SB 602: Insurance; prior authorization and utilization review requirements for healthcare plans; reform

Georgia law already requires health insurers to post prior authorization rules online and report approval and denial statistics. This bill amends Article 2 of Chapter 46 of Title 33 of the Official Code of Georgia Annotated to expand what insurers must disclose and how quickly they must act. When a request is denied, insurers must now give doctors the clinical criteria, detailed reasoning, the reviewing physician's credentials, and appeal rights. Insurers must also exempt providers from prior authorization for services where they approved at least 80 percent of requests in the past year, and cannot retroactively deny coverage once a service is authorized. The bill shortens response deadlines (from 7 calendar days to 48 hours for routine requests, and from 72 to 24 hours for urgent ones), extends how long authorizations stay valid (up to one year), limits documentation demands, requires electronic transmission systems compatible with providers' health records, exempts emergency care and opioid use disorder medication from prior authorization, and removes a prior exception to automatic authorization for insurer noncompliance. The changes take effect January 1, 2027 and apply to policies issued or renewed on or after that date.

• Requires insurers to give healthcare providers detailed reasoning, clinical criteria, reviewer credentials, and appeal rights whenever a prior authorization is denied.
• Forces insurers to exempt a provider from prior authorization for a specific service if the provider had an 80 percent or higher approval rate for that service over the prior 12 months.
• Shortens insurers' response deadlines for prior authorization decisions from 7 calendar days to 48 hours, and for urgent requests from 72 hours to 24 hours.
• Extends how long a prior authorization stays valid, generally to one year or the length of treatment, and bars retroactive denial of already-authorized services.
• Exempts emergency care, urgent care, incidental covered services, and opioid use disorder medications from prior authorization requirements entirely.
• Removes a prior good-faith exception that let insurers avoid automatic authorization penalties for minor rule violations, restoring automatic authorization for any deadline violation.

Health insurers and utilization review entities operating in Georgia, healthcare providers such as doctors and hospitals who submit prior authorization requests, and patients covered by Georgia health plans who rely on timely authorization decisions for medical care, including those being treated for opioid use disorder.

Patients could see faster insurance decisions and fewer surprise denials after treatment has already been authorized, while doctors with strong approval track records could skip prior authorization paperwork altogether. Insurers would face stricter deadlines, more required disclosures, and less flexibility to avoid automatic authorization penalties.

• Section 1 requires insurers to disclose detailed denial reasoning, reviewer credentials, and appeal rights, and expands the statistics insurers must publish, including compliance with timing and procedural rules.
• Section 2 mandates that insurers exempt providers from prior authorization for a service if the provider's approval rate was at least 80 percent over the prior year, for a minimum 12-month exemption.
• Section 3 limits documentation requests to what is medically necessary and requires utilization review programs to accept electronic requests compatible with providers' health record systems.
• Section 5 extends how long a prior authorization stays valid, generally up to one year, and Section 6 creates a new process for retroactive authorization requests within ten days of service.
• Section 7 exempts opioid use disorder medications, along with emergency and urgent care, from prior authorization.
• Section 8 and 9 shorten insurer response deadlines to 48 hours for routine determinations and 24 hours for urgent ones.
• Section 10 extends the period insurers must honor a prior authorization from a previous plan from 30 to 90 days after a person's coverage changes.
• Section 11 removes the existing exception allowing insurers to avoid automatic authorization penalties for minor, good-faith rule violations.

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

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

• health insurance
• prior authorization
• medical billing
• opioid treatment
• insurance regulation