SB101: SB101 Duchenne Muscular Dystrophy; testing in the newborn screening system; require

Right now, Georgia law does not specifically require health insurance plans to cover orthotic devices (braces and similar supports) or prosthetic devices (artificial limbs) as a category. This bill adds a new section to Georgia's insurance code (O.C.G.A. Title 33) requiring most health benefit policies issued or renewed on or after January 1, 2026 to cover these devices when a doctor says they are medically necessary for daily living, job duties, hygiene, or physical activity. The coverage must include the device itself, its components like sockets and liners, fitting and training, and repairs, up to three devices per limb every three years. Replacement before three years is allowed if there is documented physical change or the device is badly damaged. Insurers can apply normal cost-sharing rules but cannot single out this coverage for extra restrictions. The bill excludes state employee plans, Medicaid contracts, and federally regulated self-funded employer plans. It also requires the Insurance Commissioner to report on claims data by July 1, 2032, and to write implementing rules. The law would take effect as soon as the Governor signs it.

• Adds a new Code section (O.C.G.A. § 33-24-59.34) requiring most Georgia health benefit policies issued or renewed on or after January 1, 2026 to cover medically necessary orthotic and prosthetic devices.
• Defines orthotic and prosthetic devices in detail and excludes items like over-the-counter braces, wigs, and dental appliances from the requirement.
• Limits covered devices to three per affected limb per person every three years, but allows earlier replacement if there is documented physical change or major damage.
• Requires coverage of related materials, fittings, training, and repairs, and bars insurers from applying stricter cost-sharing rules to this coverage than to other medical devices.
• Excludes state employee plans, Medicaid managed care contracts, and federally regulated self-funded employer plans from the requirement.
• Directs the Insurance Commissioner to collect claims data from insurers and report to House and Senate insurance committees by July 1, 2032, and to issue implementing rules.

Georgia residents covered by individual or group health insurance plans who need orthotic or prosthetic devices, health insurers that sell major medical coverage in the state, and the Georgia Department of Insurance, which will collect data and write rules. State employees, Medicaid recipients, and people on self-funded employer plans governed by federal law are not covered by this requirement.

People who rely on braces or artificial limbs for daily activities, work, hygiene, or exercise would gain a guaranteed insurance benefit covering the device, its parts, fittings, training, and repairs, potentially reducing out-of-pocket costs. Insurers would face new coverage mandates and reporting duties starting in 2026.

• Section 1 adds O.C.G.A. § 33-24-59.34, defining terms such as 'orthotic device,' 'prosthetic device,' 'medically necessary,' and 'health benefit policy.'
• Subsection (b) requires covered policies issued or renewed on or after January 1, 2026 to cover devices needed for daily living, job duties, hygiene, and physical activity.
• Subsection (c) caps coverage at three devices per limb per person every three years and lists covered components like sockets, liners, and joints.
• Subsection (d) allows earlier replacement of a device less than three years old if there is documented physiological change or damage, or if repair costs exceed 60 percent of the device's cost.
• Subsection (e) states insurers are not required to repair or replace devices damaged by misuse, malicious damage, gross neglect, loss, or theft.
• Subsection (f) sets cost-sharing rules, requiring parity with other medical and surgical benefits and limiting restrictions on out-of-network coverage.
• Subsection (h) requires the Insurance Commissioner to report claims data to legislative insurance committees by July 1, 2032.
• Section 2 makes the Act effective upon the Governor's signature or upon becoming law without signature.

1. 2025-05-13Effective Date 2025-05-13
2. 2025-05-13Act 183
3. 2025-05-13Senate Date Signed by Governor (Senate)
4. 2025-04-10Senate Sent to Governor (Senate)
5. 2025-04-04Senate Agreed House Amend or Sub (Senate)
6. 2025-04-04House Passed/Adopted By Substitute (House)
7. 2025-04-04House Third Readers (House)
8. 2025-04-02House Committee Favorably Reported By Substitute (House)

• Randy Robertson (R, SD-029)Primary sponsor
• Bo Hatchett (R, SD-050)
• Chuck Payne (R, SD-054)
• Ricky Williams (R, SD-025)
• Shawn Still (R, SD-048)
• John Albers (R, SD-056)
• Carden Summers (R, SD-013)
• Ben Watson (R, SD-001)
• Drew Echols (R, SD-049)
• Sam Watson (R, SD-011)
• Kay Kirkpatrick (R, SD-032)
• Russ Goodman (R, SD-008)
• Chuck Hufstetler (R, SD-052)
• Max Burns (R, SD-023)
• Clint Dixon (R, SD-045)
• Mike Hodges (R, SD-003)
• Marty Harbin (R, SD-016)
• David Clark (R, HD-100)

1. PassedSenate voteFebruary 27, 2025

   46 yea, 4 nay (2 not voting, 4 absent)

   Passage: Senate Vote #101

2. PassedHouse voteApril 4, 2025

   167 yea, 2 nay (3 not voting, 8 absent)

   Passage: House Vote #427

3. PassedSenate voteApril 4, 2025

   51 yea, 1 nay (3 not voting, 1 absent)

   Agree To House Substitute: Senate Vote #489

• health insurance coverage
• prosthetic devices
• orthotic devices
• disability accommodations
• insurance regulation