Georgia CommonsHB 1033: Georgia Access to Healthcare for Alzheimer's Disease and Dementias Act; enact
Introduced version, the latest LegiScan holds · Last action January 29, 2026 · Introduced
The text as LegiScan holds it, read from the PDF the legislature publishes with its margin line numbers, running heads, and page footers removed. Line breaks are joined into paragraphs here; no word is changed.
Underlined words are what the bill adds to current law and struck-through words are what it removes, as the printed bill shows them.
House Bill 1033
By: Representatives Scott of the 76th, Davis of the 87th, Schofield of the 63rd, and Burnough of the 77th
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to provide for coverage for diagnostic testing and treatment for Alzheimer's disease and Alzheimer's related dementias; to provide for definitions; to include certain diagnostic imaging services under biomarker testing; to prohibit certain utilization management practices that unreasonably delay or deny medically necessary biomarker testing; to require health benefit policies to cover certain diagnostic testing and treatments for Alzheimer's disease and Alzheimer's related dementias; to allow but limit cost sharing requirements; to require access to healthcare services that are timely and proximal; to provide for coverage of healthcare services by out-of-network providers; to provide for annual reporting; to provide for rules and regulations; to provide for a short title; to provide for an effective date and applicability; to provide for related matters; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
This Act shall be known and may be cited as the "Georgia Access to Healthcare for Alzheimer's Disease and Dementias Act."
SECTION 2.
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, is amended by revising Code Section 33-24-59.33, relating to required coverage for biomarker testing, as follows:
"33-24-59.33.
(a) As used in this Code section, the term:
(1) 'Biomarker' means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Such term includes, but is not limited to, gene mutations, protein expression, known gene-drug interactions for medications, and characteristics of genes. Such term also includes blood based biomarkers used in the detection of Alzheimer's disease and Alzheimer's related dementias.
(2) 'Biomarker testing' means the analysis of a patient's tissue, blood, or other biospecimen for the presence of a biomarker. Such term includes, but is not limited to, single-analyte tests, multiplex panel tests, whole genome sequencing, protein expression, whole exome, and whole transcriptome, diagnostic imaging, and cerebrospinal fluid analysis.
(3) 'Consensus statements' means statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy. Such statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.
(4) 'Diagnostic imaging' means magnetic resonance imaging, computed tomography
(CT) scanning, positron emission tomography (PET) scanning, amyloid PET imaging, tau PET imaging, positron emission tomography/computed tomography (PET/CT), and other advanced imaging services.
(4)(5) 'Health benefit policy' means any individual or group plan, policy, or contract for healthcare services issued, delivered, issued for delivery, or renewed in this state which provides major medical benefits, including those contracts executed by the State of Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a health care corporation, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, or other insurer or similar entity. (5)(6) 'Nationally recognized clinical practice guidelines' means evidence based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy. Such guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.
(7) 'Step therapy protocol' means a protocol that establishes the specific sequence in which a healthcare treatment or service for Alzheimer's disease or Alzheimer's related dementias is deemed medically appropriate for a particular patient and covered by an insurer under a health benefit policy. Such term includes fail-first requirements.
(b) All health benefit policies renewed or issued on or after July 1, 2023, shall include coverage for biomarker testing as provided in this Code section. All health benefit policies renewed or issued on or after July 1, 2026, shall include coverage for biomarker testing for Alzheimer's disease and Alzheimer's related dementias as provided in this Code section.
(c) Biomarker testing shall be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the testing is supported by medical and scientific evidence, including, but not limited to:
(1) A labeled indication for a test that has been approved or cleared by the United States Food and Drug Administration (FDA);
(2) An indicated test for an FDA approved drug;
(3) A national coverage determination made by the federal Centers for Medicare and Medicaid Services or a local coverage determination made by a medicare administrative contractor;
(4) Nationally recognized clinical practice guidelines and consensus statements; or
(5) Warnings and precautions on FDA approved drugs.
(d) Health benefit policies shall ensure biomarker testing coverage is provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples. Biomarker testing coverage provided under this Code section shall not be subject to step therapy protocols or other utilization management practices that unreasonably delay or deny such testing.
(e) The insurer or similar entity subject to this Code section shall approve or deny a prior authorization request and notify the enrollee and the enrollee's healthcare provider within seven calendar days for nonurgent requests or within 72 hours for urgent requests. If the insurer or similar entity fails to respond in accordance with such time frames, such request shall be deemed approved.
(f) Enrollees, healthcare providers, and testing service providers shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy or an adverse utilization review determination under a health benefit policy, including, but not limited to, the rights of consumers under Article 2 of Chapter 20A of Title 33, the 'Patient's Right to Independent Review Act.' Such process shall be made readily accessible on the insurer's or similar entity's website."
SECTION 3.
Said chapter is further amended by adding a new Code section to read as follows:
"33-24-59.37.
(a) As used in this Code section, the term:
(1) 'Alzheimer's disease' means a progressive, degenerative disease or condition that attacks the brain and results in impaired memory, thinking, and behavior.
(2) 'Alzheimer's related dementia' means any disease from a class of degenerative brain disorders that cause impairment or changes in memory, thinking, or behavior that are progressive and irreversible. Such diseases include, but are not limited to, Alzheimer's disease, Lewy body dementia, frontotemporal dementia, and vascular dementia.
(3) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or out-of-pocket expense and any maximum limitation on the application of such deductible, coinsurance, copayment, or out-of-pocket expense.
(4) 'Health benefit policy' means any individual or group plan, policy, or contract for healthcare services issued, delivered, issued for delivery, or renewed in this state which provides major medical benefits, including the state health benefit plan, by a health insurer. Such term shall not include any self-insured health benefit plan subject to the exclusive jurisdiction of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.
(5) 'Health insurer' means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Commissioner, that contracts, offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including those of an accident and sickness insurance company, a health maintenance organization, a healthcare plan, a managed care plan, or any other entity providing a health benefit policy.
(6) 'Medically necessary' means such healthcare services that a prudent physician or other healthcare provider would provide to a patient for the purpose of screening, preventing, diagnosing, managing, or treating Alzheimer's disease or Alzheimer's related dementias and their symptoms, including minimizing the progression of such disease or related dementias, in a manner that is:
(A) In accordance with the generally accepted standards of medical or other healthcare practice;
(B) Clinically appropriate in terms of type, frequency, extent, site, and duration; and
(C) Not primarily for the economic benefit of the insurer or for the convenience of the patient, treating physician, or other healthcare provider.
(7) 'State health benefit plan' means the health insurance plan or plans established pursuant to Part 6 of Article 17 of Chapter 2 of Title 20, Code Section 31-2-2, and Article 1 of Chapter 18 of Title 45 for state and public employees, members and employees of the Board of Regents, public school teachers and employees, and their dependents, and retirees.
(8) 'Step therapy protocol' means a protocol that establishes the specific sequence in which a healthcare treatment or service for Alzheimer's disease or Alzheimer's related dementias is deemed medically appropriate for a particular patient and covered by an insurer under a health benefit policy. Such term includes fail-first requirements.
(b) All health benefit policies issued or renewed on or after July 1, 2026, and all health benefit policies under the state health benefit plan issued or renewed on or after January 1, 2027, shall include coverage for:
(1) Medically necessary treatments for Alzheimer's disease and Alzheimer's related dementias that are approved by the federal Food and Drug Administration for the treatment of such diseases; and
(2) Diagnostic testing for Alzheimer's disease and Alzheimer's related dementias and administrative costs for such testing.
(c) Coverage provided under this Code section shall not be subject to step therapy protocols or other utilization management practices that unreasonably delay or deny access to covered healthcare treatments or services for Alzheimer's disease or Alzheimer's related dementias.
(d) The coverage provided under this Code section shall be subject to the same cost sharing requirements established for all covered benefits within such health benefit policy; provided, however, that at least one diagnostic testing per covered individual per year shall be covered without any cost sharing requirement. The cost sharing requirements for the coverage provided under this Code section shall not exceed the maximum annual out-of-pocket limit applicable to essential health benefits under federal law.
(e) Health insurers shall ensure a covered person has access to healthcare services for the diagnosis and treatment of Alzheimer's disease or Alzheimer's related dementias, including, but not limited to, biomarker testing, diagnostic imaging, and infusion services provided by an in-network healthcare provider within a reasonable time and within reasonable geographic proximity to such covered person. If such healthcare service by an in-network healthcare provider within a reasonable time and within reasonable proximity to the covered person is not available, then the health insurer shall cover such healthcare service provided by an out-of-network healthcare provider at in-network rates and shall reimburse reasonable travel costs incurred by the covered person.
(f) No later than July 1, 2027, and annually thereafter, the Commissioner shall submit a report to the chairpersons of the House Committee on Insurance and the Senate Insurance and Labor Committee regarding the implementation of the coverage required under this Code section. All health insurers issuing or renewing health benefit policies subject to the provisions of this Code section shall provide the department with all data requested by the department for inclusion in such report. The report shall include, but not be limited to:
(1) The number of claims for diagnostic testing and healthcare treatments for Alzheimer's disease and Alzheimer's related dementias submitted, approved, and denied;
(2) The average amount of cost sharing requirement per such claim;
(3) The average time for processing of prior authorization requests for such claims; and
(4) Aggregate demographic and geographic utilization data.
(g) The Commissioner shall promulgate rules and regulations necessary to implement the provisions of this Code section."
SECTION 4.
This Act shall become effective on July 1, 2026, and shall apply to all health benefit plans, policies, and contracts issued, delivered, issued for delivery, or renewed in this state on or after such date.
SECTION 5.
All laws and parts of laws in conflict with this Act are repealed.