Compilation of Rules and Regulations of the State of Georgia Department 350 - DEPARTMENT OF MEDICAL ASSISTANCE

Here is a comprehensive overview of the Rules and Regulations of the State of Georgia – Department 350: Department of Medical Assistance, effective through early 2025:

πŸ›οΈ Administrative Structure

Department 350 administers Georgia’s Medicaid program, known as the State Plan for Medical Assistance, under the authority of O.C.G.A. Β§β€―49‑4‑142.

The Department of Medical Assistance (DMA) was established by the Georgia General Assembly in 1977 to oversee medical assistance programs, including setting eligibility, reimbursement rates, and provider standards.

πŸ“˜ Key Chapters & Rules

Chapter 350‑1: Administration

Rule 350‑1‑.01 – Definitions: Defines terms such as "Medical Assistance," "Provider," and "State Plan" .

Rule 350‑1‑.02 – Department of Medical Assistance: Details the Department's authority to administer the State Plan, establish rules, and enter into cooperative arrangements .

Rule 350‑1‑.03 – Commissioner of Medical Assistance: Outlines the responsibilities of the Commissioner as the chief administrative officer of the Department .

Rule 350‑1‑.04 – Board of Medical Assistance: Describes the composition and functions of the Board, which sets general policy for the Department .

Rule 350‑1‑.05 – Practice of Non-Discrimination: Affirms the Department's commitment to non-discrimination in accordance with federal civil rights laws .

Chapter 350‑2: Procedures for Adoption, Amendment, and Repeal of Rules and for Public Notice of Changes in Methods and Standards for Setting Payment Rates

Establishes the process for adopting, amending, or repealing rules and for providing public notice of changes in payment methods and standards .

Chapter 350‑3: Sanctions for Nursing Facilities

Rule 350‑3‑.01 – Definitions: Provides definitions specific to nursing facility sanctions .

Rule 350‑3‑.02 – Remedies: Lists potential remedies the Department may impose if a facility fails to meet program requirements .

Rule 350‑3‑.03 – Imposition of Remedies: Details the procedures for imposing remedies .

Rule 350‑3‑.04 – Civil Monetary Penalties: Specifies conditions under which civil monetary penalties may be assessed .

Rule 350‑3‑.05 – Temporary Management: Describes the appointment of temporary management in certain situations .

Rule 350‑3‑.06 – Monitoring: Outlines monitoring requirements for facilities under sanction .

Rule 350‑3‑.07 – Notice: Specifies notice requirements for facilities facing sanctions .

Rule 350‑3‑.08 – Administrative Review: Details the process for administrative review of sanctions .

Rule 350‑3‑.09 – Administrative Hearing: Describes the procedures for administrative hearings related to sanctions .

Chapter 350‑4: Administrative Review, Hearings, and Appeals

Rule 350‑4‑.01 – Hearings Conducted by the Department of Medical Assistance: Outlines the procedures for hearings conducted by the Department .

Rule 350‑4‑.02 – Hearings Conducted by the Department of Human Resources: Specifies procedures for hearings conducted by the Department of Human Resources .

Rule 350‑4‑.03 – Right to Representation: Details the rights of parties to be represented in hearings .

Rule 350‑4‑.04 – Administrative Review: Describes the process for administrative review of decisions .

Rule 350‑4‑.05 – Hearing Requests: Specifies the procedures for requesting a hearing .

Rule 350‑4‑.06 – Dismissal of Hearing Requests: Outlines conditions under which hearing requests may be dismissed .

Rule 350‑4‑.07 – Informal Disposition; Settlement: Provides guidelines for informal resolution and settlement of disputes .

Rule 350‑4‑.08 – The Administrative Law Judge: Defines the role and responsibilities of the Administrative Law Judge .

Rule 350‑4‑.09 – Disqualification of the Administrative Law Judge: Specifies grounds for disqualification of the Administrative Law Judge .

Rule 350‑4‑.10 – Ex Parte Communications: Addresses prohibitions on ex parte communications .

Rule 350‑4‑.11 – Notice of Hearing: Details requirements for providing notice of hearings .

Rule 350‑4‑.12 – Pre-Hearing Conferences: Describes the use of pre-hearing conferences .

Rule 350‑4‑.13 – Time and Place of Hearing: Specifies the time and location for hearings .

Rule 350‑4‑.14 – Continued and Reopened Hearings: Outlines procedures for continuing and reopening hearings .

Rule 350‑4‑.15 – Default; Abandonment: Addresses issues of default and abandonment in hearings .

Rule 350‑4‑.16 – Discovery: Specifies rules regarding discovery in hearings .

Rule 350‑4‑.17 – Subpoenas: Details the issuance and enforcement of subpoenas .

Rule 350‑4‑.18 – Depositions: Outlines procedures for depositions .

Rule 350‑4‑.19 – Pleadings and Amendments; Automatic Filings: Specifies requirements for pleadings and amendments .

Rule 350‑4‑.20 – Rules of Evidence; Official Notice: Addresses rules of evidence and official notice .

Rule 350‑4‑.21 – Substitution of Parties; Intervention: Details procedures for substitution of parties and intervention .

Rule 350‑4‑.22 – Consolidation and Severance: Specifies rules for consolidation and severance of cases .

Rule 350‑4‑.23 – Service: Outlines requirements for service of documents .

Rule 350‑4‑.24 – The Hearing: Describes the conduct of the hearing .

Rule 350‑4‑.25 – Motions: Specifies procedures for filing and ruling on motions .

Rule 350‑4‑.26 – Summary Determination: Addresses procedures for summary determinations .

Rule 350‑4‑.27 – The Hearing Record: Details requirements for maintaining the hearing record .

Rule 350‑4‑.28 – Decision of the Administrative Law Judge: Specifies requirements for the decision of the Administrative Law Judge .

Rule 350‑4‑.29 – Appeal of Administrative Law Judge's Decision: Outlines procedures for appealing the Administrative Law Judge's decision .

Rule 350‑4‑.30 – Appeal of the Commissioner's Decision: Specifies procedures for appealing the Commissioner's decision .

Chapter 350‑5: Disclosure of Information on Medicaid Applicants, Recipients, and Providers

Rule 350‑5‑.01 – Types of Applicant and Recipient Information to be Safeguarded: Identifies types of information that must be protected .

Rule 350‑5‑.02 – Use of Applicant and Recipient Information: Specifies permissible uses of protected information .

Rule 350‑5‑.03 – Access to Applicant and Recipient Information: Details who may access protected information .

Rule 350‑5‑.04 – Disclosure of Provider Information: Addresses the disclosure of provider information

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