More than a year after the state launched the Pathways to Coverage program, offering Medicaid in exchange for work or other state-approved activities, advocates say the program is too difficult…
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WEEK 4
The first month of session is behind us and there is still so much to do! We’re excited about the discussion and movement around provider directory transparency. If you’re interesting in receiving action alerts as important legislation moves through the legislative process and small advocacy actions you can take, join the Georgia Health Action Network(GHAN)!
To see a full list of bills we’re following, click here.
WHAT HAPPENED THIS WEEK
Improving Provider Directories
SB 302, the Improving Provider Directories Act, will be heard, and possibly voted on, in the Senate Insurance and Labor Committee this Thursday.
Please call or email the members of the committee to let them know that you support the Improving Provider Directories Act!
Sen. Charlie Bethel (Chairman) 404-651-7738
Sen. David Shafer (Vice Chairman) 404-656-0048
Sen. P.K. Martin (bill sponsor) 404-656-3933
Sen. Gail Davenport 404-463-5260
Sen. Marty Harbin 404-656-0078
Sen. Ed Harbison 404-656-0074
Sen. Burt Jones 404-656-0082
Sen. Joshua McKoon 404-463-3931
Sen. Renee Unterman (bill co-sponsor)
Sen. Larry Walker 404-656-0081
Network Adequacy
GHF supports updating Georgia’s network adequacy standards. We don’t expect to see legislation this year, but there are conversations happening in both chambers and in both parties. GHF will be advocating for a study committee to meet during 2016 so that the legislature will have enough information during the 2017 legislative session to debate the best standards for Georgia. To read more about network adequacy and why it matters to Georgia, check out our new policy brief.
Surprise Out-Of-Network Billing
In both the House and Senate we are still hearing strong interest in addressing surprise out-of-network billing. It is probable that we will soon see a bill that adresses this issue and we will keep you updated on any such developments.
Closing Georgia’s Coverage Gap
Rep. Stacey Abrams has sponsored HB 823, the Expand Medicaid Now Act. While we don’t expect this legislation to receive a hearing this year, it is sparking important conversations about the coverage gap in Georgia. Read more here.
If you want to get involved in the movement to close Georgia’s coverage gap you can share this video with your social network and sign this petition.
LET’S CHAT
This week we are highlighting in our Consumer Health Advocacy Today video series a conversation with Representative Debbie Buckner on her health priorities for the 2016 legislative session.
As consumers navigate the new landscape of increasingly narrow networks and high deductibles, they need the right tools and information to choose a health insurance plan that best fits their medical needs and their household budgets. Provider directories are the primary tool available to consumers to determine whether the plan they are selecting has a narrow or broad network and to identify which providers are in their plan. As such, these directories should be accurate, up-to-date, and should truly function as a tool. Despite the important role directories play, they are notorious for being rife with errors and for lacking the functionality to help consumers make optimal choices in the market. By drawing upon model legislation from the National Association of Insurance Commissioners (NAIC) and best practices from other states, Georgia can take steps to improve directories. This policy brief:
– explains the role provider directories play as a tool for consumer decision-making
– describes current provider directory provision in Georgia
– describes common problems with provider directories
– outlines recent policy activity around provider directories
– highlights other state examples of provider directory improvements
When consumers enroll in a health insurance plan, they gain access to a network of medical providers. This network must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. While network adequacy is not a new concept, it has a new urgency in light of the sheer number of newly insured Georgians enrolled in individual plans; the move on the part of insurance companies toward narrow networks and tiered networks, which limit the number of providers plan enrollees can access; new federal standards; and a new model act from the National Association of Insurance Commissioners (NAIC) that provides updated guidance for states. Georgia health care consumers need and deserve clear standards and protections that ensure their coverage translates to access to care without financial hardship. Georgians for a Healthy Future released today at a public policy form held in Atlanta a new policy brief on network adequacy. This policy brief:
– explains the importance of network adequacy for access to care
– outlines current network adequacy standards in Georgia
– summarizes recent policy activity around network adequacy
– sets forth consumer-oriented principles for network adequacy standards in Georgia
– provides policy recommendations to achieve network adequacy in Georgia.
Week 3
Week three was a very exciting one for Georgia health care consumers! The introduction of SB 302 signaled true movement on consumer priorities, like insurer provider directory transparency. Check below to see what happened and how you can get involved.
If you’re looking for a list of all the bills we’re tracking and their status in the legislature, click here.
What Happened This Week
Improving Provider Directories
We are very excited to share with you that last week Senator P.K. Martin (R-9th) introduced legislation to address provider directory inaccuracies and usability limitations. Senators Burke (R-11th), Watson (R-1st), Parent (D-42nd), and Unterman (R-45th) are also co-sponsors of SB 302. The bill has been assigned to the Senate Insurance Committee and we expect it will receive a hearing within the next week. Read SB 302.
Please join us in thanking Sen. Martin for introducing such an important piece of legislation! You can email him here or call him at 404-656-3933.
Rep. Stacey Abrams has sponsored HB 823, the Expand Medicaid Now Act. While we don’t expect this legislation to receive a hearing this year, it is sparking important conversations about the coverage gap in Georgia. Read more here.If you want to get involved in the movement to close Georgia’s coverage gap you can share this video with your social network and sign this petition.
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!
Georgians for a Healthy Future is excited to release our new enrollment toolkit! The toolkit is a comprehensive compilation of fact sheets, neatly organized, that are designed to walk consumers through each step of the enrollment process – from how to get health insurance (enrollment) to how to use health insurance once they have it (post enrollment). You can download it here.
Need more information like this? You’re in luck! GHF has created the GEAR Network for people just like you. GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners that are working with people to educate them on their health and health coverage options. We’ll send out weekly emails full of local resources and the information you need to know through OE3 and beyond. For more information on GEAR, check out this presentation.
At Georgians for a Healthy Future, we pride ourselves on strong partnerships. Over the past few years, we have been collaborating with Georgia Equality and the Health Initiative to ensure that the health care needs of LGBT Georgians are not neglected.
These partnerships brought Whitney Griggs, GHF’s Consumer Education Specialist, to Savannah on September 12th for the annual Savannah Pride Festival. Together with the Health Initiative, Whitney distributed information related to LGBT health care needs and spoke to festival attendees about how to enroll in health insurance. Of particular interest was our joint fact sheet with Georgia Equality on Transgender Health Care. Some of the festival attendees who picked up this fact sheet shared stories of having been denied coverage due to being trans-identified in the past, but who can now get coverage that meets their needs because of the Affordable Care Act. People that stopped by the table were also interested to learn that health care services must be provided regardless of gender identity or expression. This means that health insurance plans must cover transition-related care, as long as that care is covered for cisgendered people under on the same plan. So services such as hormone replacement therapy and gender-specific care (like mammograms and prostate exams) must be covered if they are covered for other people enrolled in the same plan.
Whitney also gave out some tips for trans-identified folks to keep in mind when enrolling in health insurance:
- On all enrollment forms, check the sex box that matches the sex you believe is on file with the Social Security Administration.
- Some important questions to ask include:
- Is hormone replacement therapy covered?
- Is my doctor included in the plan’s network?
- Is there a network of trans-friendly doctors and/or doctors who have training working with or currently serve trans clients?
- Are reconstructive surgeries covered?
All in all, it was great day in Savannah (despite the rain) and people learned a lot from GHF and the Health Initiative.
If you have a specific question about LGBT health care and health insurance, feel free to reach out to Whitney Griggs at wgriggs@healthyfuturega.org or the Health Initiative at (404) 688-2524
The pre-game to the 2016 Georgia legislative session kicked off with the convening of House and Senate study committees last week. Study committees meet during the off-session to take a deeper dive into specific policy issues that may arise when the session gets underway. Each committee will produce a report on its findings and recommendations by the end of the year and potentially introduce legislation during the 2016 session. Click here for a complete listing of House and Senate study committees.
GHF is following and participating in health-related study committees that directly impact consumers. Here’s what you need to know.
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 is to understand how the current insurance environment is affecting the stability of providers and consumers’ access to care. The committee consists of legislators and representatives from the provider, insurer, and consumer communities, including GHF’s Executive Director Cindy Zeldin as the consumer representative. The committee plans to examine the operations of rental networks, contractual issues between insurers and providers, and network adequacy.
The first meeting of this committee was held on September 14th at the State Capitol and focused on “rental networks,” also known as silent PPOs. The committee heard testimony from physician and insurer groups as well as from the Department of Insurance. Rental networks occur when third-party entities “rent out” physician-insurer negotiated rates to other payers. The second study committee meeting is scheduled for October 26th at Tift Regional Health System in Tifton and will focus on “all-products clauses” and provider stability issues. The committee will then be back at the State Capitol on November 9th for a meeting focusing on network adequacy and provider directories.
Georgians for a Healthy Future has identified network adequacy and the need for more accurate and user-friendly provider directories as important, emerging consumer issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all and other health care services an insurer guarantees to provide. GHF will present recommendations on meaningful standards to measure and ensure that provider networks are adequate, as well as how to design provider directories effectively for consumer use. If you are interested in providing testimony or input to this committee, please contact Senator Burke, the study committee chair. Please also let GHF know if these issues have emerged for communities or populations you serve so we can provide the strongest and most informed consumer voice we can on the committee.
Senate Study Committee on Youth Mental Health Substance Use Disorders (SR 487)
The first meeting of the Senate Study Committee on Youth Mental Health Substance Use Disorders convened last week at the State Capitol. The committee is charged with examining prevention strategies and identifying promising approaches to address youth Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD). The first meeting included overview presentations from representatives of the Department of Education, Department of Behavioral Health and Developmental Disabilities, and Georgia Council on Substance Abuse (GCSA). The next meeting on October 7th will focus on ADHD and the meeting following that, on October 22nd, will delve into substance use disorders. Georgians for a Healthy Future 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. We are teaming up with GCSA to host a lunch-time policy forum and discussion on this approach on October 22nd at the Loudermilk Center prior to the study committee’s meeting later that afternoon. Please save the date and we’ll send more details soon. If you are interested in testifying at the October 22nd study committee meeting to talk about prevention, please let Senator Unterman’s office know (you can also reach out to GHF and we can try to pass along your request).
Senate Study Committee on Women’s Adequate Healthcare (SR 560)
The Senate Study Committee on Women’s Adequate Healthcare met to discuss 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. The Department of Public Health, Department of Human Services and Georgia Obstetrical and Gynecology Society along with Dr. Daniel G. Becker and Dr. Scheinberg vaginal rejuvenation surgeon presented data and information on areas in which women’s health is in high risk and he being one of the top cosmetic surgeon make this data matters, although some women don’t like surgery and prefer to use other products as analbleachingblueprint.com/vaginal-lightening-cream for this, the policy options to move the needle in the right direction on major health indicators. The next meeting will be health on October 6, 2015, from 9am- 2pm, at Georgia Regents University in Augusta.
House Study Committee on School Based Health Centers (HR 640)
Committee members for the House Study Committee on School Based Health Centers met to explore 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. The committee heard from Voices for Georgia’s Children, the Partnership for Equity and Child Mental Health, and the Global Partnership for Telehealth on the details of the relationship between health and education outcomes. The committee tentatively scheduled the next meeting for September 29th and two additional meetings to follow.
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