HB 830: Insurance; establish State Oversight Board within office of the Commissioner of Insurance

House Bill 830

By: Representatives Beckles of the 96th, Flournoy of the 74th, Frye of the 122nd, Williams of the 168th, Dawson of the 65th, and others

A BILL TO BE ENTITLED

AN ACT

To amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to establish the State Oversight Board within the office of the Commissioner of Insurance; to provide for the membership, duties, and powers of such board; to provide for rules and regulations; to provide for insurer liability for certain delays or denials in healthcare coverage; to provide for a private cause of action; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Title 33 of the Official Code of Georgia Annotated, relating to insurance, is amended in Chapter 2, relating to department and Commissioner, by adding a new Code section to read as follows:

"33-2-35.

(a) There is established within the office of the Commissioner the State Oversight Board. The board shall be composed of nine members, as follows:

(1) Three healthcare professionals, including physicians and nurses, to be appointed by the Speaker of the House of Representatives;

(2) Three hospital administration officials, to be appointed by the President of the Senate;

(3) Two members with experience in the public sector, to be appointed by the Governor; and

(4) One member representing the office of the Commissioner as designated by the Commissioner; provided that such member shall not be the Commissioner.

(b) Appointed members shall serve for a period of three years. The members shall elect a chairperson and vice chairperson from among their membership whose duties shall be established by the board.

(c) The board shall fix a time and place for regular meetings, provided that the board shall meet at least quarterly.

(d) Board members shall receive no compensation for their services but shall be allowed actual and necessary expenses in the performance of their duties. Any legislative members of the board shall receive the allowances provided for in Code Section 28-1-8. Citizen members shall receive a daily expense allowance in the amount specified in subsection (b) of Code Section 45-7-21 as well as the mileage or transportation allowance authorized for state employees. If any members selected to serve on the board are state officials, other than legislative members, or are state employees, they shall receive no compensation for their services on the board but shall be reimbursed for expenses incurred in the performance of their duties as members of the board in the same manner as reimbursements are made in their capacity as state officials or state employees. The funds necessary for the reimbursement of the expenses of state officials, other than legislative members, and state employees shall come from funds appropriated to or otherwise available to their respective departments.

(e) The board shall advise the office of the Commissioner on matters related to health insurers' denials and delays in healthcare coverage in this state. The board shall:

(1) Develop and promulgate rules and regulations to govern health insurance practices within this state;

(2) Have access to any and all information, including, but not limited to, documents, materials, forms, rate filings, and data, submitted by health insurers to the office of the Commissioner; provided, however, that confidential treatment of such submissions shall be preserved;

(3) Review data and identify any trends, issues, and concerns regarding health insurance premiums, healthcare coverage, prior authorization practices, and patient access to healthcare services;

(4) Investigate health insurer denials or delays in healthcare coverage, compensation to healthcare providers, and patient access to healthcare services; and

(5) Take action, including imposing fines or other penalties, against health insurers that violate federal or state law, state regulations, or otherwise commit practices that are harmful to consumers.

(f) The board, no later than June 30, 2026, and annually thereafter, shall submit to the Commissioner a report of its activities and recommendations for further action by the Commissioner.

(g) Every health insurer shall submit to the board such data as required and requested by the board so that the board can perform its duties as provided in subsection (e) of this Code section.

(h) Any meetings held by the board shall be open to the public and subject to Chapter 14 of Title 50, relating to open meetings. Any rules and regulations shall be adopted, established, promulgated, amended, repealed, filed, and published by the board in accordance with the applicable provisions and procedures set forth in Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'

(i) The Commissioner shall promulgate any rules and regulations necessary to implement the provisions of this Code section."

SECTION 2.

Said title is further amended in Article 2 of Chapter 46, relating to prior authorizations, by adding a new Code section to read as follows:

"33-46-29.1.

(a) An insurer shall be liable for harm caused to a covered person for the unnecessary delay in or wrongful denial of healthcare coverage caused by the act or inaction of the insurer or the insurer's private review agent or utilization review entity.

(b) Any covered person who suffers harm as provided in subsection (a) of this Code section may bring an action against the insurer and may recover or obtain against such insurer:

(1) Actual damages;

(2) Equitable relief;

(3) Punitive damages;

(4) Reasonable attorney fees and costs; and

(5) Any other relief that the court deems proper.

(c) An insurer shall notify the office of the Commissioner and the State Oversight Board of any actions filed against it pursuant to this Code section."

SECTION 3.

This Act shall become effective on July 1, 2025.

SECTION 4.

All laws and parts of laws in conflict with this Act are repealed.