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GeorgiaHB 1972025-2026 Regular SessionHouse

Insurance; health care provider to respond to a private review agent or utility review entity's attempt to discuss the patient's care; detail the effort

Sponsored By: Michelle Au (Democrat), Sharon Cooper (Republican), Lee Hawkins (Republican), Trey Kelley (Republican), Mark Newton (Republican), Deborah Silcox (Republican)

Signed by Governor

HealthRulesGeneral Bill

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Insurers must offer selective care approval relief

Beginning January 1, 2026, this law applies to state-regulated health policies issued or renewed in Georgia. Insurers using prior authorization must maintain programs allowing fewer advance approval requirements for selected providers and services. These programs must use provider performance and adherence to care backed by medical evidence. Insurers choose participation criteria and covered services; no provider or service is guaranteed relief. Insurers must report program details to the Georgia Department of Insurance by July 1, 2026, and annually afterward. Reports must describe participation criteria, covered procedures and services, participating-provider counts, and any other information the department requires. The Insurance Commissioner sets the reporting format and process.

Reviewers must seek provider input before denials

Beginning January 1, 2026, this law applies to state-regulated health policies issued or renewed in Georgia. When reviewers question whether care is medically necessary, they must try to discuss it before making an adverse decision. The discussion must involve the treating provider or a qualified designee and a clinical peer trained in a related specialty. Reviewers must make this effort during normal working hours. They can contact the provider directly or use a callback system. If a clinical peer is unavailable, a public website can let providers choose a scheduled discussion. Reviewers must give providers notice explaining an adverse decision. This process does not guarantee coverage.

Sponsors & Cosponsors

Sponsors

  • Michelle Au

    Democrat • House

  • Sharon Cooper

    Republican • House

  • Lee Hawkins

    Republican • House

  • Trey Kelley

    Republican • House

  • Mark Newton

    Republican • House

  • Deborah Silcox

    Republican • House

Cosponsors

  • Kay Kirkpatrick

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 389 • No: 0

House vote • 4/4/2025

Agree to Senate Substitute

Yes: 162 • No: 0 • Other: 6

Senate vote • 4/2/2025

PASSAGE BY SUBSTITUTE

Yes: 53 • No: 0 • Other: 1

House vote • 3/4/2025

PASSAGE

Yes: 174 • No: 0 • Other: 4

Actions Timeline

  1. Effective Date

    1/1/2026

  2. House Date Signed by Governor

    5/14/2025House

  3. Act 303

    5/14/2025

  4. House Sent to Governor

    4/9/2025House

  5. House Agreed Senate Amend or Sub

    4/4/2025House

  6. Senate Tabled

    4/2/2025Senate

  7. Senate Taken from Table

    4/2/2025Senate

  8. Senate Third Read

    4/2/2025Senate

  9. Senate Passed/Adopted By Substitute

    4/2/2025Senate

  10. Senate Committee Favorably Reported By Substitute

    3/31/2025Senate

  11. Senate Recommitted

    3/28/2025Senate

  12. Senate Read Second Time

    3/20/2025Senate

  13. Senate Committee Favorably Reported

    3/18/2025Senate

  14. Senate Read and Referred

    3/6/2025Senate

  15. House Third Readers

    3/4/2025House

  16. House Passed/Adopted

    3/4/2025House

  17. House Committee Favorably Reported

    2/11/2025House

  18. House Second Readers

    2/4/2025House

  19. House First Readers

    2/3/2025House

  20. House Hopper

    1/30/2025House

Bill Text

  • HB 197/AP* (v5)

    PDF

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