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Legislation Signed into Law

2019

Primary Focus: Access to Services, Compliance
Title/Description: Coverage for Autism
Citation: O.C.G.A. § 33-24-59.10
Summary: 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.
Effective Date: January 1, 2016 (subsection (b) effective January 1, 2019)
Notes: GA SB118

2017

Primary Focus: Controlled Substances
Title/Description: Review of PDMP data when filling certain prescriptions
Citation: GA CODE § 16–13–63
Summary: 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
Effective Date: 7/1/2017
Notes: Enacted by The General Assembly of Georgia through House Bill 249.

2015-2016

HB 429
Introduced: 2/2015
Sponsor: Many (click link to see sponsors)
Status: Signed into Law 4/2015
Summary: 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”).

2011-2012

Primary Focus: Access to Services
Title/Description: Interstate Compact on Mental Health
Citation: O.C.G.A. § 37-10-2
Summary: 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.
Effective Date: May 1, 2012
Notes: HB 942

2009-2010

Primary Focus: Access to Services
Title/Description: “Drug” defined; Right of minor to obtain treatment of drug abuse on his consent alone; binding effect of consent; informing minor’s parent, spouse, custodian, or guardian of treatment
Citation: O.C.G.A. § 37-7-8
Summary: 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.
Effective Date: 2010
Notes: N/A

Primary Focus: Access to Services
Title/Description: Coverage of Treatment of Mental Disorders
Citation: O.C.G.A. § 33-24-28.1
Summary: 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.
Effective Date: 2010
Notes: N/A

Primary Focus: Access to Services
Title/Description: Coverage for Treatment of Mental Disorders Under Accident and Sickness Insurance Benefit Plans Providing Major Medical Benefits Covering Small Groups; Federal Law
Citation: O.C.G.A. § 33-24-29
Summary: 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.
Effective Date: 2010
Notes: N/A

Georgia Parity Law

There are several sections of the state insurance law relevant to parity. Three for behavioral health coverage and one for autism coverage:

It is not possible to provide direct links to any of these sections. To find them, click here. Then scroll down and click on the plus sign (+) next to “Title 33”. Then scroll down and click on the plus sign (+) next to “Chapter 24”. Then click on the plus sign (+) next to “Article 1. General Provisions”. Then scroll to the section you want from our list above.

Behavioral Health Coverage

Individual Plans

Individual plans are required to offer optional coverage for behavioral health services that is “at least as extensive” as coverage for other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” or financial requirements for behavioral health services that are not in place for other medical services, except that plans must only cover 30 days of inpatient care and 45 visits for outpatient care.

Small Employer Fully-Insured Plans

Small employer fully-insured plans are required to offer optional coverage for behavioral health services “at least as extensive” as coverage for other medical services.

Annual maximums and lifetime maximums must be the same for behavioral health services and other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services that are not in place for other medical services, except that plans may limit days for inpatient care and visits for outpatient care. It does not specify any number for either of these limitations.

Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place or are different that those in place for other medical services.

Large Employer Fully-Insured Plans

Large employer fully-insured plans are required to offer optional coverage for behavioral health services “at least as extensive” as coverage for other medical services.

Annual maximums and lifetime maximums must be the same for behavioral health services and other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services that are not in place for other medical services, explicitly including limits for inpatient care and visits for outpatient care. It does not specify any number for either of these limitations.

Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place or are different that those in place for other medical services.

Autism Coverage

This section requires individual plans, small employer fully-insured plans with more than 10 employees, large employer fully-insured plans and state employee plans to cover autism services through age 6.

There is a $30,000 annual maximum for applied behavior analysis, but plans may not limit outpatient visits otherwise.

Plans can review a child’s treatment plan once a year.

Autism spectrum disorder is defined as it is in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

Treatment of autism is defined as:

  • Habilitative or rehabilitative services
  • Counseling services provided by a licensed psychiatrist, licensed psychologist, professional counselor, or clinical social worker
  • Therapy services provided by a licensed or certified speech therapist, speech-language pathologist, occupational therapist, physical therapist, or marriage and family therapist

Plans can file for an exemption if they can prove that complying with this section of the law caused premiums to increase by 1% or more over a 12-month time span.

Get Support

Georgia Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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