SB 101: Duchenne Muscular Dystrophy; testing in the newborn screening system; require

Currently, Georgia law does not specifically require health insurance plans to cover orthotic devices (external braces or supports) or prosthetic devices (replacements for missing body parts). This bill adds a new section to Georgia's insurance code requiring most health benefit policies issued or renewed on or after January 1, 2026 to cover these devices when a doctor says they are medically necessary for daily living, job duties, hygiene, or physical activity. The coverage must include the device itself, its components (like sockets, joints, and liners), fitting and training, and repairs. Insurers can limit coverage to three devices per limb every three years, but must allow earlier replacement if a person's condition changes or repairs would cost more than 60 percent of a new device. Insurers do not have to cover damage from misuse or theft. The bill does not apply to state employee plans, Medicaid contracts, or certain federally regulated employer plans, and it requires an insurance commissioner's report by July 1, 2032. It takes effect once signed by the Governor.

• Requires most Georgia health benefit policies renewed or issued on or after January 1, 2026 to cover medically necessary orthotic and prosthetic devices.
• Defines which devices count as orthotic or prosthetic, excluding basic over-the-counter items like arch supports, canes, or dental appliances.
• Limits covered devices to three per affected limb every three years, while allowing earlier replacement if a person's medical condition changes or repair costs exceed 60 percent of a new device's cost.
• Requires coverage of device components, fittings, training, and repairs, and treats the benefit as comparable to other medical and surgical coverage.
• Exempts state employee plans, Medicaid managed care contracts, and certain self-funded employer plans from the new requirement.
• Directs the insurance commissioner to report to legislative insurance committees by July 1, 2032 on claims data from 2026 to 2030.

Georgians who need orthotic braces or prosthetic limbs, health insurers that sell individual or group policies in Georgia, and the state insurance commissioner's office, which must collect data and write implementing rules. State employee plans and Medicaid managed care contracts are excluded.

People who rely on braces or prosthetic limbs for daily activities, work, hygiene, or exercise would gain a guaranteed insurance benefit covering the device, its parts, fitting, training, and repairs, rather than depending on whether their specific plan happens to include that coverage.

• Section 1 adds new Code Section 33-24-59.34 defining terms like 'orthotic device,' 'prosthetic device,' 'medically necessary,' and 'covered person.'
• Subsection (b) requires coverage for devices needed for daily living, job activities, hygiene, or physical activities, effective for policies issued or renewed on or after January 1, 2026.
• Subsection (c) caps coverage at three devices per limb every three years and specifies covered components like sockets, joints, liners, and connective parts.
• Subsection (d) sets conditions under which early replacement or socket replacement counts as medically necessary, including irreparable damage or repair costs over 60 percent of replacement cost.
• Subsection (e) exempts insurers from covering repair or replacement due to misuse, malicious damage, gross neglect, loss, or theft.
• Subsection (f) treats the coverage as comparable to other medical and surgical benefits and allows standard cost-sharing, with limits on how out-of-network coverage can be restricted.
• Subsection (h) requires the insurance commissioner to report to House and Senate insurance committees by July 1, 2032 using claims data insurers must provide.
• Section 2 sets the effective date as upon the Governor's approval or the bill becoming law without signature.

1. 2025-05-13Effective Date 2025-05-13
2. 2025-05-13Act 183
3. 2025-05-13Senate Date Signed by Governor (Senado)
4. 2025-04-10Senate Sent to Governor (Senado)
5. 2025-04-04Senate Agreed House Amend or Sub (Senado)
6. 2025-04-04House Passed/Adopted By Substitute (Cámara de Representantes)
7. 2025-04-04House Third Readers (Cámara de Representantes)
8. 2025-04-02House Committee Favorably Reported By Substitute (Cámara de Representantes)

• Randy Robertson (R, SD-029)Patrocinador principal
• Bo Hatchett (R, SD-050)
• Chuck Payne (R, SD-054)
• Ricky Williams (R, SD-025)
• Shawn Still (R, SD-048)
• John Albers (R, SD-056)
• Carden Summers (R, SD-013)
• Ben Watson (R, SD-001)
• Drew Echols (R, SD-049)
• Sam Watson (R, SD-011)
• Kay Kirkpatrick (R, SD-032)
• Russ Goodman (R, SD-008)
• Chuck Hufstetler (R, SD-052)
• Max Burns (R, SD-023)
• Clint Dixon (R, SD-045)
• Mike Hodges (R, SD-003)
• Marty Harbin (R, SD-016)
• David Clark (R, HD-100)

1. AprobadaVotación: Senado27 de febrero de 2025

   46 a favor, 4 en contra (2 sin votar, 4 ausentes)

   Passage: Senate Vote #101

2. AprobadaVotación: Cámara de Representantes4 de abril de 2025

   167 a favor, 2 en contra (3 sin votar, 8 ausentes)

   Passage: House Vote #427

3. AprobadaVotación: Senado4 de abril de 2025

   51 a favor, 1 en contra (3 sin votar, 1 ausentes)

   Agree To House Substitute: Senate Vote #489

• health insurance coverage
• prosthetic devices
• orthotic devices
• disability access
• insurance regulation