Georgia Statutes

A bill to be entitled an Act to amend Titles 15, 20, 31, 33, 37, 45, and 49 of the O.C.G.A., relating to courts, education, health, insurance, mental health, public officers and employees, and social services, respectively, so as to implement the recommendations of the Georgia Behavioral Health Reform and Innovation Commission; to provide for related matters; to repeal conflicting laws; and for other purposes.

This legislation aims to ensure compliance with federal laws related to mental health parity, requiring annual reports and data calls on mental health care parity by private insurers, establishing information repositories, defining treatment limitations, addressing consumer complaints, revising provisions for independent review panels, and implementing various measures to enhance mental health care, substance use disorder treatment, workforce data collection, and accountability within the state of Georgia.

GA 33-46-1 et.al., including GA 33-46-20 (New provisions not codified yet; see Title 33 Insurance, Chapter 46 – Certification of Private Review Agents)

The new law focuses on transparency and disclosure requirements associated with current prior authorization requirements.  Insurers must disclose the criteria in a timely fashion when making adverse decisions along with publishing aggregate statistics on their websites.  The statistics shall cover trends associated with approval/denial rates; reasons for the denials, whether the denial was appealed, the outcome of the appeal, and time between submission and response.

Adopted through SB 80; signed by the Governor on May 10, 2021.

Outlines coverage requirements for autism, including accident and sickness contract, policy, and benefit plans. Defines autism spectrum disorder and qualifying treatment services.
Section (b) updates coverage for autism by changing the age limit for an individual covered under a policy or contract from 6 years and under, to 20 years and under.
Does not create obligations under individualized family service plan, an individualized education plan as required by the federal Individuals with Disabilities Education Act, or an individualized service plan.
Provides how an insurer, corporation, or health maintenance organization, or a governmental entity providing coverage for treatment pursuant to the Code can be exempt from providing coverage for behavioral health treatment.
Also provides discussion of relationship to Affordable Care Act and reporting requirements.

GA SB118

On and after July 1, 2018, when a prescriber is prescribing a controlled substance listed in paragraph (1) or (2) of Code Section 16–13–26 or benzodiazepines, the prescriber shall seek and review information from the Prescription Drug Monitoring Program (PDMP) the first time the prescriber issues such prescription to a patient and thereafter at least once every 90 days, unless the:
(i) Prescription is for no more than a three-day supply of such substance and no more than 26 pills;
(ii) Patient is in a hospital or health care facility, including but not limited to, a nursing home, an intermediate care home, a personal care home, or hospice program, which provides patient care and prescriptions to be administered and used by a patient on the premises of the facility;
(iii) Patient has had outpatient surgery at a hospital or ambulatory surgical center and the prescription is for no more than a ten-day supply of such substance and no more than 40 pills;
(iv) Patient is terminally ill or under the supervised care of an outpatient hospice program; or
(v) Patient is receiving treatment for cancer

Enacted by The General Assembly of Georgia through House Bill 249.

This bill changed the section of the state insurance law about autism coverage to what it is currently (that section is summarized at the bottom of this page under “Georgia Parity Law,” “Autism Coverage”).

Provides for the care and treatment of mentally retarded persons regardless of residence requirements and authorizes supplementary agreements for joint or cooperative use of mental health resources. Compact eligibility is on a nationwide basis.
This compact’s goals include setting the legal basis for higher quality and faster responses to mental health issues in the states. The compact identifies public safety and humanitarianism as key motivations for providing such services.

HB 942

Defines “drug,” what qualifies as consent for minor seeking drug abuse treatment, and when providers can provide information to a spouse, parent, custodian, or guardian of a minor.

Every insurer authorized that issues accident and sickness insurance benefit plans, policies, or contracts is required to make coverage for the treatment of mental disorders, that is at least as extensive as coverage for the treatment of other types of physical illnesses available.
Plans must also cover the spouse and the dependents of the insured if the insured’s spouse and dependents are covered under such benefit plan, policy, or contract.
Optional endorsements cannot contain any exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions which apply to the treatment of mental disorders unless such provisions apply generally to other similar benefits in the plan.

Defines covered plans and limitations.
Creates coverage for the treatment of mental disorders that is at least as extensive and has the same annual and lifetime dollar limits as that provided by the respective plan, policy, or contract for the treatment of other types of physical illnesses.
Plans may provide for different limits on the number of inpatient treatment days and outpatient treatment visits.
Coverage must also cover the spouse and the dependents of the insured if the insured’s spouse and dependents are covered under such benefit plan, policy, or contract.
Cannot contain any exclusions, reductions, or other limitations as to coverages which apply to the treatment of mental disorders unless such provisions apply generally to other similar benefits provided or paid for under the accident and sickness insurance benefit plan, policy, or contract.