services. Therefore, the federal independent dispute resolution process under sections 2799A-1(c) and 2799A-2(b) of the PHS Act and 45 CFR 149.510 and 149.520 will not apply in those cases in Georgia.

Letter from CMS to Governor of Georgia, dated December 13, 2021.