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Quality Measurement and Reporting in Georgia

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Quality Measurement and Reporting in Georgia

Subtopic Statute/Regulation Description
Grievance programs (Reporting requirements, Management of grievance reports) Complaint Procedure for Developmentally Disabled and Representatives, Ga. Code Ann. § 37-4-109 Complaint Procedure for Developmentally Disabled and Representatives
FAIR Appeals and Judicial Review, Ga. Code Ann. § 33-33-7 FAIR Appeals and Judicial Review
HMO's Complaint System, Ga. Code Ann. § 33-21-9 HMO's Complaint System
Hospice Reports to the Department, Ga. Comp. R. & Regs. 111-8-37-.06 Hospice Reports to the Department
Information Provided for Independent Review, Ga. Code Ann. § 33-20A-36 Information Provided for Independent Review
Investigations in Long Term Care Facilities, Ga. Code Ann. § 31-8-83 Investigations in Long Term Care Facilities
Medicaid Review of Complaints and Denied Claims, Ga. Code Ann. § 33-21A-7 Medicaid Review of Complaints and Denied Claims
Mental Health Facility Complaint Procedure, Ga. Code Ann. § 37-3-149 Mental Health Facility Complaint Procedure
Notifications and Marketing Materials to Members, Ga. Code Ann. § 33-30A-6 Notifications and Marketing Materials to Members
Public Health Complaints, Ga. Comp. R. & Regs. 511-7-1-.13 Public Health Complaints
Reporting of Abuse in Long Term Care Facilities, Ga. Code Ann. § 31-8-82 Reporting of Abuse in Long Term Care Facilities
Responsibility of State Ombudsman, Ga. Code Ann. § 31-8-53 Responsibility of State Ombudsman
Right to File Grievance; Complaint Investigation, Ga. Code Ann. § 43-34A-6 Right to File Grievance; Complaint Investigation
Quality assessment for health plans Health Plan Required Provisions, Ga. Code Ann. § 33-21-18.1 Health Plan Required Provisions
HMO Quality Assurance, Ga. Comp. R. & Regs. 290-5-37-.07 HMO Quality Assurance
Home Care Service Plans, Ga. Comp. R. & Regs. 111-8-65-.11 Home Care Service Plans
Hospital Quality Management, Ga. Comp. R. & Regs. 111-8-40-.13 Hospital Quality Management
Power to Regulate and Violations, Ga. Code Ann. § 33-31-12 Power to regulate and violations. 
Suspension of an HMO Certificate, Ga. Code Ann. § 33-21-5 Suspension of an HMO Certificate
Quality reporting requirements – providers and health plans Home Health Agencies Scope of Services, Ga. Comp. R. & Regs. 111-8-31-.08 Home Health Agencies Scope of Services
Quality assurance programs for hospitals or public programs Hospice Inspections and Investigations, Ga. Comp. R. & Regs. 111-8-37-.05 Hospice Inspections and Investigations
Hospice Patient and Family Rights, Ga. Comp. R. & Regs. 111-8-37-.10 Hospice Patient and Family Rights
Hospice Quality Management, Ga. Comp. R. & Regs. 111-8-37-.09 Hospice Quality Management
Mental Health Facility Restraints and Abuses, Ga. Code Ann. § 37-3-165 Mental Health Facility Restraints and Abuses
Termination of a Physician's Contract, Ga. Code Ann. § 33-20A-61 Termination of a Physician's Contract
External review for insurance and/or peer review purposes (Cross reference to Private Insurance Data and Medical Peer Review) Information Provided for Independent Review, Ga. Code Ann. § 33-20A-36 Information Provided for Independent Review
Long Term Care Regulations, Ga. Code Ann. § 33-42-6 Long Term Care Regulations
Medicare Standards for Policy Provisions, Ga. Code Ann. § 33-43-3 Medicare Standards for Policy Provisions
Standards to Determine the Necessity of Treatment, Ga. Code Ann. § 33-20A-40 Standards to Determine the Necessity of Treatment
Performance measurement for health care providers or insurance plans Inspection of Private Home Care Providers, Ga. Code Ann. § 31-7-303 Inspection of Private Home Care Providers
Inspections of Home Health Agencies, Ga. Code Ann. § 31-7-154 Inspections of Home Health Agencies
Regulation of HMOs, Ga. Code Ann. § 33-21-20.1 Regulation of HMOs
Restraints and Abuses, Ga. Code Ann. § 37-4-124 Restraints and Abuses
Click on the individual state law in the table above to see our summary of the individual law.


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