Georgia CommonsHouse · Engrossed · 2025-2026 Regular Session
HB 124: Insurance; require coverage for healthcare services for pediatric autoimmune neuropsychiatric disorders; provisions
Last action February 26, 2025 · Senate Read and Referred
House Bill 124 would require Georgia health insurance plans, including the state employees' health plan, to cover diagnosis and treatment of PANDAS and PANS, two neuropsychiatric conditions that can appear suddenly in children after infection.
The summaries below were written by an AI model (claude-sonnet-5) from the text of the bill and are not part of it. Quote the text, not the summary. The stored text is the Introduced version, the latest the General Assembly's website lists.
In plain language
Currently, Georgia law does not specifically require insurance plans to cover care for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) or pediatric acute onset neuropsychiatric syndrome (PANS), conditions where children suddenly develop obsessive-compulsive symptoms, tics, or other behavioral changes. This bill adds new sections to Georgia's insurance code and to the law governing the state employees' health plan to require that coverage. Under the bill, most health insurance policies renewed or issued in Georgia on or after July 1, 2025 must cover PANDAS and PANS diagnosis, treatment, management, and monitoring when the care follows nationally recognized clinical practice guidelines. The state health benefit plan for state employees and retirees must provide the same coverage starting January 1, 2026. Insurers can apply their normal deductibles and copays to this care but cannot create special extra costs just for PANDAS or PANS treatment. The bill excludes self-insured plans governed by the federal ERISA law, and directs the state Insurance Commissioner to write implementing rules.
What the bill does
- Adds a new Code section requiring most Georgia health insurance policies issued or renewed on or after July 1, 2025 to cover PANDAS and PANS care.
- Requires the state employees' health benefit plan to cover the same conditions starting January 1, 2026.
- Defines PANDAS and PANS in state law based on their clinical presentation in children and adolescents.
- Bars insurers from imposing special, higher deductibles or copays for PANDAS or PANS care beyond what applies to other covered services.
- Excludes self-insured health plans regulated exclusively under the federal ERISA law from the new coverage mandate.
- Directs the state Insurance Commissioner to create rules and regulations to carry out the new requirement.
Who it affects
Children and adolescents diagnosed with PANDAS or PANS and their families, private health insurers and HMOs operating in Georgia, the State of Georgia as administrator of the state employees' health plan, and state employees and retirees covered by that plan.
Why it matters
Families whose children develop sudden obsessive-compulsive symptoms or tics linked to strep infections would gain a legal right to insurance coverage for diagnosis and treatment, rather than facing coverage denials, as long as the care follows recognized clinical guidelines and normal cost-sharing rules apply.
Key provisions
- Section 1 adds O.C.G.A. § 33-24-59.34, defining 'health benefit policy,' 'nationally recognized clinical practice guidelines,' PANDAS, and PANS, and excluding ERISA self-insured plans.
- Section 1 requires covered policies issued or renewed on or after July 1, 2025 to cover PANDAS/PANS diagnosis, treatment, management, and monitoring supported by clinical guidelines.
- Section 1 bars insurers from imposing special deductibles, coinsurance, or copays for PANDAS/PANS beyond those generally applied to other covered services.
- Section 1 directs the Insurance Commissioner to issue implementing rules and regulations.
- Section 2 adds O.C.G.A. § 45-18-4.2, applying the same coverage requirement and cost-sharing limits to the state health benefit plan for state employees, dependents, and retirees, effective January 1, 2026.
- Section 3 repeals conflicting laws.
From the bill
“All health benefit policies renewed or issued on or after July 1, 2025, shall include coverage for healthcare services for PANDAS or PANS for an individual covered under such policy as provided in this Code section.”
“Special deductibles, coinsurance, copayment, and other limitations that are not generally applicable to other healthcare services covered by a health benefit policy shall not be imposed on coverage for healthcare services for PANDAS or PANS.”
Discussed in meetings (1)
The House and Senate meetings that took this bill up, from their machine transcripts. Each account was written by Georgia Commons with AI and is not part of the record; the video is what was said.
Senate Retirement Committee, March 10, 2026
From 0:41:20 · Watch on the General Assembly's Vimeo channel
Summary by Georgia Commons: During action following the presentation of HB 1234, a committee member named HB 124 in a do-pass motion. The committee seconded the motion, members voiced approval, and the chair declared it carried. No provisions of HB 124 were presented or debated. The transcript does not clarify whether the number was stated in error or whether the motion was intended to apply to this bill.
Status timeline
- Senate Read and Referred (Senate)
- House Passed/Adopted (House)
- House Third Readers (House)
- House Committee Favorably Reported (House)
- House Second Readers (House)
- House First Readers (House)
- House Hopper (House)
Sponsors
- Mitchell Scoggins (R, HD-14)
- Lee Hawkins (R, HD-27)
- Matt Hatchett (R, HD-155)
- David Clark (R, HD-100)
- Mark Newton (R, HD-127)
- Tim Fleming (R, HD-114)
Votes
- House voteFebruary 24, 2025
173 yea, 0 nay (2 not voting, 5 excused)
Topics
- health insurance coverage
- children's health
- PANDAS and PANS
- state employee benefits
- insurance mandates