Georgia 2025-2026 Regular Session

Georgia House Bill HB197 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	25 HB 197/AP
2		-	House Bill 197 (AS PASSED HOUSE AND SENATE)
3		-	By: Representatives Hawkins of the 27
4		-	th
5		-	, Newton of the 127
6		-	th
7		-	, Kelley of the 16
8		-	th
9		-	, Silcox of
10		-	the 53
11		-	rd
12		-	, Cooper of the 45
13		-	th
14		-	, and others
	1	+	25 LC 46 1247S
	2	+	The Senate Committee on Rules offered the following
	3	+	substitute to HB 197:
15	4		A BILL TO BE ENTITLED
16	5		AN ACT
17		-	To amend Code Section 33-46-6 of the Official Code of Georgia Annotated, relating to
18		-	1
	6	+	To amend Code Section 33-46-6 of the Official Code of Georgia Annotated, relating to1
19	7		requirements for certification, utilization of nationally recognized accreditation standards,2
20	8		and website identifying nationally recognized accreditation entities, so as to detail the effort3
21	9		that shall be made by treating health care provider to respond to a private review agent or4
22	10		utility review entity's attempt to reach such provider to discuss the patient's care; to amend5
23	11		Chapter 46 of Title 33 of the Official Code of Georgia Annotated, relating to certification of6
24	12		private review agents, so as to provide for health insurers to implement and maintain a7
25	13		program that allows for the selective application of reductions in prior authorization8
26	14		requirements under certain circumstances; to provide for an annual filing; to provide for the9
27	15		promulgation of rules and regulations; to provide for related matters; to provide for an10
28	16		effective date and applicability; to repeal conflicting laws; and for other purposes.11
29	17		BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12
30	18		SECTION 1.13
31	19		Code Section 33-46-6 of the Official Code of Georgia Annotated, relating to requirements14
32	20		for certification, utilization of nationally recognized accreditation standards, and website15
33		-	H. B. 197
34		-	- 1 - 25 HB 197/AP
35		-	identifying nationally recognized accreditation entities, is amended by revising paragraph (5)
36		-	16
	21	+	- 1 - 25 LC 46 1247S
	22	+	identifying nationally recognized accreditation entities, is amended by revising paragraph (5)16
37	23		of subsection (a) as follows:17
38	24		"(5) In any instances where the private review agent or utilization review entity is18
39	25		questioning the medical necessity of care, the treating health care provider, or such19
40	26		provider's appropriately qualified designee, shall be able to discuss the plan of treatment20
41	27		with a clinical peer trained in a related specialty and no adverse determination shall be21
42	28		made by the private review agent or utilization review entity until an effort has been22
43	29		made to discuss the patient's care with the patient's treating provider, or such provider's23
44	30		appropriately qualified designee who shall be familiar with the patient's case, during24
45		-	normal working hours. Such effort shall include contacting the treating provider or his
46		-	25
	31	+	normal working hours. Such effort shall include contacting the treating provider or his25
47	32		or her designee, implementing a callback telecommunications system, or the use of a26
48	33		public website whereby such provider or designee may elect to receive a scheduled27
49	34		communication at a later time in the event that a clinical peer is not available. In the28
50	35		event of an adverse determination, notice to the provider will specify the reasons for the29
51	36		review determination;"30
52	37		SECTION 2.31
53	38		Chapter 46 of Title 33 of the Official Code of Georgia Annotated, relating to certification of32
54	39		private review agents, is amended by adding a new Code section to read as follows:33
55	40		"33-46-20.1.34
56	41		(a) Each insurer that utilizes prior authorization requirements shall implement and35
57	42		maintain a program that allows for the selective application of reductions in prior36
58	43		authorization requirements based on the stratification of healthcare providers' performance37
59	44		and adherence to evidence based medicine. Such program shall promote quality,38
60	45		affordable healthcare and reduce unnecessary administrative burdens for both the insurer39
61	46		and the healthcare provider.40
62		-	H. B. 197
63		-	- 2 - 25 HB 197/AP
	47	+	- 2 - 25 LC 46 1247S
64	48		(b) Criteria for participation by healthcare providers and the healthcare services included41
65	49		in the program shall be at the discretion of the insurer; provided, however, that such insurer42
66	50		shall submit to the department a filing concerning such program. Such filing shall include43
67	51		a full narrative description of the program, the criteria for participation in the program, a44
68	52		list of the procedures and services subject to the program, the number of healthcare45
69	53		providers participating in the program, and any other information deemed necessary by the46
70	54		department.47
71	55		(c) No later than July 1, 2026, each insurer that utilizes prior authorization requirements48
72	56		shall make the filing provided for in subsection (b) of this Code section, and such filing49
73	57		shall be submitted annually in a form and manner provided for by rules and regulations50
74	58		promulgated by the Commissioner."51
75	59		SECTION 3.52
76	60		This Act shall become effective on January 1, 2026, and shall apply to all policies or53
77	61		contracts issued, delivered, issued for delivery, or renewed in this state on or after such date.54
78	62		SECTION 4.55
79	63		All laws and parts of laws in conflict with this Act are repealed.56
80		-	H. B. 197
81	64		- 3 -