HB 1033: Georgia Access to Healthcare for Alzheimer's Disease and Dementias Act; enact

Georgia already requires health plans to cover certain biomarker tests, but current law does not specifically address Alzheimer's disease. This bill expands the existing biomarker testing law (O.C.G.A. § 33-24-59.33) to include blood based biomarkers and diagnostic imaging like PET and MRI scans used to detect Alzheimer's, and bars insurers from using step therapy or other utilization rules that unreasonably delay or deny that testing. The bill also creates a new Code section requiring health plans, including the state health benefit plan for state employees and teachers, to cover FDA-approved treatments and diagnostic testing for Alzheimer's disease and related dementias starting July 1, 2026 (January 1, 2027 for the state plan). It caps cost sharing, guarantees at least one no-cost diagnostic test per year, requires access to nearby in-network providers or out-of-network coverage at in-network rates if none are available, and requires the Insurance Commissioner to report annually on how the law is working.

• Expands the definition of biomarker testing to include blood based biomarkers and diagnostic imaging such as MRI, CT, and PET scans used to detect Alzheimer's disease.
• Bars insurers from using step therapy protocols or other utilization management practices that unreasonably delay or deny medically necessary Alzheimer's biomarker testing.
• Creates a new requirement that health plans, including the state health benefit plan, cover FDA-approved Alzheimer's treatments and diagnostic testing starting in 2026 or 2027.
• Guarantees at least one diagnostic test per year with no cost sharing and caps total out-of-pocket costs at the federal essential health benefits limit.
• Requires insurers to cover out-of-network providers at in-network rates and reimburse travel costs if no nearby in-network provider is available.
• Requires the Insurance Commissioner to submit annual reports on claims, costs, and outcomes starting July 1, 2027.

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 of Georgia employees and retirees, and healthcare providers who order or perform diagnostic imaging and infusion treatments.

Patients seeking Alzheimer's diagnosis or treatment would gain guaranteed insurance coverage, capped costs, and at least one free diagnostic test a year, plus access to nearby providers or reimbursed travel. Insurers would face new coverage mandates, reporting duties, and limits on delaying tests.

• Section 2 amends O.C.G.A. § 33-24-59.33 to add blood based biomarkers and diagnostic imaging (MRI, CT, PET, amyloid and tau PET scans) to covered biomarker testing for Alzheimer's disease, effective for policies issued after July 1, 2026.
• Section 2 prohibits step therapy protocols or other utilization management practices that unreasonably delay or deny biomarker testing, and requires insurers to decide prior authorization requests within 7 days (72 hours for urgent cases).
• Section 3 creates new Code Section 33-24-59.37 requiring coverage of FDA-approved Alzheimer's treatments and diagnostic testing, effective July 1, 2026 for most plans and January 1, 2027 for the state health benefit plan.
• Section 3(d) requires at least one diagnostic test per covered person per year with no cost sharing and caps out-of-pocket costs at the federal essential health benefits maximum.
• Section 3(e) requires access to in-network providers within reasonable time and distance, or coverage of out-of-network providers at in-network rates plus reimbursed travel costs.
• Section 3(f) requires the Insurance Commissioner to report annually to House and Senate insurance committees on claims, costs, prior authorization times, and utilization data, starting July 1, 2027.
• Section 4 sets the overall effective date as July 1, 2026, applying to health plans issued or renewed on or after that date.

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

• Sandra Scott (D, HD-076)Patrocinador principal
• 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
• state health benefit plan