House Bill 928
By: Representatives Willis of the 55th, Crawford of the 89th, McQueen of the 61st, Jackson
of the 165th, and Miller of the 62nd
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 that utilization review by an insurer shall not be
required in the instance in which a physician has determined the existence of dense breast
tissue and the medical necessity of a breast ultrasound; to provide for a definition; to provide
for related matters; to provide for an effective date and applicability; to repeal conflicting
laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance
generally, is amended by revising Code Section 33-24-59.32, relating to cost-sharing
requirements for diagnostic and supplemental breast screening examinations, as follows:
"33-24-59.32.
(a) As used in this Code section, the term:
(1) 'Breast <del>magnetic resonance imaging' or 'breast</del> MRI' means a diagnostic and
screening tool, including standard and abbreviated breast MRI, that uses radio waves and
magnets to produce detailed images of structures within the breast.
(2) 'Breast ultrasound' means a noninvasive diagnostic and screening tool that uses
high-frequency sound waves and their echoes to produce detailed images of structures
within the breast.
(3) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any
maximum limitation on the application of such a deductible, coinsurance, copayment, or
similar out-of-pocket expense.
<ins>(4) 'Dense breast tissue' means heterogeneously or extremely dense breast tissue based
on nationally recognized guidelines or systems for breast imaging reporting of
mammography, including, but not limited to, the Breast Imaging Reporting and Data
System established by the American College of Radiology.
</ins> <del>(4)(5)</del> 'Diagnostic breast examination' means a medically necessary and clinically
appropriate examination of the breast, including such examination using breast MRI,
breast ultrasound, or mammogram, that is:
(A) Used to evaluate an abnormality seen or suspected from a screening examination
for breast cancer; or
(B) Used to evaluate an abnormality detected by another means of examination.
<del>(5)(6)</del> 'Health benefit policy' means any individual or group plan, policy, or contract for
<del>health care</del> <ins>healthcare</ins> services issued, delivered, issued for delivery, executed, or
renewed by an insurer in this state.
<del>(6)(7)</del> 'Insurer' means any person, corporation, or other entity authorized to provide
health benefit policies under this title.
<del>(7)(8)</del> 'Mammogram' means a diagnostic or screening mammography exam using a
low-dose X-ray to produce an image of the breast.
<del>(8)(9)</del> 'Supplemental breast screening examination' means a medically necessary and
clinically appropriate examination of the breast, including such examination using breast
MRI, breast ultrasound, or mammogram, that is:
(A) Used to screen for breast cancer when there is no abnormality seen or suspected
in the breast; or
(B) Based on personal or family medical history or additional factors that may increase
the individual's risk of breast cancer.
(b) A health benefit policy that provides coverage for diagnostic <ins>breast</ins> examinations <del>for
breast cancer</del> shall include provisions that ensure that the cost-sharing requirements
applicable to diagnostic <ins>breast examinations</ins> and supplemental breast screening
examinations are no less favorable than the cost-sharing requirements applicable to
screening mammography for breast cancer.
(c) Nothing in this Code section shall be construed to preclude existing utilization review
provided under Chapter 46 of this title, <ins>except that, if a supplemental breast screening
examination reveals the existence of dense breast tissue, following the patient notification
required in Code Section 31-1-17, the diagnosing physician may determine whether a
breast ultrasound is medically necessary, and such determination shall not be disputed
through utilization review or any other procedure by an insurer for purposes of denying
insurance coverage for such examinee.
</ins> (d) If under federal law application of subsection (b) of this Code section would result in
Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, such
cost-sharing requirement shall apply only for Health Savings Account qualified High
Deductible Health Plans with respect to the deductible of such plan after the enrollee has
satisfied the minimum deductible under Section 223 of the Internal Revenue Code, except
with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C)
of the Internal Revenue Code, in which case the requirements of subsection (b) of this
Code section shall apply regardless of whether the minimum deductible under Section 223
of the Internal Revenue Code has been satisfied.
(e) The Commissioner shall promulgate rules and regulations necessary to implement the
provisions of this Code section in accordance with current guidelines established by
professional medical organizations such as the National Comprehensive Cancer Network."
SECTION 2.
This Act shall become effective on July 1, 2025, and shall apply to all applicable policies,
contracts, and certificates executed, delivered, issued for delivery, or renewed in this state
on or after October 1, 2025.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.