Open Enrollment Ends

Pranaya Outreach 10.15GHF helped over 100 people get covered

Open enrollment formally concluded on January 31, 2016 and 587,845 Georgians enrolled in the Marketplace (healthcare.gov).

Throughout open enrollment, GHF worked to get Georgians enrolled through direct service and the creation of GEAR (or the Georgia Enrollment Assister Resource Network). GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners who work with consumers to educate them on their health and health care coverage options. If you are interested in learning more about GEAR or want to sign up for the newsletter, email Whitney. Additionally, during this open enrollment period we have provided enrollment assistance to 78 applicants and their families, totaling 141 Georgians. Of those, 91%  received financial assistance.


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Legislative Update January 25, 2016

The second week of the Legislative Session was primarily focused on the budget. Check out the updates below on provider directories, closing the coverage gap, and other issues that are important to Georgia health care consumers.


YOU’RE INVITED!

Please join GHF and Georgia Watch on Tuesday, February 2 for a breakfast policy discussion Getting What You Pay For: Consumer Protections for Network Adequacy, Surprise Medical Bills, and Provider Directories, for more information, click here.

 

The event is free, but we ask that you RSVP to that we may have an accurate head count.

 


WHAT HAPPENED THIS WEEK?

Improving Provider Directories
Improving provider directories continues to be an issue of interest in both the House and Senate and on both sides of aisle.  We hope to see a bill within the coming weeks.  As soon as we have a bill number, we’ll pass the information along to you. Be on the lookout for an action alert soon!

 

Surprise Out-of-Network Billing
In both the House and Senate we are hearing strong interest in addressing surprise out-of-network billing. It is probable that we will soon see a bill that addresses this issue and we will keep you updated with any such developments.

 

Closing Georgia’s Coverage Gap
While we do not have a bill number, House Democrats have announced that they will be proposing a bill to close Georgia’s coverage gap. You can read about that here.
Action Alert: Governor Deal and the legislature need to hear from you that closing the coverage gap is good for Georgia’s citizens and economy. Add your name to a petition of close Georgia’s coverage gap (and then forward it to a friend!).

 

Governor Deal Proposes a Budget
Governor Deal has released his budget proposal for the 2016 legislative session. This budget will take effect in July 2016 and run through the end of June 2017. We are just beginning to parse through the budget but we have already identified two items to watch:
  • In the FY 2016 budget, the legislature included $23 million for partialMedicaid payment parity, with the understanding that full parity may be achievable over the next several budget years. The Governor’s budget maintains last year’s partial parity, but does not add any more funding. We will encourage the legislature to increase the funding for payment parity as they make their budget changes. Need a refresher on what parity has to do with access to care? Check out this blog post.
  • Under the proposed budget, monthly insurance premiums for non-certified public school personnel (like bus drivers, cafeteria workers, etc.) will increase in January 2017. You can read more about these changes here.
If you want more information about the budget and its implications for consumers, check out the Georgia Budget & Policy Institute’s FY 2017 budget report.

 

Network Adequacy
Georgians for a Healthy Future supports updating Georgia’s network adequacy standards to ensure that consumers can access an in-network provider for all covered benefits in their plan. This past fall, the National Association of Insurance Commissioners updated its model act on network adequacy. Shortly thereafter, Georgia’s Consumer and Provider Protection Act Study Committee recommended a multi-stakeholder review of the model act to determine how Georgia should proceed on this important issue. While there hasn’t been any movement on network adequacy yet this legislative session, it’s an issue we’re closely watching. You can check out the network adequacy page on our website for background materials, videos, and news articles on network adequacy.

LET’S CHAT

This week we’re highlighting in our Consumer Health Advocacy Today a conversation with Rep. Lee Hawkins who is concerned about health literacy in Georgia. We agree with him that many Georgians lack the information they need to make informed decisions about their health insurance. Check out his video below. If you want to learn more about health literacy, check out this blog entry.
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LOOKING FOR A FULL LIST OF BILLS RELATING TO CONSUMER HEALTH CARE?
GHF is monitoring legislative activity that could impact Georgia consumers. We are tracking bills as they move through the legislative process. Stay updated with our legislative tracker here.

Health Care Unscrambled 2016

Thank you for making Health Care Unscrambled 2016 a success! If you weren’t able to attend last week’s Health Care Unscrambled, don’t worry! We’ve pulled together the highlights.

Whether we are giving a dental care or a full mouth restoration, we use the best technology and tools in the industry. Our partner Martindale dental is committed to providing an exceptional level of customer service. Our dental team provides caring, comprehensive treatment with an emphasis on preventative dental care, and the use of products from sensitivity toothpaste to the teeth whitening kits used by denstists.

Health Care Unscrambled in the news

Andy Miller, Georgia Health News

 

“Support for a higher cigarette tax, and for the emerging trend of ambulance crews treating people in their homes rather than in ERs were two areas of general unanimity on the panel, at an event sponsored by the group Georgians for a Healthy Future. But as expected, there was sharp division among the four legislators on the panel when it came to the issue of expanding the state’s Medicaid program….” Read More.

 

Regina Willis, Atlanta Progressive News
” ‘One of the biggest concerns I have is our rural hospitals…. I have personally seen what happened when some of my friends in Dooly County, when their hospital closed; here is some advice on how to whiten teeth in the comfort of your own home, directly recommended by one of the best Chandler dentist if not the best one. I had friends who worked for the Sedation Dentistry Provider there, doctors, nurses and so forth,” State Sen. Greg Kirk (R-Americus) said during a recent panel…” Read More.

Pictures, videos, & more

12496026_10153463293267861_1666740753110048770_oWe had a great (lookin’) crowd at Health Care Unscrambled this year! Check out our Facebook album to see if you made any of the photos!
The Twitter conversation was as lively as the panel discussions! You can find theStorify from the event here.

Humidification is pretty standard these days. No, you don’t have to have humidification, but it makes CPAP Machineo much more comfortable to use warm and moist air than cool dry air.

Lee_Hawkins_ThumbnailRep. Hawins on the importance of consumer health literacy

 

debbie_buckner_thumbnailRep. Buckner on her health care policy priorities

 

Greg_Kirk_ThumbnailRep. Kirk on the  importance of rural hospitals

 

Lynn_Quincy_thumbnailPresentation – Lynn Quincy, Consumers UnionLynn Quincy on health value

 


Presentations and event materials 

  • Health Advocate’s Guide to the 2016 Legislative Session
  • Health Care Unscrambled 2016 Program
  • Fact Sheet – A Networking & Resource Center for Advocates Working for Better Value in Health Care: Health Care Value Hub
  • Fact Sheet – A Framework for Thinking about Health Care Value Strategies
  • Presentation – Sue Polis, Trust for America’s Health
  • Presentation – Lynn Quincy, Consumers Union

Event Sponsors

Champion

Hemophilia of Georgia

Advocate

Easter Seals Southern Georgia
Harry Heiman & Abby Friedman
Polsinelli, P.C.

Ally

Alston & Bird
Insure GA
Jeremy Burnette
Susan Kupferberg & Richard Mitchell
Robert & Amy Arogeti
Xerox

 

Supporter

 

Alan Levow
The Columbus Organization
CEU Concepts
Cindy Zeldin & Doug Busk
Georgia Academy of Family Physicians
Georgia Council on Substance Abuse
Georgia Equality
Grady Health Foundation
Hayslett Group
Ilene Engel
Kennedy Center for Mental Health Policy and Research at Morehouse School of Medicine
Lois & Larry Frank
The Mabra Firm
Medical Association of Georgia
Mercer College of Health Professions
Nelson Mullins

 

Host

 

Albany ARC
Aliyya Haque
American Academy of Pediatrics, Georgia Chapter
American College of Physicians, Georgia Chapter
Jay & Jackie Berkelhamer
Allyson Burroughs
Sylvia Caley
Dekalb Medical Center
Representative Stacey Evans
GEEARS: Georgia Early Education Alliance for Ready Students
Georgia Budget & Policy Institute
Georgia Charitable Care Network
Georgia’s AllStar Dental Academy and  Dental Hygienists’ Association
Georgia WAND
Georgia Watch
Jewish Community Relations Council of Atlanta
Julie Edelson
Linda Lowe
Dante McKay
Memorial Health
Planned Parenthood Southeast
Monica Ponder
Shepherd Center
Lewis & Joanie Shubin
Andy & Maura George Simpson
Marci Thomas
UGA College of Public Health
United Way of Greater Atlanta
Voices for Georgia’s Children

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7 Weeks with GHF

Meet our new intern Victoria!

VictoriaAs the newest member of GHF, I am excited to spend the next seven weeks with the GHF team as they work to bridge the coverage gap, improve health insurance literacy, and reduce health disparities in the state of Georgia. This internship will not only provide an amazing experience to learn more about consumer health care issues, but it will allow me to pursue a passion of mine,  helping people to improve their health. During my time here I will assist in conducting outreach and education and engage in health care policy advocacy during the legislative session.

Interning at GHF isn’t just an opportunity to learn about health care issues in Georgia. I am looking forward to applying and use all of the knowledge and skills I gain here in my future career and in my civic life. I hope to learn more about health policies and programs and their impact on Georgians, how to build sustainable coalitions, and how to create and improve media messages. I also look forward to learning how to brainstorm and implement new ways to do community outreach. This internship will serve as part of my last semester at the State University of New York at Potsdam, providing me with a Bachelors degree in both Community Health and French. After graduation I hope to pursue a career  in health policy advocacy, recreational therapy, international health education, being an entrepreneur on health topics, or nutrition education. This internship will be another step towards my future career. I look forward to working with all of you during my time at GHF.

by Victoria Congleton


Legislative Update January 19, 2016

The 2016 Legislative Session is underway! At GHF, we are working on issues that are important to Georgia’s health care consumers. As these issues come up during the legislative session, we will bring you weekly updates.

WHAT HAPPENED THIS WEEK
Improving Provider Directories

Georgians for a Healthy Future has identified provider directory accuracy and usability as important health care consumer issues. Without accurate information about which providers are in-network and accepting new patients, consumers face challenges selecting the health plan that best fits their needs. Provider directories are also an important tool when consumers go to access care: without accurate information, consumers risk ending up out-of-network or not being able to access the care they need. We expect to see legislation introduced in this area and we look forward to working with legislators on its passage.  As soon as we have a bill number, we’ll pass the information along to you. Be on the lookout for an action alert soon!

 

Network Adequacy 
Georgians for a Healthy Future supports updating Georgia’s network adequacy standards to ensure that consumers can access an in-network provider for all covered benefits in their plan. This past fall, the National Association of Insurance Commissioners updated its model act on network adequacy. Shortly thereafter, Georgia’s Consumer and Provider Protection Act Study Committee recommended a multi-stakeholder review of the model act to determine how Georgia should proceed on this important issue. While there hasn’t been any movement on network adequacy yet this legislative session, it’s an issue we’re closely watching. You can check out the network adequacy page on our website for background materials, videos, and news articles on network adequacy.

 

Surprise Out-of-Network Billing 
Sometimes consumers end up with out-of-network bills despite making the effort to stay in network or because inadequate provider networks require them to go out of network to get the care that they need. These surprise bills can be hazardous to consumers’ finances. Here’s a fact sheet from Consumers Union on this issue.
In both the House and Senate we are hearing strong interest in addressing surprise out-of-network billing. It is probable that we will soon see a bill that addresses this issue and we will keep you updated with any such developments.

 

Closing Georgia’s Coverage Gap
Last week’s Health Care Unscrambled featured a bipartisan legislative panel. Senators Greg Kirk and Emanuel Jones and Representatives Lee Hawkins and Debbie Buckner addressed the coverage gap at length. While they all agreed that there were too many Georgians without access to care, they differed on how to cover those people. You can read Georgia Health News’s coverage of the panel here.
Additionally, House democrats dropped a bill to close the coverage gap by expanding Medicaid. You can read about that here.

 

Governor Deal Proposes a Budget
This week, Governor Deal released his budget proposal for the 2016 legislative session. This budget will take effect in July 2016 and run through the end of June 2017. We are just beginning to parse through the budget but we have already identified two items to watch:
  • In the FY 2016 budget, the legislature included $23 million for partialMedicaid payment parity, with the understanding that full parity may be achievable over the next several budget years. The Governor’s budget maintains last year’s partial parity, but does not add any more funding. We will encourage the legislature to increase the funding for payment parity as they make their budget changes.
  • Under the proposed budget, monthly insurance premiums for non-certified public school personnel (like bus drivers, cafeteria workers, etc.) will increase in January 2017. You can read more about these changes here.

 

Responding to the State of the State
Cindy_01GHF’s Executive Director, Cindy Zeldin responds to Governor Deal’s State of the State.
“Individuals, families, and communities are stronger and healthier when people have coverage. The decline in our state’s uninsured rate has had positive benefits not only for the people who have gained coverage but also for our local health systems, communities, and the economy. Yet there are still a large number of Georgians who are stuck in a coverage gap because we haven’t expanded Medicaid. While policymakers have an important responsibility to look at costs, it is also important to look at what we are getting as a state for our investments. The overwhelming evidence we are seeing from other states shows that expanding Medicaid is a sound investment: it improves access to care for the people who gain coverage, strengthens local health systems, and bolsters the economy. We hope that our state leaders will look comprehensively at this important issue and consider steps this Legislative Session to close the coverage gap here in Georgia.”

Introducing CHAT: Consumer Health Advocacy Today
Throughout the legislative session, GHF will be filming legislators and advocates at the Gold Dome to bring you a window into the Georgia legislative session. We kicked the video series off with interviews from some of our speakers from Health Care Unscrambled. Check them out below!

 

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Senator Greg Kirk on his health priority for the legislative session: keeping rural hospitals open.

 

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Representative Lee Hawkins’s thinks consumer health literacy is the most important issue for Georgia health care consumers.
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Representative Debbie Buckner on her health priorities this session. The top of her list? Medicaid expansion.
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Lynn Quincy from Consumer’s Union spoke at our second panel: What’s Next? Emerging Issues from Health Advocates. Her focus? Health value.

Looking for a full list of bills relating to consumer health care?  
GHF is monitoring legislative activity that could impact Georgia consumers. We are tracking bills as they move through the legislative process. Stay updated with our legislative tracker here.

The first five years

Dec18.2015forumIn December, the ACA Implementation Research Network released its Georgia state report at a policy forum held at the Community Foundation for Greater Atlanta. The report provides a detailed look at the key decisions made by Georgia policymakers around the implementation of the Affordable Care Act over the past five years. Georgians for a Healthy Future’s Executive Director Cindy Zeldin participated in a discussion with advocates, policymakers, and stakeholders to reflect on the report’s findings. The conversation ranged from health insurance enrollment best practices to health system reform to what it will take to close the coverage gap in Georgia. The ACA Implementation Research Network is jointly operated by the Nelson A. Rockefeller Institute of Government, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania. The Georgia state report was written by Michael Rich, Professor of Political Science and Environmental Sciences at Emory University.  Download the Report.


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Study committee work has finished, reports trickle in

Georgia legislative study committees meet during the off-session to take a deeper dive into specific policy issues and develop strategies for the legislature to address them. Each committee produces a report on its findings and recommendations that they want to move forward in the next legislative session. Click here for a complete listing of House and Senate study committees.  GHF has been following and participating in the study committees focused on health issues impacting consumers. Below is a run-down of committees that have published their reports, the issues they investigated, and report recommendations.

Senate Study Committee on the Consumer and Provider Protection Act (SR 561)

In light of changing practices and norms in the insurance market Senate Bill 158, the Consumer and Provider Protection Act, was introduced in 2015. This bill outlined provisions for consumer and provider protections regarding health insurance and created the Senate Study Committee on the Consumer and Provider Protection Act. The aim of this committee was to understand how the current insurance environment affects the stability of providers and consumers’ access to care. The committee members included legislators and representatives from the provider, insurer, and consumer communities, including GHF’s Executive Director Cindy Zeldin as the consumer representative.

Committee recommendations include the following:

  • Rental networksWhen insurers create networks for health plans, they contract with providers who agree to offer services at discounted rates. Rental networks are created when the same insurer “rents out” or sells access to network providers, at a different discounted rate, to other payers (e.g. insurers, third party payers, employers). Oftentimes this is done without provider’s consent, so a provider may unknowingly treat someone who is part of the rental network and have to accept a different payment amount. The committee agreed that transparency for both consumers and providers can be improved by including a more complete definition of “rental networks” in Georgia Code and further defining the Georgia Department of Insurance’s regulatory authority in this area.
  • Provider contracting- The committee agreed that more discussions need to take place in two areas surrounding how insurers contract with providers. First, insurers are allowed to change the terms of a contract with a provider, at any point, without the provider’s consent. Second, providers argue that some insurers include all-product clauses in contracts, which means a provider has to participate in all plans offered by the insurer or none.
  • Health provider network adequacy- As you may have read in the November Peach Pulse, the National Association of Insurance Commissioners (NAIC) has put together a model act to address network adequacy. The committee recommended convening a multi-stakeholder group to review the Model Act to determine whether Georgia should consider adopting some of the Model Act’s measures and if we need additional legislation and regulation in these areas to protect and provide an appropriate level of access to care for consumers in the future.

GHF has identified network adequacy and the need for more accurate and user-friendly provider directories as important, emerging consumer issues. We support the setting and enforcement of network adequacy standards for all health plans in Georgia. As the multi-stakeholder group looks into these issues further, GHF will continue to add the consumer voice to the dialogue to keep consumer priorities at the forefront of the minds of decision-makers.

Senate Study Committee on Youth Attention Deficit Hyperactivity Disorder and Mental Health Substance Use Disorders (SR 487)

The committee was charged with identifying prevention and screening approaches for youth substance use disorders (SUD) and examining issues around the diagnosis rate of youth attention deficit hyperactivity disorder (ADHD). The committee made recommendations in the following five areas:

  • Behavioral therapy- Behavioral therapy should be the first line of treatment for ADHD in young children and be required treatment for any child under six who has a diagnosis and receives medication.
  • School workforce- Georgia must increase efforts to reduce student-behavioral health personnel ratios in schools and maximize resources available to students.
  • Clubhouse Services Provided by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD)- The committee supports the clubhouse programs that provide a place for youth to go for substance use recovery support. The committee recommended increasing state funding for them, as well as creating additional clubhouse sites across the state.
  • SBIRT: Screening, Brief Intervention, and Referral to Treatment- While the Committee supports SBIRT programs and training in the state, currently Medicaid does not bill for services, so the Committee will continue to monitor states that have recently activated Medicaid codes for SBIRT.
  • School-Based Health Clinics- The Committee plans to monitor and share findings with Georgia’s CMOs and the House Study Committee on School-Based Health Centers (see below for committee summary), to potentially convene a joint study on the issue in 2016

GHF appreciates the Committee’s special focus on SBIRT and has been working over the past two years with the Georgia Council on Substance Abuse to raise awareness about the promise of taking a public health approach to substance use disorders that focuses on prevention through screening. GHF will continue to advocate for the activation of Medicaid codes to bill for SBIRT services because it is an effective approach to reducing youth substance use disorders and creating a bright future for our youth.

Senate Study Committee on Women’s Adequate Healthcare (SR 560)

The focus of the Senate Study Committee on Women’s Adequate Healthcare was on the current condition of women’s healthcare in Georgia, areas with existing deficits, and the growing number of women who are at risk of unhealthy outcomes. Here are some of the Committee’s recommendations:

  • The Georgia Maternal Mortality Review Committee and the Alzheimer’s Disease and Related Dementia (ADRD) State Registry are important initiatives that the Committee strongly supports.
  • Strategies for funding and development (e.g. loan forgiveness, tax credits, increasing GME residency slots, etc) for health care providers that serve women across the state should be increased.
  • The Committee will continue to monitor the status of the Rural Hospital Stabilization Pilot Program to inform future opportunities for patient-centered medical homes and increase the use of telemedicine.
  • Continue state funding to Elder Abuse Investigations and Prevention under DHS and the Cancer State Aid Program for FY 2016.

House Study Committee on School Based Health Centers (HR 640)

The intent of the committee was to provide recommendations on how to establish school-based health centers in communities to ensure students are healthy and achieve academic success. Committee members looked at the associations between health and education and ways in which school based health centers can be leveraged to increase access, provide affordable care, and produce cost savings. I am giving my children focus supplements and it has really helped a lot with their grades. Key committee recommendations include the following:

  • Steps to establish a SBHC should include three stages: planning, implementation, and sustainability.
  • Telemedicine is an important element, especially in rural areas and is most effective when integrated into a healthcare system that is capable of delivering comprehensive services. State-wide investments should be made to increase use of telemedicine for systems of care and expanding the scope of practice for on-site providers who can be authorized to deliver services.
  • Lake Forest Elementary School (Fulton County) and Albany Area Primary Health Care at Turner Elementary are models that have been successfully implemented.

The legislative session begins January 11th and many of these recommendations will be moving forward in the form of bills, policy changes within state agencies and through additional study committees. GHF will continue to follow these issues and keep you posted on progress and advocacy opportunities to get involved. Stay tuned!


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Dec 11, 2017
Uncertainty about federal tax overhaul clouds Georgia's budget process
James Salzer

Laura Colbert, the executive director of Georgians for a Healthy Future, said her organization is “very concerned” that Medicaid reductions could be in the offing after the tax bill gets…

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