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.
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 1403 – Georgia
Introduced: 2022 Status: Inactive / Dead
A BILL to be entitled an Act to amend Code Section 31-6-47 of the Official Code of Georgia Annotated, relating to exemptions from certificate of need requirements, so as to provide an exemption for acute …
Ga. Code Ann. § 31-7-94.1. Rural Hospital Organization Assistance Act; legislative findings; certification of rural hospitals for grant eligibility; rules and regulations: Hospital Authorities Law – Georgia
Introduced: Status: Enacted
In order to preserve the availability of primary health care services provided by such hospitals to residents of rural counties, the General Assembly has determined that a program of state grants is necessary and recommends …
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Ga. Code Ann. § 33-1-19. Special Advisory Commission on Mandated Health Insurance Benefits: Georgia Insurance Code—General provisions – Georgia
Introduced: Status: Enacted
The Special Advisory Commission on Mandated Health Insurance Benefits shall advise the Governor and the General Assembly on the social and financial impact of current and proposed mandated benefits and providers. For definitions, see section …
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Ga. Code Ann. § 33-1-2. Definitions: Georgia Insurance Code—General Provisions – Georgia
Introduced: Status: Enacted
Provides definitions for the Georgia Insurance Code (Title 33).
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Ga. Code Ann. § 33-1-26. Governor’s request for waiver from federal Patient Protection and Affordable Care Act; expiration of authority: Georgia Insurance Code—General Provisions – Georgia
Introduced: Status: Enacted
Grants the governor the authority to submit an application for a waiver.
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Ga. Code Ann. § 33-20-13. Management of corporations; general powers; requirements as to reserves, minimum subscriber’s surpluses, and charges: Health Care Plan Act – Georgia
Introduced: Status: Enacted
A health care corporation may in its discretion limit the benefits that it will furnish, may divide such benefits as it elects to furnish into classes or kinds, and may furnish different benefits with different …
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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.
KEY RESOURCES
- Georgia State General Assembly
- Georgia Office of the Attorney General
- Georgia Governor’s Office of Planning and Budget