Health care researchers and advocates want Georgia to implement new policies across its health insurance system as the state concludes its yearlong process of redetermining eligibility for Medicaid and the Children's Health Insurance Program.
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The 2016 Legislative Session is underway! At GHF, we are working on issues that are important to Georgia’s health care consumers. As these issues come up during the legislative session, we will bring you weekly updates.
WHAT HAPPENED THIS WEEK
Improving Provider Directories
Georgians for a Healthy Future has identified provider directory accuracy and usability as important health care consumer issues. Without accurate information about which providers are in-network and accepting new patients, consumers face challenges selecting the health plan that best fits their needs. Provider directories are also an important tool when consumers go to access care: without accurate information, consumers risk ending up out-of-network or not being able to access the care they need. We expect to see legislation introduced in this area and we look forward to working with legislators on its passage. As soon as we have a bill number, we’ll pass the information along to you. Be on the lookout for an action alert soon!
Network Adequacy
Georgians for a Healthy Future supports updating Georgia’s network adequacy standards to ensure that consumers can access an in-network provider for all covered benefits in their plan. This past fall, the National Association of Insurance Commissioners updated its model act on network adequacy. Shortly thereafter, Georgia’s Consumer and Provider Protection Act Study Committee recommended a multi-stakeholder review of the model act to determine how Georgia should proceed on this important issue. While there hasn’t been any movement on network adequacy yet this legislative session, it’s an issue we’re closely watching. You can check out the network adequacy page on our website for background materials, videos, and news articles on network adequacy.
Surprise Out-of-Network Billing
Sometimes consumers end up with out-of-network bills despite making the effort to stay in network or because inadequate provider networks require them to go out of network to get the care that they need. These surprise bills can be hazardous to consumers’ finances. Here’s a fact sheet from Consumers Union on this issue.
In both the House and Senate we are hearing strong interest in addressing surprise out-of-network billing. It is probable that we will soon see a bill that addresses this issue and we will keep you updated with any such developments.
Closing Georgia’s Coverage Gap
Last week’s Health Care Unscrambled featured a bipartisan legislative panel. Senators Greg Kirk and Emanuel Jones and Representatives Lee Hawkins and Debbie Buckner addressed the coverage gap at length. While they all agreed that there were too many Georgians without access to care, they differed on how to cover those people. You can read Georgia Health News’s coverage of the panel here.
Additionally, House democrats dropped a bill to close the coverage gap by expanding Medicaid. You can read about that here.
Governor Deal Proposes a Budget
This week, Governor Deal released his budget proposal for the 2016 legislative session. This budget will take effect in July 2016 and run through the end of June 2017. We are just beginning to parse through the budget but we have already identified two items to watch:
- In the FY 2016 budget, the legislature included $23 million for partialMedicaid payment parity, with the understanding that full parity may be achievable over the next several budget years. The Governor’s budget maintains last year’s partial parity, but does not add any more funding. We will encourage the legislature to increase the funding for payment parity as they make their budget changes.
- Under the proposed budget, monthly insurance premiums for non-certified public school personnel (like bus drivers, cafeteria workers, etc.) will increase in January 2017. You can read more about these changes here.
Responding to the State of the State
GHF’s Executive Director, Cindy Zeldin responds to Governor Deal’s State of the State.“Individuals, families, and communities are stronger and healthier when people have coverage. The decline in our state’s uninsured rate has had positive benefits not only for the people who have gained coverage but also for our local health systems, communities, and the economy. Yet there are still a large number of Georgians who are stuck in a coverage gap because we haven’t expanded Medicaid. While policymakers have an important responsibility to look at costs, it is also important to look at what we are getting as a state for our investments. The overwhelming evidence we are seeing from other states shows that expanding Medicaid is a sound investment: it improves access to care for the people who gain coverage, strengthens local health systems, and bolsters the economy. We hope that our state leaders will look comprehensively at this important issue and consider steps this Legislative Session to close the coverage gap here in Georgia.”
Introducing CHAT: Consumer Health Advocacy Today
Throughout the legislative session, GHF will be filming legislators and advocates at the Gold Dome to bring you a window into the Georgia legislative session. We kicked the video series off with interviews from some of our speakers from Health Care Unscrambled. Check them out below!
Senator Greg Kirk on his health priority for the legislative session: keeping rural hospitals open.
Representative Lee Hawkins’s thinks consumer health literacy is the most important issue for Georgia health care consumers.
Representative Debbie Buckner on her health priorities this session. The top of her list? Medicaid expansion.
Lynn Quincy from Consumer’s Union spoke at our second panel: What’s Next? Emerging Issues from Health Advocates. Her focus? Health value.
Looking for a full list of bills relating to consumer health care?
GHF is monitoring legislative activity that could impact Georgia consumers. We are tracking bills as they move through the legislative process. Stay updated with our legislative tracker here.
In December, the ACA Implementation Research Network released its Georgia state report at a policy forum held at the Community Foundation for Greater Atlanta. The report provides a detailed look at the key decisions made by Georgia policymakers around the implementation of the Affordable Care Act over the past five years. Georgians for a Healthy Future’s Executive Director Cindy Zeldin participated in a discussion with advocates, policymakers, and stakeholders to reflect on the report’s findings. The conversation ranged from health insurance enrollment best practices to health system reform to what it will take to close the coverage gap in Georgia. The ACA Implementation Research Network is jointly operated by the Nelson A. Rockefeller Institute of Government, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania. The Georgia state report was written by Michael Rich, Professor of Political Science and Environmental Sciences at Emory University. Download the Report.
Georgia legislative study committees meet during the off-session to take a deeper dive into specific policy issues and develop strategies for the legislature to address them. Each committee produces a report on its findings and recommendations that they want to move forward in the next legislative session. Click here for a complete listing of House and Senate study committees. GHF has been following and participating in the study committees focused on health issues impacting consumers. Below is a run-down of committees that have published their reports, the issues they investigated, and report recommendations.
Senate Study Committee on the Consumer and Provider Protection Act (SR 561)
In light of changing practices and norms in the insurance market Senate Bill 158, the Consumer and Provider Protection Act, was introduced in 2015. This bill outlined provisions for consumer and provider protections regarding health insurance and created the Senate Study Committee on the Consumer and Provider Protection Act. The aim of this committee was to understand how the current insurance environment affects the stability of providers and consumers’ access to care. The committee members included legislators and representatives from the provider, insurer, and consumer communities, including GHF’s Executive Director Cindy Zeldin as the consumer representative.
Committee recommendations include the following:
- Rental networks– When insurers create networks for health plans, they contract with providers who agree to offer services at discounted rates. Rental networks are created when the same insurer “rents out” or sells access to network providers, at a different discounted rate, to other payers (e.g. insurers, third party payers, employers). Oftentimes this is done without provider’s consent, so a provider may unknowingly treat someone who is part of the rental network and have to accept a different payment amount. The committee agreed that transparency for both consumers and providers can be improved by including a more complete definition of “rental networks” in Georgia Code and further defining the Georgia Department of Insurance’s regulatory authority in this area.
- Provider contracting- The committee agreed that more discussions need to take place in two areas surrounding how insurers contract with providers. First, insurers are allowed to change the terms of a contract with a provider, at any point, without the provider’s consent. Second, providers argue that some insurers include all-product clauses in contracts, which means a provider has to participate in all plans offered by the insurer or none.
- Health provider network adequacy- As you may have read in the November Peach Pulse, the National Association of Insurance Commissioners (NAIC) has put together a model act to address network adequacy. The committee recommended convening a multi-stakeholder group to review the Model Act to determine whether Georgia should consider adopting some of the Model Act’s measures and if we need additional legislation and regulation in these areas to protect and provide an appropriate level of access to care for consumers in the future.
GHF has identified network adequacy and the need for more accurate and user-friendly provider directories as important, emerging consumer issues. We support the setting and enforcement of network adequacy standards for all health plans in Georgia. As the multi-stakeholder group looks into these issues further, GHF will continue to add the consumer voice to the dialogue to keep consumer priorities at the forefront of the minds of decision-makers.
Senate Study Committee on Youth Attention Deficit Hyperactivity Disorder and Mental Health Substance Use Disorders (SR 487)
The committee was charged with identifying prevention and screening approaches for youth substance use disorders (SUD) and examining issues around the diagnosis rate of youth attention deficit hyperactivity disorder (ADHD). The committee made recommendations in the following five areas:
- Behavioral therapy- Behavioral therapy should be the first line of treatment for ADHD in young children and be required treatment for any child under six who has a diagnosis and receives medication.
- School workforce- Georgia must increase efforts to reduce student-behavioral health personnel ratios in schools and maximize resources available to students.
- Clubhouse Services Provided by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD)- The committee supports the clubhouse programs that provide a place for youth to go for substance use recovery support. The committee recommended increasing state funding for them, as well as creating additional clubhouse sites across the state.
- SBIRT: Screening, Brief Intervention, and Referral to Treatment- While the Committee supports SBIRT programs and training in the state, currently Medicaid does not bill for services, so the Committee will continue to monitor states that have recently activated Medicaid codes for SBIRT.
- School-Based Health Clinics- The Committee plans to monitor and share findings with Georgia’s CMOs and the House Study Committee on School-Based Health Centers (see below for committee summary), to potentially convene a joint study on the issue in 2016
GHF appreciates the Committee’s special focus on SBIRT and has been working over the past two years with the Georgia Council on Substance Abuse to raise awareness about the promise of taking a public health approach to substance use disorders that focuses on prevention through screening. GHF will continue to advocate for the activation of Medicaid codes to bill for SBIRT services because it is an effective approach to reducing youth substance use disorders and creating a bright future for our youth.
Senate Study Committee on Women’s Adequate Healthcare (SR 560)
The focus of the Senate Study Committee on Women’s Adequate Healthcare was on the current condition of women’s healthcare in Georgia, areas with existing deficits, and the growing number of women who are at risk of unhealthy outcomes. Here are some of the Committee’s recommendations:
- The Georgia Maternal Mortality Review Committee and the Alzheimer’s Disease and Related Dementia (ADRD) State Registry are important initiatives that the Committee strongly supports.
- Strategies for funding and development (e.g. loan forgiveness, tax credits, increasing GME residency slots, etc) for health care providers that serve women across the state should be increased.
- The Committee will continue to monitor the status of the Rural Hospital Stabilization Pilot Program to inform future opportunities for patient-centered medical homes and increase the use of telemedicine.
- Continue state funding to Elder Abuse Investigations and Prevention under DHS and the Cancer State Aid Program for FY 2016.
House Study Committee on School Based Health Centers (HR 640)
The intent of the committee was to provide recommendations on how to establish school-based health centers in communities to ensure students are healthy and achieve academic success. Committee members looked at the associations between health and education and ways in which school based health centers can be leveraged to increase access, provide affordable care, and produce cost savings. I am giving my children focus supplements and it has really helped a lot with their grades. Key committee recommendations include the following:
- Steps to establish a SBHC should include three stages: planning, implementation, and sustainability.
- Telemedicine is an important element, especially in rural areas and is most effective when integrated into a healthcare system that is capable of delivering comprehensive services. State-wide investments should be made to increase use of telemedicine for systems of care and expanding the scope of practice for on-site providers who can be authorized to deliver services.
- Lake Forest Elementary School (Fulton County) and Albany Area Primary Health Care at Turner Elementary are models that have been successfully implemented.
The legislative session begins January 11th and many of these recommendations will be moving forward in the form of bills, policy changes within state agencies and through additional study committees. GHF will continue to follow these issues and keep you posted on progress and advocacy opportunities to get involved. Stay tuned!
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!
Several health-related study committees met during the summer and fall months, and most of them are wrapping up their work. The Consumer and Provider Protection Act Study Committee held its final open meeting in November with a focus on network adequacy and provider directories. Claire McAndrew from Families USA, a national consumer health advocacy organization, and Georgians for a Healthy Future’s Health Policy Analyst Meredith Gonsahn delivered testimony on the importance of setting network adequacy standards and ensuring provider directory accuracy and usability. Look out for a final report from the committee later in December!
This workbook is a take-home, interactive resource for the newly enrolled. It covers topics that enrollment assisters may not have time to cover during the enrollment appointment, such as how to find a primary care provider, how to make your first appointment, and even how to make a budget. People can fill in the workbook with their own information so they have all of their important health coverage information in one place. Download the workbook here.
North Fulton Community Charities, a non-profit human service agency that assists families in need in North Fulton County, invited Georgians for a Healthy Future to present our Medicaid chart book to its community leaders. Board members, city and county council people, and state legislators were in attendance, along with interested community members. We had a constructive conversation with participants about how Georgia can close the coverage gap. If your organization, church, or community group would like us to present at your next meeting (either about closing the coverage gap or about helping people enroll in health insurance), contact Laura at lcolbert@healthyfuturega.org.
Earlier this year, two separate proposed health insurance mergers were announced. A November New York Times article laid out some of the concerns that consumer advocates have about the proposed mergers and featured comments from Cindy Zeldin, Georgians for a Healthy Future’s Executive Director. Our Health Policy Analyst Meredith Gonsahn is monitoring this important issue – be on the lookout for a policy brief in the new year that provides more detailed insights about the potential effects of these mergers. You can also learn more by visiting the Coalition to Protect Patient Choice.
Georgians for a Healthy Future hit the road again recently, this time to Savannah! Along with the Georgia Budget & Policy Institute and the Chatham County Safety Net Planning Council, we hosted Coverage and Access to Care: A Local Focus on Savannah. The event provided the opportunity to have a roundtable discussion about the health and health care needs of people in Georgia’s coastal region. We were joined by representatives from local hospitals, insurers, non-profit organizations, enrollment assisters, and interested Savannah residents for the gathering.
Guided by the chart book, the group had a dynamic discussion about how we could make Georgia’s Medicaid program work better for those who are already enrolled, as well as the benefits of expanding it to cover Georgians in the coverage gap. It was clear the attendees were eager to talk about improving coverage and access to care by closing Georgia’s coverage gap.
Our conversation also touched on the open enrollment period and the needs of consumers enrolling through the health insurance Marketplace (aka healthcare.gov). GHF highlighted our new toolkit and Health Insurance User’s Manual as tools to help Savannah-area consumers get enrolled, stay enrolled, and effectively use their coverage.
This roundtable event gave us the opportunity to learn from the Savannah stakeholders, meet new partners, and identify areas where we can work together to improve Georgia’s health care system. We look forward to returning to Savannah soon to build on this visit.
Dear Friends,
It’s an exciting time in health advocacy. The nation’s uninsured rate has plummeted over the past two years as Americans who were left out of our health system for too long have finally been invited in. Here in Georgia, half a million people gained coverage through the health insurance marketplace last year and we are working hard to raise awareness during this current open enrollment period.
But the pathway to coverage remains blocked for our lowest-income citizens here in Georgia because our state policymakers have not yet taken action to expand Medicaid. Approximately 300,000 Georgians are stuck in a coverage gap: they don’t qualify for Medicaid today and can’t access tax credits to buy private health insurance because their income is too low. Many of these Georgians are working in jobs that don’t come with health insurance. They are restaurant workers, child care workers, and even some veterans. They are our friends and neighbors, and we all suffer when they are left out.
Georgians for a Healthy Future is committed to making sure the voices of these Georgians are heard as public policy decisions are made that impact their lives. In the coming year, we plan to redouble our efforts to close the coverage gap in Georgia. This means we’ll be criss-crossing the state to talk to people who fall into the gap and to connect with community leaders, launching a digital advocacy campaign to mobilize the voices in support of closing this gap, and continuing to make the case directly to policymakers.
We need your help to do this. We need your partnership, your stories, and your voice. And on November 12th, Georgia Gives Day, we hope you will help support our campaign to close the coverage gap by choosing to give to Georgians for a Healthy Future.
You can donate here.
Your partner in advocacy,
Cindy Zeldin
Executive Director
Georgians for a Healthy Future
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