During the 2015 Legislative Session, the State Senate established the Consumer and Provider Protection Act Study Committee. This committee will review and make recommendations around several health insurance practices, including network adequacy. GHF has identified network adequacy, or the sufficiency of the health care providers patients can access when they enroll in a health insurance plan, as an important emerging consumer health issue. Our Executive Director, Cindy Zeldin, is a member of the study committee and looks forward to bringing the consumer perspective to the committee’s work. Cindy also recently appeared on WABE and Top Docs Radio to talk about network adequacy and participated in a panel discussion along with several state legislators at the Medical Association of Georgia’s Summer Legislative Education Seminar to discuss this important issue. Stay tuned for study committee agendas, updates, and opportunities to weigh in!

Study Committee Schedule:

September 14, 9:00 – 12:00

State Capitol, Room 450

October 26, 2:00 – 5:00

Tift Regional Healthy System, Tifton

November 9, 9:00 – 12:00

State Capitol

Did you know that thanks to the Affordable Care Act, you can receive certain preventive services at absolutely no cost? It’s true! One of the key requirements of the ACA is that insurance companies must cover recommended preventive services at no cost to the consumer – even if you haven’t met your deductible. These include services such as mammograms, annual physicals, colonoscopies, well-woman exams, cholesterol screenings, tobacco cessation, and many more. Click here for a full list of the preventive services that must be covered by all insurance companies. There is also an additional list of required services for women and a separate one for children. It’s important to take advantage of these no-cost preventive services to keep you and your family healthy. Evidence shows that preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they become complicated and debilitating conditions.

If you have any questions about your insurance, please contact our Consumer Education Specialist, Whitney Griggs by email or at 404-567-5016 x 5

Please join us on Wednesday, March 25, from 8:45 am to mid-day for a morning of advocacy!  GHF will provide individuals and organizations with the opportunity to advocate for the important health issues that matter to you in the closing days of this legislative session.  You may want to advocate for closing the coverage gap, Medicaid payment parity, raising the tobacco tax, the Family Care Act, rural health care access, or another health policy issue.  You’re all invited to participate!  We’ll provide breakfast, an advocacy training, and an opportunity to share and network with other health advocates.

To sign up, click here.  If you have any questions, please contact Laura Colbert.

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.

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.

The 2014 Georgia Legislative Session has ended. Thank you to so many of you for reaching out to your legislators during this past session to let them know that covering Georgia’s uninsured and improving access to health care for all Georgians are important priorities for you. Thank you to the dozens of committed advocates who joined us for Cover Georgia day at the Capitol, and thank you to the more than 8,000 of you who signed the Cover Georgia petition to express your support for the Medicaid expansion.

This was a disappointing legislative session for health care consumers. HB 990, which prohibits Medicaid expansion without prior legislative approval, and the portions of HB 707 (amended onto HB 943) that would prevent state entities from serving as health insurance navigators, prohibit the state from setting up a health insurance exchange, and limit the ability of state and local employees to advocate for the Medicaid expansion passed through the General Assembly. While some of the most harmful elements of HB 707 were removed before its final passage, this bill sends a horrible message to Georgia health care consumers who seek information about how to enroll in and utilize the new health insurance options available to them through the Affordable Care Act.

On the upside, hundreds of Georgians are enrolling each day in health insurance. At last count, more than 139,000 Georgians have enrolled in health care coverage through the Health Insurance Marketplace, and Georgians for a Healthy Future is actively working alongside our coalition partners to maximize enrollment leading up to the March 31^st deadline. And despite the setbacks of the 2014 Legislative Session, the Cover Georgia coalition will continue to advocate for covering our state’s uninsured, strengthening our state’s health care delivery system, and growing the economy by implementing the Medicaid expansion.

Thank you again for your continued support and advocacy!

Action Alert—Stop HB 707!

House Bill 707 would prohibit the state of Georgia from leveraging federal dollars to cover the uninsured and from providing consumer assistance to Georgians enrolling in health insurance. HB 707 was designed and promoted by the tea party to prevent hard-working Georgians from accessing health care, and it is in danger of becoming law in Georgia. We need your voice! Georgia citizens deserve better than to have the door slammed in their face when they seek out information about how to cover themselves and their family. Our state’s struggling hospitals and uninsured citizens deserve an honest policy discussion about Medicaid expansion, not a gag order on state and local employees. Call Lt. Governor Casey Cagle at 404-656-5030 and your state senator (locate your state senator here) and ask them to oppose HB 707.

House Bill 707 would:

1. Prohibit any state agency, department or political subdivision from using resources or spending funds to advocate for the expansion of Medicaid. This would stifle conversation and analysis about how to leverage federal dollars from covering the state’s uninsured.

2. Prohibit the state of Georgia from running an insurance exchange or accepting federal dollars related to an exchange. This broad language could stop quality local programs that provide assistance to vulnerable Georgians getting coverage through the exchange.

3. End the University of Georgia Health Navigator Program. Currently, the University of Georgia is providing enrollment assistance to consumers seeking out health insurance with federal grant money. HB 707 would prohibit UGA from sitting down with uninsured consumers and helping them enroll in a private health insurance plan.

4. Prohibit the Commissioner of Insurance from investigating or enforcing any alleged violation of federal health insurance requirements mandated by the Affordable Care Act. Under HB 707, if a consumer has been treated unfairly by their health insurance company, they may have no state recourse.

HB 707 has already passed the state House of Representatives and may be up for a vote in the State Senate early next week. We need your voice to prevent this harmful bill from becoming law!

Last week, health insurance premiums for the Marketplace were a hot topic, as Georgia’s Insurance Commissioner released some information about the rates that insurance companies proposed for the Marketplace. Georgians for a Healthy Future was frequently cited in media coverage of this issue, drawing attention to the fact that many consumers who were shut out of the market in the past would now be able to purchase insurance for the first time, with hefty tax credits that will make these plans affordable.

This issue was covered by the Atlanta Journal- Constitution, Georgia Health News, The Augusta Chronicle, and WSAV-Savannah. Articles featuring comments by Georgians for a Healthy Future’s Executive Director are available below.