SB602: SB602 Insurance; prior authorization and utilization review requirements for healthcare plans; reform

Georgia law already requires health insurers to use a prior authorization and utilization review process before certain healthcare services are covered, under Article 2 of Chapter 46 of Title 33 of the Official Code of Georgia Annotated. This bill rewrites much of that process. It requires insurers to give healthcare providers more detailed information when a request is denied, including the reviewing physician's credentials and appeal rights, and to publish more detailed statistics on approvals, denials, and response times. The bill also expands the existing program that exempts high-performing providers from prior authorization, limits how much paperwork insurers can demand, requires electronic systems compatible with providers' medical records, and shortens the deadlines insurers have to respond to requests (from 7 days to 48 hours for standard requests, and from 72 hours to 24 hours for urgent ones). It extends how long an approved authorization stays valid, creates a process for retroactive authorization after a service is already provided, and exempts opioid use disorder medications and emergency care from prior authorization. The changes would take effect January 1, 2027, and apply to policies issued or renewed on or after that date.

• Requires insurers to give healthcare providers the clinical criteria, detailed reasoning, reviewing physician's credentials, and appeal rights whenever a request is denied (an 'adverse determination').
• Expands the required public statistics insurers must post, including total requests, denial reasons, appeal rates, and compliance with time and procedural requirements.
• Broadens the existing exemption ('gold-carding') so any insurer must exempt a provider from prior authorization on a service once the insurer approved at least 80% of that provider's requests for it over the prior year.
• Limits documentation insurers can demand during utilization review to what is reasonably necessary and bars duplicate or irrelevant paperwork requests.
• Requires utilization review systems to accept requests electronically and be compatible with providers' electronic health records.
• Shortens insurer response deadlines from 7 calendar days to 48 hours for standard requests and from 72 hours to 24 hours for urgent requests, and lengthens how long an approved prior authorization stays valid.

Health insurers and their private review agents or utilization review entities operating in Georgia, healthcare providers and physicians who submit prior authorization requests and appeals, and patients covered under Georgia health plans, especially those needing ongoing treatment, urgent care, or opioid use disorder medication.

Patients could see faster insurer decisions on care and fewer denials reversed after treatment already began, while providers with strong track records could skip prior authorization for some services. Insurers would face tighter deadlines, more disclosure duties, and new limits on paperwork and technology requirements.

• Section 1 rewrites O.C.G.A. § 33-46-20 to require insurers to disclose clinical criteria, reasoning, and reviewer credentials at the time of an adverse determination and to expand required public statistics.
• Section 2 revises § 33-46-20.1 so every insurer must exempt a provider from prior authorization on a service after an 80% approval rate over the prior 12 months, for at least 12 months.
• Section 3 amends § 33-46-21 to limit documentation requests to what is medically necessary and to require electronic systems compatible with provider health records.
• Section 5 revises § 33-46-23 so services performed within 45 business days of approval cannot be revoked, and authorizations generally remain valid for up to one year.
• Section 6 adds § 33-46-23.2 letting providers request retroactive authorization within ten days of rendering a service and barring denial solely for lack of prior authorization.
• Section 7 revises § 33-46-24 to exempt opioid use disorder medications, in addition to emergency and urgent care, from prior authorization.
• Sections 8 and 9 shorten insurer notification deadlines to 48 hours for standard requests and 24 hours for urgent requests.
• Section 13 sets the effective date as January 1, 2027, applying to policies issued, delivered, or renewed on or after that date.

1. 2026-02-26Senate Read and Referred (Senate)
2. 2026-02-25Senate Hopper (Senate)

• Nabilah Islam Parkes (D, SD-007)Primary sponsor
• Randal Mangham (D, SD-055)
• Donzella James (D, SD-028)
• RaShaun Kemp (D, SD-038)
• Sally Harrell (D, SD-040)

• health insurance
• prior authorization
• utilization review
• opioid treatment access
• healthcare provider regulation