That’s a problem, said Laura Colbert, the director of the patient advocacy group Georgians for a Healthy Future. “Middle-income consumers with pre-existing conditions who want to remain in the marketplace…
Blog (March 2016)
Since our founding in 2008, Georgians for a Healthy Future has worked tirelessly to provide a strong voice for health care consumers in the policy sphere. One of the most important ways we advocate on behalf of consumers is by engaging with state policymakers to bring important health care challenges and barriers to light and work collaboratively to address them. While this is a year-round endeavor, the 40-day Legislative Session is when the rubber really meets the road.
This year, improving provider directories was our top legislative priority. Over the past three years, we have heard time and again that these directories, intended to inform patients and consumers about which doctors are in their plan, were error-ridden. A secret shopper survey we conducted earlier this year confirmed this: one in five health care providers listed in the directories we reviewed weren’t even in the network, and three-quarters of directory listings contained at least one error. This was unacceptable. Consumers need and deserve an accurate and functional tool that can help them make the best health care choices for themselves and their families.
Throughout the Legislative Session, we have asked you to contact your legislators in support of SB 302, legislation to improve the accuracy and usability of provider directories. Last night at 11:23pm, SB 302 cleared its final hurdle by receiving a favorable Senate “agree” vote to the modest changes made to the bill in the House of Representatives! This means the legislation has successfully passed the General Assembly and now heads to the Governor for his signature.
I also hope that you will continue to engage with Georgians for a Healthy Future. We deeply value your support, whether it be as avolunteer, community partner, or donor. And while we’ll be taking a breather this weekend to celebrate this legislative victory, we also remain vigilant. There are still too many Georgians who can’t access the care they need, and our work to get Georgians covered, ensure access to care, enhance value for consumers, and build a healthier Georgia continues.
Provider directories, or the listing of health care providers that are participating in a particular health plan, are intended to inform patients and consumers about which doctors are in their plan and how they can contact them to set up an appointment. For these directories to serve as the tool that consumers need, they must be accurate and up-to-date. A secret shopper survey conducted by the statewide consumer health advocacy organization Georgians for a Healthy Future, however, found these directories to be error-ridden, a problem that places consumers at risk when they seek to access an appropriate in-network health care provider. An analysis of four provider directories associated with plans offered by three of the state’s largest insurers found:
» Three-quarters of the listings had at least one inaccuracy (not in-network, not accepting new patients, not practicing at the location listed, inaccurate or inoperable phone number, or languages spoken inaccurately listed)
» One in five health care providers listed as participating in a plan’s network were not; in one directory forty percent of the providers listed were not actually participating in the plan » Among the providers who were confirmed to be in-network, thirteen percent were not accepting new patients; in one directory one in four confirmed in-network providers were not accepting new patients
» Fifteen percent of telephone numbers associated with providers listed in the directories were inaccurate or inoperable
These inaccuracies and usability limitations make it difficult for health care consumers, particularly those who haven’t had insurance before, to find and access an appropriate medical care provider. Setting basic standards for provider directories and protections for the consumers who rely upon them would go a long way towards making provider directories the tool that patients and consumers need when they shop for and use their health insurance.
Download the full set of findings here.
Today is day 36 of the 2016 legislative session and with only four legislative days left, there is still so much to do. This morning, SB 302 was passed unanimously on the House floor, but other bills are yet to be decided. You can see a full list here. For updates as we draw closer to the end of this session,sign up for the Georgia Health Action Network (GHAN).
WHAT HAPPENED THIS WEEK
On March 9, SB 302 passed in the House Insurance Committee and this morning was passed unanimously on the House floor.The bill now goes to the governor to sign. We are so grateful to all of you that have followed this bill’s progress with us and called your legislators in support of this important piece of consumer legislation!
Medicaid Payment Parity
The Senate has yet to vote on the FY17 budget which contains $26.5 million to bring the state closer to Medicaid payment parity. Full parity would allow doctors to be reimbursed at the same rates for seeing Medicaid patients as Medicare patients.
The final Senate HHS Committee meeting is today. The calendar includes: SR 974, the Senate Surprise Billing Practices Study Committee, SR 1056, the Premium Assistance Program Study Committee, and SB 919, which would provide tax credits for contributions to rural hospitals. Join GHAN for an eblast with updates from that committee meeting!
This week’s featured CHAT (Consumer Health Advocacy Today) is a brief interview with Senator PK Martin, sponsor of SB 302.
We want to hear from you – new SEP rules
At the beginning of last year’s open enrollment period, GHF created GEAR, the Georgia Enrollment Assister Resource Network (GEAR). GEAR is a coalition of enrollment assisters and those closely involved in the enrollment process. Now the open enrollment is passed, GEAR is turning to tax time and special enrollment periods (SEPs). Last month, CMS announced the new special enrollment confirmation process. Georgians will now be required to provide sufficient proof to the marketplace to determine their SEP eligibility. Failure to provide supporting documents may lead to the denial of coverage. At GHF we advocate for policies that make enrollment in health insurance more inclusive and fight policies that put up unnecessary barriers. We want to hear from you about this! If you’re an enrollment assister and are experiencing trouble enrolling consumers during a special enrollment period, let us know! If you’d like to join the GEAR network, you can do that here.
Crossover day is behind us and we are quickly approaching Sine Die, the final day of the legislative session. We are proud to say that one of GHF’s biggest legislative priorities – ensuring accurate provider directories for health care consumers – passed the full Senate unanimously last week! Thank you to those of you who contacted your legislators to voice your support! This week’s legislative update includes an a run down of which health care bills made it through Crossover Day and which did not. You can see a list of all the bills were’re tracking here along with supplemental information on most bills like relevant news, articles ad committee testimony delivered by GHF.
WHAT HAPPENED THIS WEEK
The Provider Directory Improvement Act
Last week SB 302 went for a vote in the Senate chamber and passed unanimously, 50 – 0! The bill is now in the House Insurance Committee where we expect it to receive a hearing soon. Join the Georgia Health Action Network(GHAN) to get important alerts about committee hearings, votes, and steps you can take to make sure your voice is heard at the Gold Dome!
Surprise Out-of-Network Billing
SB 382, the Surprise Billing and Consumer Protection Act had two hearings last week. While there is strong support for the legislation among consumer advocates and many health care stakeholders, hit did not pass through the Senate Health and Human Services Committee prior to Crossover Day. SR 974 is still a possible path to bring Senate-side policymakers together with stakeholders and advocates in the off-session to further study this complex issue.
Medicaid Payment Parity
The governor’s budget, introduced earlier this legislative session, maintained last year’s partial Medicaid payment parity. Full Medicaid parity would allow doctors to be reimbursed at the same rates for seeing Medicaid patients as Medicare patients. The FY 2017 budget, as passed by the House, adds $26.5 million for for Medicaid payment parity. The bill is now in the Senate for consideration.
Closing Georgia’s Coverage Gap
If you’ve been following our updates, you know that this session has seen growing interest in addressing the issue of Georgia’s uninsured rate and our struggling rural health infrastructure. Neither Sen. Rhett’s SB 368 nor Rep. Abram’s HB 823 crossed over. However, Sen. Rhett’s SR 1056, which proposes a study committee to look at approaches to covering the uninsured, is still viable as a Senate-side study committee (but would still need to pass through the Senate HHS Committee and the full Senate) and stakeholders continue to express interest in continuing the conversation passed the legislative session.
CROSSOVER DAY UPDATE
- HB 919: Tax credits for contributions to rural health care organizations – CROSSED OVER
HB 919 passed out of the House on February 25 and is now in the Senate Health and Human Services Committee. The total cap for the tax credits was reduced from $250 million to $100 million. GHF encourages policymakers to look at this legislation in conjunction with other bills around closing the coverage gap and addressing rural health so that we can tackle our rural health challenges comprehensively, including developing a pathway for rural, uninsured Georgians to gain coverage so they can better access health care services and finding a solution that can drawn down federal dollars available to the state through the Medicaid program.
- HB 838: Health insurers to pay brokers a minimum of 4% of premiums collected – CROSSED OVER
This bill passed out of the House on February 24th and is now in the Senate Insurance and Labor Committee.
- HB 1055: Repeal Certificate of Need program – DID NOT CROSS OVER
CON regulates the construction of health care facilities and the services they provide. This bill would have eliminate that structure and set up a different one based on permits. Read more on this bill from Georgia Health News.
- HB 684: To allow dental hygienists to provide certain services without direct supervision – DID NOT CROSS OVER
According to recent reports made on https://www.life-smiles.net/, this bill would have allowed dental hygienists to clean teeth in safety-net health centers with the permission of a dentist. Read more about the bill here.
- HB 965: “The Honorable Jimmy Carter Cancer Treatment Access Act” – CROSSED OVER
HB 965 would require that insurance companies cover stage four cancer treatment recommended by a physician regardless of cancer’s response to other treatments. The bill passed the House on February 22nd and is now in the Senate Insurance and Labor Committee.
- SB 158: “Insurer Transparency Act” – CROSSED OVER
This bill defines and regulates rental networks through the Department of Insurance. SB 158 passed the Senate on February 16th and is now in the House Insurance Committee. Read: great guide to tenant screening
- HB 768: The ABLE Act – CROSSED OVER
The ABLE Act would establish a tax exempt account to pay for qualified expenses for people with significant disabilities that started before the age of 26. HB 768 passed the House on February 23rd and is now in the Senate Finance Committee.
- SB 299: “Georgia Health Care Transparency Initiative” – DID NOT CROSS OVER
SB 299 proposed to create the Georgia Health Care Transparency Initiative and an all-payer claims database.
- SB 291: “Georgia Affordable Free Market Health Care Act” – DID NOT CROSS OVER
SB 291 proposed to allow direct contracts between physicians and patients for primary care services.
- HB 834: Establish charity care organizations for healthcare for the uninsured – DID NOT CROSS OVER
This bill proposed tax credits for donations to charity care organizations.
- HB 694: Disclosure of Health Care Fees Act – DID NOT CROSS OVER
HB 694 would proposed to require providers to disclose all fees prior to non-emergency services.
- SB 265: Physician Direct Pay Act – DID NOT CROSS OVER
SB 265 proposed to allow direct contracts between physicians and patients for primary care services.
As SB 302 moves over to the House for consideration, we talked to Sen. Elena Parent about why she supports the Provider Directory Improvement Act.