HB1122: HB1122 Insurance; group or individual accident and sickness plans; provisions

26 LC 46 1395S House Bill 1122 (COMMITTEE SUBSTITUTE) By: Representatives Douglas of the 78th, Newton of the 127th, Hugley of the 141st, Hawkins of the 27th, and Howard of the 129th A BILL TO BE ENTITLED AN ACT To amend Article 1 of Chapter 24 of Title 33 of the Official Co de of Georgia Annotated,1 relating to general provisions regarding insurance generally, so as to require certain benefits2 for peripheral artery disease screening tests for enrollees enrolled in health benefit policies;3 to provide for definitions; to provide for exceptions; to amend Chapter 18 of Title 45 of the4 Official Code of Georgia Annotated, relating to employees' insurance and benefits plans, so5 as to require certain benefits for peripheral artery disease screening tests; to amend Article6 7 of Chapter 4 of Title 49 of the Official Code of Georgia Anno tated, relating to medical7 assistance generally, so as to require certain benefits for peripheral artery disease screening8 tests; to provide for a plan amendment when necessary; to provide for legislative findings;9 to provide for definitions; to provide for related matters; to provide for effective dates and10 applicability contingent upon appropriations by the General Assembly; to repeal conflicting11 laws; and for other purposes.12 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:13 H. B. 1122 (SUB) - 1 - 26 LC 46 1395S SECTION 1.14 The General Assembly finds that:15 (1) Atherosclerosis occurs when blood flow is reduced because arteries become16 narrowed or blocked with fatty deposits;17 (2) Atherosclerosis is responsible for more deaths in the Unit ed States than any other18 condition, and heart attacks resulting from clogged coronary arteries are the leading cause19 of death in America;20 (3) Atherosclerosis also occurs in the legs and is known as pe ripheral artery disease21 (PAD),and having PAD significantly increases the risk for heart attack, stroke,22 amputation, and death;23 (4) While most Americans are aware of atherosclerosis in the h eart, many Americans24 have never heard of PAD, and Americans with PAD are often unawa re of the serious25 risks of the disease;26 (5) An estimated 21 million Americans have PAD, and about 200,000 of them, who are27 disproportionately minorities, suffer avoidable amputations every year as a result of such28 disease;29 (6) Screening and arterial testing for PAD is cost effective and should be part of routine30 medical care; and31 (7) Once PAD is detected, amputations and deaths can be reduce d through the use of32 national, evidence based PAD care guidelines.33 SECTION 2.34 Article 1 of Chapter 24 of Title 33 of the Official Code of Geo rgia Annotated, relating to35 general provisions regarding insurance generally, is amended by adding a new Code section36 to read as follows:37 "33-24-59.37.38 (a) As used in this Code section, the term:39 H. B. 1122 (SUB) - 2 - 26 LC 46 1395S (1) 'At-risk individual' means an individual who:40 (A) Is 65 years of age or older;41 (B) Is at least 50 years of age but not older than 64 years of age with risk factors for42 atherosclerosis, such as diabetes mellitus, a history of smokin g, hyperlipidemia,43 hypertension, or a family history of peripheral artery disease;44 (C) Is younger than 50 years of age with diabetes mellitus and one additional risk45 factor as provided in subparagraph (B) of this paragraph for atherosclerosis; or46 (D) Has a known atherosclerotic disease in another vascular be d, such as coronary,47 carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.48 (2) 'Health benefit policy' means any individual or group plan , policy, or contract for49 healthcare services issued, delivered, issued for delivery, or renewed in this state which50 provides major medical benefits by a healthcare corporation, he alth maintenance51 organization, preferred provider organization, accident and sic kness insurer, fraternal52 benefit society, hospital service corporation, medical service corporation, or other insurer53 or similar entity.54 (3) 'Peripheral artery disease screening test' means:55 (A) Noninvasive physiologic studies of extremity arteries, com monly referred to as56 ankle-brachial index testing; or57 (B) Ankle plethysmographic pulse volume recordings and Doppler waveforms.58 (b) A health benefit policy amended, delivered, issued, or renewed on or after January 1,59 2027, shall provide coverage, no less than once every 12 months , for a peripheral artery60 disease screening test for any at-risk individual.61 (c) The benefits provided in this Code section shall be subjec t to the same deductibles,62 coinsurance, copayment provisions, and other limitations establ ished for all covered63 benefits within such policy. Special deductibles, coinsurance, copayment, and other64 limitations that are not generally applicable to other benefits shall not be applicable to the65 benefits described in this Code section.66 H. B. 1122 (SUB) - 3 - 26 LC 46 1395S (d) This Code section shall not be applicable to self-funded, employer sponsored health67 insurance plans subject to the exclusive jurisdiction of the fe deral Employee Retirement68 Income Security Act of 1974, 29 U.S.C. Section 1001, et seq., as amended."69 70 SECTION 3.71 Chapter 18 of Title 45 of the Official Code of Georgia Annotate d, relating to employees'72 insurance and benefits plans, is amended by adding a new Code section to read as follows:73 "45-18-4.3.74 (a) As used in this Code section, the term:75 (1) 'At-risk individual' means an individual who:76 (A) Is 65 years of age or older;77 (B) Is at least 50 years of age but not older than 64 years of age with risk factors for78 atherosclerosis, such as diabetes mellitus, a history of smokin g, hyperlipidemia, or79 hypertension, or a family history of peripheral artery disease;80 (C) Is younger than 50 years of age with diabetes mellitus and one additional risk81 factor as provided in subparagraph (B) of this paragraph for atherosclerosis; or82 (D) Has a known atherosclerotic disease in another vascular be d, such as coronary,83 carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.84 (2) 'Peripheral artery disease screening test' means:85 (A) Noninvasive physiologic studies of extremity arteries, com monly referred to as86 ankle-brachial index testing; or87 (B) Ankle plethysmographic pulse volume recordings and Doppler waveforms.88 (b) The health insurance plan established pursuant to this article shall provide benefits for89 an enrollee which shall include coverage, no less than once eve ry 12 months, for a90 peripheral artery disease screening test for at-risk individuals.91 (c) The benefits provided in this Code section shall be subjec t to the same deductibles,92 coinsurance, copayment provisions, and other limitations establ ished for all covered93 H. B. 1122 (SUB) - 4 - 26 LC 46 1395S benefits within such plan. Special deductibles, coinsurance, c opayment, and other94 limitations that are not generally applicable to other benefits shall not be applicable to the95 benefits described in this Code section."96 SECTION 4.97 Article 7 of Chapter 4 of Title 49 of the Official Code of Geor gia Annotated, relating to98 medical assistance generally, is amended by adding a new Code section to read as follows:99 "49-4-159.5.100 (a) As used in this Code section, the term:101 (1) 'At-risk individual' means an individual who:102 (A) Is 65 years of age or older;103 (B) Is at least 50 years of age but not older than 64 years of age with risk factors for104 atherosclerosis, such as diabetes mellitus, a history of smokin g, hyperlipidemia, or105 hypertension, or a family history of peripheral artery disease;106 (C) Is younger than 50 years of age with diabetes mellitus and one additional risk107 factor as provided in subparagraph (B) of this paragraph for atherosclerosis; or108 (D) Has a known atherosclerotic disease in another vascular be d, such as coronary,109 carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.110 (2) 'Peripheral artery disease screening test' means:111 (A) Noninvasive physiologic studies of extremity arteries, com monly referred to as112 ankle-brachial index testing; or113 (B) Ankle plethysmographic pulse volume recordings and Doppler waveforms.114 (b) The department shall provide Medicaid recipients with peri pheral artery disease115 screening tests for at-risk individuals no less than once every 12 months.116 (c) To implement the provisions of this Code section, the depa rtment shall, when117 necessary, submit a Medicaid state plan amendment or waiver request to the United States118 Department of Health and Human Services."119 H. B. 1122 (SUB) - 5 - 26 LC 46 1395S SECTION 5.120 (a) Except as provided in subsection (b) of this section, this Act shall become effective on121 January 1, 2027, and shall apply to the state health benefit plan, the state Medicaid plan,122 and all health benefit policies or contracts issued, delivered, issued for delivery, or renewed123 in this state on or after such date.124 (b)(1) Section 3 of this Act shall become effective only if fu nds are specifically125 appropriated for purposes of Section 3 of this Act in an appropriations Act enacted by the126 General Assembly. If funds are appropriated as described in th is paragraph, then127 Section 3 of this Act shall become effective on the later of:128 (A) The date on which such appropriations Act becomes effective; or129 (B) The beginning date of the fiscal year for which such appropriations are made.130 (2) Section 4 of this Act shall become effective only if funds a r e s p e c i f i c a l l y131 appropriated for purposes of Section 4 of this Act in an appropriations Act enacted by the132 General Assembly. If funds are so appropriated as described in this paragraph, then133 Section 4 of this Act shall become effective on the later of:134 (A) The date on which such appropriations Act becomes effective; or135 (B) The beginning date of the fiscal year for which such appropriations are made.136 (3) This section and Section 6 of this Act shall become effective on July 1, 2026.137 SECTION 6. 138 All laws and parts of laws in conflict with this Act are repealed.139 H. B. 1122 (SUB) - 6 -