House Bill 124
By: Representatives Scoggins of the 14th, Hawkins of the 27th, Hatchett of the 155th, Clark
of the 100th, Newton of the 127th, and others
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 and Article 1 of Chapter 18 of Title 45 of the
Official Code of Georgia Annotated, relating to general provisions relative to insurance and
the state employees' health insurance plan and post-employment health benefit fund,
respectively, so as to require coverage for healthcare services for pediatric autoimmune
neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric
acute onset neuropsychiatric syndrome (PANS) in accordance with nationally recognized
clinical practice guidelines; to provide for definitions; to allow for deductibles; to prohibit
special deductibles; to provide for rules and regulations; to provide for related matters; to
repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
general provisions relative to insurance, is amended by adding a new Code section to read
as follows:
<ins>"33-24-59.34.
(a) As used in this Code section, the term:
</ins>
<ins>(1) '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. 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.
(2) '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.
(3) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute
onset obsessive compulsive or tic disorders or other behavioral changes presenting in
children and adolescents that are not otherwise explained by another known neurologic
or medical disorder.
(4) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections' or 'PANDAS' means a condition in which a streptococcal infection in a child
or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,
tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and
remitting course of symptom severity.
</ins>
<ins>(b) 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.
(c) Healthcare services for PANDAS or PANS for an individual covered under a health
benefit policy shall be covered for the purposes of diagnosis, treatment, appropriate
management, or ongoing monitoring of a covered person's disorder when such services are
supported by nationally recognized clinical practice guidelines.
(d) The benefits in a health benefit policy as provided for in this Code section shall be
subject to the same deductibles, coinsurance, copayment provisions, and other limitations
established for all covered benefits within such health benefit policy. 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.
(e) The Commissioner shall promulgate rules and regulations necessary to implement the
provisions of this Code section."
</ins> SECTION 2.
Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to the
state employees' insurance health insurance plan and post-employment health benefit fund,
is amended by adding a new Code section to read as follows:
<ins>"45-18-4.2.
(a) As used in this Code section, the term:
(1) '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
</ins>
<ins>systematic review of evidence and an assessment of the benefits and risks of alternative
care options and include recommendations intended to optimize patient care.
(2) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute
onset obsessive compulsive or tic disorders or other behavioral changes presenting in
children and adolescents that are not otherwise explained by another known neurologic
or medical disorder.
(3) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections' or 'PANDAS' means a condition in which a streptococcal infection in a child
or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,
tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and
remitting course of symptom severity.
(4) 'State health benefit plan' means the health insurance plan or plans established
pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and
public employees, dependents, and retirees.
(b) Beginning January 1, 2026, the state health benefit plan shall include coverage for
healthcare services for PANDAS or PANS for an individual covered under such policy as
provided in this Code section.
(c) Healthcare services for PANDAS or PANS for an individual covered under the state
health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate
management, or ongoing monitoring of a covered person's disorder when such services are
supported by nationally recognized clinical practice guidelines.
(d) The benefits in the state health benefit plan as provided for in this Code section shall
be subject to the same deductibles, coinsurance, copayment provisions, and other
limitations established for all covered benefits within such plan. Special deductibles,
coinsurance, copayment, and other limitations that are not generally applicable to
healthcare services covered by such plan shall not be imposed on coverage for healthcare
services for PANDAS or PANS."
</ins>
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.