Laura Colbert, executive director of Georgians for Healthy Future said there are good provisions in the bill, but there are other things the bill didn’t address. “HB 769 nibbles around…
Health care bills re-appropriated for new purposes
Each year, as the end of the legislative session comes into view, legislators work to ensure that priority legislation can be successfully passed before the Sine Die deadline. Sine Die is the day that legislative session ends and is scheduled for March 29th this year. This often results in major changes to legislative language or the combination of related bills. These changes are evident in several notable health care bills, which we have detailed here.
- This week, the Senate HHS committee heard HB 161, which effectively decriminalizes needle exchange programs in Georgia. The bill passed out of committee but with major additions. The additions are largely taken from SB 352 which, among other things, establishes a Commission on Substance Abuse & Recovery headed by a Director (for a more detailed review of SB 352, read our previous coverage here). The bill now awaits approval by the Senate Rules Committee in order to receive a vote on the Senate floor.
- The House HHS committee this week voted to pass SB 325 which, in its original form, would have allowed Georgia to enter into the Interstate Medical Licensure Compact. However, all of the bill’s original language was removed and substituted with new legislative language that, among other provisions, limits step therapy and sets up a process for physicians to request exceptions (previously HB 519). Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the treatment prescribed by a patient’s physician. SB 325 will now go to the House Rules committee to be approved for a vote by the full House.
Health Care Bills Favored By Legislative Leadership Passed
Rural health bill and Health Coordination & Innovation Council bill passed by respective chambers
Two bills named as priorities by legislative leaders passed their respective chambers this week. The rural health care bill, HB 769, passed the Senate and SB 357, legislation creating the new Health Coordination & Innovation Council, passed the House. Both bills included negotiated changes to better coordinate the two bills’ likely impacts. Because the bills passed with changes, they will each need to return to their chamber of origin for an “Agree” vote before they are eligible for the Governor’s signature.
Legislation Impacting Social Determinants of Health
Legislation concerning suspension of young students passed by Senate committee
HB 740, which requires schools to provide a multi-tiered system of supports for a student in pre-school through third grade prior to expelling or suspending the student for five or more days, was passed by the Senate Education & Youth Committee on Thursday. The legislation provides increased opportunities for schools to screen students for a variety of academic and behavioral health needs, and connect them to the appropriate health and other services. The bill will now need approval by the Senate Rules Committee to reach the floor for a vote by the full Senate.
Legislation to promote healthy housing fails; Resolution proposing study committee introduced
Housing, one of the most recognized social determinants of health, can influence a person’s physical and mental health, and access to economic opportunity and necessary social and health services. Earlier this session, Representative Scott Hilton introduced HB 954, which would have prohibited landlords from retaliating against tenants who complain about unhealthy or unsafe rental housing but the bill never received a hearing in the House Judiciary Committee. In order to lay the groundwork on this issue for future legislative sessions, Representative Sharon Cooper has sponsored HR 1431 establishing a study committee on healthy housing, which if passed would evaluate the scope of unhealthy housing problems in the state, its impact on Georgia families and the costs of unhealthy housing to the state and local communities, and would identify promising initiatives and policies in other states that address unhealthy housing.
Rural health care bill moves forward, does not include closing the coverage gap
The legislature began the final quarter of the 2018 session last week. Committees were especially busy as they began to consider the numerous bills that passed from the opposite chamber the previous week.
The Senate HHS committee this week considered HB 769, the result of the House Rural Development Council’s efforts to address barriers to health care in rural Georgia. The bill proposes a number of programs that incentivize health care providers to practice in rural areas, as well as establishes a Rural Health System Innovation Center within the State Office of Rural Health. It also increases the value of donations made to rural hospitals in an attempt to provide rural hospitals with additional funding. Senator Orrock correctly pointed out during the hearing that significant federal funding is available to help strengthen rural hospitals if state leaders would close Georgia’s coverage gap by providing health insurance to low-income Georgians. The Senate HHS committee passed HB 769 with no amendments to close the coverage gap, and the bill now proceeds to the Senate Rules committee.
Health Coordination & Innovation Council Bill Approved
Changes made to SB 357 to earn committee approval
On Tuesday, the House Health & Human Services Committee heard SB 357, which would establish a Health Coordination and Innovation Council to coordinate health care planning across state agencies and within the health care system. SB 357 will no longer include the creation of a Health System Innovation Center to support the work of the Council because it was seen as duplicative to HB 769’s Rural Health System Innovation Center. Changes were also made to enumerate who can be appointed to the Council; no consumer representation was included in the changes. The House HHS committee approved SB 357 on Friday, so the bill will move forward for consideration by the House Rules committee in order to receive a floor vote by the full House.
Correction: FY2019 Budget Passed By House This Week
House passes its version of the FY2019 budget
Last week’s legislative update incorrectly stated that the FY2019 state budget, which begins on July 1, 2018 and runs through June 30, 2019, had been passed by the House prior to Crossover Day. The House was still working on its version of the state budget through late last week and passed it on Friday, March 9th. The budget includes several new investments in children’s mental health and mostly maintains funding for other health care programs and priorities. For more information on the health care highlights in the proposed FY2019 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.
Legislation Increases Screening Opportunities for Young Students
Bill would require schools to take certain steps before suspending students in preschool through 3rd grade
Education, in combination with the other social determinants of health, plays a major role in a person’s health and well-being. HB 740, sponsored by Representative Randy Nix, requires school systems to provide a multi-tiered system of supports for a student in pre-school through third grade prior to expelling or suspending the student for five or more days (unless the student possessed a weapon, drugs, or other dangerous instrument or the child’s behavior endangers the safety of others). While the legislation does not prescribe what types of supports must be provided, it is likely that schools will use the opportunity to screen students for a variety of academic and behavioral health needs, and connect them to the appropriate health services. Children with behavioral health conditions drop out of school at much higher rates than those without, so this opportunity to identify behavioral health and other health-related barriers to learning is a critical prevention strategy. HB 740 is expecting to be heard in the Senate Education & Youth Committee today.
A flurry of activity for Crossover Day
Last Wednesday was Crossover Day at the Capitol, meaning a bill must cross from its chamber of origin to the opposite chamber to remain viable for this legislative session. This week’s legislative update provides a rundown of consumer health legislation: which bills made it through and which did not. You can see a list of all the bills we’re tracking here, along with more information about the bills included here
Surprise billing & transparency legislation keeps moving
SB 359, the most comprehensive surprise billing legislation to be considered by the Georgia General Assembly this session, received approval by the full Senate on Wednesday and will be considered by the House Insurance Committee in the coming weeks. As previously reported, HB 678, a bill that increases provider network and billing transparency, passed the House several weeks ago. It has since been referred to the Senate Health & Human Services Committee. HB 799, which addressed out of network care in emergency situations, did not receive a vote by the House but much of the bill’s language is included in SB 359.
Legislation to close Georgia’s coverage gap did not receive legislative attention
HB 669, sponsored by House MInority Leader Bob Trammell, did not receive a committee hearing or a vote by the Crossover Day deadline. The legislation would expand Georgia’s Medicaid program to cover adults making less than $16,000 annually and parents making less than $21,000 for a family of three, as 32 other states have now done. The bill was assigned to the House Appropriations Committee and remains the most significant step the state could take towards addressing the opioid crisis, strengthening rural hospitals, and increasing access to care for thousands of hard-working Georgians.
Crossover Day Recap
HB 683: Amended FY2018 Budget | CROSSED OVER
HB 683 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2018. The “little budget”, as it is known, has passed both chambers of the General Assembly but has not yet received “agrees” by both chambers, the final step before sending the budget to the Governor for his signature.
HB 684: FY 2019 Budget | REMAINS IN HOUSE
HB 684 is the budget document for the coming state fiscal year which will run from July 1, 2018 to June 30, 2019. The budget includes several new investments in children’s mental health and mostly maintains funding for other health care programs and priorities. For more information on the health care highlights in the proposed FY2019 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.
HB 769: Recommendations from the House Rural Development Council | CROSSED OVER
HB 769 is the result of the 2017 House Rural Development Council’s work. The bill includes a number of provisions, most prominently of which is the creation of a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The bill also increases the rural hospital tax credit to 100%, directs the Department of Community Health to streamline and create efficiencies within the state medical plan, allows for the establishment of micro-hospitals, sets up an incentive program for physicians practicing in rural areas, and redefines “rural county”.
HB 827: Rural hospitals tax credit increase | CROSSED OVER
HB 827, introduced by Rep. Trey Kelley, would expand the rural hospital tax credit program from a 90% credit to a 100% credit. The tax credit program went into effect last year and has resulted in the donation of about $10 million to rural hospitals thus far.
HB 872: Provider network transparency | DID NOT CROSS OVER
HB 872, sponsored by Rep. Knight, requires insurers to make a plain language description of their provider network standards publicly available on their website among other provisions. The bill also stipulates that if an insurer advertises a physician as being in a plan’s provider network when a consumer enrolls in an insurance plan, the insurer is required to cover the health care services received from that provider at an in-network rate during the entire contract year.
HB 873: Prescription drug formulary and prior authorization transparency | DID NOT CROSS OVER
This bill requires that insurers provide an easy-to-find, accurate, and updated drug formulary list on their website and requires the Insurance Commissioner to create rules about the format and information within the formulary so that consumers can more easily understand what prescriptions are covered under their insurance plan and the costs associated. The legislation also requires that a single, standard prior authorization form be developed that would apply to all insurers and pharmacy benefit managers regulated in Georgia.
HB 877: “Modified risk” tobacco | DID NOT CROSS OVER
HB 877 would have cut Georgia’s tobacco tax in half for so-called “modified risk” tobacco products. The bill lost decisively on the House floor by a vote of 109-59. Thank you to those of you who contacted your state representatives last week ahead of the House’s vote!
SB 325: Interstate Medical Licensure Compact Act | CROSSED OVER
SB 325 would allow Georgia to enter the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It also grants states easier access to investigative and disciplinary information about providers.
SB 351: Changes for APRNs | CROSSED OVER
SB 351 would expand from four to eight the number of advanced practice registered nurses a physician is allowed to supervise and would allow APRNs to order radiographic imaging for patients if their supervising physician delegated the authority. The legislation is significantly diminished from the original proposal which would have granted APRNs a greater scope of practice.
SB 352: Legislation to establish Commission on Substance Abuse & Recovery | CROSSED OVER
SB 352 establishes a Commission on Substance Abuse & Recovery, headed by a director, which would be charged with coordinating data among relevant government entities; informing strategies to combat the opioid crisis within the Departments of Public Health and Education, the Attorney General’s Office, and other state entities; consulting with the Governor’s office on a potential Medicaid waiver related to opioid abuse; and developing and informing other efforts to expand access to prevention, treatment, and recovery support services across the state.
SB 357: Legislation to establish Health Coordination and Innovation Council | CROSSED OVER
SB 357 establishes the Health Coordination and Innovation Council, the Health System Innovation Center, and an advisory board to the Council. The Council would act as a permanent statewide coordinating platform, bringing together all of health care’s major stakeholders, and the Center is proposed as a research body that would collect and analyze data to support the work of the Council.
SB 418: FDA and USDA Preemption bill | DID NOT CROSS OVER
SB 418, sponsored by Rep. John Wilkinson, would preempt local governments from regulating any product currently under the jurisdiction of the FDA, USDA, or the Georgia Department of Agriculture, including tobacco and marijuana. The bill failed in the Senate by a 34-19 vote, but is expected to come back in an amended form.
GHF is excited to welcome Michelle Conde as the organization’s new Communications & Special Projects Manager. In this role, Michelle will manage GHF’S external communication channels (email, social media, earned media) and leverage social media for digital advocacy. She will also provide policy research support as needed and contribute to the organization’s policy analysis efforts.
Michelle is a recent graduate of Georgia State’s Andrew Young School of Public Policy, where she received her Master’s in Public Policy with a focus on nonprofit policy. She is a creative and highly motivated leader with familiarity in working with diverse communities and quickly finding resourceful solutions. Before joining GHF she served as a policy fellow at Voices for Georgia’s Children and as a volunteer at Hemophilia of Georgia for over a decade. She is also a founding member of Hemophilia of Georgia’s Advocacy Board where she participates in efforts to advocate and educate the public and legislators.
We are pleased that Michelle has joined our team! You can contact Michelle at firstname.lastname@example.org or 404-567-5016 x 3
Last week saw a flurry of activity under the Gold Dome as legislators worked to move bills forward before a key deadline this week. Crossover Day, the 28th day of the Georgia legislative session, is the day by which a bill must be passed from its originating chamber to the opposite chamber to remain viable. The deadline prompted legislative committees to take action on many bills last week so that they could be considered on the House and Senate floors ahead of this week’s cut-off. Two bills in particular caught our attention and warrant yours as well.
Bill would cut tobacco tax on “modified risk” tobacco products
Last week, the House Ways & Means committee approved HB 877, which would cut in half the tobacco tax on so-called “modified risk” tobacco products. Tobacco companies have been developing new products that they claim reduce the risk and harm of smoking and are working to gain the FDA’s approval later this year. Health advocates know that HB 877 is a bad bill because: 1) there is no data to quantify the claim of reduced risk; 2) the labeling of a product as “modified risk” may contribute to a false sense of safety and actually encourage tobacco use, particularly among minors: and 3) Georgia already has the second lowest tobacco tax in the country. HB 877 is now in the House Rules committee awaiting a vote by the full House.
Call your state representative!
Contact your state representative and ask them to vote “No” on HB 877! Tell them that Georgia should not lower the tax on any tobacco products and, instead, should consider implementing a new tax on e-cigarettes and other nicotine-delivery devices that are currently untaxed.
Comprehensive surprise billing legislation approved by Senate committee
SB 359, sponsored by Senator Chuck Hufstetler, was approved by the Senate Health & Human Services Committee last week. This legislation addresses surprise out-of-medical billing through improved disclosure, clarification of responsibilities in out-of-network emergency situations, and the opportunity for mediation when a consumer receives a surprise bill. (For more details on the legislation, see our February 5th legislative update.) The bill is expected to be on the Senate floor for a vote on Crossover Day, Wednesday, February 28th.
Contact your state senator!
Contact your state senator and ask them to vote “Yes” on SB 359! Tell them that too many Georgia consumers are receiving surprise out-of-network medical bills and that this legislation provides them with important, necessary protections.
What Happened Last Week
Expansion of rural hospital tax credit approved by House
HB 827 expands Georgia’s existing tax credit for donations to rural hospitals from 90% to 100%, making the program a dollar-for dollar match. Last year, this program brought about $10 million to rural hospitals across the state. While an expansion of this tax credit may provide some limited relief to rural hospitals, they would see much greater gains if Georgia’s legislature closed the state’s coverage gap by insuring all low-income Georgians, a point made on the House floor during the debate of this bill. The House passed HB 827 and it has been referred to the Senate Finance Committee for further consideration.
No hearing yet for legislation that would close Georgia’s coverage gap
With the legislative session more than halfway over, HB 669, which would expand Georgia’s Medicaid program to cover adults making less than $16,000 annually and parents making less than $21,000 for a family of three, has yet to earn a hearing. The bill sits in the House Appropriations Committee, but has not yet been brought up for consideration. HB 669 is the most significant step our state legislature could take towards addressing the opioid crisis, strengthening rural hospitals, and increasing access to care for thousands of hard-working Georgians. Ask your state legislator to request a hearing for this critical piece of legislation.
Bills impacting health care providers pass Senate HHS committee
The Senate HHS committee approved two bills this week that impact health care providers in Georgia. SB 325 aims to improve access to care by entering Georgia into the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It also grants states easier access to investigative and disciplinary information about providers. SB 351 would expand from four to eight the number of advanced practice registered nurses a physician is allowed to supervise and would allow APRNs to order radiographic imaging for patients if their supervising physician delegated the authority. The legislation is significantly diminished from the original proposal which would have granted APRNs a greater scope of practice. Both SB 325 and SB 351 await approval by the Senate Rules Committee to be scheduled for a vote by the full chamber.
On February 15th, the Cover Georgia coalition, including Georgians for a Healthy Future, hosted Cover Georgia Day at the Capitol in order to ask state law makers to close Georgia’s coverage gap by extending health insurance to low-income Georgians.
The event began at Atlanta City Hall where GHF welcomed participants including advocates, nurses, medical students and community members. During the morning welcome Representatives Sam Park and Kim Schofield spoke to participants encouraging them to continue working to close Georgia’s coverage gap and Rep. Park shared a personal account of how Medicaid helped to save his mother’s life. Following that, GHF provided a short briefing about the need to close Georgia’s coverage gap and how to be an effective advocate.
At the end of the morning session, participants joined more than 100 advocates from the American Cancer Society at the Georgia Capitol where participants lobbied “on the ropes”. When speaking with their legislators, advocates emphasized the urgency of the issue and the need for every person in Georgia to have health care coverage. They also provided state lawmakers with a new tool called An Insurance Card for Every Georgian.
After talking with their legislators, advocates attended a large press conference in the South Rotunda featuring Neil Campbell of Georgia Council on Substance Abuse; Dr. Mitzi Rubin, a family physician and leader at the Georgia Association of Family Physicians; and Andy Freeman of the American Cancer Society. Ms. Campbell pointed out that providing more Georgians with health insurance is the most significant step our state could take towards addressing the opioid crisis. Dr. Rubin described how a lack of access to health insurance impacts her patients and their health. Mr. Freeman discussed the dual benefits of increasing Georgia’s tobacco tax: 1) reduced numbers of people smoking; 2) the increase in revenue from a tobacco tax would provide more than enough funding to pay for health insurance for low-income Georgians.
Cover Georgia Day was incredibly successful due to the partnership of Cover Georgia coalition partners, health care providers, and grassroots advocates, all of whom are committed to closing Georgia’s coverage gap. Thanks to all who participated.
If you missed Cover Georgia Day at the Capitol, it’s not too late to contact your state legislators to ask them to put a health insurance card in the wallet of every Georgian. Take action today!
Legislative session is more than half-way complete
The state legislative session is more than half-way over already and the General Assembly has been working diligently to complete its constitutional responsibility to pass a state budget. Thus far the House and Senate have passed their versions of the amended FY2018 budget and are working to come to consensus on a final version. The House is still considering the FY2019 budget. Other bills prioritized by legislative leaders have made their way through the legislative process and await the Governor’s signature.
Action under the Gold Dome
GHF supports legislation that provides important consumer protections within private insurance
The first half of the legislative session has been punctuated by the introduction of many bills that would impact health care and coverage for Georgia consumers. Several of these bills stand out as they align with GHF’s policy priority of facilitating greater access to care and ensuring financial protections for consumers purchasing private insurance. For these reasons, GHF is actively supporting the following bills:
- SB 359–legislation to address surprise out-of-medical billing through improved disclosure, clarification of responsibilities in out-of-network emergency situations, and the opportunity for mediation when a consumer receives a surprise bill. (For more, see our February 5th legislative update.)
- HB 872–would allow consumers to receive services from their preferred provider at an in-network rate for the entire coverage year, if the insurer advertises the provider as being in-network at the time a consumer enrolls in a health insurance plan
- HB 873–would simplify the prior authorization process for providers and patients seeking access to restricted or expensive health services or medications and would clarify and improve the information that insurers must provide to consumers about their prescription drug coverage (Re-visit last week’s legislative update for more information about HB 872 and 873.)
Rural health care bill moves forward
One of the legislature’s biggest efforts in 2017 was the work of the House Rural Development Council which, among other things, studied barriers to health care and possible solutions in Georgia’s rural communities. The result of their studies is HB 769 which creates a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The Center would be responsible for collecting data from the health-focused state agencies and analyzing it for planning purposes, similar to the Health System Innovation Center proposed within SB 357. The bill would also make some changes to the state’s certificate of need program to make allowances for “micro-hospitals”, provides for an insurance premium assistance program for rural physicians, and increases the rural hospital tax credit to 100% of the donation.
The House Health and Human Services Committee approved HB 769 last week and it must be advanced by the House Rules Committee for consideration by the full chamber.
Surprise billing legislation gets more attention
All three bills introduced to address surprise out of network medical billing will receive the attention of the General Assembly this session. HB 678 was passed by the House last Monday and has been referred to the Senate Health & Human Services (HHS) Committee for its consideration. That committee plans to take up another piece of surprise billing legislation–SB 359, which provides the most comprehensive protections to consumers of the three bills–in its hearing today. HB 799, a bill that primarily addresses out of network care in emergency situations, is similarly scheduled for a hearing today by the House Insurance Committee.
Stay up-to-date with the legislative session
As the activity in the General Assembly picks up speed in the second half of this year’s session, it can be hard to keep up. We have the tools you need to stay in touch with health policy under the Gold Dome.
Pair of consumer protection bills introduced in House
Two bills that propose stronger protections for consumers in health insurance were introduced last week by a group of House lawmakers led by Representative David Knight. We are encouraged by the introduction of both bills which aim to provide consumers with increased transparency and enhanced financial protections, along with heightened accountability on the part of health insurers and pharmacy benefit managers. We will monitor and weigh in on the bills as they progress through the legislative process.
HB 872: Provider network transparency
HB 872 requires insurance companies to be more transparent about the structure of and changes within their provider networks, beginning with a provision that requires insurers to make publicly available a plain language description of their provider network standards on their website among other provisions. Importantly, the bill also stipulates that if an insurer advertises a physician as being in a plan’s provider network as a consumer enrolls in an insurance plan, the insurer is required to cover the health care services received from that provider at an in-network rate during the entire contract year. That means that a consumer may select a plan during open enrollment that includes their preferred provider and would be able to receive services at an in-network rate for the entire plan year regardless of changes to the provider’s participation status.
HB 873: Prescription drug formulary & prior authorization transparency
HB 873, titled the Prescription Drug Benefits Freedom of Information and Consumer Protection Act, proposes to improve the consistency and clarity of prescription drug formularies and prior authorization processes. The bill requires that insurers provide an easy-to-find, accurate, and updated formulary list on their website and requires the Insurance Commissioner to create rules about the format and information within the formulary so that consumers can more easily understand what prescriptions are covered under their insurance plan, the cost-sharing associated with the drug, and any prior authorization required to gain access to the prescription. The legislation also requires that a single, standard prior authorization form be developed that would apply to all insurers and pharmacy benefit managers regulated in Georgia to allow consumers and providers to more easily request access to higher cost and more restricted health services and prescriptions. The standard form would be developed by an advisory committee made up of an equal number of consumers, physicians, pharmacists, insurers, insurance agents, and pharmacy benefit managers.
Both chambers busy with health care legislation
House Insurance Committee approves HB 678
The House Insurance Committee, chaired by Representative Richard Smith, considered and approved HB 678 last week. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and insurers about the consumer’s provider network. HB 678 is expected to receive a vote by the full House today. (For a more detailed summary of HB 678, check out last week’s legislative update.)
Senate approves SB 352 and SB 357
Two pieces of legislation resulting from the Health Care Reform Task Force were approved by the Senate this week. Both SB 352, which establishes the Commission on Substance Abuse and Recovery and creates a director position to lead the commission, and SB 357, which establishes the Health Coordination and Innovation Council among other actions, received strong support from legislators. The bills will now move to the House for its consideration. (For more information on both bills, read the January 29th legislative update.)
Surprise medical billing emerges as prominent issue at the Capitol
Surprise out-of-network medical billing is emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Three pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way. In this week’s legislative update, we will provide a broad look at each bill and its provisions. (If you would like more information about any of the bills, click on the provided links to read the full legislation.) All three bills seek to protect patients, and we will monitor and weigh in on the bills as they undergo the inevitable amendment process in committee. We appreciate all of the bill sponsors for remaining vigilant towards protecting patients from unexpected medical bills.
HB 678: Increased network and billing transparency by health care providers and insurers
HB 678 is sponsored by Rep. Richard Smith, chairman of the House Insurance Committee, and has the backing of several powerful House lawmakers. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and practices and by insurers. Providers must inform consumers about their participation in the patient’s insurance network and about how to check the network status of other providers with which the primary provider has coordinated services (e.g. laboratory or radiology services). It also requires insurers to provide consumers with information about when and how to receive approval for services from an out of network provider. Insurers must also communicate to a consumer ahead of a planned procedure if the provider is out of network (OON), and if so, the estimated amount the insurer will cover for the OON services. Lastly, HB 678 provides consumers with 90 days from the time of receiving a medical bill to pay the bill, negotiate payment or initiate arbitration through the Georgia Department of Insurance. After that time period, providers would be allowed to initiate collection proceedings to secure their payment.
HB 799: Out of network care in emergency situations
While HB 678 applies only to non-emergency situations, HB 799 applies solely to emergency care and medically necessary follow-up care. The legislation, sponsored by Rep. Sharon Cooper, Chairperson of the House Health & Human Services Committee, disallows managed care plans from denying payment for emergency services and disallows hospitals from billing patients for medically necessary care following an emergency situation except for their standard co-pays, co-insurance, and deductibles. For a patient receiving emergency care at an OON hospital and who is covered by a plan that requires prior authorization for post-stabilization care, the legislation outlines how the OON hospital and insurer must coordinate the patient’s transfer to an in-network facility and defines which entities are responsible for specific costs. Under this bill, if a patient (or their representative) does not consent to be transferred to an in-network hospital, the OON hospital must provide verbal notice to the patient that they may be financially responsible for any further post-stabilization care provided.
SB 359: Consumer Coverage & Out of Network Medical Care Act
SB 359 is the only Senate-side legislation introduced thus far to address surprise out-of-network billing and is sponsored by Senator Chuck Hufstetler, Chairman of the Senate Finance and member of HHS committees. The legislation contains many of the same transparency provisions for non-emergency care as HB 678 with regard to information that health care providers and hospitals must supply to consumers, but provides for more robust disclosure by insurers to consumers about possible OON costs. It also contains provisions similar to that of HB 799 with respect to emergency situations, but goes farther to stipulate that insurers must treat OON emergency care as if it were in-network by applying a consumer’s cost-sharing towards their in-network deductible and out-of-pocket maximum. The legislation also makes mediation available to consumers who receive elective medical care during which an unexpected event arises resulting in surprise bill greater than $1000. SB 359 is expected to be more controversial than the other two bills because it sets a payment resolution process that sank previous legislative attempts.
RSVP today for Cover Georgia Day at the Capitol!
Join us next Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!
Can’t make it? Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.
Legislation prioritized by Senate leaders approved by HHS Committee
At Thursday’s Senate Health & Human Services Committee, the two pieces of legislation resulting from the Health Care Reform Task Force were considered. Both SB 357 and SB 352 received strong support from legislators and stakeholders. GHF’s partners at the Georgia Council on Substance Abuse and Mental Health America of Georgia rose in support of SB 352, which would create a 15-member Commission on Substance Abuse & Recovery supported by a director. Both bills were passed by unanimous voice votes. You can find a description of both bills in last week’s legislative update blog.
Nilofer Chollampat is GHF’s Legislative Advocacy Intern for the spring 2018 semester. In this role, Nilofer will help to monitor the activity of legislative committees, the status of relevant bills, and other legislative activity. Nilofer will also support the Cover Georgia coalition in their advocacy to expand Medicaid in Georgia as well as other legislative and advocacy-related projects.
Nilofer isin her second year at Emory University’s Rollins School of Public Health and holds a bachelor’s degree in Psychobiology and Statistics from UC Davis. She’ll be graduating in May with a degree in Health Policy and Management. Nilofer came to GHF after working on academic research, the Georgia Department of Public Health, and a practicum with a non-profit research organization. Other than her love of health policy work, Nilofer likes to watch all the TV shows.