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GeorgiaSB 52025-2026 Regular SessionSenateWALLET

Private Review Agents; health insurers to implement and maintain a program that allows for the selective application of reductions in prior authorization requirements; provide

Sponsored By: Ed Harbison (Democrat), Chuck Hufstetler (Republican), Kay Kirkpatrick (Republican), Michael 'Doc' Rhett (Democrat), Larry Walker (Republican), Ben Watson (Republican)

Signed by Governor

InsuranceInsurance and LaborGeneral Bill

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Bill Overview

Analyzed Economic Effects

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

More coverage for children's neuropsychiatric care

Georgia requires coverage for PANDAS and PANS, two pediatric neuropsychiatric conditions. The requirement covers individual and group major medical policies issued, delivered, issued for delivery, or renewed starting July 1, 2025. Self-insured plans covered by ERISA are excluded. Georgia's state health plan must provide this coverage starting January 1, 2026, for covered employees, dependents, and retirees. Covered care includes diagnosis, treatment, appropriate management, and ongoing monitoring supported by nationally recognized clinical guidelines. These guidelines must use evidence reviews, transparent methods, and conflict-of-interest policies, and come from independent organizations or medical societies. Regular deductibles, copays, coinsurance, and other limits still apply; plans cannot add special costs or limits for these conditions. The Insurance Commissioner can issue rules to carry out these coverage requirements.

Fewer insurance approval steps for some patients

Beginning July 1, 2025, Georgia insurers using prior authorization must maintain programs to reduce advance approval requirements selectively. Reductions depend on providers' performance and use of evidence-based medicine. Insurers choose participation criteria, participating providers, and which services qualify, so fewer approval steps are not guaranteed for everyone. Insurers must report to the Georgia Department of Insurance by July 1, 2026, and every year afterward. Reports must describe the program, participation rules, covered services, provider counts, and any other required information in the Commissioner's required format. The law does not change patients' deductibles, copays, or coinsurance.

Sponsors & Cosponsors

Sponsors

  • Ed Harbison

    Democrat • Senate

  • Chuck Hufstetler

    Republican • Senate

  • Kay Kirkpatrick

    Republican • Senate

  • Michael 'Doc' Rhett

    Democrat • Senate

  • Larry Walker

    Republican • Senate

  • Ben Watson

    Republican • Senate

Cosponsors

  • Lee Hawkins

    Republican • House

Roll Call Votes

All Roll Calls

Yes: 272 • No: 3

Senate vote • 4/4/2025

AGREE TO HOUSE SUBSTITUTE

Yes: 52 • No: 0 • Other: 3

House vote • 4/2/2025

PASSAGE

Yes: 169 • No: 2 • Other: 3

Senate vote • 2/12/2025

PASSAGE

Yes: 51 • No: 1 • Other: 1

Actions Timeline

  1. Effective Date

    7/1/2025

  2. Senate Date Signed by Governor

    5/14/2025Senate

  3. Act 299

    5/14/2025

  4. Senate Sent to Governor

    4/10/2025Senate

  5. Senate Agreed House Amend or Sub

    4/4/2025Senate

  6. House Third Readers

    4/2/2025House

  7. House Passed/Adopted By Substitute

    4/2/2025House

  8. House Committee Favorably Reported By Substitute

    3/31/2025House

  9. House Withdrawn, Recommitted

    3/27/2025House

  10. House Committee Favorably Reported

    2/26/2025House

  11. House Second Readers

    2/18/2025House

  12. House First Readers

    2/13/2025House

  13. Senate Third Read

    2/12/2025Senate

  14. Senate Passed/Adopted

    2/12/2025Senate

  15. Senate Read Second Time

    2/3/2025Senate

  16. Senate Committee Favorably Reported

    1/30/2025Senate

  17. Senate Read and Referred

    1/14/2025Senate

  18. Senate Hopper

    1/13/2025Senate

Bill Text

  • SB 5/AP* (v9)

    PDF

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