HB 124: Insurance; require coverage for healthcare services for pediatric autoimmune neuropsychiatric disorders; provisions

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.

• 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.

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.

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.

• 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.

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
• children's health
• PANDAS and PANS
• state employee benefits
• insurance mandates