Momentum builds to close Georgia’s coverage gap

The 2019 legislative session is now in full swing and the past few weeks have brought the introduction of two bills that would close Georgia’s coverage gap by expanding Medicaid.

HB 37: Expand Medicaid Now Act; enact and SB 36 are sponsored by Representative Bob Trammell and Senator Steve Henson respectively. Each bill expands Medicaid in Georgia as envisioned by the Affordable Care Act by increasing Medicaid eligibility for adults up to 138% of the federal poverty guidelines (FPL). This is equivalent to $17,236 annually for an individual and $29,435 for a family of three.

In addition, Governor Kemp has announced that his office will seek an 1115 Medicaid waiver. An 1115 waiver provides states with the ability to experiment with or tailor their Medicaid programs. Governor Kemp has not released details of the waiver, so its impact on consumers is uncertain. The waiver could close Georgia’s coverage gap, among other changes to Medicaid coverage. Legislation to allow Georgia’s Medicaid agency to seek an 1115 waiver is expected to be introduced soon by Senate Republicans.

Tell Governor Kemp and your legislators that you support putting a health insurance cards in the pockets of Georgians regardless of their income.

Consumer protection bills introduced

Surprise medical billing emerges as a prominent issue

Surprise out‑of‑network medical billing is once again emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Two pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way.

HB 84: Insurance; provide for consumer protections regarding health insurance
Rep. Richard Smith, Chair of the House Insurance Committee, introduced HB 84 to increase transparency related to possible surprise medical bills. This bill sets disclosure requirements for health care providers, insurers, and hospitals. The legislation requires that information on billing, reimbursement, and arbitration of services must be provided to the consumer at their request. The bill also allows for an arbitration process between the consumer and the health care provider, the specifics of which would be determined by Georgia’s Department of Insurance. This bill currently sits in the House Insurance Committee and is in House second readers.

SB 56: Consumer Coverage and Protection for Out-of-Network Medical Care Act
Senator Chuck Hufstetler, Chair of the Senate Finance Committee, introduced SB 56 to address surprise out-of-network billing. This legislation disallows surprise billing in emergency situations under insurance plans issued after July 1, 2019. The bill contains similar transparency provisions to HB 84. For consumers who receive elective medical care after which they receive a surprise bill greater than $1000, the legislation makes available a mediation process through the Department of Insurance. This bill was referred to the Senate Insurance and Labor Committee.

Legislative calendar set

Legislature plans to finish work by April 2nd

The schedule for the remainder of the legislative session has been set in HR 152. Crossover Day, the day that legislation must move from one chamber to the other in order to be considered in 2019, will fall on March 7th. The remaining sixteen legislative days will be broken up throughout March, culminating on Sine Die, the last day of the session, on April 2nd. The full calendar can be viewed here.

RSVP for Cover Georgia Day

Join us at the state Capitol on February 28th!

Join us on Thursday, February 28th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hardworking Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it? Call or send an email to your state legislators asking them to put an insurance card in the pockets of all Georgians.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation

General Assembly meets for joint budget hearings

Last week the Georgia General Assembly met for the joint budget hearings during which Senate and House legislators heard from agency leaders and Governor Brian Kemp about the proposed current and upcoming state budgets. This year’s budgetary considerations consist of requested changes to the current FY 2019 state budget which will run through June 30th and proposals for the FY 2020 general state budget, which will begin on July 1st.

The House will now craft the budget requests into legislation and continue its funding considerations. Both chambers reconvened yesterday, January 28th, for the fifth day of legislative session.

2019 joint session budget hearings

Budget requests presented to the General Assembly

Last week, the General Assembly heard from department commissioners and other leaders regarding their budget requests for the amended FY 2019 budget (sometimes called the “little budget”) and the upcoming FY 2020 budget (called the “big budget”). Here we highlight some of the primary asks made by the state agencies that most impact consumer health. For more detailed budget analysis, please see the Georgia Budget and Policy Institute’s Overview of Georgia’s 2020 Fiscal Year Budget document.

Department of Community Health 

The Department of Community Health (DCH) oversees Medicaid, PeachCare, and other state health care programs. Commissioner Berry requested an increase of $71 million in the amended FY 2019 budget to include $33.7 million for growth in Medicaid expense and $18.7 million for the Indigent Care Trust Fund, which draws down additional federal money for Disproportionate Share Hospital payments.

Commissioner Berry’s most significant request in the FY 2020 budget was an increase of $92 million to offset a reduction in the federal cost-sharing payments for Medicaid and PeachCare for Kids. Georgia’s Federal Medical Assistance Percentage (FMAP) rate will drop from 67.62% to 67.30% for Medicaid and from 100% to 88.61% for PeachCare for Kids, prompting the funding request.

Department of Behavioral Health and Developmental Disabilities 

The Department of Behavioral Health and Developmental Disabilities (DBHDD) provides treatment, support services, and assistance to Georgians with disabilities, behavioral health challenges, and substance use disorders. Commissioner Fitzgerald’s request for the little budget mirrored the Governor’s recommendations to add $8.4 million for the Georgia Apex Program to provide support counselors for mental health services in high schools.

Commissioner Fitzgerald requested that the big budget include an increase of $78.6 million for the Department. The additional funds would be partially compromised of an additional $10.2 million for behavioral health crisis beds, $2.5 million for supported housing, and 125 new slots for NOW and COMP waivers to reduce the current waiting list.

Department of Human Services

The Department of Human Services (DHS) delivers a wide range of human services designed to promote self-sufficiency, safety and well-being for all Georgians. Commissioner Crittenden requested that the big budget include $849,951 to increase funds for 50 additional Medicaid eligibility caseworkers.

The Department of Public Health did not present during the joint budget hearings last week and the Department of Insurance did not have any budgetary requests that were specifically health related. We will include summaries from both departments as we learn more.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• Look out for the 2019 Consumer Health Advocates Guide coming soon!

Georgians for a Healthy Future released its 2019 policy priorities at this morning’s ninth annual Health Care Unscrambled legislative breakfast. These annual priorities outline the issues that GHF believes are most pressing for Georgia consumers and are best addressed by the state legislature. GHF will work to move all of these issues forward by engaging state policy makers, consumers, and coalition partners throughout the legislative session and the remainder of the year.

1. Increase the number of Georgians with health insurance.

Georgia’s uninsured rate hit a historic low of 12.9% in 2016, but remains one of the highest uninsured rates in the country because Georgia has not accepted federal funds to cover low-income Georgians. Approximately 240,000 Georgians remain stuck in the resulting coverage gap. These Georgians do not qualify for Medicaid under current rules and do not earn enough money to qualify for financial help through the Marketplace. Georgians for a Healthy Future supports closing this gap by extending health insurance to all Georgians with incomes up to 138 percent of the federal poverty level.

2. Stabilize Georgia’s health insurance Marketplace

Almost half a million Georgians are enrolled in health care coverage through the health insurance Marketplace. While Georgia’s Marketplace has proven robust, the last two years have brought declines in enrollments, as federal policy changes have undercut its stability. Other states have taken steps to shore up their markets by implementing state reinsurance programs, instituting state-level consumer protections and enforcement mechanisms, limiting the sale of short-term junk plans, and investing in outreach & enrollment. Georgians for a Healthy Future supports policies that promote affordable, comprehensive coverage and a competitive, stable Marketplace.

3. Ensure access to care and financial protections for consumers purchasing private health insurance.

When consumers enroll in a health insurance plan, they should have reasonable access to all covered services in the plan. As narrow provider networks become more common, health care consumers are at increased risk of not being able to access the medical services and providers they need without going out-of-network and receiving surprise out-of-network medical bills. In 2015, the National Association of Insurance Commissioners adopted a network adequacy model act for states. Georgians for a Healthy Future supports using this act as a foundation to develop quantitative standards for Georgia. Georgians for a Healthy Future further supports legislation that will hold consumers harmless when consumers end up with out-of-network bills despite making appropriate efforts to stay in network or because inadequate provider networks require them to go out of network to receive the services that they need.

4. Set and enforce standards that provide for equitable coverage of mental health and substance use treatment services by health plans.

The 2008 passage of the Mental Health Parity and Addiction Equity Act (Parity Act) required that health plans cover behavioral health services as they would physical health services. The Parity Act is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and there is appropriate oversight. GHF supports legislation that sets standards and oversight procedures to ensure that Georgia consumers receive the coverage for mental health and substance use disorder benefits to which they are entitled by law and for which they have paid.

5. Prevent nicotine use and addiction by young Georgians

Georgia has one of the lowest tobacco taxes in the country at just 37 cents per pack, which makes tobacco much more accessible to youth in Georgia than in many other states. Moreover, Georgia does not apply an excise tax on the nicotine-delivery devices (e.g. e-cigarettes, vaping pens) that are preferred by young people today. For price-sensitive young people, increasing the price of tobacco and nicotine products decreases use and addiction, and the burden of chronic disease in Georgia. Georgians for a Healthy Future supports legislation to increase Georgia’s tobacco tax by at least $1 and to add an equitable excise tax on all nicotine delivery devices.

6. Support partners in integrating health and equity in the policies across every sector to address social determinants of health that prevent equitable access to care and equitable health status.

Factors outside the health system such as adequate housing, education, and economic opportunity impact the health of individuals, families, and communities. Left unaddressed, these and other complicating factors can inhibit the effectiveness of approaches that are strictly within the health system. Georgians for a Healthy Future supports policies that aim to advance health and health equity by addressing the social determinants of health.

To download GHF’s 2019 policy priorities, click here.

Early voting is underway ahead of the upcoming November 6th Election Day. Georgians across the state are heading to the polls to cast their votes for Governor, Insurance Commissioner, state legislators and other elected positions, and voters’ decisions about the candidates in each race will have a critical impact on consumers health issues in Georgia.

All of Georgia’s state legislative seats are on the ballot this fall and a record number of seats are being competitively contested. The resulting changes in the General Assembly could have a big impact on the future of health and health care for Georgia consumers.

Georgia’s General Assembly is made up of two chambers: the House of Representatives and the Senate. Georgia has one of the largest state legislatures in the nation with a total of 236 members, made up of 56 Senators and 180 Representatives. Every Georgia resident has one Georgia Senator and one Georgia House member, both of whom are up for re-election every two years.

Constitutionally, the General Assembly is only responsible for proposing and passing an annual state budget; however, during the body’s annual 40-day session, legislators also propose, debate, and pass laws for the state of Georgia, including those that regulate health care, health coverage, or that impact health through another sector (like education or transportation).  

All appropriations bills, which designate how state funds are to be spent, must originate in the House. Health care is the state’s second largest expenditure and made up almost 20% of this year’s annual budget. Each year, after the Governor proposes a state budget, the legislative leaders of the House turn the proposed budget into a bill for consideration by the House’s appropriations committee and then by the full chamber. When the House has approved the budget, the budget goes through the same process in the Senate. Once approved by both chambers, any differences are worked out in a conference committee, before sending the budget back to the Governor to be approved or vetoed.

The decisions made during the General Assembly’s budget considerations can have a big impact on health care and coverage for Georgians. For example, the General Assembly has over the last three years approved pay increases for primary care and OB-GYN doctors and dentists treating Medicaid patients, which improves access to care for the almost 2 million Georgians who rely on Medicaid for health coverage.

Members of the General Assembly may also propose laws to address issues of concern for their constituents. These issues can range from surprise out-of-network medical billing to the opioid crisis to Medicaid expansion to Georgia’s health insurance Marketplace. Many legislators receive ideas for legislation from concerns and complaints brought to them by their constituents (an important reason to get to know your legislators!).

Each year, hundreds of bills are proposed and only a fraction successfully pass both chambers. Health-related bills typically pass through the Health & Human Services and Insurance Committees in each chamber. Legislators can consider bills until Sine Die, the 40th and last day of the legislative session. When approved by both chambers, successful legislation goes to the Governor for approval or veto.

One of the most impactful pieces of health-related legislation passed by the state legislature in recent years is HB 990 (2014), which requires the General Assembly to approve any expansion of Medicaid. This bill effectively revoked the Governor’s ability to act independently to close Georgia’s coverage gap, making it more difficult to expand health coverage to low-income adults in Georgia. 

Georgia’s General Assembly will have many new faces after the upcoming election, each of whom will play a role in shaping the state’s health care landscape over the next two years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blogs in the series:

• Eight questions for health care voters to ask Georgia candidates
• A consumer health advocates guide to the 2018 elections: Georgia’s Governor

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Early voting began last week ahead of the upcoming November 6^th Election Day. Georgians across the state are heading to the polls to cast their votes for Governor, Insurance Commissioner, state legislators and other elected positions, and voters’ decisions about the candidates in each race will have a critical impact on consumers health issues in Georgia.

One of the most visible positions on the ballot and one that plays a meaningful role in health care policy for the state is Georgia’s Governor. The Governor heads the state’s executive branch, which is broadly responsible for implementing, supporting, and enforcing Georgia’s laws.

As head of the executive branch, the Governor has the authority to appoint and provide direction to the leaders of most of Georgia’s executive branch departments, including the Commissioners of the Departments of Community Health (the state’s Medicaid agency), Public Health, Behavioral Health and Developmental Disabilities, and Family and Children Services. Because most health-related programs in the state are run by one of these agencies, the ability to appoint department leadership provides the Governor with outsized influence on the direction, priorities, and initiatives within each.

Ahead of the state legislative session, the Governor has the added responsibility of proposing an annual state budget for the General Assembly’s consideration. Health care is regularly the state’s second largest expenditure, making up almost 20% of the annual budget. Aside from expected items like Medicaid expenditures, the Governor may propose special investments that promote his/her health-related priorities. For example, Georgia’s FY19 budget includes an additional $21.4 million to improve and expand children’s behavioral health services as recommended to Governor Deal by his Commission on Children’s Mental Health. Once the legislature has considered and passed a budget, the Governor has the power to veto or approve the spending plan.

At the end of each year’s legislative session, the Governor has 40 days to approve or veto (“veto” means “to reject”) legislation. Most laws passed by the General Assembly are approved but a few each year are rejected by the Governor because they are ill-informed, controversial, or contrary to the Governor’s priorities. In recent years, Governor Deal has vetoed some health-related laws like SB 357 in 2018, which would have established a Health Care Coordination and Innovation Council.

Once a bill is approved, the Governor may direct the executive branch agencies about how the law should be carried out. For example, if the Georgia General Assembly approves future legislation to expand Medicaid in Georgia, the Governor may provide the Commissioner of Community Health with instructions about how the expansion should be implemented, including program elements that make it easier or harder for people to enroll in or use their new coverage.

Georgia’s next Governor will have a significant role in shaping the state’s health care landscape over the next four years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blog, Eight questions for health care voters to ask Georgia candidates, where you can find a list of questions to help health care voters get to know the candidates on their ballots.

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Linda Smith Lowe Health Advocacy Award: Sylvia Caley

Community Impact Award: CaringWorks

Powerhouse Policymaker Award: Commissioner Frank Berry

Power House Policymaker Award: Representative Bob Trammel

Sylvia Caley, JD, MBA, RN recently retired as a clinical professor at Georgia State University College of Law teaching law students and other professional graduate students enrolled in the HeLP Legal Services Clinic. In addition, she teaches Health Legislation and Advocacy, a year-long course in which law students work with community partners to address health-related legislative and regulatory issues affecting the community. She was an adjunct clinical assistant professor at Morehouse School of Medicine, Department of Pediatrics. She is the director of the Health Law Partnership (HeLP), an interdisciplinary community collaboration among Children’s Healthcare of Atlanta, the Atlanta Legal Aid Society, and the College of Law. She is a member of the Ethics Committees at Grady Health System and Children’s Healthcare of Atlanta and also is a member of the Public Policy Committee at Children’s. She also is a member of the Advisory Committee on Organ Transplantation, U. S. Department of Health & Human Services. Her research interests focus on using interdisciplinary and holistic approaches to address the socio-economic and environmental issues affecting the health and well-being of children, specifically the lives of low-income, chronically ill, and disabled children. For her years of service and leadership in Georgia, we are proud to honor Sylvia with the Linda Smith Lowe Health Advocacy Award.

CaringWorks, Inc. was founded in 2002 with a mission to reduce homelessness and empower the marginalized by providing access to housing and services that foster dignity, self-sufficiency and well-being. It was built on the single idea that every citizen, no matter their social or economic standing, should have the chance to improve their quality of life. CaringWorks specializes in providing housing, mental health services, substance use disorder treatment, and an array of related social supports to individuals and families who are experiencing homelessness.

In the 15 years since it’s founding, CaringWorks has grown into one of the largest supportive housing providers in the greater Atlanta area. In 2018, the agency will impact over 900 extremely low-income men, women and children who are facing homelessness, over 90% of whom are expected to achieve permanent, sustainable housing. It collaborates with partners throughout the city of Atlanta, Fulton, DeKalb, Rockdale, Henry and Newton counties to serve the individuals considered to be the most vulnerable and at-risk of injury, illness, or death. For their service, commitment, and impact, we are proud to honor CaringWorks with the Community Impact Award.

Frank W. Berry is the Commissioner for the Georgia Department of Community Health (DCH). In this role, he leads the $14 billion agency responsible for health care purchasing, planning and regulation, and improving the health outcomes of Georgians. The agency administers Georgia Medicaid and the State Health Benefit Plan (SHBP), and provides access to health care coverage for approximately one in four Georgians. In addition to Medicaid and SHBP, he also oversees Healthcare Facility Regulation Division, Office of Health Planning (which implements the Certificate of Need program), and the State Office of Rural Health.

Prior to joining DCH, Berry served as the Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities for four and a half years, and has more than 30 years of public service experience. He was previously the Chief Executive Officer of View Point Health Community Service Board. Berry serves as the Chairman for the ABLE Board and is a member of the First Lady’s Children’s Cabinet. Commissioner Berry has demonstrated his dedication to bettering health care in Georgia we are proud to recognize him as a 2018 Powerhouse Policymaker.

Bob Trammell practices law at the Trammell Firm, which he founded in Luthersville, Georgia in 2003. He is truly a son of the 132^nd district; his law office is located in the former home of his grandparents. Bob started his legal career as a law clerk in the United States District Court for the Northern District of Georgia. He subsequently practiced law at King and Spalding before returning home to start his own firm. Since 2011, Bob has served as the county attorney for Meriwether County. He is also a member of the Meriwether County Chamber of Commerce and the Meriwether County Bar Association.

Education has always been a priority for Bob, particularly because both of his parents are retired educators. Bob is a 1996 summa cum laude graduate of the University of Georgia, where he was a Foundation Fellow majoring in English and Political Science. He obtained his law degree from the University of Virginia School of Law in Charlottesville, Virginia in 1999. Bob believes strongly that education is essential to preparing Georgia’s workforce for the jobs of today and the jobs of the future. Investment in science, technology, engineering, and math programs is the key to creating job opportunities for all Georgians.

Bob and his wife Jenny reside in Luthersville where they are busy raising daughters Mary, three years old, and Virginia, who will be two in September. Jenny, a graduate of the University of Georgia, works as a pharmacist with CVS-Caremark in LaGrange. Bob and Jenny can think of no other place that they would want to raise their family. Bob believes in making Georgia the best place to work, learn, and live for not only his family, but for all Georgians.  For his steadfast commitment to improving the lives of all Georgians, we are honored to recognize him as a 2018 Powerhouse Policymaker.

We hope you’ll join us tomorrow, on September 6th as we recognize our amazing awardees! RSVP

Legislative session is more than half-way complete

The state legislative session is more than half-way over already and the General Assembly has been working diligently to complete its constitutional responsibility to pass a state budget. Thus far the House and Senate have passed their versions of the amended FY2018 budget and are working to come to consensus on a final version. The House is still considering the FY2019 budget. Other bills prioritized by legislative leaders have made their way through the legislative process and await the Governor’s signature.

Action under the Gold Dome

GHF supports legislation that provides important consumer protections within private insurance

The first half of the legislative session has been punctuated by the introduction of many bills that would impact health care and coverage for Georgia consumers. Several of these bills stand out as they align with GHF’s policy priority of facilitating greater access to care and ensuring financial protections for consumers purchasing private insurance. For these reasons, GHF is actively supporting the following bills:

• SB 359–legislation to address surprise out-of-medical billing through improved disclosure, clarification of responsibilities in out-of-network emergency situations, and the opportunity for mediation when a consumer receives a surprise bill. (For more, see our February 5th legislative update.)
• HB 872–would allow consumers to receive services from their preferred provider at an in-network rate for the entire coverage year, if the insurer advertises the provider as being in-network at the time a consumer enrolls in a health insurance plan
• HB 873–would simplify the prior authorization process for providers and patients seeking access to restricted or expensive health services or medications and would clarify and improve the information that insurers must provide to consumers about their prescription drug coverage (Re-visit last week’s legislative update for more information about HB 872 and 873.)

Rural health care bill moves forward

One of the legislature’s biggest efforts in 2017 was the work of the House Rural Development Council which, among other things, studied barriers to health care and possible solutions in Georgia’s rural communities. The result of their studies is HB 769 which creates a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The Center would be responsible for collecting data from the health-focused state agencies and analyzing it for planning purposes, similar to the Health System Innovation Center proposed within SB 357.  The bill would also make some changes to the state’s certificate of need program to make allowances for “micro-hospitals”, provides for an insurance premium assistance program for rural physicians, and increases the rural hospital tax credit to 100% of the donation.

The House Health and Human Services Committee approved HB 769 last week and it must be advanced by the House Rules Committee for consideration by the full chamber.

Surprise billing legislation gets more attention

All three bills introduced to address surprise out of network medical billing will receive the attention of the General Assembly this session. HB 678 was passed by the House last Monday and has been referred to the Senate Health & Human Services (HHS) Committee for its consideration. That committee plans to take up another piece of surprise billing legislation–SB 359, which provides the most comprehensive protections to consumers of the three bills–in its hearing today. HB 799, a bill that primarily addresses out of network care in emergency situations, is similarly scheduled for a hearing today by the House Insurance Committee.

Stay up-to-date with the legislative session

As the activity in the General Assembly picks up speed in the second half of this year’s session, it can be hard to keep up. We have the tools you need to stay in touch with health policy under the Gold Dome.

• Updated for 2018: GHF’s annual Consumer Health Advocate’s Guide
• Sign up for the Georgia Health Action Network (GHAN) emails–action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• Follow GHF on Twitter and Facebook at @healthyfuturega

Surprise medical billing emerges as prominent issue at the Capitol 

Surprise out-of-network medical billing is emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Three pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way. In this week’s legislative update, we will provide a broad look at each bill and its provisions. (If you would like more information about any of the bills, click on the provided links to read the full legislation.) All three bills seek to protect patients, and we will monitor and weigh in on the bills as they undergo the inevitable amendment process in committee. We appreciate all of the bill sponsors for remaining vigilant towards protecting patients from unexpected medical bills.

HB 678: Increased network and billing transparency by health care providers and insurers 

HB 678 is sponsored by Rep. Richard Smith, chairman of the House Insurance Committee, and has the backing of several powerful House lawmakers. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and practices and by insurers. Providers must inform consumers about their participation in the patient’s insurance network and about how to check the network status of other providers with which the primary provider has coordinated services (e.g. laboratory or radiology services). It also requires insurers to provide consumers with information about when and how to receive approval for services from an out of network provider. Insurers must also communicate to a consumer ahead of a planned procedure if the provider is out of network (OON), and if so, the estimated amount the insurer will cover for the OON services. Lastly, HB 678 provides consumers with 90 days from the time of receiving a medical bill to pay the bill, negotiate payment or initiate arbitration through the Georgia Department of Insurance. After that time period, providers would be allowed to initiate collection proceedings to secure their payment.

HB 799: Out of network care in emergency situations

While HB 678 applies only to non-emergency situations, HB 799 applies solely to emergency care and medically necessary follow-up care. The legislation, sponsored by Rep. Sharon Cooper, Chairperson of the House Health & Human Services Committee, disallows managed care plans from denying payment for emergency services and disallows hospitals from billing patients for medically necessary care following an emergency situation except for their standard co-pays, co-insurance, and deductibles. For a patient receiving emergency care at an OON hospital and who is covered by a plan that requires prior authorization for post-stabilization care, the legislation outlines how the OON hospital and insurer must coordinate the patient’s transfer to an in-network facility and defines which entities are responsible for specific costs. Under this bill, if a patient (or their representative) does not consent to be transferred to an in-network hospital, the OON hospital must provide verbal notice to the patient that they may be financially responsible for any further post-stabilization care provided.

SB 359: Consumer Coverage & Out of Network Medical Care Act

SB 359 is the only Senate-side legislation introduced thus far to address surprise out-of-network billing and is sponsored by Senator Chuck Hufstetler, Chairman of the Senate Finance and member of HHS committees. The legislation contains many of the same transparency provisions for non-emergency care as HB 678 with regard to information that health care providers and hospitals must supply to consumers, but provides for more robust disclosure by insurers to consumers about possible OON costs. It also contains provisions similar to that of HB 799 with respect to emergency situations, but goes farther to stipulate that insurers must treat OON emergency care as if it were in-network by applying a consumer’s cost-sharing towards their in-network deductible and out-of-pocket maximum. The legislation also makes mediation available to consumers who receive elective medical care during which an unexpected event arises resulting in surprise bill greater than $1000. SB 359 is expected to be more controversial than the other two bills because it sets a payment resolution process that sank previous legislative attempts.

RSVP today for Cover Georgia Day at the Capitol!

Join us next Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it? Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.

Legislation prioritized by Senate leaders approved by HHS Committee

At Thursday’s Senate Health & Human Services Committee, the two pieces of legislation resulting from the Health Care Reform Task Force were considered. Both SB 357 and SB 352 received strong support from legislators and stakeholders. GHF’s partners at the Georgia Council on Substance Abuse and Mental Health America of Georgia rose in support of SB 352, which would create a 15-member Commission on Substance Abuse & Recovery supported by a director. Both bills were passed by unanimous voice votes. You can find a description of both bills in last week’s legislative update blog.

New legislation would establish proposed Health Coordination and Innovation Council

Last week, the first legislation to result from the Lieutenant Governor’s Health Care Reform Task Force was introduced. SB 357, sponsored by Senator Dean Burke, would establish the Health Coordination and Innovation Council, the Health System Innovation Center, and an advisory board to the Council.

Health Coordination & Innovation Council

According to the Task Force’s final report, the Health Coordination and Innovation Council (aka “the Council”) will act as a permanent statewide coordinating platform, bringing together all of health care’s major stakeholders. As the legislation is currently written the Council will be made up of 13 members including the director of health policy & strategic planning, the Commissioners of the Departments of Community Health, Public Health, Human Services, and Behavioral Health and Developmental Disabilities, and eight members to be appointed by the Governor representing Georgia’s medical schools and academia and private health care sector. A consumer representative is not explicitly written into the bill text at this time.

Health System Innovation Center

The Health System Innovation Center is proposed as a research organization that utilizes academic, public health policy, data, and workforce resources to develop new approaches for financing and delivering health care in Georgia. The structure of the Center is not outlined in the legislation, but it is clear that its initial charge will be to synthesize existing studies and data to inform a strategic plan to improve access to health care in rural Georgia. The Center’s work will inform the Council.

We expect more legislation and proposals may emerge from the Health Care Reform Task Force in the coming days. As these proposals emerge, we will continue to keep you updated.

Legislation establishes Commission on Substance Abuse & Recovery

Senator Renee Unterman continues to spearhead efforts to address the opioid and substance use crisis in Georgia and last week, she introduced SB 352 which, among other things, establishes a Commission on Substance Abuse & Recovery. The Commission is to be headed by the director of Substance Abuse & Recovery and will serve as chair of the 15-member commission, including two representatives from the advocacy community. The Commission is charged with coordinating data among relevant government entities; informing strategies to combat the opioid crisis within the Departments of Public Health and Education, the Attorney General’s Office, and other state entities; consulting with the Governor’s office on a potential Medicaid waiver related to opioid abuse; and developing and informing other efforts to expand access to prevention, treatment, and recovery support services across the state.

Come to the state Capitol on February 15th!

Join us on Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it? Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.

House continues to consider state budget bills

The Georgia House of Representatives continues its consideration of both the “little” and “big” budgets this week. HB 683, the FY2018 supplementary budget (also called the “little budget”), makes necessary, mid-year adjustments to the current state budget. The Governor’s proposed amended FY2018 budget provides an extra $5 million to the Georgia Trauma Care Network Commission from increased Super Speeder collections, but includes few other health care-related changes. The House Appropriations Committee and its subcommittees spent much of last week in budget hearings regarding the FY 2019 budget. The House’s consideration of the “big budget” will accelerate when they pass the FY2018 supplementary budget to the Senate for its consideration

The Legislature plans to finish work by March 29th

The schedule for the remainder of the legislative session has been set. Crossover Day, the day that legislation must move from one chamber to the other in order to be considered in 2018, will fall on February 28. The legislature will be in session Monday through Thursday each week until Crossover Day. The remaining 12 legislative days will be broken up throughout March, culminating on Sine Die, the last day of the session, on March 29th. The full calendar can be accessed here.