Georgia 2025-2026 Regular Session

Georgia Senate Bill SB205 Compare Versions

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

Old	New	Differences
1	1	25 LC 52 0719
2	2	Senate Bill 205
3	3	By: Senators Watson of the 11th, Brass of the 6th, Hodges of the 3rd, Watson of the 1st,
4	4	Kirkpatrick of the 32nd and others
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	To amend Article 1 of Chapter 24 of Title 33 and Article 1 of Chapter 18 of Title 45 of the
8	8	1
9	9	Official Code of Georgia Annotated, relating to general provisions relative to insurance and2
10	10	the state employees' health insurance plan and post-employment health benefit fund,3
11	11	respectively, so as to require coverage for healthcare services for pediatric autoimmune4
12	12	neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric5
13	13	acute onset neuropsychiatric syndrome (PANS) in accordance with nationally recognized6
14	14	clinical practice guidelines; to provide for definitions; to allow for deductibles; to prohibit7
15	15	special deductibles; to provide for rules and regulations; to provide for related matters; to8
16	16	repeal conflicting laws; and for other purposes.9
17	17	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10
18	18	SECTION 1.11
19	19	Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to12
20	20	general provisions relative to insurance, is amended by adding a new Code section to read13
21	21	as follows:14
22	22	"33-24-59.34.
23	23	15
24	24	(a) As used in this Code section, the term:16
25	25	S. B. 205
26	26	- 1 - 25 LC 52 0719
27	27	(1) 'Health benefit policy' means any individual or group plan, policy, or contract for17
28	28	healthcare services issued, delivered, issued for delivery, or renewed in this state which18
29	29	provides major medical benefits, including those contracts executed by the State of19
30	30	Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a20
31	31	health care corporation, health maintenance organization, preferred provider organization,21
32	32	accident and sickness insurer, fraternal benefit society, hospital service corporation,22
33	33	medical service corporation, or other insurer or similar entity. Such term shall not23
34	34	include any self-insured health benefit plan subject to the exclusive jurisdiction of the24
35	35	federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001,25
36	36	et seq.26
37	37	(2) 'Nationally recognized clinical practice guidelines' means evidence based clinical27
38	38	practice guidelines developed by independent organizations or medical professional28
39	39	societies utilizing a transparent methodology and reporting structure and with a29
40	40	conflict-of-interest policy. Such guidelines establish standards of care informed by a30
41	41	systematic review of evidence and an assessment of the benefits and risks of alternative31
42	42	care options and include recommendations intended to optimize patient care.32
43	43	(3) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute33
44	44	onset obsessive compulsive or tic disorders or other behavioral changes presenting in34
45	45	children and adolescents that are not otherwise explained by another known neurologic35
46	46	or medical disorder.36
47	47	(4) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal37
48	48	infections' or 'PANDAS' means a condition in which a streptococcal infection in a child38
49	49	or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,39
50	50	tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and40
51	51	remitting course of symptom severity.41
52	52	S. B. 205
53	53	- 2 - 25 LC 52 0719
54	54	(b) All health benefit policies renewed or issued on or after July 1, 2025, shall include42
55	55	coverage for healthcare services for PANDAS or PANS for an individual covered under43
56	56	such policy as provided in this Code section.44
57	57	(c) Healthcare services for PANDAS or PANS for an individual covered under a health45
58	58	benefit policy shall be covered for the purposes of diagnosis, treatment, appropriate46
59	59	management, or ongoing monitoring of a covered person's disorder when such services are47
60	60	supported by nationally recognized clinical practice guidelines.48
61	61	(d) The benefits in a health benefit policy as provided for in this Code section shall be49
62	62	subject to the same deductibles, coinsurance, copayment provisions, and other limitations50
63	63	established for all covered benefits within such health benefit policy. Special deductibles,51
64	64	coinsurance, copayment, and other limitations that are not generally applicable to other52
65	65	healthcare services covered by a health benefit policy shall not be imposed on coverage for53
66	66	healthcare services for PANDAS or PANS.54
67	67	(e) The Commissioner shall promulgate rules and regulations necessary to implement the55
68	68	provisions of this Code section."56
69	69	SECTION 2.57
70	70	Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to the58
71	71	state employees' insurance health insurance plan and post-employment health benefit fund,59
72	72	is amended by adding a new Code section to read as follows:60
73	73	"45-18-4.2.61
74	74	(a) As used in this Code section, the term:62
75	75	(1) 'Nationally recognized clinical practice guidelines' means evidence based clinical63
76	76	practice guidelines developed by independent organizations or medical professional64
77	77	societies utilizing a transparent methodology and reporting structure and with a65
78	78	conflict-of-interest policy. Such guidelines establish standards of care informed by a66
79	79	S. B. 205
80	80	- 3 - 25 LC 52 0719
81	81	systematic review of evidence and an assessment of the benefits and risks of alternative67
82	82	care options and include recommendations intended to optimize patient care.68
83	83	(2) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute69
84	84	onset obsessive compulsive or tic disorders or other behavioral changes presenting in70
85	85	children and adolescents that are not otherwise explained by another known neurologic71
86	86	or medical disorder.72
87	87	(3) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal73
88	88	infections' or 'PANDAS' means a condition in which a streptococcal infection in a child74
89	89	or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,75
90	90	tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and76
91	91	remitting course of symptom severity.77
92	92	(4) 'State health benefit plan' means the health insurance plan or plans established78
93	93	pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and79
94	94	public employees, dependents, and retirees.80
95	95	(b) Beginning January 1, 2026, the state health benefit plan shall include coverage for81
96	96	healthcare services for PANDAS or PANS for an individual covered under such policy as82
97	97	provided in this Code section.83
98	98	(c) Healthcare services for PANDAS or PANS for an individual covered under the state84
99	99	health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate85
100	100	management, or ongoing monitoring of a covered person's disorder when such services are86
101	101	supported by nationally recognized clinical practice guidelines.87
102	102	(d) The benefits in the state health benefit plan as provided for in this Code section shall88
103	103	be subject to the same deductibles, coinsurance, copayment provisions, and other89
104	104	limitations established for all covered benefits within such plan. Special deductibles,90
105	105	coinsurance, copayment, and other limitations that are not generally applicable to91
106	106	healthcare services covered by such plan shall not be imposed on coverage for healthcare92
107	107	services for PANDAS or PANS."93
108	108	S. B. 205
109	109	- 4 - 25 LC 52 0719
110	110	SECTION 3.
111	111	94
112	112	All laws and parts of laws in conflict with this Act are repealed.95
113	113	S. B. 205
114	114	- 5 -