Georgia 2025-2026 Regular Session

Georgia House Bill HB124 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	25 LC 52 0603
2	2	House Bill 124
3	3	By: Representatives Scoggins of the 14
4	4	th
5	5	, Hawkins of the 27
6	6	th
7	7	, Hatchett of the 155
8	8	th
9	9	, Clark
10	10	of the 100
11	11	th
12	12	, Newton of the 127
13	13	th
14	14	, and others
15	15	A BILL TO BE ENTITLED
16	16	AN ACT
17	17	To amend Article 1 of Chapter 24 of Title 33 and Article 1 of Chapter 18 of Title 45 of the
18	18	1
19	19	Official Code of Georgia Annotated, relating to general provisions relative to insurance and2
20	20	the state employees' health insurance plan and post-employment health benefit fund,3
21	21	respectively, so as to require coverage for healthcare services for pediatric autoimmune4
22	22	neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric5
23	23	acute onset neuropsychiatric syndrome (PANS) in accordance with nationally recognized6
24	24	clinical practice guidelines; to provide for definitions; to allow for deductibles; to prohibit7
25	25	special deductibles; to provide for rules and regulations; to provide for related matters; to8
26	26	repeal conflicting laws; and for other purposes.9
27	27	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10
28	28	SECTION 1.11
29	29	Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to12
30	30	general provisions relative to insurance, is amended by adding a new Code section to read13
31	31	as follows:14
32	32	"33-24-59.34.
33	33	15
34	34	(a) As used in this Code section, the term:16
35	35	H. B. 124
36	36	- 1 - 25 LC 52 0603
37	37	(1) 'Health benefit policy' means any individual or group plan, policy, or contract for17
38	38	healthcare services issued, delivered, issued for delivery, or renewed in this state which18
39	39	provides major medical benefits, including those contracts executed by the State of19
40	40	Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a20
41	41	health care corporation, health maintenance organization, preferred provider organization,21
42	42	accident and sickness insurer, fraternal benefit society, hospital service corporation,22
43	43	medical service corporation, or other insurer or similar entity. Such term shall not23
44	44	include any self-insured health benefit plan subject to the exclusive jurisdiction of the24
45	45	federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001,25
46	46	et seq.26
47	47	(2) 'Nationally recognized clinical practice guidelines' means evidence based clinical27
48	48	practice guidelines developed by independent organizations or medical professional28
49	49	societies utilizing a transparent methodology and reporting structure and with a29
50	50	conflict-of-interest policy. Such guidelines establish standards of care informed by a30
51	51	systematic review of evidence and an assessment of the benefits and risks of alternative31
52	52	care options and include recommendations intended to optimize patient care.32
53	53	(3) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute33
54	54	onset obsessive compulsive or tic disorders or other behavioral changes presenting in34
55	55	children and adolescents that are not otherwise explained by another known neurologic35
56	56	or medical disorder.36
57	57	(4) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal37
58	58	infections' or 'PANDAS' means a condition in which a streptococcal infection in a child38
59	59	or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,39
60	60	tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and40
61	61	remitting course of symptom severity.41
62	62	H. B. 124
63	63	- 2 - 25 LC 52 0603
64	64	(b) All health benefit policies renewed or issued on or after July 1, 2025, shall include42
65	65	coverage for healthcare services for PANDAS or PANS for an individual covered under43
66	66	such policy as provided in this Code section.44
67	67	(c) Healthcare services for PANDAS or PANS for an individual covered under a health45
68	68	benefit policy shall be covered for the purposes of diagnosis, treatment, appropriate46
69	69	management, or ongoing monitoring of a covered person's disorder when such services are47
70	70	supported by nationally recognized clinical practice guidelines.48
71	71	(d) The benefits in a health benefit policy as provided for in this Code section shall be49
72	72	subject to the same deductibles, coinsurance, copayment provisions, and other limitations50
73	73	established for all covered benefits within such health benefit policy. Special deductibles,51
74	74	coinsurance, copayment, and other limitations that are not generally applicable to other52
75	75	healthcare services covered by a health benefit policy shall not be imposed on coverage for53
76	76	healthcare services for PANDAS or PANS.54
77	77	(e) The Commissioner shall promulgate rules and regulations necessary to implement the55
78	78	provisions of this Code section."56
79	79	SECTION 2.57
80	80	Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to the58
81	81	state employees' insurance health insurance plan and post-employment health benefit fund,59
82	82	is amended by adding a new Code section to read as follows:60
83	83	"45-18-4.2.61
84	84	(a) As used in this Code section, the term:62
85	85	(1) 'Nationally recognized clinical practice guidelines' means evidence based clinical63
86	86	practice guidelines developed by independent organizations or medical professional64
87	87	societies utilizing a transparent methodology and reporting structure and with a65
88	88	conflict-of-interest policy. Such guidelines establish standards of care informed by a66
89	89	H. B. 124
90	90	- 3 - 25 LC 52 0603
91	91	systematic review of evidence and an assessment of the benefits and risks of alternative67
92	92	care options and include recommendations intended to optimize patient care.68
93	93	(2) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute69
94	94	onset obsessive compulsive or tic disorders or other behavioral changes presenting in70
95	95	children and adolescents that are not otherwise explained by another known neurologic71
96	96	or medical disorder.72
97	97	(3) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal73
98	98	infections' or 'PANDAS' means a condition in which a streptococcal infection in a child74
99	99	or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,75
100	100	tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and76
101	101	remitting course of symptom severity.77
102	102	(4) 'State health benefit plan' means the health insurance plan or plans established78
103	103	pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and79
104	104	public employees, dependents, and retirees.80
105	105	(b) Beginning January 1, 2026, the state health benefit plan shall include coverage for81
106	106	healthcare services for PANDAS or PANS for an individual covered under such policy as82
107	107	provided in this Code section.83
108	108	(c) Healthcare services for PANDAS or PANS for an individual covered under the state84
109	109	health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate85
110	110	management, or ongoing monitoring of a covered person's disorder when such services are86
111	111	supported by nationally recognized clinical practice guidelines.87
112	112	(d) The benefits in the state health benefit plan as provided for in this Code section shall88
113	113	be subject to the same deductibles, coinsurance, copayment provisions, and other89
114	114	limitations established for all covered benefits within such plan. Special deductibles,90
115	115	coinsurance, copayment, and other limitations that are not generally applicable to91
116	116	healthcare services covered by such plan shall not be imposed on coverage for healthcare92
117	117	services for PANDAS or PANS."93
118	118	H. B. 124
119	119	- 4 - 25 LC 52 0603
120	120	SECTION 3.
121	121	94
122	122	All laws and parts of laws in conflict with this Act are repealed.95
123	123	H. B. 124
124	124	- 5 -