Georgia CommonsSB 205: Insurance; pediatric autoimmune neuropsychiatric disorders; require coverage for healthcare services
Introduced version, the latest LegiScan holds · Last action February 20, 2025 · 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.
Senate Bill 205
By: Senators Watson of the 11th, Brass of the 6th, Hodges of the 3rd, Watson of the 1st, Kirkpatrick of the 32nd 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:
"33-24-59.34.
(a) As used in this Code section, the term:
(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.
(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."
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:
"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 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."
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.