HB124: HB124 Insurance; require coverage for healthcare services for pediatric autoimmune neuropsychiatric disorders; provisions

PANDAS and PANS are conditions in which children can develop sudden obsessive-compulsive behaviors, tics, or other neuropsychiatric symptoms, sometimes linked to a strep infection. Georgia law does not currently require insurers to cover treatment for these conditions. This bill would add new sections to the state insurance code (O.C.G.A. § 33-24-59.34) and the law governing the state employees' health plan (O.C.G.A. § 45-18-4.2) requiring coverage of healthcare services for PANDAS and PANS when those services are backed by nationally recognized clinical practice guidelines. Most private health benefit policies would have to include this coverage starting July 1, 2025, and the state health benefit plan covering state employees, dependents, and retirees would have to include it starting January 1, 2026. Insurers could apply their normal deductibles and copays to this coverage but could not create special, higher cost-sharing rules just for PANDAS or PANS treatment. The Insurance Commissioner would write rules to carry out the law.

• Adds a new Georgia law (O.C.G.A. § 33-24-59.34) requiring most private and group health insurance policies to cover healthcare services for PANDAS and PANS starting July 1, 2025.
• Adds a new law (O.C.G.A. § 45-18-4.2) requiring the state employees' health benefit plan to cover the same conditions starting January 1, 2026.
• Limits required coverage to services supported by nationally recognized clinical practice guidelines, a term the bill defines as evidence-based standards from independent medical groups.
• Allows insurers to apply normal deductibles, coinsurance, and copays to this coverage but bans special, higher cost-sharing rules that apply only to PANDAS or PANS care.
• Directs the Georgia Insurance Commissioner to issue rules and regulations to put the coverage requirement into practice.
• Exempts self-insured employer health plans regulated exclusively under the federal Employee Retirement Income Security Act from the new state requirement.

Children and adolescents diagnosed with PANDAS or PANS and their families, health insurance companies and HMOs selling policies in Georgia, the state agency running the state employees' health benefit plan, state employees and retirees on that plan, and the Georgia Insurance Commissioner's office, which must write implementing rules.

Families of children with sudden-onset obsessive-compulsive symptoms or tics linked to PANDAS or PANS would gain a guaranteed right to insurance coverage for diagnosis and treatment, potentially reducing out-of-pocket costs, while insurers and the state health plan would face a new coverage mandate starting in 2025 and 2026.

• Section 1 adds O.C.G.A. § 33-24-59.34, defining PANDAS, PANS, 'health benefit policy,' and 'nationally recognized clinical practice guidelines' for purposes of the new mandate.
• Section 1 requires all applicable health benefit policies renewed or issued on or after July 1, 2025, to cover PANDAS and PANS healthcare services.
• Section 1 bars insurers from imposing special deductibles, coinsurance, or copays on PANDAS/PANS care beyond what applies to other covered benefits.
• Section 1 excludes self-insured plans governed exclusively by the federal ERISA law from the requirement.
• Section 2 adds O.C.G.A. § 45-18-4.2, applying the same coverage mandate, definitions, and cost-sharing limits to the state employees' health benefit plan beginning January 1, 2026.
• Section 3 repeals any conflicting laws.

1. 2025-02-26Senate Read and Referred (Senate)
2. 2025-02-24House Passed/Adopted (House)
3. 2025-02-24House Third Readers (House)
4. 2025-02-06House Committee Favorably Reported (House)
5. 2025-01-29House Second Readers (House)
6. 2025-01-28House First Readers (House)
7. 2025-01-27House Hopper (House)

• Mitchell Scoggins (R, HD-014)Primary sponsor
• Lee Hawkins (R, HD-027)
• James Hatchett (R, HD-155)
• David Clark (R, HD-100)
• Mark Newton (R, HD-127)
• Tim Fleming (R, HD-114)

1. PassedHouse voteFebruary 24, 2025

   173 yea, 0 nay (2 not voting, 5 absent)

   Passage: House Vote #70

• health insurance coverage mandates
• pediatric mental health
• PANDAS and PANS
• state employee health plan
• insurance regulation