HB 197 Georgia House · 2025-2026 Regular Session

Insurance; health care provider to respond to a private review agent or utility review entity's attempt to discuss the patient's care; detail the effort

HB 197 requires health care providers to make a specific effort to discuss a patient's care with insurance review agents (like private or utility review entities) when medical necessity is questioned. This includes contacting providers directly, using callback systems, or offering website scheduling for later communication during normal business hours. The bill also mandates that insurers implement performance-based programs to reduce prior authorization requirements for high-performing providers who follow evidence-based medicine, with annual reporting to the state department by 2026. It applies to all Georgia health insurance policies issued or renewed on or after January 1, 2026.

Issues: ✓ Healthcare

Bill status signed all 5 stages cleared

Introduction

Jan 2025

Committee Review

Mar 2025

House Passage

Mar 2025

Senate Passage

Apr 2025

Signed into Law

May 2025

Introduced Jan 30, 2025 Signed May 14, 2025

Maddy AI version diff · 1 comparison

What changed between versions

LC 46 1010/a → HB 197/AP* · 4 edits

MODERATE

The bill was amended to reflect its passage through both legislative chambers and to clarify its purpose. The primary substantive change is the addition of a new section requiring health insurers to create programs that selectively reduce prior authorization requirements for healthcare providers who demonstrate high performance and adherence to evidence-based medicine. The effective date and applicability language was also updated to align with the new provisions.

Scope change

The bill's scope was expanded from solely amending existing certification requirements to also mandating that insurers implement programs for selective prior authorization reductions based on provider performance.

REQUIREMENT

Added a new Code section (33-46-20.1) requiring insurers to implement programs that allow selective reductions in prior authorization requirements based on healthcare providers' performance and adherence to evidence-based medicine.

SCOPE

Changed the bill's title description from a general purpose statement to specifically mention amending Chapter 46 of Title 33 to provide for selective application of prior authorization reductions.

TIMELINE

Updated the effective date language to apply to policies issued, delivered, or renewed on or after January 1, 2026, and added a requirement for insurers to submit program filings by July 1, 2026.

TECHNICAL

Updated the bill header to indicate it has passed both the House and Senate, and adjusted the page numbering and formatting to reflect the final amended version.

Floor votes · Senate Apr 2, 2025 · House Mar 4, 2025

How they voted

52–0

Passed · 3 other

Total votes 55

Apr 2, 2025

D Democratic22

21 Yea 1

95% Yea

R Republican33

31 Yea 2

93% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

May 14, 2025

Signed into law

Act 303

upper

May 14, 2025

Signed into law

House Date Signed by Governor

lower

Apr 4, 2025

Introduced

House Agreed Senate Amend or Sub

lower

Apr 2, 2025

Upper · Passed

Senate Passed/Adopted By Substitute

upper

Mar 31, 2025

Upper · Passed

Senate Committee Favorably Reported By Substitute

upper

Mar 28, 2025

Committee

Senate Recommitted

upper

Mar 18, 2025

Upper · Passed

Senate Committee Favorably Reported

upper

Mar 6, 2025

Committee

Senate Read and Referred

upper

Mar 4, 2025

Lower · Passed

House Passed/Adopted

lower

Feb 11, 2025

Lower · Passed

House Committee Favorably Reported

lower

Jan 30, 2025

Introduced

House Hopper

lower

6 primary · 0 co-sponsors