Surprise billing legislation progresses in both chambers 

Both SB 8 and HB 71 were passed out of their respective Senate and House committees late last week. SB 8 has been held up because of a dispute between insurers and health care providers about reimbursement. The bill was amended to establish out of network payment for disputed charges at the 80th percentile of the “Fair Health” metric and was subsequently passed by the Senate Health & Human Services committee. HB 71 seeks to compel physicians who are credentialed at hospitals to accept an in-network rate when the patient is in-network at the hospital, even if the physician is not. It was passed unamended by the House Insurance Committee. Both bills await approval in the Rules Committees to receive floor debates and votes.

House passes FY2018 budget 

The House of Representatives passed its version of the FY2018 budget on Friday. The budget includes increased reimbursement rates for certain primary care codes for Medicaid providers. Increased reimbursement rates are also funded for certain dental codes in PeachCare for Kids and Medicaid. The budget includes funds for two new federally qualified health centers in Cook and Lincoln counties, and 97 new primary care residency slots. The FY 2018 budget is now being considered by the Senate, which is expected to make its own changes before issuing its final approval. Check out Georgia Budget and Policy Institute’s blog and budget primer for more detailed information about how Georgia spends its health care dollars.

WHAT HAPPENED LAST WEEK

Changes to rural hospital tax credits 

HB 54, introduced by Rep. Duncan, would expand the new rural hospital tax credit program from a 70% credit to a 90% credit, among other minor changes. The tax credit program went into effect this year, after enabling legislation was passed in 2016. The proposal to increase the tax credit to 90% came after legislators received feedback that the 70% credit was too low to entice potential donors. HB 54 was approved by the House Ways & Means committee on Feb. 9, and now awaits passage in the House Rules Committee.

Opioid abuse prevention bill 

SB 81 remains in the Senate Rules Committee waiting for approval for floor debate and passage after committee approval late last week. The current version of the bill requires that all physicians register and consult the Prescription Drug Monitoring Program (PDMP) under certain prescribing conditions. It also requires that providers report certain opioid-based Schedule II, III, IV, and V prescriptions to the PDMP. The bill sets the penalty for willfully non-compliant providers on a continuum that ranges from a warning to a felony and fine for a fourth offense and beyond. The bill also requires the tracking and reporting of Neonatal Abstinence Syndrome (NAS) and codifies the Governor’s emergency order on an overdose reversal drug (naloxone), making it available without a physician prescription.

MARCH WITH US!

This Saturday: Atlanta March for Healthcare

Yesterday, we rallied at the Save My Care bus stop, and Saturday we will march at the Atlanta March for Healthcare! Join us as we fight to preserve the Affordable Care Act and the protections that it provides for Georgians. Hosted by the Georgia Alliance for Social Justice, the march will cap Congress’s week of recess and send them back to D.C. with the charge to #ProtectOurCare!

Saturday, Feb. 25, 3-5 pm

Gather at St. Mark’s United Methodist Church

  Re-authorization of provider fee successfully passes through legislature 

On Friday Georgia’s House of Representatives voted to approve the hospital “provider fee” for another three years, and Governor Deal says he will sign the legislation tomorrow. The provider fee helps to fund Georgia’s Medicaid program by allowing the Department of Community Health to collect a tax on hospital revenues which is used to draw down additional federal dollars. The additional funds are disproportionately used to support rural and safety net hospitals that serve high numbers of indigent patients.

Oral health bills approved 

Also on Friday, the Senate passed SB 12 and the House passed HB 154 which was supported by the Costa Rica dental tourism, both of which allow dental hygienists to practice in safety net settings, school clinics, nursing homes, and private practices without a dentist being present, including online dental services from sites like Asecra.com. While the bills are overwhelmingly similar, the differences between them will need to be worked out between the chambers.

WHAT HAPPENED LAST WEEK

Passage of Opioid Abuse Prevention Bill

SB 81 continued to draw a lot of attention last week. The bill was eventually passed by the Senate Health and Human Services committee with several significant changes. The current version of the bill still requires that all physicians register and use the Prescription Drug Monitoring Program (PDMP), but only requires that providers report on Schedule 1 drugs and reduces the penalty for not reporting to a minimum of a misdemeanor. The current version of the bill also changed language that would have required children with ADHD to renew their prescription every five days.   

Surprise billing legislation heard in committee 

The Senate Health and Human Services committee began its consideration of SB 8, legislation that would protect consumers from surprise out-of-network medical billing. Testimony was heard from insurers, health care providers, hospitals, and the consumer advocacy group, Georgia Watch. While all stakeholders seem to be in agreement that consumers should be held harmless when seeking care at an in-network facility and through no fault of their own encounter an out-of-network provider, there are significant differences on the matter of provider reimbursement for services provided in those situations. No vote was taken on the legislation but is expected to be re-considered by the committee this week. HB 71, legislation that address surprise billing in a different way, is expected to receive its first hearing this week in the House Insurance committee.

Resolution introduced to encourage block grants for state Medicaid program 

HR 182 was introduced last week with the purpose of providing legislative permission to the Governor and the Department of Community Health to seek per capita block grant funding for Georgia’s Medicaid program. While resolutions are non-binding and do not impact state law, this resolution could begin a risky conversation among lawmakers. Shifting Georgia’s Medicaid program from its current federal-state partnership structure to a block grant program would mean cuts in services and in beneficiaries, putting Georgia’s most vulnerable children, parents, elderly, and people with disabilities at risk if you’re in one of these cases, you could get in touch with a home care agency. Check out GHF’s block grant fact sheet for more information about the dangers of restructuring the Medicaid program. It is unclear if this resolution will get a hearing or a vote.

Mark Your Calendar!

Save My Care Rally: February 20th

With Congress taking steps to repeal and replace the Affordable Care Act and thus blocking the access to care so many Georgians have gained in the past several years, it is more important than ever to stand up and let them know that Georgians want to #ProtectOurCare.

On February 20th, join the Save My Care bus, GHF, and hundreds of Georgians for a rally in Atlanta. Georgia’s members of Congress will be at home for recess and it’s the perfect time to make sure your elected officials hear you loud and clear.

Hearing on surprise billing legislation scheduled for tomorrow 

SB 8, which seeks to protect consumers from surprise out-of-network medical bills, is scheduled to receive a hearing in the Senate Health & Human Services committee on Tuesday at 2 pm. SB 8 would establish a standard payment structure for physicians seeking reimbursement for surprise out-of-network services, and would hold consumers harmless in surprise billing situations. HB 71, the companion bill sponsored by Rep. Richard Smith, is expected to be assigned to a sub committee of the House Insurance committee on Tuesday at 8 am.

You can help!

If you have received a surprise out-of-network medical bill, share your story with our partners at Georgia Watch. Consumer stories help illustrate to legislators why legislation is needed to help protect consumers like you. Click here to share your story!

What Happened Last Week

Senate passes provider fee renewal

On Thursday the Senate passed SB 70 which renews the provider fee (also called the “bed tax”) for another three years in order to fund Georgia’s Medicaid program. This allows the Department of Community Health to collect the 1.45% tax on hospital revenues in order to draw down federal Medicaid dollars. These additional dollars are disproportionately used to support rural and safety net hospitals who serve high numbers of indigent patients. The bill will now move to the House where it expects an easy passage.

“Expand Medicaid NOW Act” reintroduced

House Minority Leader Stacey Abrams introduced HB 188, the Expand Medicaid NOW Act, last week. While we do not expect this bill to gain much traction because of the evolving health reform efforts at the federal level, it calls attention to the need to provide health care coverage to the 300,000 Georgians who are stuck in our state’s coverage gap because they do not currently qualify for Medicaid and cannot access health insurance through the Affordable Care Act’s Marketplace. The bill has been referred to the House Appropriations Committee.

Oral health legislation moves forward

Both HB 154 and SB 12, bills that allow dental hygienists to provide cleanings and other specified services in schools, safety net clinics, nursing homes, and private dentists’ practices under “general supervision”, received committee hearings and votes last week. Both bills will move to their Chambers’ respective Rules Committees to be approved for floor votes by the House and Senate.

Debate over opioid abuse prevention bill 

SB 81 received its first hearing in the Senate Health & Human Services committee last week. The bill seeks to address the growing opioid abuse epidemic in Georgia in a number of ways, including: 1) Extending the Prescription Drug Monitoring Program, a database of prescriptions written for certain narcotics and requiring physicians to consult this registry prior to prescribing under certain conditions; 2) Codifying the Governor’s emergency order increasing the availability of anti-overdose drug, Naloxone; 3) Requiring the tracking and reporting of Neonatal Abstinence Syndrome; and 4) Establishing penalties for providers who are not in compliance with drug prescription reporting requirements. While few dispute the need to address this issue, the scope of drug and drug classes that the bill covers, along with the severity of the penalty that physicians may be subject to for violating the law are currently points of contention. No vote was taken in Thursday’s committee hearing, but suggested changes were made and the bill is expected to be back before the same committee later this week.

Resources for you

Georgians for a Healthy Future has tools you can use to track and understand the Georgia legislative session. Stay up-to-date on the bills that matter to you with our legislation tracker and sign up for Georgia Health Action Network (GHAN) action alerts so you know when to engage.

Get Your 2017 Consumer Health Advocate’s Guide!

GHF’s annual Consumer Health Advocate’s Guide is your map for navigating the Georgia legislative session. The Guide provides information on the legislative process, and contact information for legislators, key agency officials, and health advocates. This year, we’ve added a glossary of terms to help you understand what is happening under the Gold Dome. This tool will help advocates, volunteers, and consumers navigate the 2017 Georgia General Assembly.  Download your copy here.

It is a time of uncertainty for health care. Congressional leaders have already begun the process to repeal the Affordable Care Act, landmark legislation that established a framework for coverage that has resulted in the lowest uninsured rate ever recorded, rights and protections for health care consumers, and provisions to advance health equity. With the 2017 Georgia legislative session underway, state leaders have acknowledged that something must be done about Georgia’s high number of uninsured, the state’s struggling rural health care system, and the impending funding cuts to hospitals. With so much uncertainty and change, it may be hard to keep track of what’s going on in health policy.

Join us for a webinar to learn about and discuss expected and proposed changes at the both the state and national levels. We will provide you with the most recent information about “repeal & replace” efforts and #ProtectOurCare advocacy, and how that will impact Georgia. We will also preview health care in Georgia’s 2017 state legislative session and tell you how you can get involved in the health care issues that you care about through advocacy and public engagement. Join us for a look ahead at health care policy in 2017. Register here to join us!

Georgians for a Healthy Future will be at the Capitol throughout the forty-day session to monitor health-related legislation, serve as a voice for health care consumers, and keep you informed about opportunities to engage and take action. For the past four years, our top legislative priority had been closing Georgia’s coverage gap by expanding Medicaid. In the wake of the 2016 election, the national policy landscape has shifted considerably, knocking that off the table this year and placing existing coverage, care, and consumer protections at risk. Despite this backdrop of uncertainty and a critical need for federal advocacy, there will be important decisions made over the next three months at the state level that impact the health of individuals, families, and communities.

While it is early, here are the major health care issues we preliminarily expect legislators to tackle in 2017:

• Renewal of the provider fee commonly known as the “hospital tax” or “bed tax” to help fund Medicaid and keep hospital doors open
• Development of a set of reforms to improve mental health services based on the recommendations of a legislative study committee that has been meeting over the past several months
• Creation of a “repeal” task force to assess the impact of changes to or repeal of the Affordable Care Act on Georgia
• Addressing the practice of surprise medical billing, which can leave insured consumers with unexpected bills when a health care provider is out-of-network
• Increasing reimbursement rates for certain primary care services for health care providers participating in Medicaid
• Improving access to dental care for children, seniors, and people with disabilities

Georgians for a Healthy Future has several ways for you to stay up-to-date on what’s happening under the Gold Dome this year:

• Learn: Download our 2017 policy priorities, read up on how the legislative process works, and track health-related legislation
• Engage: Sign up for our Georgia Health Action Network (GHAN) action alerts
• Participate: Identify and contact your specific legislators on issues you care about

Stay tuned for updates throughout the session.

The Senate Opioid Abuse study committee has begun to flesh out key issues and considerations to draft recommendations for an omnibus bill that includes prevention, treatment, regulatory and enforcement and budgetary provisions to address Georgia’s opioid crisis GHF is encouraged by the committee’s focus on prevention as we have been raising awareness of the need to view substance use disorders as a public health issue that warrants prevention through our Somebody Finally Asked Me campaign. More specifically, we have been advocating for wider use of screening tools such as Screening, Brief Intervention and Referral to Treatment (SBIRT) for youth.

While the committee did not discuss SBIRT, over the past two meetings, the committee heard from hospital systems, pharmacists, the Georgia Division of Family & Child Services (DFCS) and substance abuse research experts on other steps the state could take.

Proposals included:

• Increasing funding and wider promotion of substance abuse education with a focus on opioid use in schools and restoring some public health funds.
• Improving provider education and training around prescribing, especially for pregnant women, and educating patients on prescription drug use and how to take saliva drug test before that.
• Increasing access to drug treatment programs for pregnant women, allowing the sale of narcan over the counter, and adding buprenorphine to the Medicaid formulary, this could lead to addiction because of all the drugs and there are some great reviews for Quick Fix 6.2, but it could easily be taken care of with the help of an intervention, click here if you don´t know what is an intervention.
• Promising protocols and programs that hospitals and emergency departments could implement to improve care delivery for chronic pain management, although if these pains are in a specific area like a headache, is better to visit some headache specialists, also children with neonatal abstinence syndrome and their mothers.
• Current initiatives and ways to improve state and agency-level policies to improve response systems for law enforcement and child welfare services.

Presentations from Northside Hospital, Augusta University, DFCS, Tanner Health System, and the Georgia Substance Abuse Research Alliance are available upon request. The committee plans to dive deeper into analysis of law enforcement policies, therapeutic services and recommendations for budget appropriations during the upcoming meetings and a website for finding rehab facilities near me. GHF will continue to advocate for the committee to consider additional prevention methods in its recommendations. We have requested to present recommendations to activate Medicaid codes to promote the use of a substance use screening tool called SBIRT (Screening, Brief Intervention, and Referral to treatment) at the next committee meeting and are awaiting a response. The next committee meeting is scheduled for November 9, 2016 at 1:00 PM at the Capitol. Stay tuned for more updates and information!

Some of the most pressing and contentious health and insurance issues facing San Diego help will be front and center during anticipated legislative study committee meetings this fall. Study committees meet during the off-session to take a closer look into specific policy issues and develop recommendations for the upcoming legislative session. Check out a full listing of House and Senate study committees. Below is a summary of the committees GHF will be actively engaged on the advocacy and policy fronts:

Senate Study Committee on Surprise Billing Practices (SR 974)

This study committee is charged with assessing laws to protect consumers against surprise billing. Surprise billing can occur when an insured consumer receives care from an out-of-network provider and is charged for the amount the insurance did not pay. In some cases consumers seek care knowing the risk. In other cases consumers end up with bills despite making appropriate efforts to stay in-network or because inadequate provider networks require them to go out-of-network to receive care they need. Surprise billing was a hot button issue during the 2016 legislative session as more consumers reported receiving a surprise bill and experiencing financial repercussions. This led to the introduction of legislation (SB 382). This legislation included a wide range of provisions for consumer notifications, network adequacy standards, independent dispute resolutions and regulatory oversight. Although SB 382 did not pass it served as a starting point for discussion and preparation for this study committee. GHF has identified surprise billing and the need for legislation that holds consumers harmless in surprise billing scenarios as a policy priority. GHF, in partnership with Georgia Watch, has been actively engaged on this issue and will present recommendation to the committee. If you are interested in providing testimony or input to this committee, please contact Senator Renee Unterman, the study committee chair. The meeting schedule has not been announced but stay tuned for updates.

Senate Study Committee on Premium Assistance (SR 1056)

This committee will closely examine models and policies for premium assistance programs as an alternative to Medicaid expansion and is anticipated to be a forum for a robust discussion about policy options to close the coverage gap. Because Georgia has not yet accepted federal funds to cover low-income Georgians through Medicaid or a Medicaid waiver, approximately 300,000 Georgians remain stuck in a 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. Closing the coverage gap by opening up coverage through Medicaid to all Georgians with incomes up to 138 percent of the federal poverty level is a policy priority GHF champions.  During the last legislative session SB 368 was introduced and policymakers took a first step toward conversation on ways to close the coverage gap. Although SB 368 did not pass, it sparked a process that led to the upcoming study committee. GHF will present recommendations to the committee and amplify our campaign to close the coverage through our Cover Georgia Coalition. Cover Georgia is a coalition of more than 70 organizations that have come together to educate the public, engage Georgia’s policymakers, and advocate to close the coverage gap by expanding Medicaid. To learn more about Cover Georgia click here and to join please contact Laura Colbert at lcolbert@healthyfuturega.org or 404-567-5016 ext. 2.  Study committee appointments and meeting schedule have not been announced. If you are interested in providing testimony or input to this committee stay tuned for updates.

Senate Study Committee on Opioid Abuse (SR 1165)

In light of the rise of opioid addiction and related overdose deaths, this study committee was created to examine legislative approaches Georgia could take to curb the opioid epidemic and save lives. Committee members have been appointed and include the commissioner of public health, Director of Georgia Drugs and Narcotics agency, a pharmacist, medical doctor and citizen with personal experience with opioid overdose claim that the cases of prescription drug abuse amongst teens are rising. The first committee meeting is scheduled for September 30^th in Gainesville and the second meeting will be held October 27^th at the Capitol. Save the dates and we will provide more information soon. GHF in partnership with the Georgia Council on Substance Abuse will present recommendations on activating Medicaid codes to promote the use of an evidence-based substance use screening and prevention tool known as SBIRT (screening, brief intervention, and referral to treatment) statewide and a fiscal analysis of the costs and benefits of implementing SBIRT through Medicaid to the committee. To find out more about SBIRT and our Preventing Youth Substance Use Disorders coalition visit our website. If you are interested in providing testimony or input to this committee please contact Senator Renee Unterman, the study committee chair.

Other Study Committees to Watch

• Senate Study Committee on Hearing Aids for Children (SR 1091)
• Senate Study Committee on Emergency Cardiac Centers (SR 1154)
• Senate Study Committee on State Sponsored Self-Insured Group Health Insurance Plan (SR 1166)
• House Study Committee on Mental Illness Initiative (HR 1093)
• House Study Committee on Professional Employer Organizations (HR 1341)