25 LC 46 1213
House Bill 928
By: Representatives Willis of the 55
th
, Crawford of the 89
th
, McQueen of the 61
st
, Jackson
of the 165
th
, and Miller of the 62
nd
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
1
insurance generally, so as to provide that utilization review by an insurer shall not be2
required in the instance in which a physician has determined the existence of dense breast3
tissue and the medical necessity of a breast ultrasound; to provide for a definition; to provide4
for related matters; to provide for an effective date and applicability; to repeal conflicting5
laws; and for other purposes.6
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
SECTION 1.8
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance9
generally, is amended by revising Code Section 33-24-59.32, relating to cost-sharing10
requirements for diagnostic and supplemental breast screening examinations, as follows: 11
"33-24-59.32.12
(a) As used in this Code section, the term:13
(1) 'Breast magnetic resonance imaging' or 'breast
MRI' means a diagnostic and14
screening tool, including standard and abbreviated breast MRI, that uses radio waves and15
magnets to produce detailed images of structures within the breast.16
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(2) 'Breast ultrasound' means a noninvasive diagnostic and screening tool that uses
17
high-frequency sound waves and their echoes to produce detailed images of structures18
within the breast.19
(3) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any20
maximum limitation on the application of such a deductible, coinsurance, copayment, or21
similar out-of-pocket expense.22
(4) 'Dense breast tissue' means heterogeneously or extremely dense breast tissue based
23
on nationally recognized guidelines or systems for breast imaging reporting of24
mammography, including, but not limited to, the Breast Imaging Reporting and Data25
System established by the American College of Radiology.26
(4)(5) 'Diagnostic breast examination' means a medically necessary and clinically27
appropriate examination of the breast, including such examination using breast MRI,28
breast ultrasound, or mammogram, that is:29
(A) Used to evaluate an abnormality seen or suspected from a screening examination30
for breast cancer; or31
(B) Used to evaluate an abnormality detected by another means of examination.32
(5)(6) 'Health benefit policy' means any individual or group plan, policy, or contract for33
health care healthcare services issued, delivered, issued for delivery, executed, or34
renewed by an insurer in this state.35
(6)(7) 'Insurer' means any person, corporation, or other entity authorized to provide36
health benefit policies under this title.37
(7)(8) 'Mammogram' means a diagnostic or screening mammography exam using a38
low-dose X-ray to produce an image of the breast.39
(8)(9) 'Supplemental breast screening examination' means a medically necessary and40
clinically appropriate examination of the breast, including such examination using breast41
MRI, breast ultrasound, or mammogram, that is:42
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(A) Used to screen for breast cancer when there is no abnormality seen or suspected
43
in the breast; or44
(B) Based on personal or family medical history or additional factors that may increase45
the individual's risk of breast cancer.46
(b) A health benefit policy that provides coverage for diagnostic breast
examinations for47
breast cancer shall include provisions that ensure that the cost-sharing requirements48
applicable to diagnostic breast examinations and supplemental breast screening49
examinations are no less favorable than the cost-sharing requirements applicable to50
screening mammography for breast cancer.51
(c) Nothing in this Code section shall be construed to preclude existing utilization review52
provided under Chapter 46 of this title, except that, if a supplemental breast screening53
examination reveals the existence of dense breast tissue, following the patient notification54
required in Code Section 31-1-17, the diagnosing physician may determine whether a55
breast ultrasound is medically necessary, and such determination shall not be disputed56
through utilization review or any other procedure by an insurer for purposes of denying57
insurance coverage for such examinee.58
(d) If under federal law application of subsection (b) of this Code section would result in59
Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, such60
cost-sharing requirement shall apply only for Health Savings Account qualified High61
Deductible Health Plans with respect to the deductible of such plan after the enrollee has62
satisfied the minimum deductible under Section 223 of the Internal Revenue Code, except63
with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C)64
of the Internal Revenue Code, in which case the requirements of subsection (b) of this65
Code section shall apply regardless of whether the minimum deductible under Section 22366
of the Internal Revenue Code has been satisfied.67
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(e) The Commissioner shall promulgate rules and regulations necessary to implement the
68
provisions of this Code section in accordance with current guidelines established by69
professional medical organizations such as the National Comprehensive Cancer Network."70
SECTION 2.71
This Act shall become effective on July 1, 2025, and shall apply to all applicable policies,72
contracts, and certificates executed, delivered, issued for delivery, or renewed in this state73
on or after October 1, 2025.74
SECTION 3.75
All laws and parts of laws in conflict with this Act are repealed.76
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