As part of a multi-specialty physician coalition led by the Medical Association of Georgia, the Georgia Association of Pathologists (GAP), in partnership with the CAP, supported state legislative passage of Senate Bill 20 requiring health plan network adequacy and adequate access to clinical laboratory services to ensure covered persons have full access to their plan’s covered benefits. The bill passed the legislature overwhelmingly 52-1 in the Senate and the House by a vote of 166-2. The bill will now go to Governor Brian Kemp (R) for consideration.

The bill expressly provides that “an insurer providing a network plan shall contract with and maintain a network of participating providers in sufficient number and appropriate type, including primary care and specialty care, pharmacies, clinical laboratories, and facilities, throughout such plan's service area to ensure covered persons have access to the full scope of benefits and services covered under such plan.”

Authority is conferred upon the Commissioner of Insurance to assess health plan compliance with the network adequacy requirement. Factors to be considered by the Commissioner include: “the availability of providers, the willingness of nonparticipating providers to enter into reasonable network contract agreements with an insurer, and good faith efforts by an insurer to enter into network contract agreements with such nonparticipating providers.”

If enacted Georgia would join Louisiana, Washington, Virginia, and New Hampshire with health plan network adequacy laws that explicitly includes clinical laboratory and pathology services, provisions secured by the CAP.

Also, this session, the Georgia Association of Pathologists (GAP), in collaboration with the CAP, communicated its support for Georgia House Bill 85, legislation to mandate Medicaid and private insurance coverage of biomarker testing. The legislation, led by the American Cancer Society, and supported by numerous physician groups also secured overwhelming support at the legislature. The legislation is consistent with the new CAP public policy that supports mandated coverage for biomarker testing and the waiver of prior authorization for such testing.

That bill also now goes to Georgia Governor Brian Kemp for consideration. If enacted, Georgia would join Arizona, Louisiana, Illinois, and Rhode Island, states having a similar biomarker coverage mandate in law.