Title 31, Chapter 7, Section 131
( 31-7-131)
As used in this article, the term: (1) "Peer review" means the procedure by which professional health
care providers evaluate the quality and efficiency of services
ordered or performed by other professional health care providers,
including practice analysis, inpatient hospital and extended care
facility utilization review, medical audit, ambulatory care
review, claims review, underwriting assistance, and the compliance
of a hospital, nursing home, convalescent home, or other health
care facility operated by a professional health care provider with
the standards set by an association of health care providers and
with applicable laws, rules, and regulations. (2) "Professional health care provider" means an individual who is
licensed, or an organization which is approved, to practice or
operate in the health care field under the laws of Georgia,
including, but not limited to, the following individuals or
organizations: (A) A physician; (B) A dentist; (C) A podiatrist; (D) A chiropractor; (E) An optometrist; (F) A psychologist; (G) A pharmacist; (H) A registered or practical nurse; (I) A physical therapist; (J) An administrator of a hospital, a nursing or convalescent
home, or other health care facility; (K) A corporation or other organization operating a hospital, a
nursing or convalescent home, or other health care facility, as
well as the officers, directors, or employees of such
corporation or organization or the members of such corporation's
or organization's governing board who are performing a peer
review function; (L) A rehabilitation supplier registered with the State Board of
Workers' Compensation; and (M) An occupational therapist. (3) "Review organization" means the Joint Commission on
Accreditation of Healthcare Organizations. Such term also means
any other national accreditation body or any panel, committee, or
organization: (A) Which:
(i) Is primarily composed of professional health care
providers; (ii) Is an insurer, self-insurer, health maintenance
organization, preferred provider organization, provider
network, or other organization engaged in managed care; or (iii) Provides professional liability insurance for health
care providers; and (B) Which engages in or utilizes peer reviews and gathers and
reviews information relating to the care and treatment of
patients for the purposes of: (i) Evaluating and improving the quality and efficiency of
health care rendered; (ii) Reducing morbidity or mortality; (iii) Evaluating claims against health care providers or
engaging in underwriting decisions in connection with
professional liability insurance coverage for health care
providers; (iv) Compiling aggregate data concerning the procedures and
outcomes of hospitals for the purposes of evaluating the
quality and efficiency of health care services. Under no
circumstances shall any such aggregate data or any other peer
review information relating to an individual professional
health care provider be disclosed or released to any person or
entity without the express prior written consent of such
health care provider, but such aggregate data or other peer
review information may be released to another review
organization upon the written request of such organization if
such requesting review organization has specific reason to
believe that immediate access to such aggregate data or
information is necessary to protect the public health, safety,
and welfare. Such aggregate data and other peer review
information shall be used for peer review purposes only and in
no event shall such aggregate data or any other peer review
information be sold or otherwise similarly distributed, but a
review organization shall be authorized to utilize the
services of and pay a fee to another person or entity to
compile or analyze such aggregate data; or (v) Evaluating the quality and efficiency of health care
services rendered by a professional health care provider in
connection with such provider's participation as or request to
participate as a provider in or for an insurer, self-insurer,
health maintenance organization, preferred provider
organization, provider network, or other organization engaged
in managed care; or (vi) Performing any of the functions or activities described in Code Section 31-7-15. |