SB 5: Private Review Agents; health insurers to implement and maintain a program that allows for the selective application of reductions in prior authorization requirements; provide

This bill has two main parts. First, it lets health insurers in Georgia set up voluntary programs that reduce prior authorization requirements (the insurer approval doctors often need before providing treatment) for healthcare providers who show strong performance and follow evidence based medicine. Insurers choose which providers and services qualify, but must file a description of the program with the Georgia Department of Insurance every year starting no later than July 1, 2026. Second, the bill requires private health insurance policies and the State Health Benefit Plan (covering state and public employees) to cover diagnosis, treatment, and monitoring of PANDAS and PANS, two neuropsychiatric conditions linked to strep infections in children, when the care follows nationally recognized clinical guidelines. Coverage applies to private policies issued or renewed on or after July 1, 2025, and to the state plan starting January 1, 2026. Insurers can apply normal deductibles and copays but cannot impose special extra costs just for this coverage. The Insurance Commissioner must write rules to implement both parts.

• Requires insurers using prior authorization to create a program that reduces those requirements for providers who meet performance and evidence based medicine criteria.
• Requires insurers to file an annual report on the program with the Department of Insurance starting no later than July 1, 2026, describing criteria, covered services, and participating providers.
• Requires private health insurance policies issued or renewed on or after July 1, 2025 to cover diagnosis, treatment, and monitoring of PANDAS and PANS when supported by nationally recognized clinical guidelines.
• Requires the State Health Benefit Plan for state and public employees to provide the same PANDAS and PANS coverage starting January 1, 2026.
• Bars insurers from charging special extra deductibles, coinsurance, or copays for PANDAS and PANS treatment beyond what applies to other covered care.
• Directs the Insurance Commissioner to write rules and regulations to carry out both the prior authorization program and the PANDAS/PANS coverage requirements.

Health insurers and the Department of Insurance, healthcare providers whose prior authorization burden may be reduced, families of children diagnosed with PANDAS or PANS, and state and public employees covered by the State Health Benefit Plan.

Families of children with PANDAS or PANS, conditions often difficult to get insurers to cover, would gain a guaranteed right to coverage for diagnosis and treatment. Doctors with strong track records could face fewer insurance approval delays, though participation criteria remain up to each insurer.

• Section 1-1 adds O.C.G.A. § 33-46-20.1, requiring insurers to create a prior authorization reduction program based on provider performance, with an annual filing to the Department of Insurance due no later than July 1, 2026.
• Section 2-1 adds O.C.G.A. § 33-24-59.34, defining PANDAS and PANS and requiring private health benefit policies issued or renewed on or after July 1, 2025 to cover related healthcare services.
• Section 2-1 bars insurers from imposing special deductibles or copays on PANDAS/PANS coverage beyond those generally applied to other covered services.
• Section 2-2 adds O.C.G.A. § 45-18-4.2, extending the same PANDAS and PANS coverage requirement to the State Health Benefit Plan beginning January 1, 2026.
• Section 3-1 sets the overall effective date as July 1, 2025, applying to policies issued, delivered, or renewed on or after that date.

1. 2025-05-14Effective Date 2025-07-01
2. 2025-05-14Act 299
3. 2025-05-14Senate Date Signed by Governor (Senado)
4. 2025-04-10Senate Sent to Governor (Senado)
5. 2025-04-04Senate Agreed House Amend or Sub (Senado)
6. 2025-04-02House Passed/Adopted By Substitute (Cámara de Representantes)
7. 2025-04-02House Third Readers (Cámara de Representantes)
8. 2025-03-31House Committee Favorably Reported By Substitute (Cámara de Representantes)

• Kay Kirkpatrick (R, SD-032)Patrocinador principal
• Larry Walker (R, SD-020)
• Ben Watson (R, SD-001)
• Chuck Hufstetler (R, SD-052)
• Ed Harbison (D, SD-015)
• Michael Rhett (D, SD-033)
• Lee Hawkins (R, HD-027)

1. AprobadaVotación: Senado12 de febrero de 2025

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

   Passage: Senate Vote #47

2. AprobadaVotación: Cámara de Representantes2 de abril de 2025

   169 a favor, 2 en contra (3 sin votar, 6 ausentes)

   Passage: House Vote #378

3. AprobadaVotación: Senado4 de abril de 2025

   52 a favor, 0 en contra (3 sin votar, 1 ausentes)

   Agree To House Substitute: Senate Vote #478

• health insurance
• prior authorization
• PANDAS and PANS
• pediatric healthcare
• state employee benefits