"These gaps really make it so that Georgians can't afford needed health care. If they receive health care, they're left with medical debt, or they have to make really tough…
We seem to be approaching cross-over day at the speed of light! Last week saw progress towards increasing provider directory transparency, Medicaid payment parity, ending surprise out-of-network billing, and even closing the coverage gap! Check out our updates below. If you’re looking for a complete list of all the bills we’re following, click here.
WHAT HAPPENED THIS WEEK
The Provider Directory Improvement Act (SB 302)
Last Thursday, the Provider Directory Improvement Act was passed unanimously out of the Senate Insurance and Labor committee. The bill now goes to the Rules Committee. We’re excited about the progress made and will keep you posted as the bill continues to move through the process. You can review our fact sheet on SB 302 and read our longer policy brief on the importance of accurate provider directories here.
Closing Georgia’s Coverage Gap
Last week, the Georgia Legislature held its first-ever hearing on closing the coverage gap. Closing the gap is the most important step our state policymakers can take to lower the number of uninsured, improve access to care, and stabilize the rural health infrastructure in our state. The hearing focused on discussion of SB 368, legislation introduced by Sen. Rhett to extend coverage to low-income, uninsured Georgians. While some pieces of the bill are problematic and the committee took no action, they started an important conversation. If you are interested in getting involved in the movement to close the gap, join our Georgia Health Action Network (GHAN) to receive updates on how you can help! If your organization supports closing the gap, please consider joining the Cover Georgia coalition to help amplify your voice.
Surprise Out-of-Network Billing
On February 16th, Sen. Unterman introduced SB 382, the Surprise Billing and Consumer Protection Act. This bill has been scheduled for a hearing today at 3:00 PM in the Senate Health and Human Services Committee. Addressing surprise out-of-network billing is an important issue for Georgia consumers, and the legislation is complex. Sen. Unterman has simultaneously also introduced SR 974, the Senate Surprise Billing Study Committee. Should SB 382 not move during this session, SR 974 provides legislators with the opportunity to study this important consumer issue during the off-session period.
Medicaid Payment Parity
The governor’s budget, introduced earlier this legislative session, maintained last year’s partial Medicaid payment parity. Full Medicaid parity would allow doctors to be reimbursed at the same rates for seeing Medicaid patients as Medicare patients. Last week, $26.5 million was added to the FY 2017 budget for this purpose. While this does not restore full parity, it is a significant step towards that goal. The FY 2017 budget has passed in the House and goes to the Senate for consideration.
Rep. Duncan’s HB 919 would provide up to $250 million in tax credits to individuals or corporations for contributions to rural health care organizations. This legislation has sparked a conversation about the ever worsening plight of our rural hospitals. However, state funding could be better utilized by helping those in rural communities get health insurance coverage, an approach which would also draw down considerable federal dollars (at least $9 in federal funding for every $1 of state funding). This would be much more effective in reducing the uncompensated care burden of rural hospitals, while also providing patients with the benefits of health coverage, something that HB 919 does not accomplish in its current form. Because of this session’s multiple bills that attempt to address Georgia’s uninsured population and health care infrastructure, we hope that lawmakers will take this opportunity to consider these issues in tandem through a study committee. This will allow all stakeholders to take part in an open conversation about how to best utilize state and federal dollars to save our rural hospital and provide quality health care to all Georgians.
In this week’s Consumer Health Advocacy Today, we sit down with Sen. Rhett to talk about his proposal to close the coverage gap. Here’s what he had to say.
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
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.
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.
Thank you for making Health Care Unscrambled 2016 a success! If you weren’t able to attend last week’s Health Care Unscrambled, don’t worry! We’ve pulled together the highlights.
Whether we are giving a dental care or a full mouth restoration, we use the best technology and tools in the industry. Our partner Martindale dental is committed to providing an exceptional level of customer service. Our dental team provides caring, comprehensive treatment with an emphasis on preventative dental care, and the use of products from sensitivity toothpaste to the teeth whitening kits used by denstists.
Health Care Unscrambled in the news
Pictures, videos, & more
Humidification is pretty standard these days. No, you don’t have to have humidification, but it makes CPAP Machineo much more comfortable to use warm and moist air than cool dry air.
Presentations and event materials
- Health Advocate’s Guide to the 2016 Legislative Session
- Health Care Unscrambled 2016 Program
- Fact Sheet – A Networking & Resource Center for Advocates Working for Better Value in Health Care: Health Care Value Hub
- Fact Sheet – A Framework for Thinking about Health Care Value Strategies
- Presentation – Sue Polis, Trust for America’s Health
- Presentation – Lynn Quincy, Consumers Union
Hemophilia of Georgia
Easter Seals Southern Georgia
Harry Heiman & Abby Friedman
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.