Duchenne Muscular Dystrophy; testing in the newborn screening system; require

Georgia device coverage expands with replacement limits

Beginning January 1, 2026, eligible Georgia individual and group major medical policies must cover medically necessary braces and prosthetic devices. This applies to policies issued, delivered, issued for delivery, or renewed in Georgia on or after that date. Devices must support daily living, essential work tasks, personal hygiene, or physical activity. Medical need follows state law and nationally recognized, evidence-based clinical guidelines. Coverage includes custom-made or custom-fitted devices, parts, supplies, design, fabrication, measurements, fittings, training, and repairs. Routine store-bought supports, canes, crutches, dental appliances, artificial eyes or ears, and purely cosmetic devices are excluded. Prostheses that do not meaningfully affect movement or muscle and bone function are also excluded. The required benefit is limited to three devices per affected limb per person during any three-year period. Replacing a device less than three years old requires documented body changes, irreparable device or part changes, or repair costs exceeding 60% of its cost. Socket replacement requires documented limb or functional changes, irreparable damage, or wear from high activity or excessive weight. Insurers need not cover repairs or replacements caused by misuse, malicious damage, gross neglect, loss, or theft. Cost sharing can still apply, but insurers cannot impose special charges only on this coverage. Benefits must be comparable to other medical and surgical benefits; out-of-network limits cannot be more restrictive than those benefits. Insurers can offer greater benefits or better terms. The mandate excludes specified state employee plans, self-funded employer plans governed by federal benefits law, and Medicaid services under state insurer contracts. Georgia's insurance commissioner must issue implementing rules and report to lawmakers by July 1, 2032. Insurers must supply claim counts submitted and paid, plus total amounts paid, for policy years 2026–2030.