Georgia 2025-2026 Regular Session

Georgia House Bill HB928 Compare Versions

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

Old	New	Differences
1	1	25 LC 46 1213
2	2	House Bill 928
3	3	By: Representatives Willis of the 55
4	4	th
5	5	, Crawford of the 89
6	6	th
7	7	, McQueen of the 61
8	8	st
9	9	, Jackson
10	10	of the 165
11	11	th
12	12	, and Miller of the 62
13	13	nd
14	14
15	15	A BILL TO BE ENTITLED
16	16	AN ACT
17	17	To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
18	18	1
19	19	insurance generally, so as to provide that utilization review by an insurer shall not be2
20	20	required in the instance in which a physician has determined the existence of dense breast3
21	21	tissue and the medical necessity of a breast ultrasound; to provide for a definition; to provide4
22	22	for related matters; to provide for an effective date and applicability; to repeal conflicting5
23	23	laws; and for other purposes.6
24	24	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
25	25	SECTION 1.8
26	26	Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance9
27	27	generally, is amended by revising Code Section 33-24-59.32, relating to cost-sharing10
28	28	requirements for diagnostic and supplemental breast screening examinations, as follows: 11
29	29	"33-24-59.32.12
30	30	(a) As used in this Code section, the term:13
31	31	(1) 'Breast magnetic resonance imaging' or 'breast
32	32	MRI' means a diagnostic and14
33	33	screening tool, including standard and abbreviated breast MRI, that uses radio waves and15
34	34	magnets to produce detailed images of structures within the breast.16
35	35	H. B. 928
36	36	- 1 - 25 LC 46 1213
37	37	(2) 'Breast ultrasound' means a noninvasive diagnostic and screening tool that uses
38	38	17
39	39	high-frequency sound waves and their echoes to produce detailed images of structures18
40	40	within the breast.19
41	41	(3) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any20
42	42	maximum limitation on the application of such a deductible, coinsurance, copayment, or21
43	43	similar out-of-pocket expense.22
44	44	(4) 'Dense breast tissue' means heterogeneously or extremely dense breast tissue based
45	45	23
46	46	on nationally recognized guidelines or systems for breast imaging reporting of24
47	47	mammography, including, but not limited to, the Breast Imaging Reporting and Data25
48	48	System established by the American College of Radiology.26
49	49	(4)(5) 'Diagnostic breast examination' means a medically necessary and clinically27
50	50	appropriate examination of the breast, including such examination using breast MRI,28
51	51	breast ultrasound, or mammogram, that is:29
52	52	(A) Used to evaluate an abnormality seen or suspected from a screening examination30
53	53	for breast cancer; or31
54	54	(B) Used to evaluate an abnormality detected by another means of examination.32
55	55	(5)(6) 'Health benefit policy' means any individual or group plan, policy, or contract for33
56	56	health care healthcare services issued, delivered, issued for delivery, executed, or34
57	57	renewed by an insurer in this state.35
58	58	(6)(7) 'Insurer' means any person, corporation, or other entity authorized to provide36
59	59	health benefit policies under this title.37
60	60	(7)(8) 'Mammogram' means a diagnostic or screening mammography exam using a38
61	61	low-dose X-ray to produce an image of the breast.39
62	62	(8)(9) 'Supplemental breast screening examination' means a medically necessary and40
63	63	clinically appropriate examination of the breast, including such examination using breast41
64	64	MRI, breast ultrasound, or mammogram, that is:42
65	65	H. B. 928
66	66	- 2 - 25 LC 46 1213
67	67	(A) Used to screen for breast cancer when there is no abnormality seen or suspected
68	68	43
69	69	in the breast; or44
70	70	(B) Based on personal or family medical history or additional factors that may increase45
71	71	the individual's risk of breast cancer.46
72	72	(b) A health benefit policy that provides coverage for diagnostic breast
73	73	examinations for47
74	74	breast cancer shall include provisions that ensure that the cost-sharing requirements48
75	75	applicable to diagnostic breast examinations and supplemental breast screening49
76	76	examinations are no less favorable than the cost-sharing requirements applicable to50
77	77	screening mammography for breast cancer.51
78	78	(c) Nothing in this Code section shall be construed to preclude existing utilization review52
79	79	provided under Chapter 46 of this title, except that, if a supplemental breast screening53
80	80	examination reveals the existence of dense breast tissue, following the patient notification54
81	81	required in Code Section 31-1-17, the diagnosing physician may determine whether a55
82	82	breast ultrasound is medically necessary, and such determination shall not be disputed56
83	83	through utilization review or any other procedure by an insurer for purposes of denying57
84	84	insurance coverage for such examinee.58
85	85	(d) If under federal law application of subsection (b) of this Code section would result in59
86	86	Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, such60
87	87	cost-sharing requirement shall apply only for Health Savings Account qualified High61
88	88	Deductible Health Plans with respect to the deductible of such plan after the enrollee has62
89	89	satisfied the minimum deductible under Section 223 of the Internal Revenue Code, except63
90	90	with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C)64
91	91	of the Internal Revenue Code, in which case the requirements of subsection (b) of this65
92	92	Code section shall apply regardless of whether the minimum deductible under Section 22366
93	93	of the Internal Revenue Code has been satisfied.67
94	94	H. B. 928
95	95	- 3 - 25 LC 46 1213
96	96	(e) The Commissioner shall promulgate rules and regulations necessary to implement the
97	97	68
98	98	provisions of this Code section in accordance with current guidelines established by69
99	99	professional medical organizations such as the National Comprehensive Cancer Network."70
100	100	SECTION 2.71
101	101	This Act shall become effective on July 1, 2025, and shall apply to all applicable policies,72
102	102	contracts, and certificates executed, delivered, issued for delivery, or renewed in this state73
103	103	on or after October 1, 2025.74
104	104	SECTION 3.75
105	105	All laws and parts of laws in conflict with this Act are repealed.76
106	106	H. B. 928
107	107	- 4 -