23 SB 20/AP
S. B. 20
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Senate Bill 20
By: Senators Kirkpatrick of the 32nd, Watson of the 1st, Hufstetler of the 52nd, Tillery of
the 19th, Butler of the 55th and others
AS PASSED
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 20E of Title 33 of the Official Code of Georgia Annotated, the "Surprise
1
Billing Consumer Protection Act," so as to ensure consumer access to quality healthcare by2
setting adequacy standards for network plans offered by an insurer; to provide for an3
exemption; to provide for standards for network plans; to prohibit an insurer from denying4
preauthorization for healthcare services to be performed by a participating provider solely5
because the referral was made by a nonparticipating provider; to provide for telehealth6
services; to provide for monitoring and reports; to authorize the Commissioner to ensure7
compliance through multiple means; to provide for rules, regulations, and penalties; to8
provide for a short title; to provide for related matters; to provide for an effective date and9
applicability; to repeal conflicting laws; and for other purposes.10
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:11
SECTION 1.12
This Act shall be known and may be cited as the "Consumer Access to Contracted Healthcare13
(CATCH) Act."14 23 SB 20/AP
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SECTION 2.
15
Chapter 20E of Title 33 of the Official Code of Georgia Annotated, the "Surprise Billing16
Consumer Protection Act," is amended by adding new Code sections to read as follows:17
"33-20E-24.
18
(a) The requirements of this Code section shall not apply to a health maintenance19
organization, as defined in Code Section 33-21-1, possessing a valid certificate of authority20
obtained in accordance with Code Section 33-21-2.21
(b)(1) An insurer providing a network plan shall contract with and maintain a network22
of participating providers in sufficient number and appropriate type, including primary23
care and specialty care, pharmacies, clinical laboratories, and facilities, throughout such24
plan's service area to ensure covered persons have access to the full scope of benefits and25
services covered under such plan.26
(2) An insurer providing coverage for mental health or substance use disorders as part27
of a network plan shall contract with and maintain a network of participating providers28
that specialize in mental health and substance use disorder services in sufficient number29
and appropriate type throughout such plan's service area to ensure covered persons have30
access to the full scope of mental health and substance use disorder benefits and services31
covered under such plan.32
(c) The Commissioner shall determine and may further assess the adequacy and breadth33
of a network plan using appropriate qualitative and quantitative criteria, which may include34
but are not limited to federal rules and regulations for network plans promulgated annually35
by the Center for Consumer Information and Insurance Oversight in the Notice of Benefit36
and Payment Parameters issued to qualified health plans, the ability of the network to meet37
the needs of all covered persons, the availability of participating providers that are within38
a reasonable time and distance to covered persons and accepting patients, appointment wait39
times, and the availability of other healthcare service delivery system options.40 23 SB 20/AP
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(d) An insurer shall not deny preauthorization for healthcare services to be performed by41
a participating provider solely because the covered person's referral to such provider was42
made by a nonparticipating provider.43
(e) An insurer shall not:44
(1) Require prior authorization, medical review, or administrative clearance for a45
telehealth service that would not be required if such service were provided in person;46
(2) Require demonstration that it is necessary to provide a service to a covered person47
through telehealth;48
(3) Require a provider to be employed by another provider or agency in order to provide49
a telehealth service that would not be required if such service were provided in person;50
(4) Restrict or deny coverage of a telehealth service based solely on the communication51
technology or application used to deliver such service;52
(5) Require a provider to be part of a telehealth network;53
(6) Require a covered person to utilize telehealth or telemedicine in lieu of a54
nonparticipating provider accessible for in-person consultation or contact; or55
(7) Be required to pay a facility fee to a hospital for telehealth services unless the56
hospital is the originating site as defined in subsection (b) of Code Section 33-24-56.4.57
(f) The Commissioner shall adopt rules and regulations to implement and administer this58
Code section.59
33-20E-25.60
(a)(1) An insurer shall monitor on an ongoing basis the ability, clinical capacity, and61
legal authority of its participating providers to furnish all contracted covered benefits to62
all covered persons under a network plan.63
(2) Beginning January 1, 2025, and annually thereafter, in a manner and format as64
determined by the Commissioner, an insurer shall report to the Commissioner such65
quantitative data as necessary to demonstrate compliance with Code Section 33-20E-24.66 23 SB 20/AP
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(b) The Commissioner is authorized to conduct a data call, market conduct examination,67
or compliance audit to determine compliance with the provisions in Code68
Section 33-20E-24, as authorized by Code Section 33-2-11, and the insurer subject to such69
data call, market conduct examination, or compliance audit shall pay all the actual expenses70
incurred, in accord with Code Section 33-2-15.71
(c)(1) When the Commissioner determines noncompliance with the provisions in Code72
Section 33-20E-24, the Commissioner shall notify the insurer of the determination and73
shall set forth the reasons for the determination. Prior to such determination, the74
Commissioner shall consider factors that might hinder an insurer's compliance, including,75
but not limited to, the availability of providers, the willingness of nonparticipating76
providers to enter into reasonable network contract agreements with an insurer, and good77
faith efforts by an insurer to enter into network contract agreements with such78
nonparticipating providers.79
(2) The Commissioner may set forth proposed remedies that will render compliance in80
the judgment of the Commissioner, may order that healthcare services provided by81
nonparticipating providers be covered at an in-network level of benefits, and may impose82
any administrative penalties authorized by this title.83
(d) Within 30 days of notification from the Commissioner, the insurer shall submit a84
response to the Commissioner that addresses all of the Commissioner's concerns.85
(e) Within 30 days of the submission of the response, the Commissioner shall determine86
whether such response is acceptable and shall notify the insurer of the determination and87
shall set forth the reasons for the determination.88
(f) If the response is deemed unacceptable to the Commissioner, the insurer shall have the89
right to request a hearing in accord with Code Section 33-2-17.90 23 SB 20/AP
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33-20E-26.91
(a) For each and every act in violation of Code Section 33-20E-24, the Commissioner may92
impose a monetary penalty of up to $2,000.00, unless the insurer knew or reasonably93
should have known of the violation, in which case the monetary penalty imposed may be94
up to $5,000.00 for each and every act in violation.95
(b) The Commissioner may take any action authorized, including, but not limited to,96
issuing an administrative order imposing monetary penalties, imposing a compliance plan,97
ordering the insurer to develop a compliance plan, or ordering the insurer to reprocess98
claims."99
SECTION 3.100
This Act shall become effective on January 1, 2024, and shall apply to all policies or101
contracts issued, delivered, issued for delivery, or renewed in this state on or after such date.102
SECTION 4.103
All laws and parts of laws in conflict with this Act are repealed.104