25 LC 52 0603
House Bill 124
By: Representatives Scoggins of the 14
th
, Hawkins of the 27
th
, Hatchett of the 155
th
, Clark
of the 100
th
, Newton of the 127
th
, and others
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 and Article 1 of Chapter 18 of Title 45 of the
1
Official Code of Georgia Annotated, relating to general provisions relative to insurance and2
the state employees' health insurance plan and post-employment health benefit fund,3
respectively, so as to require coverage for healthcare services for pediatric autoimmune4
neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric5
acute onset neuropsychiatric syndrome (PANS) in accordance with nationally recognized6
clinical practice guidelines; to provide for definitions; to allow for deductibles; to prohibit7
special deductibles; to provide for rules and regulations; to provide for related matters; to8
repeal conflicting laws; and for other purposes.9
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10
SECTION 1.11
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to12
general provisions relative to insurance, is amended by adding a new Code section to read13
as follows:14
"33-24-59.34.
15
(a) As used in this Code section, the term:16
H. B. 124
- 1 - 25 LC 52 0603
(1) 'Health benefit policy' means any individual or group plan, policy, or contract for17
healthcare services issued, delivered, issued for delivery, or renewed in this state which18
provides major medical benefits, including those contracts executed by the State of19
Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a20
health care corporation, health maintenance organization, preferred provider organization,21
accident and sickness insurer, fraternal benefit society, hospital service corporation,22
medical service corporation, or other insurer or similar entity. Such term shall not23
include any self-insured health benefit plan subject to the exclusive jurisdiction of the24
federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001,25
et seq.26
(2) 'Nationally recognized clinical practice guidelines' means evidence based clinical27
practice guidelines developed by independent organizations or medical professional28
societies utilizing a transparent methodology and reporting structure and with a29
conflict-of-interest policy. Such guidelines establish standards of care informed by a30
systematic review of evidence and an assessment of the benefits and risks of alternative31
care options and include recommendations intended to optimize patient care.32
(3) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute33
onset obsessive compulsive or tic disorders or other behavioral changes presenting in34
children and adolescents that are not otherwise explained by another known neurologic35
or medical disorder.36
(4) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal37
infections' or 'PANDAS' means a condition in which a streptococcal infection in a child38
or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,39
tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and40
remitting course of symptom severity.41
H. B. 124
- 2 - 25 LC 52 0603
(b) All health benefit policies renewed or issued on or after July 1, 2025, shall include42
coverage for healthcare services for PANDAS or PANS for an individual covered under43
such policy as provided in this Code section.44
(c) Healthcare services for PANDAS or PANS for an individual covered under a health45
benefit policy shall be covered for the purposes of diagnosis, treatment, appropriate46
management, or ongoing monitoring of a covered person's disorder when such services are47
supported by nationally recognized clinical practice guidelines.48
(d) The benefits in a health benefit policy as provided for in this Code section shall be49
subject to the same deductibles, coinsurance, copayment provisions, and other limitations50
established for all covered benefits within such health benefit policy. Special deductibles,51
coinsurance, copayment, and other limitations that are not generally applicable to other52
healthcare services covered by a health benefit policy shall not be imposed on coverage for53
healthcare services for PANDAS or PANS.54
(e) The Commissioner shall promulgate rules and regulations necessary to implement the55
provisions of this Code section."56
SECTION 2.57
Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to the58
state employees' insurance health insurance plan and post-employment health benefit fund,59
is amended by adding a new Code section to read as follows:60
"45-18-4.2.61
(a) As used in this Code section, the term:62
(1) 'Nationally recognized clinical practice guidelines' means evidence based clinical63
practice guidelines developed by independent organizations or medical professional64
societies utilizing a transparent methodology and reporting structure and with a65
conflict-of-interest policy. Such guidelines establish standards of care informed by a66
H. B. 124
- 3 - 25 LC 52 0603
systematic review of evidence and an assessment of the benefits and risks of alternative67
care options and include recommendations intended to optimize patient care.68
(2) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute69
onset obsessive compulsive or tic disorders or other behavioral changes presenting in70
children and adolescents that are not otherwise explained by another known neurologic71
or medical disorder.72
(3) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal73
infections' or 'PANDAS' means a condition in which a streptococcal infection in a child74
or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,75
tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and76
remitting course of symptom severity.77
(4) 'State health benefit plan' means the health insurance plan or plans established78
pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and79
public employees, dependents, and retirees.80
(b) Beginning January 1, 2026, the state health benefit plan shall include coverage for81
healthcare services for PANDAS or PANS for an individual covered under such policy as82
provided in this Code section.83
(c) Healthcare services for PANDAS or PANS for an individual covered under the state84
health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate85
management, or ongoing monitoring of a covered person's disorder when such services are86
supported by nationally recognized clinical practice guidelines.87
(d) The benefits in the state health benefit plan as provided for in this Code section shall88
be subject to the same deductibles, coinsurance, copayment provisions, and other89
limitations established for all covered benefits within such plan. Special deductibles,90
coinsurance, copayment, and other limitations that are not generally applicable to91
healthcare services covered by such plan shall not be imposed on coverage for healthcare92
services for PANDAS or PANS."93
H. B. 124
- 4 - 25 LC 52 0603
SECTION 3.
94
All laws and parts of laws in conflict with this Act are repealed.95
H. B. 124
- 5 -