Georgia 2025-2026 Regular Session

Georgia Senate Bill SB5 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	25 LC 52 0855S
2		-	Senate Bill 5
3		-	By: Senators Kirkpatrick of the 32nd, Walker III of the 20th, Watson of the 1st, Hufstetler
4		-	of the 52nd, Harbison of the 15th and others
5		-	AS PASSED
	1	+	LC 52 0855S
	2	+	The House Committee on Rules offers the following substitute to SB 5:
6	3		A BILL TO BE ENTITLED
7	4		AN ACT
8		-	To amend Chapter 46 of Title 33 of the Official Code of Georgia Annotated, relating to
9		-	1
	5	+	To amend Chapter 46 of Title 33 of the Official Code of Georgia Annotated, relating to1
10	6		certification of private review agents, so as to provide for health insurers to implement and2
11	7		maintain a program that allows for the selective application of reductions in prior3
12	8		authorization requirements under certain circumstances; to provide for an annual filing; to4
13	9		provide for the promulgation of rules and regulations; to amend Chapter 24 of Title 33 and5
14	10		Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to insurance6
15	11		generally and employees' insurance and benefits plans, respectively, so as to require coverage7
16	12		for healthcare services for pediatric autoimmune neuropsychiatric disorders associated with8
17	13		streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome9
18	14		(PANS) in accordance with nationally recognized clinical practice guidelines; to provide for10
19	15		definitions; to allow for deductibles; to prohibit special deductibles; to provide for rules and11
20	16		regulations; to provide for an effective date and applicability; to provide for related matters;12
21	17		to repeal conflicting laws; and for other purposes.13
22	18		BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:14
23		-	S. B. 5
24		-	- 1 - 25 LC 52 0855S
25		-	PART I
26		-	15
	19	+	- 1 - LC 52 0855S
	20	+	PART I15
27	21		SECTION 1-1.16
28	22		Chapter 46 of Title 33 of the Official Code of Georgia Annotated, relating to certification of17
29	23		private review agents, is amended by adding a new Code section to read as follows:18
30		-	"33-46-20.1.
31		-	19
	24	+	"33-46-20.1.19
32	25		(a) Each insurer that utilizes prior authorization requirements shall implement and20
33	26		maintain a program that allows for the selective application of reductions in prior21
34	27		authorization requirements based on the stratification of healthcare providers' performance22
35	28		and adherence to evidence based medicine. Such program shall promote quality,23
36	29		affordable healthcare and reduce unnecessary administrative burdens for both the insurer24
37	30		and the healthcare provider.25
38	31		(b) Criteria for participation by healthcare providers and the healthcare services included26
39	32		in the program shall be at the discretion of the insurer; provided, however, that such insurer27
40	33		shall submit to the department a filing concerning such program. Such filing shall include28
41	34		a full narrative description of the program, the criteria for participation in the program, a29
42	35		list of the procedures and services subject to the program, the number of healthcare30
43	36		providers participating in the program, and any other information deemed necessary by the31
44	37		department.32
45	38		(c) No later than July 1, 2026, each insurer that utilizes prior authorization requirements33
46	39		shall make the filing provided for in subsection (b) of this Code section, and such filing34
47	40		shall be submitted annually in a form and manner provided for by rules and regulations35
48	41		promulgated by the Commissioner."36
49		-	S. B. 5
50		-	- 2 - 25 LC 52 0855S
51		-	PART II
52		-	37
	42	+	- 2 - LC 52 0855S
	43	+	PART II37
53	44		SECTION 2-1.38
54	45		Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance39
55	46		generally, is amended by adding a new Code section to read as follows:40
56		-	"33-24-59.34.
57		-	41
	47	+	"33-24-59.34.41
58	48		(a) As used in this Code section, the term:42
59	49		(1) 'Health benefit policy' means any individual or group plan, policy, or contract for43
60	50		healthcare services issued, delivered, issued for delivery, or renewed in this state which44
61	51		provides major medical benefits, including those contracts executed by the State of45
62	52		Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a46
63	53		healthcare corporation, health maintenance organization, preferred provider organization,47
64	54		accident and sickness insurer, fraternal benefit society, hospital service corporation,48
65	55		medical service corporation, or other insurer or similar entity. Such term shall not49
66	56		include any self-insured health benefit plan subject to the exclusive jurisdiction of the50
67	57		federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001,51
68	58		et seq.52
69	59		(2) 'Nationally recognized clinical practice guidelines' means evidence based clinical53
70	60		practice guidelines developed by independent organizations or medical professional54
71	61		societies utilizing a transparent methodology and reporting structure and with a conflict55
72	62		of interest policy. Such guidelines establish standards of care informed by a systematic56
73	63		review of evidence and an assessment of the benefits and risks of alternative care options57
74	64		and include recommendations intended to optimize patient care.58
75	65		(3) 'Pediatric acute-onset neuropsychiatric syndrome' or 'PANS' means a class of59
76	66		acute-onset obsessive compulsive or tic disorders or other behavioral changes presenting60
77	67		in children and adolescents that are not otherwise explained by another known neurologic61
78	68		or medical disorder.62
79		-	S. B. 5
80		-	- 3 - 25 LC 52 0855S
	69	+	- 3 - LC 52 0855S
81	70		(4) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal63
82	71		infections' or 'PANDAS' means a condition in which a streptococcal infection in a child64
83	72		or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,65
84	73		tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and66
85	74		remitting course of symptom severity.67
86	75		(b) All health benefit policies issued or renewed on or after July 1, 2025, shall include68
87	76		coverage for healthcare services for PANDAS or PANS for an individual covered under69
88	77		such policy as provided in this Code section.70
89	78		(c) Healthcare services for PANDAS or PANS for an individual covered under a health71
90	79		benefit policy shall be covered for the purposes of diagnosis, treatment, appropriate72
91	80		management, or ongoing monitoring of a covered person's disorder when such services are73
92	81		supported by nationally recognized clinical practice guidelines.74
93	82		(d) The benefits in a health benefit policy as provided for in this Code section shall be75
94	83		subject to the same deductibles, coinsurance, copayment provisions, and other limitations76
95	84		established for all covered benefits within such health benefit policy. Special deductibles,77
96	85		coinsurance, copayment, and other limitations that are not generally applicable to other78
97	86		healthcare services covered by a health benefit policy shall not be imposed on coverage for79
98	87		healthcare services for PANDAS or PANS.80
99	88		(e) The Commissioner shall promulgate rules and regulations necessary to implement the81
100	89		provisions of this Code section."82
101	90		SECTION 2-2.83
102	91		Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to employees'84
103	92		insurance and benefit plans, is amended by adding a new Code section to read as follows:85
104	93		"45-18-4.2.86
105	94		(a) As used in this Code section, the term:87
106		-	S. B. 5
107		-	- 4 - 25 LC 52 0855S
	95	+	- 4 - LC 52 0855S
108	96		(1) 'Nationally recognized clinical practice guidelines' means evidence based clinical88
109	97		practice guidelines developed by independent organizations or medical professional89
110	98		societies utilizing a transparent methodology and reporting structure and with a conflict90
111	99		of interest policy. Such guidelines establish standards of care informed by a systematic91
112	100		review of evidence and an assessment of the benefits and risks of alternative care options92
113	101		and include recommendations intended to optimize patient care.93
114	102		(2) 'Pediatric acute-onset neuropsychiatric syndrome' or 'PANS' means a class of94
115	103		acute-onset obsessive compulsive or tic disorders or other behavioral changes presenting95
116	104		in children and adolescents that are not otherwise explained by another known neurologic96
117	105		or medical disorder.97
118	106		(3) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal98
119	107		infections' or 'PANDAS' means a condition in which a streptococcal infection in a child99
120	108		or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,100
121	109		tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and101
122	110		remitting course of symptom severity.102
123	111		(4) 'State health benefit plan' means the health insurance plan or plans established103
124	112		pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and104
125	113		public employees, dependents, and retirees.105
126	114		(b) Beginning January 1, 2026, the state health benefit plan shall include coverage for106
127	115		healthcare services for PANDAS or PANS for an individual covered under such policy as107
128	116		provided in this Code section.108
129	117		(c) Healthcare services for PANDAS or PANS for an individual covered under the state109
130	118		health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate110
131	119		management, or ongoing monitoring of a covered person's disorder when such services are111
132	120		supported by nationally recognized clinical practice guidelines.112
133	121		(d) The benefits in the state health benefit plan as provided for in this Code section shall113
134	122		be subject to the same deductibles, coinsurance, copayment provisions, and other114
135		-	S. B. 5
136		-	- 5 - 25 LC 52 0855S
	123	+	- 5 - LC 52 0855S
137	124		limitations established for all covered benefits within such plan. Special deductibles,115
138	125		coinsurance, copayment, and other limitations that are not generally applicable to116
139	126		healthcare services covered by such plan shall not be imposed on coverage for healthcare117
140	127		services for PANDAS or PANS."118
141	128		PART III119
142	129		SECTION 3-1.120
143	130		This Act shall become effective on July 1, 2025, and shall apply to all policies or contracts121
144	131		issued, delivered, issued for delivery, or renewed in this state on or after such date.122
145	132		SECTION 3-2.123
146	133		All laws and parts of laws in conflict with this Act are repealed.124
147		-	S. B. 5
148	134		- 6 -