HB1033: HB1033 Georgia Access to Healthcare for Alzheimer's Disease and Dementias Act; enact

Georgia law already requires some insurance coverage for biomarker testing, a way of analyzing blood or tissue samples to detect disease. This bill expands that law to specifically cover testing for Alzheimer's disease and related dementias, and adds imaging scans like MRI, CT, and PET scans to the definition of biomarker testing. It also bars insurers from using step therapy or other utilization rules that unreasonably delay or deny that testing, and sets short deadlines (seven days for routine requests, 72 hours for urgent ones) for insurers to approve or deny prior authorization requests. The bill also creates a new law requiring health benefit policies, including the state health benefit plan covering state employees and teachers, to cover FDA approved Alzheimer's treatments and diagnostic testing starting July 1, 2026 (January 1, 2027 for the state plan). It limits how much patients can be charged for at least one diagnostic test per year, requires insurers to cover out of network care at in network rates if no nearby in network provider is available, and requires the Insurance Commissioner to report annually to legislative committees on how the coverage is working.

• Expands the definition of biomarker testing to include diagnostic imaging such as MRI, CT, PET, amyloid PET, and tau PET scans.
• Requires health benefit policies renewed or issued on or after July 1, 2026 to cover biomarker testing for Alzheimer's disease and related dementias.
• Bans step therapy protocols and other utilization management practices that unreasonably delay or deny biomarker testing or Alzheimer's related care.
• Sets strict prior authorization response deadlines (seven days for routine, 72 hours for urgent requests), with automatic approval if insurers miss the deadline.
• Requires coverage of FDA approved Alzheimer's treatments and diagnostic testing, with at least one test per year free of cost sharing (deductibles, copays, or coinsurance).
• Requires insurers to cover out of network care at in network rates and reimburse travel costs if no in network provider is available within a reasonable time or distance.

People with Alzheimer's disease or related dementias and their families, health insurers and HMOs operating in Georgia, the state health benefit plan covering state employees, teachers, and university system staff, and healthcare providers who order or perform diagnostic testing and treatment for these conditions.

Patients and families dealing with Alzheimer's or related dementias would gain guaranteed insurance coverage for diagnostic testing and FDA approved treatments, faster insurer decisions on prior authorization, capped out of pocket costs for at least one annual test, and a path to out of network care paid at in network rates if local providers are unavailable.

• Section 2 amends O.C.G.A. § 33-24-59.33 to add Alzheimer's related definitions and to include diagnostic imaging (MRI, CT, PET, amyloid PET, tau PET) within biomarker testing coverage.
• Section 2 requires insurers to respond to prior authorization requests within seven calendar days for nonurgent and 72 hours for urgent requests, with automatic approval if they miss the deadline.
• Section 3 creates new O.C.G.A. § 33-24-59.37 requiring coverage of FDA approved Alzheimer's treatments and diagnostic testing starting July 1, 2026, and January 1, 2027 for the state health benefit plan.
• Section 3 caps cost sharing so at least one diagnostic test per person per year is covered with no deductible, copay, or coinsurance.
• Section 3 requires insurers to cover out of network providers at in network rates and reimburse reasonable travel costs when no suitable in network provider is nearby.
• Section 3 requires the Insurance Commissioner to report annually to House and Senate insurance committees starting July 1, 2027, on claims, costs, and processing times.
• Section 4 sets the effective date as July 1, 2026, applying to health benefit plans issued or renewed on or after that date.

1. 2026-01-29House Second Readers (House)
2. 2026-01-28House First Readers (House)
3. 2026-01-27House Hopper (House)

• Sandra Scott (D, HD-076)Primary sponsor
• Viola Davis (D, HD-087)
• Kim Schofield (D, HD-063)
• Rhonda Burnough (D, HD-077)
• Stacey Evans (D, HD-057)

• Alzheimer's disease
• health insurance coverage
• dementia care
• biomarker testing
• prior authorization rules