Bill > HB928

This bill amends Georgia's insurance code to address breast cancer screening and dense breast tissue, specifically focusing on utilization review for breast ultrasounds. The bill defines several key terms, including "dense breast tissue" as heterogeneously or extremely dense breast tissue based on nationally recognized guidelines like the Breast Imaging Reporting and Data System. The legislation requires health benefit policies that cover diagnostic breast examinations to ensure cost-sharing requirements for diagnostic and supplemental breast screening examinations are no less favorable than those for screening mammography. Most significantly, the bill introduces a new provision that if a supplemental breast screening examination reveals dense breast tissue, and the diagnosing physician determines a breast ultrasound is medically necessary, an insurer cannot dispute this determination through utilization review or other procedures to deny insurance coverage. The bill will become effective on July 1, 2025, and will apply to insurance policies executed or renewed on or after October 1, 2025, with the goal of improving access to potentially life-saving breast cancer screening for individuals with dense breast tissue.

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https://www.legis.ga.gov/legislation/72077