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. § 33-20A-6. Financial incentive programs prohibited; capitated payment arrangement allowed: Patient Protection Act of 1996 – Georgia
Introduced: Status: Enacted
Prevents a managed care plan from using a financial incentive or disincentive program for ordering or providing less than medically necessary and appropriate care. Capitated payments are not prohibited, however.
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Ga. Code Ann. § 33-20A-7. Penalizing provider for discussing necessary or appropriate care with patient prohibited; penalty for providing records and assistance prohibited; penalty for violations: Patient Protection Act of 1996 – Georgia
Introduced: Status: Enacted
No health care provider may be penalized for considering, studying, or discussing medically necessary or appropriate care with or on behalf of his or her patient.
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Ga. Code Ann. § 33-20A-7.1. Standards and procedures for verification of benefits and precertifications: Patient Protection Act of 1996 – Georgia
Introduced: Status: Enacted
When an enrollee, provider, facility, or home health care provider obtains precertification for any covered health care service, the managed care plan is liable for such precertified services at the reimbursement level provided under the …
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Ga. Code Ann. § 33-20A-9. Emergency services requirements; restrictive formulary requirements: Patient Protection Act of 1996 – Georgia
Introduced: Status: Enacted
Requires managed care plans include certain provisions related to emergency care.
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Ga. Code Ann. § 33-20A-9.1. Legislative intent; consumer choice option; provisions; increased expenses; covered benefits; forms: Patient Protection Act of 1996 – Georgia
Introduced: Status: Enacted
Except for managed care plans offering a consumer choice option under subparagraph (d)(2)(C) of this Code section, every managed care plan offered by a managed care entity shall offer a separate consumer choice option to …
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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.