Recently enroll in health insurance for the first time and ready to see a doctor? When you do so, it is important to select health care providers that are in your insurance plan’s network of providers. You get the best deal when you use in-network providers, and your insurance plan may not pay at all for care from an out-of-network provider. To find the names of providers in your area who are in your insurance plan’s network you can:

• Contact your insurance company by phone. The number is on the back of your card.
• Look on your health insurance company’s website.
• Call your provider’s office and ask them: 1. Do you take my insurance? 2. Are you in my plan’s network?

If you are having trouble finding accurate information about provider networks or are having trouble getting an appointment with an in-network provider, please let Whitney Griggs, our Consumer Education Specialist, know (Whitney can be reached at wgriggs@healthyfuturega.org or 404-567-5016). Whitney can walk you through the process and help you understand your rights and protections as a consumer.

Yesterday marked the 27th day of the 2015 Legislative Session. Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015, is set for next Friday, March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.

 

It has been a big week for health care issues at the State Capitol. GHF brought the consumer perspective to Senate Insurance on Wednesday and shared with the committee through testimony from our Executive Director the challenges that consumers face in obtaining accurate information about provider networks at the time they sign up for health insurance and why setting network adequacy standards is important for consumers. Her testimony was provided as part of the discussion around SB 158. Also this week, legislation was introduced in the Senate that would establish a study committee onpreventing youth substance use disorders, the Senate began its work on the FY 2016 budget, and a range of other health care bills were discussed.

 

The State Budget:  The FY 2016 Budget passed the House of Representatives and is now in the Senate. The Senate expects to finish their revisions to the budget this week and send it back to the House and then to a conference committee.

 

Medicaid Parity:  Last week, the House of Representatives added $2.96 million in the budget to increase reimbursement for certain OB/GYN services and $1.5 million for reimbursement rate increases for certain primary care services. Because Medicaid parity has been shown to be an effective strategy for improving access to care, GHF supports raising Medicaid reimbursement rates to parity with Medicare rates. We are advocating for a higher appropriation amount for Medicaid reimbursement rate increases as the budget moves through the process.

 

SBIRT Resolution:  Senate HHS Chairwoman Renee Unterman officially introduced a resolution (SR 407) to form a joint House and Senate Study Committee on preventing youth substance use disorders. Through GHF’s work with the Georgia Council on Substance Abuse, we are advocating for a public health approach to substance use disorders that focuses on prevention. This resolution gets the conversation started about how to do that in Georgia. Please take the time to thank Senator Unterman for her support of this effort and to let your elected officials know you support SR 407.

 

SB 158 (Sen. Burke) provides certain consumer and provider protections regarding health insurance, including network adequacy language. SB 158 has been referred to the Senate Insurance Committee where it received a hearing on Wednesday, March 3.  GHF Executive Director Cindy Zeldin testified in committee, focusing specifically on the network adequacy component of the bill. GHF also met with committee members individually about the bill after the committee hearing.  While the bill is not expected to move in its current form this legislative session, there will likely be a study committee on the network adequacy component. GHF has identified network adequacy as an important consumer issue and plans to remain engaged on this topic as discussions move forward.

 

Closing the Coverage Gap: No hearings have been scheduled or are pending to address the possibility of expanding Medicaid in Georgia. Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians, an approach which GHF supports.  Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills, Rep. Rahn Mayo and Senator Vincent Fort, for their support and show your support by filling out a postcard that we’ll mail to your legislators!

 

Tobacco Tax:  No additional standalone proposals have been made to increase Georgia’s tobacco tax (other than HB 445 as previously reported).  The Senate however, may respond to the House proposal on transportation funding by including a tobacco tax increase to the regional average of around 68 cents. Importantly, Alabama’s Governor is proposing an increase in their state tobacco tax to $1.25 per pack, which would increase the regional average.  GHF continues to advocate for an increase to the national average by raising our tobacco tax by $1.23.  Such an increase would generate $585 million per year according to the fiscal note generated by the non-partisan fiscal office at GSU.

 

Other Bills of Interest

Below is a summary of bills that may impact health care consumers in Georgia, with information about where they are in the legislative process.

 

SB 1 (Sen. Bethel) provides certain insurance coverage for autism spectrum disorders. SB 1 has passed the Senate and is in the House Insurance Committee.

 

HB 1 (Rep. Peake) would allow for the limited use of medical marijuana as long as long as the provider is the best weed dispensary for conditions including cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, crohn’s disease, mitochondrial disease, fibromyalgia, parkinson’s disease, and sickle cell disease, but it is still important for people to know the the difference between CBD and THC.  HB 1 passed the House of Representatives and is now in the Senate Health and Human Services Committee. Go to Dank City – Cannabis News, Culture, Entertainment and Information to find out more.

 

HB 195  (Rep. Cooper) and SB 51 (Burke) provide parameters for substitutions of interchangeable biological products. HB 195 passed the House Health and Human Services Committee and is expected to come out of the Rules Committee next week, and Senate Bill 51 has passed the Senate and has been assigned to the House HHS committee, but is not expected to get a hearing until after crossover day.

 

HB 482 (Rep. Willard) seeks to eliminate two of the requirements that the Cancer Treatment Centers of America was subject to when they were allowed into Georgia as a destination hospital.

 

HB 416 (Rep.Rogers), routinely referred to as the badge bill, seeks to provide clarity and transparency for the patient as to the qualifications of the provider that they are seeing.  The bill calls for providers to identify the health care practitioner’s name and the type of license or educational degree the health care practitioner holds. The bill passed out of committee on Tuesday March 3.

 

HB 34 (Rep. Dudgeon) is known as the “Right to Try” bill and calls for patients with advanced illnesses and in consultation with their doctor to use potentially life-saving investigational drugs, biological products, and devices. The bill passed out of the House HHS committee.

 

HB 429 (Rep. Stephens) seeks to ban coverage denials for medically necessary treatment based solely on life expectancy or the diagnosis of a terminal condition.  The bill is in the House Insurance Committee.

 

HB 76 The House appropriations bill, provides $200,000 to continue the Prescription Drug Monitoring Program in the state, which would otherwise run out of funds and expire on June 30, 2015.  The appropriations bill is currently in the Senate.

 

HB 504 (Rep. Cooper) would extend the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis.

 

HB 436 (Rep. V. Clark) would require physicians and health care providers to offer to test pregnant women who are in their third trimester for HIV and syphilis.

 

HB 463 (Rep. Harbin) would permanently extend a $1,000 tax credit for “medical core clerkship” preceptors for “community based” nurse practitioners and physician assistants.

On Wednesday, the Supreme Court heard oral arguments for the much anticipated King v. Burwell case, a case that threatens to eliminate tax credits to buy health insurance through the Affordable Care Act (ACA) marketplaces in approximately three dozen states, including Georgia.

Here at GHF, we are happy that the ACA is working and that more than 536,000 Georgians were able to access affordable health care coverage through the Health Insurance Marketplace during the most recent open enrollment period. We look forward to the Supreme Court’s decision in King v. Burwell and hope that it will be a positive outcome for the 461,000 Georgians who currently receive tax credits through the ACA. For now, health care coverage and tax subsidies for Georgia’s consumers remain unchanged.

There has been a lot of news coverage of the case this week and there are many resources available to help advocates communicate about the case to their supporters and stakeholders.

• The Commonwealth Fund has a series of issue briefs about how subsidy shutdowns could affect consumers, health insurers, health care providers, and states. Each comes with a summary infographic.
• The Commonwealth Fund also has an interactive map of the potential impact of a subsidy shutdown on each state.
• Community Catalyst mapped the potential impact by congressional district.
• The Urban Institute has put together a report about the implications of King v. Burwell on uninsured rates, changes in types of coverage, and costs of insurance.

 

Earlier this week, the Rural Hospital Stabilization Committee (RHSC), created by Governor Deal to address the needs of struggling rural hospitals and find solutions that address those needs, issued its final report. The recommendations in the report include:

• A four site “Hub & Spoke” pilot program
• Maintenance and protection of Certificate of Need laws
• Expanded scope of practice for non-physician providers, like physicians assistants and nurse practitioners
• More support for school-based health centers

The committee’s work shines a spotlight on the health care access challenges that rural Georgians face and puts forth constructive recommendations. While we support these recommendations whole-heartedly, we are also disappointed that the committee did not address the coverage gap and Medicaid expansion in its report.

Georgia Health News interviewed Georgians for a Healthy Future’s Executive Director on this issue (click here to read the full article), and in that article she pointed to the early success of states like Kentucky, which recently reported improvements and coverage rates and in health care access due to Medicaid expansion. She also encouraged policymakers to take a comprehensive approach that includes closing Georgia’s coverage gap to help get people into health insurance and provide a reimbursement stream for rural hospitals and better equipment as Hospital Bed Movers.

Back in December, Georgians for a Healthy Future, together with several consumer and community-focused organizations including the Georgia Budget and Policy Institute, Georgia Watch, and Families First, submitted a report and provided public comment to the committee making a detailed case for such an approach. You can read that full report here.

Yesterday marked the 23rd day of the 2015 Legislative Session. We are getting closer to Crossover Day, the 30^th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015. Crossover Day is set for March 13th. Sine Die, the 40^th and final legislative day for the year, will be April 2nd.

 

As part of this week’s legislative update, we sat down with Representative Debbie Buckner and spoke with her about access to care in rural communities, Georgia’s coverage gap, and other health care issues on her mind this Legislative Session.

 

To watch the video, click on the image below.

 

 

 

The State Budget

The FY 2016 Budget passed the House of Representatives this week and now heads to the Senate for hearings. Of note, the House of Representatives added $2.96 million in the budget to increase reimbursement for certain OB/GYN services, $1.5 million for reimbursement rate increases for certain primary care services, $1.3 million to increase the hourly rate for personal support services under the Independent Care Waiver Program, and $500,000 to increase reimbursement for air-ambulance services for adult patients. The House also added in $3 million to implement the recommendations of the Rural Hospital Stabilization Committee. The House removed $22.8 million for new treatment medications for patients with Hepatitis C and $12.1 million for costs to launch a new case management program for enrollees eligible under the Aged, Blind, & Disabled program. Also of note, the House reinstated health coverage for non-certificated part-time school employees; however, local school districts and not the state would be responsible for those costs. Click here for an analysis of the health care provisions in the budget that passed the House from our friends at the Georgia Budget & Policy Institute.

 

Closing the Coverage Gap

Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians. Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills, Rep. Rahn Mayo and Sen. Vincent Fort, and show your support for closing the coverage gap by filling out a postcard that we’ll mail to your legislators!

 

Tobacco Tax

HB 445 (Carson) represents the first additional or alternative funding proposal to the transportation funding bill (HB 170). While the overall bill includes regressive provisions including an increased sales and grocery tax combined with a reduction in the income tax that GHF does not support, it is notable that a tobacco tax is in the mix in the bill. This keeps the tobacco tax on the radar and provides an opportunity for health advocates to continue to push for an increase to the national average in the tobacco tax to curb smoking rates and bring in much-needed revenue.

 

 

Other Bills of Interest

Below is a summary of bills that may impact health care consumers in Georgia, with information about where they are in the legislative process.

 

SB 1 (Sen. Bethel) provides certain insurance coverage for autism spectrum disorders. SB 1 has passed the Senate and is the House Insurance Committee.

 

SB 158 (Sen. Burke) provides certain consumer and provider protections regarding health insurance, including network adequacy language. SB 158 has been referred to the Senate Insurance Committee.

 

HB 1 (Rep. Peake) would allow for the limited use of medical marijuana for conditions including: cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, crohn’s disease, mitochondrial disease, fibromyalgia, parkinson’s disease, and sickle cell disease.  HB 1 passed the House of Representatives and is now in the Senate Health and Human Services Committee.

 

HB 195 (Rep. Cooper) and SB 51 (Burke) provides parameters for substitutions of interchangeable biological products. HB 195 passed the House Health and Human Services Committee and is expected to come out of the Rules Committee next week, and Senate Bill 51 has passed the Senate and has been assigned to the House HHS committee, but is not expected to get a hearing until after crossover day.

 

HB 482 (Rep. Willard) seeks to eliminate two of the requirements that the Cancer Treatment Centers of America are currently subject to when they were allowed into Georgia as a destination hospital.

 

HB 416 (Rep. Rogers): Routinely referred to as the badge bill, HB 416 seeks to provide clarity and transparency for the patient as to the qualifications of the provider that they are seeing.  The bill calls for providers to identify the health care practitioner’s name and the type of license or educational degree the health care practitioner holds. The bill will be heard in the House HHS committee on Monday March 2, 2015 at 3 PM.

 

HB 34 (Rep. Dudgeon) is known as the “Right to Try” bill and calls for patients with advanced illnesses and in consultation with their doctor to use potentially life-saving investigational drugs, biological products, and devices.

 

 

 

If you are a consumer who enrolled in health insurance through the Marketplace with a tax credit, you likely received a 1095-A form in the mail. You may also have some questions about how to complete the health insurance information on your tax filing form. If your organization works directly with consumers, either providing enrollment assistance or helping them with tax preparation, you may also be hearing about the 1095-A and may have some questions about how health insurance and tax filings intersect. Below is a primer, replete with flow chart, which breaks it all down for you.

Where consumers get their coverage—Marketplace, employer, Medicaid—will determine the impact coverage has on their taxes.  Consumers who have health insurance through their jobs will likely see no changes when they file their taxes – they just check the box on their tax forms indicating they had coverage throughout the year.  The same thing applies to consumers who are covered by Medicaid, Medicare, or their parent’s health plan.  Pretty simple!

During this year’s open enrollment period, 536,929 Georgians purchased health insurance through Healthcare.gov and about 90% received financial assistance to help lower the cost of their premiums.  To keep that tax credit, they’ll have to fill out Form 8962, which asks questions about their health insurance and their income. To help complete that form, all consumers that received a tax credit should have received Form 1095-A in the mail from the Marketplace. Consumers can also find this form on their Healthcare.gov account.

The health insurance tax credit is based on income and household size. When consumers applied for coverage, they estimated their income for the coming year and that amount was used to determine their tax credit. If a consumer misestimated their income, the credit they received may be too high or too low. During the tax filing process, the difference between estimated and actual income is reconciled, and the corresponding tax credit may be adjusted up or down.  This means some consumers may get a refund and some consumers may have to pay back part of their tax credit. If a consumer did not apply for a tax credit previously, they can apply for a credit to be included in their tax refund.

If a consumer went without health care coverage at any point in the year, they may need to fill out an additional Form 8965 to determine whether or not they will need to pay a fine. This year the maximum fee per family will be $285, but fines will increase each year, up to 2% of a person’s annual income.  If a person falls into Georgia’s coverage gap, they will not have to pay the fine, but will need to file the appropriate documents to prove they do not have access to affordable coverage

Household, family, and income changes should be reported throughout the year to Healthcare.gov in order to avoid surprises at tax time.

If you have questions about how your health coverage may affect your taxes, consult a tax professional.  Our partners at Georgia Watch can connect you with free tax preparation help—just click here.

 

 

If you have recently gained health insurance through the Health Insurance Marketplace, it may seem like you need to learn a whole new language to understand your coverage. Health insurance can be confusing, especially if you have never had it before or haven’t had it in a while. Just understanding a few key terms, such as premium, deductible and co-pay, will go a long way in helping you use your health insurance effectively. Click here for a simple guide to help you understand your new coverage. Additionally, if you are having trouble using your health insurance you can contact Whitney Griggs, GHF’s Consumer Education Specialist, at wgriggs@healthyfuturega.org or at (404) 567-5016, extension 5.

Federal funding for the Children’s Health Insurance Program (CHIP), known as PeachCare for Kids in Georgia, expires in September 2015.  More than 200,000 Georgia kids rely on this program for access to health care services.  The U.S. Congress has signaled that it is willing to consider extending CHIP funding. This is great news. However, some of the discussions include provisions that provide access barriers.  Some concerning provisions include the removal of protections that were included in the ACA, an optional 12-month waiting period for coverage, and cuts to CHIP funding for certain groups of children in some states. (Click here for a full analysis of the draft plan.)  You can help by telling your legislators to pass a clean renewal of CHIP funding that does not impose barriers to enrollment and coverage for kids.  Here are some ways to get in touch:

• Write a letter or call your congressman. Click here to see suggested language from our partners, Voices for Georgia’s Children.  Click here to find your congressman, senator and their contact information.
• Tweet at your representatives in congress. See the list below for their Twitter handles.  Use the hashtags #ExtendCHIP #keepkidscovered and #CHIPWorks
• Share this image from Voices for Georgia’s Children (@georgiavoices) on social media to spread the word.

Senate

Johnny Isakson

@SenatorIsakson 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

David Perdue

@sendavidperdue 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

House

Buddy Carter (1^st District)

@RepBuddyCarter 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Sanford Bishop Jr. (2^nd District)

@SanfordBishop 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Lynn Westmoreland (3^rd District)

@RepWestmoreland 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Hank Johnson Jr. (4^th District)

@RepHankJohnson 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

John Lewis (5^th District)

@repjohnlewis 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Tom Price (6^th District)

@RepTomPrice 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Rob Woodall (7^th District)

@RepRobWoodall 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Austin Scott (8^th District)

@AustinScottGA08 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Doug Collins (9^th ,District)

@RepDougCollins 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Barry Loudermilk (11^th District)

@RepLoudermilk 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Rick Allen (12^th District)

@RepRickAllen 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

David Scott (13^th District)

@repdavidscott 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Tom Graves (14^th District)

@RepTomGraves 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

 

Open Enrollment has officially ended but some Georgians that missed signing up during the three month period may be able to still get coverage. Those “in line” during this last three days of Open Enrollment who were unable to select a plan due to long call center wait times or technical issues have until Sunday, February 22 to enroll. In this circumstance, coverage will begin March 1^st.  Otherwise, consumers who have a “qualifying event” may be able to get coverage through a Special Enrollment Period. Special Enrollment Periods can occur at any time during the year and are usually triggered by specific events. These events include life changes such as a marriage, birth, change in eligible immigration status and a permanent move. Another type of event that could qualify consumers is a loss of other health coverage. These types of events could include an involuntary loss of employer coverage, loss of Medicaid coverage, and a death or divorce that results in a loss of coverage. In most cases, the Special Enrollment Period lasts for 60 days after the qualifying event occurs. To learn more about what types of events could trigger a Special Enrollment period, click here. If you think you may qualify, visit https://www.healthcare.gov/get-coverage or https://localhelp.healthcare.gov/ to find in-person assistance in your area.

 

Additionally, the Centers for Medicaid and Medicare Services just announced a Special Enrollment Period for tax season for consumers who were penalized for not having coverage in 2014 and are not currently enrolled in health insurance. To qualify for this Special Enrollment Period consumers must also attest that they were not aware of the penalty for not having health insurance until after the end of Open Enrollment (February 15^th , 2015) because they filed their 2014 tax return after that date. This Special Enrollment Period will begin March 15^th and end April 30^th, 2015. Click here to learn more about the announcement.

 

As part of this week’s legislative update, we caught up with Senator Chuck Hufstetler and spoke with him about his proposal to increase the state’s tobacco tax by $1.23, which would bring Georgia up to the national average. According to a fiscal note released this week by Georgia State University at legislative request, this increase would yield more than $500 million in new revenue.