Directive 20-EX-7

The record

Jurisdiction

Georgia

Level

Sector regulator

Authority

O.C.G.A. Title 33 (Commissioner's regulatory authority over insurers, HMOs and utilization review agents); Governor's Public Health State of Emergency

Issued

2020-03-26 Mar. 26, 2020

Effective

2020-03-26

End

60 days (to May 25, 2020), subject to further evaluation (read as 2020-05-25)

In force

Mar. 26, 2020 to May 25, 2020

Quarters

2020 Q2

2020 Q22020 Q32020 Q42021 Q12021 Q22021 Q3

Limitation types

Health care ordersOther

Addressees

• all insurers authorized to write accident and health insurance and health benefit plans
• HMOs
• utilization review agents
• independent adjusters

Functions reached

• IN insurance operations (utilization review and preauthorization functions suspended)
• SX hospital scheduled surgeries (regulator's finding that hospitals were 'delaying or suspending many scheduled procedures')
• OF insurer administration

Collection

Georgia GA

Operative words

As hospitals plan for high demand of inpatient hospital services and redeploy staff to provide direct patient care, their ability to perform certain administrative functions will be impacted. Moreover, with many hospitals delaying or suspending many scheduled procedures, the need for certain administrative functions is less necessary. The purpose of this Directive is to advise insurers... that certain utilization review and notification requirements should be suspended for 60 days from the date of this letter... 1. Suspension of Preauthorization Requirements for Scheduled Surgeries or Admissions at Hospitals... 2. Suspension of Concurrent Review for Inpatient Hospital Services... 3. Suspension of Retrospective Review for Inpatient Hospital Services and Emergency Services at In-Network Hospitals and Payment of Claims

Enforcement