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HB 928

Insurance; utilization review by an insurer shall not be required in the instance in which a physician has determined the existence of dense breast tissue and the medical necessity of a breast ultrasound; provide

2025-2026 Regular Session Introduced by Omari Crawford and 4 co-sponsors

House Bill 928 allows physicians to order breast ultrasounds for women with dense breast tissue without insurer review, improving access to crucial cancer detection.

House Second Readers
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Bill Summary · HB 928

Summary of House Bill 928

Bill Number: HB 928
Title: Insurance; utilization review by an insurer shall not be required in the instance in which a physician has determined the existence of dense breast tissue and the medical necessity of a breast ultrasound; provide
Status: House First Readers
Introduced: April 04, 2025

Purpose and Intent

House Bill 928 aims to amend the insurance regulations in Georgia to eliminate the requirement for utilization review by insurers when a physician determines that a breast ultrasound is medically necessary due to the presence of dense breast tissue. This legislation seeks to improve access to necessary diagnostic procedures for women with dense breast tissue, which can complicate the detection of breast cancer.

Key Provisions

  • Utilization Review Exemption: The bill specifies that if a physician identifies dense breast tissue and deems a breast ultrasound medically necessary, insurers cannot dispute this determination through utilization review processes.

  • Definitions: The bill provides clear definitions for several terms, including:

    • Breast Ultrasound: A noninvasive diagnostic tool using sound waves to create images of breast structures.
    • Dense Breast Tissue: Defined as heterogeneously or extremely dense breast tissue based on established guidelines.
    • Diagnostic Breast Examination: Includes examinations using breast MRI, breast ultrasound, or mammogram to evaluate abnormalities.

  • Cost-Sharing Requirements: Health benefit policies must ensure that cost-sharing for diagnostic and supplemental breast examinations is no less favorable than that for screening mammography.

  • Implementation Timeline: The bill is set to take effect on July 1, 2025, and will apply to all relevant policies executed or renewed on or after October 1, 2025.

  • Regulatory Authority: The Commissioner of Insurance is tasked with promulgating necessary rules and regulations to implement the provisions of this bill in accordance with current medical guidelines.

Impact

  • Affected Parties: This legislation primarily impacts women with dense breast tissue, healthcare providers, and insurance companies in Georgia. It aims to facilitate timely access to breast ultrasounds without the barriers of insurer review processes.

  • Healthcare Providers: Physicians will have greater autonomy in determining the necessity of breast ultrasounds, potentially leading to improved patient outcomes.

  • Insurance Companies: Insurers will need to adjust their policies and practices to comply with the new regulations regarding utilization review and cost-sharing requirements.

Conclusion

House Bill 928 represents a significant step towards enhancing breast cancer detection and treatment for women with dense breast tissue in Georgia. By removing the utilization review requirement for medically necessary breast ultrasounds, the bill aims to streamline access to essential diagnostic services, thereby potentially improving health outcomes for affected individuals.

Compiled from official sources — confirm details with the bill’s official record.

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