Georgia CommonsSenate · Passed · 2025-2026 Regular Session
SB 5: Private Review Agents; health insurers to implement and maintain a program that allows for the selective application of reductions in prior authorization requirements; provide
Last action July 1, 2025 · Effective Date
Senate Bill 5 would let Georgia health insurers ease prior authorization rules for high-performing doctors, and require insurance plans to cover treatment for PANDAS and PANS in children.
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 Enrolled version, the latest the General Assembly's website lists.
In plain language
This bill has two main parts. First, it lets health insurers in Georgia set up voluntary programs that reduce prior authorization requirements (the insurer approval doctors often need before providing treatment) for healthcare providers who show strong performance and follow evidence based medicine. Insurers choose which providers and services qualify, but must file a description of the program with the Georgia Department of Insurance every year starting no later than July 1, 2026. Second, the bill requires private health insurance policies and the State Health Benefit Plan (covering state and public employees) to cover diagnosis, treatment, and monitoring of PANDAS and PANS, two neuropsychiatric conditions linked to strep infections in children, when the care follows nationally recognized clinical guidelines. Coverage applies to private policies issued or renewed on or after July 1, 2025, and to the state plan starting January 1, 2026. Insurers can apply normal deductibles and copays but cannot impose special extra costs just for this coverage. The Insurance Commissioner must write rules to implement both parts.
What the bill does
- Requires insurers using prior authorization to create a program that reduces those requirements for providers who meet performance and evidence based medicine criteria.
- Requires insurers to file an annual report on the program with the Department of Insurance starting no later than July 1, 2026, describing criteria, covered services, and participating providers.
- Requires private health insurance policies issued or renewed on or after July 1, 2025 to cover diagnosis, treatment, and monitoring of PANDAS and PANS when supported by nationally recognized clinical guidelines.
- Requires the State Health Benefit Plan for state and public employees to provide the same PANDAS and PANS coverage starting January 1, 2026.
- Bars insurers from charging special extra deductibles, coinsurance, or copays for PANDAS and PANS treatment beyond what applies to other covered care.
- Directs the Insurance Commissioner to write rules and regulations to carry out both the prior authorization program and the PANDAS/PANS coverage requirements.
Who it affects
Health insurers and the Department of Insurance, healthcare providers whose prior authorization burden may be reduced, families of children diagnosed with PANDAS or PANS, and state and public employees covered by the State Health Benefit Plan.
Why it matters
Families of children with PANDAS or PANS, conditions often difficult to get insurers to cover, would gain a guaranteed right to coverage for diagnosis and treatment. Doctors with strong track records could face fewer insurance approval delays, though participation criteria remain up to each insurer.
Key provisions
- Section 1-1 adds O.C.G.A. § 33-46-20.1, requiring insurers to create a prior authorization reduction program based on provider performance, with an annual filing to the Department of Insurance due no later than July 1, 2026.
- Section 2-1 adds O.C.G.A. § 33-24-59.34, defining PANDAS and PANS and requiring private health benefit policies issued or renewed on or after July 1, 2025 to cover related healthcare services.
- Section 2-1 bars insurers from imposing special deductibles or copays on PANDAS/PANS coverage beyond those generally applied to other covered services.
- Section 2-2 adds O.C.G.A. § 45-18-4.2, extending the same PANDAS and PANS coverage requirement to the State Health Benefit Plan beginning January 1, 2026.
- Section 3-1 sets the overall effective date as July 1, 2025, applying to policies issued, delivered, or renewed on or after that date.
From the bill
“Each insurer that utilizes prior authorization requirements shall implement and maintain a program that allows for the selective application of reductions in prior authorization requirements based on the stratification of healthcare providers' performance and adherence to evidence based medicine.”
“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.”
Status timeline
- Effective Date
- Act 299
- Senate Date Signed by Governor (Senate)
- Senate Sent to Governor (Senate)
- Senate Agreed House Amend or Sub (Senate)
- House Passed/Adopted By Substitute (House)
- House Third Readers (House)
- House Committee Favorably Reported By Substitute (House)
Show full history (18 actions)
- House Withdrawn, Recommitted (House)
- House Committee Favorably Reported (House)
- House Second Readers (House)
- House First Readers (House)
- Senate Passed/Adopted (Senate)
- Senate Third Read (Senate)
- Senate Read Second Time (Senate)
- Senate Committee Favorably Reported (Senate)
- Senate Read and Referred (Senate)
- Senate Hopper (Senate)
Sponsors
- Kay Kirkpatrick (R, SD-32)
- Larry Walker, III (R, SD-20)
- Ben Watson (R, SD-1)
- Chuck Hufstetler (R, SD-52)
- Ed Harbison (D, SD-15)
- Michael 'Doc' Rhett (D, SD-33)
- Lee Hawkins (R, HD-27)
Votes
- Senate voteFebruary 12, 2025
51 yea, 1 nay (1 not voting, 3 excused)
- House voteApril 2, 2025
169 yea, 2 nay (3 not voting, 6 excused)
- Senate voteApril 4, 2025
52 yea, 0 nay (3 not voting, 1 excused)
Topics
- health insurance
- prior authorization
- PANDAS and PANS
- pediatric healthcare
- state employee benefits