2022 Georgia Code
Title 33 - Insurance
Chapter 24 - Insurance Generally
Article 1 - General Provisions
§ 33-24-59.30. Requirements for Health Insurance Issuer for Anatomical Gifts or Organ Transplants; Medically Inappropriate Organ Transplants

1. As used in this Code section, the term:
   1. “Attending health care provider” means the attending physician and any other person administering health care services at the time of reference who is licensed, certified, or otherwise authorized or permitted by law to administer health care services in the ordinary course of business or the practice of a profession, including any person employed by or acting for any such authorized person.
   2. “Covered person” means a policyholder, subscriber, enrollee, member, or individual covered by a health benefit plan.
   3. “Health benefit plan” means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. Such term shall not include a plan providing coverage for only excepted benefits as specified in Section 2791(c) of the federal Public Health Service Act, 42 U.S.C.A. Section 300gg-91(c) and short-term policies that have a term of less than 12 months.
   4. “Health insurance issuer” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including through a health benefit plan as defined in this subsection, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization, or any similar entity, or any other entity providing a plan of health insurance or health benefits.
2. A health insurance issuer that provides coverage for anatomical gifts, organ transplants, or related treatment and services shall not:
   1. Deny coverage to a covered person solely on the basis of the individual’s disability;
   2. Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of a health benefit plan, solely for the purpose of avoiding the requirements of this subsection;
   3. Penalize or otherwise reduce or limit the reimbursement of an attending health care provider, or provide monetary or nonmonetary incentives to such a provider, to induce such provider to provide care to a covered person in a manner inconsistent with this Code section; or
   4. Reduce or limit coverage benefits to a patient for the medical or other health care services related to organ transplantation performed pursuant to this Code section as determined in consultation with the attending health care provider and patient.
3. In the case of a health benefit plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement imposed pursuant to this Code section shall not be treated as a termination of the collective bargaining agreement.
4. Nothing in this Code section shall be deemed to require a health insurance issuer to provide coverage for a medically inappropriate organ transplant.

History. Code 1981, § 33-24-59.30 , enacted by Ga. L. 2021, p. 546, § 1-4/HB 128.

Effective date. —

This Code section became effective July 1, 2021.

Editor’s notes.

Ga. L. 2021, p. 546, § 1-1/HB 128, not codified by the General Assembly, provides: “This part shall be known and may be cited as ‘Gracie’s Law.’ ”

Ga. L. 2021, p. 546, § 1-2/HB 128, not codified by the General Assembly, provides: “The General Assembly finds that:

“(1) A mental or physical disability does not diminish a person’s right to health care;

“(2) The Americans with Disabilities Act of 1990, 42 U.S.C. Section 12101 et seq., prohibits discrimination against persons with disabilities, yet many individuals with disabilities still experience discrimination in accessing critical health care services;

“(3) In other states, individuals with physical or mental disabilities have been denied lifesaving organ transplants based on assumptions that their lives are less worthy, that they are incapable of complying with posttransplant medical requirements, or that they lack adequate support systems to ensure compliance with posttransplant medical requirements;

“(4) Although organ transplant centers shall consider medical and psychosocial criteria when determining if a patient is suitable to receive an organ transplant, transplant centers that participate in Medicare, Medicaid, or other federally funded programs are required to use patient selection criteria that result in a fair and nondiscriminatory distribution of organs; and

“(5) Georgia residents in need of organ transplants are entitled to assurances that they will not encounter discrimination on the basis of a disability.”