Laura Colbert, executive director of Georgians for a Healthy Future, said people living in rural areas are more likely to have low levels of health literacy, compared to urban or…
Georgians for a Healthy Future’s eighth annual Health Care Unscrambled breakfast built on previous years’ successes with another standing room-only crowd. This year’s legislative panelists were:
Each panelist provided updates on emerging health care trends impacting Georgia and took questions from the audience about what healthcare initiatives are likely to be taken up in the 2018 legislative session. Topics included Medicaid expansion, federal funding of PeachCare for Kids (CHIP), surprise out of network medical billing, access to mental health and substance use treatment services, network adequacy, hospital closures, scope of practice for non-physician providers, Certificate of Need reform, maternal and infant mortality, rural health care access, the Prescription Drug Monitoring Program (PDMP), federal health care reform, the opioid epidemic and homelessness.
Senator Unterman, Chairwoman of the Senate HHS Committee, led the conversation with updates of the findings and recommendations from the myriad study committees she chaired or established in the 2017 off-session including the Senate Study Committees on Homelessness, Georgians Barriers toAdequate Access to Healthcare, as well as her participation on Lt. Gov. Cagle’s Health Care Reform Task Force. New Minority Leader Bob Trammell, along with Representative Sam Park, announced their intention to introduce legislation to expand Medicaid in Georgia (which has now been filed as House Bill 669) and Rep. Mark Newton, an Augusta area ER physician and Senator Elena Parent, Deputy Whip in the Senate Minority Caucus both elaborated on the Medicaid expansion debate, mental health issues facing the state, the opioid epidemic and rural health care access.
This year’s key note speaker was Robin Rudowitz, Associate Director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured. Ms. Rudowitz provided some background information on the federal Medicaid program, as well as Georgia’s program specifically. She pointed out that children are the primary beneficiaries in Georgia’s Medicaid program followed by people with disabilities, pregnant women, and seniors respectively. Georgia’s Medicaid program does not cover adults making less than 138% of the federal poverty level (about $16,000 per year for an individual and $21,000 for a family of 3) because Georgia’s policymakers have thus far refused to extend health coverage to this population. There was an extended discussion by Ms. Rudowitz and audience members about the new flexibility offered by the U.S. Department of Health & Human Services to state Medicaid programs may impact children and other enrollees, as well as how it may change existing Medicaid expansion programs in other states, This information presented by Ms. Rudowitz and subsequent discussion are sure to inform the considerations around the future of Georgia’s Medicaid program. Ms. Rudowitz’s presentation can be accessed here.
To see photos, review materials, and get more information about this year’s Health Care Unscrambled event, please visit the event page.
The 2018 legislative session has begun
The Georgia General Assembly has convened at the state capitol for its annual 40-day legislative session. This year’s session is expected to be quick as legislators prepare for primary elections in May and this fall’s general election. While the legislature is only constitutionally required to pass a state budget, we expect that a number of critical consumer health care topics will be debated. GHF will be monitoring this activity and will keep you up-to-date with weekly legislative updates (like this one!), our legislation tracker, timely analysis of legislation, and more.
The State Budget
On Thursday, Governor Deal addressed the General Assembly in his annual State of the State address and, per tradition, used the opportunity to introduce his proposed budget. The Governor minimally mentioned health care in his address, only highlighting the Commission on Children’s Mental Health. The inclusion of $20.6 million to fund the Commission’s recommendations made up the most significant health care-related change in the Governor’s proposed budget. This money will go to fund behavioral health crisis services ($10.4 million), a school-based mental health initiative called Project Apex ($4.3 million), supported employment and education ($3 million), suicide prevention ($1.1 million), provider training and telehealth ($1 million), and opioid abuse prevention ($790,000). The budget will now go to the House for its consideration before passing to the Senate.
HB 669: Medicaid Expansion
New House Minority Leader (and Health Care Unscrambled panelist) Bob Trammell introduced HB 669 requiring Georgia to authorize state dollars to drawn down additional federal dollars to expand Medicaid. Closing Georgia’s coverage gap by expanding Medicaid (or through a tailored Georgia-specific 1115 Medicaid waiver) would be the most significant step Georgia’s law makers can take to strengthen the state’s weakening rural health care system, address the opioid and substance use epidemic, and provide all Georgians with an insurance card regardless of income. Contact your legislators and let them know that you support closing Georgia’s coverage gap and they should too. Save the date. February 15th is Cover Georgia Day at the Capitol. Make plans to attend! Stay tuned for an official event announcement and RSVP link soon.
The Legislative Calendar
The schedule for the first eleven days of the 2018 legislative session was set on Monday, January 8. The General Assembly has already worked four days of the constitutionally capped 40-day session (January 8 through January 11). Tuesday, January 16 and Wednesday, January 17 are slated for budget hearings, and the next seven legislative days are as follows:
- January 18: Legislative Day 5
- January 19: Legislative Day 6
- January 22: Legislative Day 7
- January 23: Legislative Day 8
- January 24: Legislative Day 9
- January 25: Legislative Day 10
- January 29: Legislative Day 11
Earlier this week, GHF provided a summary of the recommendations from several Senate study committees and how their findings may affect the health care system and consumers in the state. The Georgia House of Representatives also convened study committees to examine issues directly related to health care, and two of these committees recently released their final recommendations.
The House Study Committee on Georgians’ Barriers to Access to Adequate Health Care (HR 240) examined a broad array of health care issues with a focus on the burden of chronic disease in Georgia. The committee, chaired by Representative Sharon Cooper, issued an exhaustive final report that included several legislative recommendations that could impact consumers. The most pertinent recommendations include:
Increasing access to immunizations: Allow schools to require the second dose of the meningitis vaccination in 12th grade; require hospitals and nursing homes to offer shingles and flu vaccinations; allocate an additional $1 million to the Department of Public Health for additional staff and screenings for the viral hepatitis program; require the Department of Juvenile Justice to check vaccination records and offer vaccinations for juveniles in their care.
Improving testing and treatment for HIV/AIDS: Rewrite state laws to focus criminalization on intention to transmit HIV, as opposed to knowledge of HIV infection; ensure access to HIV treatment regimens for sexual assault victims; increase funding to the Department of Public Health to expand their ability to test for HIV; encourage state-funded health care programs such as Medicaid to expand their outreach for HIV testing.
Facilitating continued enrollment in Medicaid: Engender a policy shift that would allow for the suspension of Medicaid benefits, as opposed to outright termination, for people entering incarceration in the state.
Addressing respiratory diseases: Build upon the existing state asthma plan, which expires in 2018, to include a broader scope of chronic respiratory diseases; expand the screening process for people at risk of COPD to help confirm additional diagnoses.
Expanding access to mental health services: Expand funding for the Department of Behavioral Health and Development Disability’s community service boards; allocate funding for psychiatric residents who specialize in mental health treatment; encourage the use of e-prescriptions for opioid medications in an effort to curb opioid abuse.
You can read the full committee report here.
The House Rural Development Council (HR 389) closely examined a variety of issues that impact rural communities in Georgia and a recurring theme across the state was a need for increased access to quality health care. After 18 meetings in all parts of rural Georgia, the council released several recommendations that could have a significant impact on rural health care consumers.
One of the most noteworthy recommendations encouraged the Department of Community Health to apply for an 1115 Medicaid waiver that would allow participating hospitals and community providers to form a closed network in order to provide care to a set number of uninsured community residents. This waiver would allow Georgia to pull down additional federal funds to provide health care to some of the state’s uninsured population and to test out new ways to deliver high quality care at a lower cost. Unfortunately this idea falls far short of expanding Medicaid, which would provide health coverage to low-income, uninsured Georgians statewide and is the most significant step our state could take in improving access to care for rural Georgians. (Note: the council report refers to this capitated, value-based delivery model as a “block grant,” but this waiver would differ from a block grant in some nuanced, but important ways.)
Like the Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare, the council heard a significant amount of testimony on the dearth of practicing medical professionals in rural counties and, as a result, their final recommendations mirror those of the Senate committee. They suggest expanding the scope of practice for mid-level practitioners to allow them to perform certain medial services not currently allowed and implementing a preceptor tax credit program to incentivize medical practitioners to train future healthcare professionals in rural areas.
Finally, the council recommended establishing a Rural Center for Health Care Innovation and Sustainability, which will be responsible for promoting a curriculum of best practices for rural health care. The center will also be used to provide mandatory training for the executive leadership and boards of rural hospitals.
You can read the full committee report here.
As always, you count on GHF to keep you up-to-date on how these recommendations may turn into legislative action when the General Assembly convenes in January. Stay tuned!
As the year winds to an end, the General Assembly’s 2017 study committees have largely completed their work and are releasing final reports, complete with notable findings and recommendations for the legislature to consider when it convenes in January. GHF monitored the activities of several Senate study committees this year as they considered changes to Georgia’s health care system that may impact consumers. (We will issue a blog later this week to provide an overview of similar House committees.)
The Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare (SR 188) chaired by Senator Renee Unterman focused heavily on provider shortages that impact Georgians’ ability to receive health care when and where they need it. These shortages are felt most heavily in rural areas of the state, including the 79 counties that have no practicing OB/GYN physicians, 63 counties with no pediatric physicians, and 9 counties with no practicing physicians at all. In its final report, the committee issued several specific recommendations to remedy the provider shortages and increase access to care. Most prominently, the committee recommended expanding the scope of practice for Advance Practice Registered Nurses (APRNs) in areas of the state with the worst health outcomes and largest provider shortages. The committee noted that Georgia has among the strictest practice environments for APRNs and expanding the scope of practice for these nurses would allow rural Georgians to access quality care despite a lack of physicians. The committee also recommended expanding the practice of telemedicine in the state by training more telemedicine presenters, loosening restrictive rules, and providing more funding to telemedicine initiatives. Lastly, the committee addressed the rash of rural hospital closures around the state, suggesting that the closures could be prevented by providing more specific training for hospital board members on healthcare finance and supporting ongoing education for hospital board members and executive staff. You can read the committee’s full report here.
Senator Unterman also chaired the Senate Study Committee on Homelessness (SR 352). The committee examined the integral link between mental health and housing stability, and discussed housing status as a social determinant of behavioral health. The committee recommended that the Department of Community Health identify ways in which the state could use Medicaid funds to support people who are at risk of becoming homeless, and they recommended increased funding to expand the Georgia Housing Voucher and Bridge Program to ensure that more people who live with behavioral health conditions are connected with supportive housing programs. During the committee’s proceedings, several health care providers testified about the health care needs of people experiencing homelessness, including the need to have health insurance coverage. The committee did not issue a recommendation about how to better provide health care services for the homeless population; however, data shows that expanding Medicaid would be a meaningful and significant step to ensuring access to care and treatment for this group of Georgians. You can read the committee’s full report here.
Finally, GHF has also been following the work of Lt. Governor Casey Cagle’s Health Care Reform Task Force, which has met throughout the year at locations across the state. The task force has held meetings about the best practices to combat the opioid crisis and treat addiction, expanding access to health care in rural areas, and strengthening preventative care across the state. The task force convened for their final meeting in October, and they will issue their formal recommendations to the state legislature in January.
It is unclear which of these recommendations will be acted on by the General Assembly during the 2018 legislative session. However, you can count on GHF to keep you updated on any resultant legislation and any other legislative decisions that will impact Georgia’s health care consumers.
I am a graduate student in the Public Health program at Georgia State University. As a part of my coursework, I completed a semester-long practicum with Georgians for a Healthy Future as the Legislative Health Policy Intern.
In my academic program, I have spent extensive time learning about health policy, the legislative process, and the healthcare landscape in the United States. While covering those topics in a classroom setting was informative, seeing the legislative process first hand was invaluable. During my time with Georgians for a Healthy Future, I had the privilege of experiencing the legislative process by visiting the Capitol for committee and advocacy meetings, tracking legislation, and meeting policy makers and advocates.
Some of what I learned in the classroom applied to my work at GHF, but I found that there are some things you can only learn through experience. I was surprised by the length of time that legislators spend discussing some bills. Minutia in bill language could be debated for a whole two-hour meeting, while some key details might be voted on within minutes. I often felt a rollercoaster of emotions as a passionate hearing drew my sympathy for a given issue, while opposition pushed back on the bill. Spending time in committee hearings solidified my understanding that health policy often lies in gray areas, despite initially appearing to be black and white.
In my time at Georgians for a Healthy Future, I have learned a great deal about the organization and working in advocacy. Something that surprised me about GHF is the great value of the small things they do, such as encouraging constituents to call their legislators, sharing facts and resources with partner organizations, and talking to consumers. Their efforts often go unseen by the general public but have significant implications for the citizens of Georgia. I have seen the fruits of their labors, and it excites me to know there is an organization working so hard to protect and give a voice to our most vulnerable Georgians. Their partner organizations are equally inspiring in working to better the health of people in the state.
look forward to taking my GHF experience and knowledge with me into the public health field. I have gained a greater understanding of health policy and how bills get passed. I have learned the importance of advocacy and that every person can have a voice. I have learned that there are so many deeply passionate, caring, and hard-working individuals working towards health equity in Georgia. I have learned that the road to policy is often long, but the payoff is worth the time and effort. I will take these lessons with me as I move into my career, and work towards the goal of creating a healthier state and nation for everyone.
MPH Candidate 2017
Georgia State University
Surprise billing legislation passed by committee
SB 8 was heard by the House Insurance committee this morning and passed unanimously. Among other transparency and notification requirements, this version of the surprise billing legislation requires that providers and hospitals must provide consumers with information about the plans in which they participate, and that upon the request of consumers, providers give an estimated cost of non-emergency services before they are provided. Insurers must inform consumers whether a provider scheduled to deliver a service is in-network, and if not, an estimation of how much the insurer will pay for the services, among other notification requirements. SB 8 will now go to the House Rules committee.
WHAT HAPPENED LAST WEEK
Senate passed the FY2018 budget
Last week, the Senate approved the FY 2018 budget. The budgets approved by the Senate and House differ slightly, so a conference committee will be appointed to meet and work out the differences. You can check the Differences Report for specifics on the variance between the House and Senate budgets, and we will provide a brief overview of the final version once the conference committee finishes its work.
Insurance coverage for children’s hearing aids passed
SB 206 was approved by the House of Representatives today, and will require private health insurance plans to cover hearing aids for children under 19 years old. The legislation stipulates that the costs cannot exceed $3000 per hearing aid and that the plans cover replacement hearing aids every four years or when the hearing aid fails before that time. Medicaid already covers hearing aids for children who qualify for coverage.
Pharmacy Patients Fair Practices Act passed by both chambers
Both HB 276 and SB 103 were approved by the Senate and House respectively last week and will get sent to the Governor for his signature. This legislation (which we previously covered here) will regulate practices of pharmacy benefit managers so as to allow consumers access to their pharmacy of choice, provide the opportunity for home delivery of medications, and prevent consumers from over-paying for prescriptions. It is really important to find a pharmacy that you can trust, I suggest to check Canadian pharmacies which have been very reliable for me.
Legislation to synchronize multiple medications passed
SB 200 will make it easier for people to synchronize their prescriptions so that they can pick up multiple prescriptions at the same time. The bill requires that insurance plans pro-rate medication co-pays for partial prescription fills so that the schedules for medications can be synced if requested by a patient. Under current law, a person may have to pay a full co-pay even if a pharmacist is providing only a part of their 30-day medication in order to synchronize multiple prescriptions. SB 200 passed the House Insurance committee last week and was approved unanimously by the House this morning.
Senate Health Reform Task Force held first public meeting
The Senate Health Reform Task Force was established by Lt. Gov. Cagle to study how federal health reform efforts would impact Georgia. The task force held its first public meeting on Friday and heard from two federal health policy professionals, Joseph Antos and Jim Frogue. Together, they provided a brief overview of the proposed American Health Care Act, some analysis of how the bill would impact Georgia, and suggestions for legislators to consider. The message from both presenters is that the AHCA is “not favorable” for Georgia because of the way the proposal cuts and caps Medicaid which would lock in Georgia’s pattern of low per capita Medicaid spending.
We agree that this proposal is “not favorable” for Georgia. Despite the harm it would do to our state, the bill seems headed for a vote in the House of Representatives. Call your Congressman today to tell him that this bill hurts Georgia!
Surprise billing legislation progresses in both chambers
Both SB 8 and HB 71 were passed out of their respective Senate and House committees late last week. SB 8 has been held up because of a dispute between insurers and health care providers about reimbursement. The bill was amended to establish out of network payment for disputed charges at the 80th percentile of the “Fair Health” metric and was subsequently passed by the Senate Health & Human Services committee. HB 71 seeks to compel physicians who are credentialed at hospitals to accept an in-network rate when the patient is in-network at the hospital, even if the physician is not. It was passed unamended by the House Insurance Committee. Both bills await approval in the Rules Committees to receive floor debates and votes.
House passes FY2018 budget
The House of Representatives passed its version of the FY2018 budget on Friday. The budget includes increased reimbursement rates for certain primary care codes for Medicaid providers. Increased reimbursement rates are also funded for certain dental codes in PeachCare for Kids and Medicaid. The budget includes funds for two new federally qualified health centers in Cook and Lincoln counties, and 97 new primary care residency slots. The FY 2018 budget is now being considered by the Senate, which is expected to make its own changes before issuing its final approval. Check out Georgia Budget and Policy Institute’s blog and budget primer for more detailed information about how Georgia spends its health care dollars.
WHAT HAPPENED LAST WEEK
Changes to rural hospital tax credits
HB 54, introduced by Rep. Duncan, would expand the new rural hospital tax credit program from a 70% credit to a 90% credit, among other minor changes. The tax credit program went into effect this year, after enabling legislation was passed in 2016. The proposal to increase the tax credit to 90% came after legislators received feedback that the 70% credit was too low to entice potential donors. HB 54 was approved by the House Ways & Means committee on Feb. 9, and now awaits passage in the House Rules Committee.
Opioid abuse prevention bill
SB 81 remains in the Senate Rules Committee waiting for approval for floor debate and passage after committee approval late last week. The current version of the bill requires that all physicians register and consult the Prescription Drug Monitoring Program (PDMP) under certain prescribing conditions. It also requires that providers report certain opioid-based Schedule II, III, IV, and V prescriptions to the PDMP. The bill sets the penalty for willfully non-compliant providers on a continuum that ranges from a warning to a felony and fine for a fourth offense and beyond. The bill also requires the tracking and reporting of Neonatal Abstinence Syndrome (NAS) and codifies the Governor’s emergency order on an overdose reversal drug (naloxone), making it available without a physician prescription.
MARCH WITH US!
This Saturday: Atlanta March for Healthcare
Yesterday, we rallied at the Save My Care bus stop, and Saturday we will march at the Atlanta March for Healthcare! Join us as we fight to preserve the Affordable Care Act and the protections that it provides for Georgians. Hosted by the Georgia Alliance for Social Justice, the march will cap Congress’s week of recess and send them back to D.C. with the charge to #ProtectOurCare!
Saturday, Feb. 25, 3-5 pm
Gather at St. Mark’s United Methodist Church
Re-authorization of provider fee successfully passes through legislature
On Friday Georgia’s House of Representatives voted to approve the hospital “provider fee” for another three years, and Governor Deal says he will sign the legislation tomorrow. The provider fee helps to fund Georgia’s Medicaid program by allowing the Department of Community Health to collect a tax on hospital revenues which is used to draw down additional federal dollars. The additional funds are disproportionately used to support rural and safety net hospitals that serve high numbers of indigent patients.
Oral health bills approved
Also on Friday, the Senate passed SB 12 and the House passed HB 154 which was supported by the Costa Rica dental tourism, both of which allow dental hygienists to practice in safety net settings, school clinics, nursing homes, and private practices without a dentist being present, including online dental services from sites like Asecra.com. While the bills are overwhelmingly similar, the differences between them will need to be worked out between the chambers.
WHAT HAPPENED LAST WEEK
Passage of Opioid Abuse Prevention Bill
SB 81 continued to draw a lot of attention last week. The bill was eventually passed by the Senate Health and Human Services committee with several significant changes. The current version of the bill still requires that all physicians register and use the Prescription Drug Monitoring Program (PDMP), but only requires that providers report on Schedule 1 drugs and reduces the penalty for not reporting to a minimum of a misdemeanor. The current version of the bill also changed language that would have required children with ADHD to renew their prescription every five days.
Surprise billing legislation heard in committee
The Senate Health and Human Services committee began its consideration of SB 8, legislation that would protect consumers from surprise out-of-network medical billing. Testimony was heard from insurers, health care providers, hospitals, and the consumer advocacy group, Georgia Watch. While all stakeholders seem to be in agreement that consumers should be held harmless when seeking care at an in-network facility and through no fault of their own encounter an out-of-network provider, there are significant differences on the matter of provider reimbursement for services provided in those situations. No vote was taken on the legislation but is expected to be re-considered by the committee this week. HB 71, legislation that address surprise billing in a different way, is expected to receive its first hearing this week in the House Insurance committee.
Resolution introduced to encourage block grants for state Medicaid program
HR 182 was introduced last week with the purpose of providing legislative permission to the Governor and the Department of Community Health to seek per capita block grant funding for Georgia’s Medicaid program. While resolutions are non-binding and do not impact state law, this resolution could begin a risky conversation among lawmakers. Shifting Georgia’s Medicaid program from its current federal-state partnership structure to a block grant program would mean cuts in services and in beneficiaries, putting Georgia’s most vulnerable children, parents, elderly, and people with disabilities at risk if you’re in one of these cases, you could get in touch with a home care agency. Check out GHF’s block grant fact sheet for more information about the dangers of restructuring the Medicaid program. It is unclear if this resolution will get a hearing or a vote.
Mark Your Calendar!
Save My Care Rally: February 20th
With Congress taking steps to repeal and replace the Affordable Care Act and thus blocking the access to care so many Georgians have gained in the past several years, it is more important than ever to stand up and let them know that Georgians want to #ProtectOurCare.
On February 20th, join the Save My Care bus, GHF, and hundreds of Georgians for a rally in Atlanta. Georgia’s members of Congress will be at home for recess and it’s the perfect time to make sure your elected officials hear you loud and clear.
The National Association of Insurance Commissioners approved an updated network adequacy model act at its Fall meeting in November. The model act is a framework that states can adopt to help ensure that consumers have meaningful and timely access to the health services in their benefit package. With more insurance companies offering narrow network plans, these basic standards are an important consumer protection, and GHF encourages state policymakers to consider tailoring and adopting the model act in Georgia. We’ll be announcing our legislative priorities for 2016 soon, and this issue will be on the list!