Bill > HB197

This bill makes two primary changes to healthcare insurance regulations in Georgia. First, it requires healthcare providers to make a meaningful effort to respond to private review agents or utilization review entities when they are attempting to discuss a patient's care, including methods such as direct contact, implementing a callback system, or using a website that allows for scheduled communications. Second, the bill mandates that health insurers develop and maintain a program allowing selective reduction of prior authorization requirements based on healthcare providers' performance and adherence to evidence-based medicine. Insurers must submit an annual filing to the state department detailing their program, including participation criteria, covered procedures, and the number of participating healthcare providers. The bill is set to take effect on January 1, 2026, and will apply to all insurance policies issued or renewed in Georgia on or after that date. The goal is to promote quality, affordable healthcare while reducing unnecessary administrative burdens for both insurers and healthcare providers by streamlining communication and prior authorization processes.

Health and Social Services

https://www.legis.ga.gov/legislation/69713