Georgia House bill backed by Rep. Kelley targets private review agent guidelines

A bill put forward in the Georgia House by state Rep. Trey Kelley seeks to change standards for private review agents who assess medical necessity in healthcare, according to the Georgia State House.

Filed as HB1236 on Friday, Feb. 6 during the 2026 regular session of the 158th General Assembly, the legislation is officially titled: ’Insurance; medical necessity of a healthcare service; provisions’.

Below is a summary based on the bill’s current text, with clarifying interpretation where helpful.

The bill aims to revise existing rules in Georgia for private review agents and utilization review entities reviewing the medical necessity of healthcare services. It would allow the treating physician or a qualified representative to discuss the care plan with a clinical peer licensed within Georgia who is trained in the same specialty, and prohibits adverse determinations except with the agreement of that peer and after attempting to reach the provider during normal working hours. It outlines acceptable ways to contact providers and requires that adverse determination notices include a rationale. The changes would apply starting Jan. 1, 2027, for policies and contracts issued or renewed from that date forward.

Along with Kelley, the bill lists Rep. Matt Hatchett (Republican-155th), Rep. Patty Marie Stinson (Democrat-150th), Rep. Demetrius Douglas (Democrat-78th), and two additional legislators as co-sponsors.

Since the start of the legislative session, Kelley has introduced 16 other bills; seven have been enacted so far.

Kelley holds a BS from Shorter University, 2008, and a JD from Georgia State University College of Law, conferred in 2014.

A Republican, Kelley was first elected to the Georgia State House in 2013 and represents District 16, succeeding Rick Crawford.

For reference, Georgia’s legislative process begins when a lawmaker, often at a constituent’s request, works with the Office of Legislative Counsel to draft a proposal. Filed with the House or Senate’s clerk, the bill undergoes a first reading and is referred to a committee, where substantial debate and analysis occurs. If passed, it moves to the chamber floor for debate and voting. To become law, it must gain approval in both chambers (sometimes involving a conference committee for differing versions) before going to the governor, who has six days during session—or 40 days after adjournment (Sine Die)—to sign, veto or let the bill become law without signature. The Georgia General Assembly convenes each year for a 40-day session beginning the second Monday in January.

Information in this article was gathered from the Georgia State House. The source data can be accessed here.