Overview
Georgia has made significant strides in legislative efforts to promote healthcare price transparency in recent sessions. The state enacted legislation in 2020 that lays the groundwork for an all-payer claims database (APCD). The law establishes an APCD advisory committee, funding for the APCD, design criteria, operation, and noncompliance penalties. The legislature also passed legislation prohibiting surprise and balance billing for both emergency and non-emergency services, making it one of the states with the most robust protections against surprise billing. Additionally, the Georgia Right to Shop Act requires insurance companies to create a webpage or toll-free phone number where patients can view the average amount for particular services, estimate out-pocket-costs, and access various quality metrics.
Georgia also recognizes the importance of telehealth as a tool to improve health care access, even before the COVID-19 pandemic. The state passed laws to require coverage parity, reimbursement parity, and cost-sharing parity in telehealth services. However, Georgia has also recently used an ACA waiver to flout federal law and to eliminate the state’s health insurance marketplace.
In antitrust regulation, the state has some legislation to prevent anticompetitive practices in healthcare markets. Notably, Georgia law prohibits most-favored nation clauses in contracts between providers and insurers and the use of non-compete provisions in physician contracts. In terms of merger review authority, Georgia law requires transacting entities to notify the attorney general of transactions involving a nonprofit hospital. While explicit approval from the AG is not mandated, the AG must hold a public hearing to solicit public opinions. Under the Certificate of Need (CON) program, healthcare entities must obtain a CON for certain expansions of services.
In 2011, the FTC and Georgia AG challenged Phoebe Putney Health System’s proposed acquisition of rival Palmyra Park Hospital from the Hospital Authority of Albany-Dougherty County (HCA). The case went all the way to the U.S. Supreme Court after the lower courts held that the transaction was immune from antitrust scrutiny under the state-action immunity doctrine. The Supreme Court reversed, finding that Georgia did not meet the two-prong state-action immunity test instated by the Court. The FTC ultimately reached a consent decree with Phoebe Putney concerning the acquisition, imposing various antitrust restrictions.
In 2024, Georgia passed legislation to change the certificate of need program, including instigating a review of the state health plan every five years, eliminating capital expenditure thresholds in some situations, and revising exemptions from certificate of need requirements.
See below for an overview of existing Georgia state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/9/2023 - 3/30/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1042 – Georgia
Introduced: 2022 Status: Enacted
A BILL to be entitled an Act to amend Chapter 34 of Title 50 of the Official Code of Georgia Annotated, relating to the “OneGeorgia Authority Act,” so as to provide for a grant program …
HB 1153 – Georgia
Introduced: 2020 Status: Inactive / Dead
Individual Short-Term Health Insurance Consumer Protection Act: A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to …
HB 1276 – Georgia
Introduced: 2022 Status: Enacted
A BILL to be entitled an Act to amend Chapter 2 of Title 31 of the Official Code of Georgia Annotated, relating to the Department of Community Health, so as to require that statistical reports …
HB 1324 – Georgia
Introduced: 2022 Status: Enacted
A BILL to be entitled an Act to amend Chapter 11 of Title 31 and Title 33 of the Official Code of Georgia Annotated, relating to emergency medical services and insurance, respectively, so as to …
HB 1339 – Georgia
Introduced: 2024 Status: In Process
This bill proposes amendments to health-related laws in Georgia. It includes changes to the “certificate of need” program, which refers to a regulatory process that requires certain health care providers to obtain state approval before …
Ga. Code Ann. § 33-20C-1. Definitions: Accurate Provider Directories – Georgia
Introduced: Status: Enacted
Definitions relate to Chapter 20 Accurate Provider Directories (sections 33-20C-1 through 33-20C-7).
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Ga. Code Ann. § 33-20C-2. Online provider directories; printed directories by request; required content; accessibility: Accurate Provider Directories – Georgia
Introduced: Status: Enacted
An insurer shall post on its website a current and accurate electronic provider directory for each of its network plans and include information such as how the insurer designates the different provider tiers or levels.
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Ga. Code Ann. § 33-20C-3. Required and accurate information in directories; reporting; reimbursement for reliance: Accurate Provider Directories – Georgia
Introduced: Status: Enacted
The insurer shall include in both its online and print directories a clearly identifiable telephone number and either a dedicated e-mail address or a link to a dedicated webpage that covered persons or the general …
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Ga. Code Ann. § 33-20C-7. Disclosure of health benefit plan surprise bill rating in advertisement; other disclosures; regulation; optional annual reporting: Accurate Provide Directories – Georgia
Introduced: Status: Enacted
Each insurer that advertises or designates any hospital as in-network shall be required to disclose the relevant health benefit plan surprise bill rating within such advertisement, notwithstanding the type or form of such advertisement.
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Ga. Code Ann. § 33-21-1. Definitions: Health Maintenance Organizations – Georgia
Introduced: Status: Enacted
Definitions relate to health maintenance organizations (sections 33-21-1 through 33-21-29).
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United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
Federal Trade Commission and the State of Georgia v. Phoebe Putney Health Systems, Inc., et al. – Georgia
District Court: United States of America Before The Federal Trade Commission; Middle District of Georgia Albany Division Status: Decided
In April 2011, the FTC challenged Phoebe Putney Health System’s acquisition of a hospital from the Hospital Authority of Albany-Dougherty County as having anticompetitive effects …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
Federal Trade Commission v. Actavis, Inc. – Georgia
District Court: Northern District of Georgia Status: Decided
The Supreme Court ruled in favor of the FTC, holding that a brand name manufacturer’s payment to a generic competitor to settle patent infringement claims …
Additional Resources
STATE BUDGET
Georgia’s budget is set for a fiscal year. The governor submits a proposed budget in January and the legislature adopts a budget in March or April. The fiscal year begins on July 1 and continues through the next June 30.
STATE LEGISLATURE
The Georgia Senate has 56 members, and the Georgia House of Representatives has 180 members, all of whom serve for two years. The Legislature must convene by the second Monday in January and sessions last 40 legislative days. The Georgia Legislature runs in 2-year cycles – bills that don’t pass or aren’t voted on during odd years carry over to the next even year.