Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up…
Tag: network adequacy
A statement from Georgians for a Healthy Future regarding COVID-19
Like many of you, our team is monitoring the COVID-19 (coronavirus) outbreak closely. We hope you and your loved ones are healthy and well during these uncertain times.
We are grateful for the actions of Georgia leaders to protect the health and safety of individuals and communities across the state. We encourage all of you to help prevent the spread of the virus by staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.
Unfortunately, this outbreak has exposed the many shortcomings of our nation’s health care system while reinforcing how important it is for all Georgians and people across the country to have access to health coverage and care. While our policymakers and health system leaders are acting quickly to expand Georgians’ pathways to testing, treatment, and care, many Georgians currently lack health care coverage or are at risk of losing it as a result of the virus. Georgia’s elected leaders should act immediately to close Georgia’s coverage gap and extend Medicaid coverage to all low-income Georgians. Closing the Medicaid coverage gap supports good health by ensuring that people confronting COVID-19 do not go untracked and untreated. This is one of several critical steps Georgia leaders should take to promote the health and economic security of all Georgians during this unprecedented health crisis.
We will continue to monitor the spread of COVID-19 and encourage state leadership to take effective action to provide access to health care for all Georgians. Thank you for your continued support.
Legislative Update: Week 9
Crossover Day brings action before suspension of legislative session
Last Thursday, March 12th was the 28th day of the Georgia legislative session, which is also referred to as Crossover Day. Crossover Day is the final day for a bill to cross from its chamber of origin to the opposite chamber to remain viable for this legislative session. The General Assembly finalized changes to the current state budget (FY2020) before suspending the legislative session on Friday, March 13th due to safety concerns about COVID-19. Lieutenant Governor Geoff Duncan and House Speaker David Ralston have committed to resuming the 2020 legislative session when public health concerns subside.
In the sections below, you will find a rundown of consumer health legislation and their statuses following Crossover Day. Those that “crossed over” remain viable and those that “did not cross over” are considered dead for this year. You can see a list of all the bills we’re tracking here.
The General Assembly convened this morning for a one-day special session. They are expected to pass a resolution approving Governor Kemp’s declaration of a public health emergency. With this action, Governor Kemp will have additional power and authority to manage the state’s response to COVID-19.
Surprise billing legislation companion bills cross over
Companion bills were introduced in the House and Senate last month to ban surprise out-of-network medical billing (also called surprise billing) in emergency and non-emergency situations. SB 359 and HB 888, sponsored by Senator Hufstetler and Representative Hawkins respectively, both contain strong consumer protections and set a fair payment resolution process that takes consumers out of fights between insurers and health care providers. Both bills have crossed over from their chambers of origin to the opposite chamber.
Legislation to extend postpartum Medicaid coverage crosses over
HB 1114, sponsored by Rep. Sharon Cooper, would allow new mothers to receive Medicaid coverage for six months after giving birth. Currently, pregnant women covered by Medicaid are covered only up to 60 days after their birth or miscarriage. Due to restrictive Medicaid eligibility requirements for Georgia parents and because Georgia has not expanded Medicaid to all low-income adults, many mothers who try to apply for Medicaid after the 60 days are ineligible and become uninsured. HB 1114 was approved by the House last Tuesday.
Crossover Day recap
HB 792: Amended FY 2020 Budget | SENT TO GOVERNOR
HB 792 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2020. The “little budget” has passed both chambers of the General Assembly and has been sent to the Governor.
HB 793: FY 2021 Budget | CROSSED OVER
HB 793 is the budget document for the coming state fiscal year which will run from July 1, 2020 to June 30, 2021. For more information on the health care highlights in the proposed FY 2021 budget, read the Community Health, Behavioral Health, and Public Health budget overviews from the Georgia Budget & Policy Institute.
HB 511: Rural transit bill | CROSSED OVER
HB 511, sponsored by Representative Kevin Tanner, would create a new division within the Georgia Department of Transportation (GDOT) that would, among other things, oversee rural transit programs including Medicaid’s non-emergency medical transportation (NEMT) services. The bill would divide the state (except for 13 metro-Atlanta counties) into eight regions in which counties could collaborate to raise revenue for and coordinate rural transit services.
HB 544: Mental health emergency involuntary treatment | DID NOT CROSS OVER
HB 544, sponsored by Rep. Chuck Efstration, would make changes to how people in mental health or SUD crises can be committed to emergency involuntary treatment. This legislation could have negative consequences for people with substance use disorders who could be involuntarily committed to treatment under certain circumstances.
HB 719: Effort to modernize HIV laws | CROSSED OVER
HB 719, sponsored by Rep. Deborah Silcox, would modernize Georgia’s HIV-related laws and make progress towards decriminalizing HIV. Current Georgia law deems it a felony for people living with HIV to have sex or donate blood without disclosing their status, or for spitting at or using bodily fluids on a law enforcement officer. Under HB 719 only the act of having sex without disclosing a person’s HIV status would remain illegal.
HB 731: | Tobacco tax increase | DID NOT CROSS OVER
HB 731, sponsored by Rep. Ron Stephens, would raise Georgia’s tobacco tax to $1.87 from its current level of $0.37.
HB 760: Mental health; peace officer authorization | DID NOT CROSS OVER
HB 760, sponsored by Rep. Sharon Cooper, would give peace officers the authority to take a person to a physician or emergency department for emergency examination under certain circumstances.
HB 842: Gracie’s Law – organ transplant discrimination| CROSSED OVER
HB 842, sponsored by Rep. Rick Williams, would protect people with disabilities from being removed from organ donor waiting lists because of their disabilities.
HB 864: | Excise tax on vaping products | DID NOT CROSS OVER
HB 864, sponsored by Rep. Bonnie Rich would add a 7% excise tax to vaping products and would require businesses that sell vaping products to register with the state for a $250 fee.
HB 918: Restricts onerous PBM audits of pharmacies | CROSSED OVER
HB 918, sponsored by Rep. Sharon Cooper, puts in place limits on the practices of PBMs within these audits so that pharmacies can more easily meet audit requests and the benefit of the doubt is given to pharmacies when small or innocuous mistakes are discovered.
HB 946: Increases accountability for PBMs | CROSSED OVER
HB 946, sponsored by Rep. Matt Knight, would increase fines on PBMs when they “steer” consumers to specific pharmacies and would prohibit PBMs from paying affiliated pharmacies more than independent ones. The bill would require PBMs to pass along rebates to insurers (who would presumably pass those savings on to consumers) and would ban programs called “co-pay accumulators.” Co-pay accumulators increase out-of-pocket costs for consumers who need prescription drugs, especially those with expensive medications and those with high deductibles and other cost-sharing.
HB 947: Examining the costs of PBMs in Medicaid | CROSSED OVER
HB 947, sponsored by Rep. Matt Knight, would require Georgia’s Department of Community Health to complete an independent study to find out if Georgia would save money by removing the current PBM structure from its Medicaid plans. If the estimated savings are more than $20 million annually, Georgia would eliminate PBMs from most of the state’s Medicaid plans.
HB 1079: Authorizes full Medicaid expansion through an 1115 waiver | DID NOT CROSS OVER
HB 1079, sponsored by Rep. Kim Schofield, would allow the state to submit a new 1115 waiver that would expand Medicaid to all Georgians making less than 138% of the federal poverty line.
HB 1114: Extending postpartum Medicaid coverage | CROSSED OVER
HB 1114, sponsored by Rep. Sharon Cooper, would allow new mothers to receive Medicaid coverage for six months after giving birth. Currently, pregnant women covered by Medicaid are covered only up to 60 days after their birth or miscarriage. Due to restrictive Medicaid eligibility requirements for Georgia parents and because Georgia has not expanded Medicaid to all low-income adults, many mothers who try to apply for Medicaid after the 60 days are ineligible and become uninsured.
HB 1151: Network adequacy | DID NOT CROSS OVER
HB 1151, sponsored by Rep. Kim Schofield, would increase consumer access to health care by imposing quantitative standards on insurance companies’ provider networks. Georgia has the narrowest provider networks in the country, forcing people to pay more to find care outside of their insurance plan’s approved providers. Network adequacy standards would ensure that consumers can access a provider in their insurance network for all covered benefits.
HB 1153: Short-term limited duration plans | DID NOT CROSS OVER
HB 1153, sponsored by Rep. Kim Schofield, would limit short-term health plans to 3 months and provide consumer protections like protections for people with pre-existing conditions.
HR 1280: Addressing childhood lead exposure | DID NOT CROSS OVER
HR 1280, introduced by Rep. Katie Dempsey, establishes a Joint Study Committee on Childhood Lead Exposure to address the issue of thousands of Georgia children under six years of age who were found to have lead poisoning, which is irreversible and can cause speech, language, and behavioral problems, lower IQ levels, and nervous system damage.
*Note: Because this is a resolution (rather than a bill), this resolution is still viable for passage and could be used to establish a House study committee.
SB 298: Raising age to purchase tobacco and vaping products| DID NOT CROSS OVER
SB 298, sponsored by Sen. Renee Unterman, would increase the age at which Georgians are allowed to purchase tobacco and vaping products to 21 years of age, among other things.
SB 303: Georgia Right to Shop Act | CROSSED OVER
SB 303, sponsored by Senator Ben Watson, Chairman of the Senate Health & Human Services committee, would require that health insurers to put on their website an interactive feature that allows consumers to estimate their out of pocket costs for a particular health care service and compare quality metrics between providers, among other things. Insurers would also have to provide a phone number that consumers can call to get the same information.
SB 313: Benchmarking for prescription drug prices | CROSSED OVER
SB 313, sponsored by Senator Dean Burke, had its second hearing in the Senate Insurance and Labor committee last Wednesday. This bill would update Georgia’s oversight of pharmacy benefit managers and add important consumer protections.
SB 348: Consumer Right to Access Act | DID NOT CROSS OVER
SB 348, sponsored by Senator Kirkpatrick, is aimed at addressing network adequacy. The bill includes similar language to SB 352 (below) and also directs Georgia’s Insurance Commissioner to set quantitative network adequacy standards to ensure Georgia consumers have adequate access to care within their insurance plans.
SB 352: Online provider directories | CROSSED OVER
SB 352, sponsored by Senator Burke, would allow consumers to see providers at in-network rates for their entire plan year, if the provider is listed as in-network at the time a person enrolls in their health plan. The providers included in a consumer’s insurance plan network changes regularly throughout the year and this bill would assure that the provider network advertised at the time of enrollment is the provider network they are able to access all year long.
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.
This year’s program began with a personal story from consumer Lori Murdock, who bravely shared her experience struggling to manage a chronic disease without health insurance because she was caught in Georgia’s coverage gap. Lori’s experience illustrates the pressing need to provide health insurance to all Georgians regardless of income.
Following Lori was our bipartisan legislative panel. This year’s legislative panelists were:
Each panelist provided updates on emerging health care trends impacting Georgia and took questions from the audience about what health issues are likely to be taken up in the 2019 legislative session. Topics included Medicaid expansion, surprise out of network medical billing, access to mental health, network adequacy, Certificate of Need reform, social determinants of health, rural health care access, federal health care reform, and affordability of health care. All three panelists shared an optimistic vision for health care in this years legislative session.
This year’s key note speaker was Dr. David Blumenthal, President of the Commonwealth Fund. Dr. Blumenthal brought a wealth of knowledge and insight to our conversation about how innovations in health care and coverage can help us achieve better health outcomes for all Georgians. He led the discussion by comparing Georgia’s health outcomes to those of our neighboring states, and then provided an agenda for improvement. He emphasized that Georgia is unlikely to overcome poor health outcomes unless state leadership improves insurance coverage, as demonstrated by the Commonwealth Fund’s own research on Medicaid expansion’s impacts on population health. Dr. Blumenthal also shared the importance of investments in the social determinants of health for improving health outcomes and ultimately saving money. Dr. Blumenthal’s presentation can be accessed here and the Georgia scorecard from the Commonwealth Fund can be found here.
To see photos, review materials, and get more information about this year’s Health Care Unscrambled event, please visit the event page.
For more event pictures visit our Facebook photo album.
Last week, Virginia became the latest state to expand health care coverage to low-income adults when the Virginia legislature voted to close the its coverage gap and Governor Northam signed the new budget. More than 400,000 Virginians are expected to gain coverage as a result, and the state anticipates declines in uncompensated care costs for hospitals, an increase in people receiving needed health services, and greater financial security for those set to gain coverage. The vote comes after years of advocacy and engagement from constituents and advocates who worked to convey to legislators the importance of health coverage and the impact the change would have on the lives of hundreds of thousands of Virginians.
Unlike Virginians, 240,000 hard-working Georgians cannot yet look forward to putting a health insurance card in their pockets. These friends and neighbors make too little to get financial help to buy health insurance and don’t qualify for Medicaid in Georgia, leaving them stuck in the state’s coverage gap.
Georgia remains one of 17 states that is still refusing billions in federal health care dollars to provide health coverage to low-income adults in the state. As in Virginia, Georgia’s Governor and state legislature can choose to close the coverage gap at any time, and here are five reasons they should do so as soon as possible:
- Thousands of Georgians would gain health coverage–240,000 Georgians would gain the peace of mind, access to care, and financial protection that insured Georgians have. These Georgians make less than $12,140 a year or $20,780 for a family of three. Most are working in sectors like retail, child care, construction, and food service, low-paying jobs that do not come with benefits.
- Georgia’s rural hospitals are economic anchor institutions–rural communities need their hospitals to provide accessible healthcare, sustain well-paid jobs, and facilitate economic stability. Closing the coverage gap would create at least 12,000 new jobs and $1.3 billion in new activity in Georgia’s rural communities each year.
- The resulting job growth is greater than what the state would gain by attracting Amazon’s HQ2–extending health coverage to more Georgians would create 56,000 new jobs across the state, more than the 50,000 jobs that Amazon is promising at its second headquarters. Even better, the new jobs would be scattered across the state rather than concentrated in and around Atlanta.
- Georgia’s tax dollars are currently sitting unused in Washington, D.C.–By refusing to extend health insurance to low-income Georgians, the state is missing out on $8 million per day ($3 billion dollars per year). Instead of giving up hard-earned tax dollars, Georgia’s policy makers could bring that money back to the state to help low-income parents, veterans, and workers put health insurance cards in their wallets.
- It is the biggest step Georgia can take to slow the substance use crisis —One quarter (25%) of Georgians who fall in the coverage gap are estimated to have a mental illness or substance use disorder. If they were covered by health insurance, treatment and recovery services would be within reach, allowing them to resume full, healthy lives. As a result, 36,000 fewer Georgians each year would experience symptoms of depression and the state could make significant progress in addressing its ongoing substance use crisis.
After five years of delay, Virginia’s leaders made the right decision and as a result, 400,000 Virginians will see healthier futures. Now is the time for Georgia’s decision makers to follow suite by putting 240,000 insurance cards in wallets all across the state.
Virginia State Capitol Image – Skip Plitt – C’ville Photography
Georgians for a Healthy Future’s Executive Director Cindy Zeldin attended the summer meeting of the National Association of Insurance Commissioners (NAIC) last week in San Diego in her capacity as a consumer representative to the NAIC. Cindy presented information on the enactment of health insurance provider directory improvement legislation in Georgia (SB 302) as part of a panel of consumer representatives discussing how the NAIC network adequacy model act is being taken up in the states. Also presenting were Claire McAndrew of Families USA, who provided a bird’s eye view of activity across the nation on network adequacy, and consumer representatives from Colorado and Maryland. This discussion was part of the Consumer Liaison meeting, which provides a forum for consumer representatives to interface with state insurance regulators from across the country.
Also at the summer meeting, the consumer representatives released a new policy paper on prescription drug access and affordability. The report, Promoting Access to Affordable Prescription Drugs: Policy Analysis and Consumer Recommendations for State Policymakers, Consumer Advocates, and Health Care Stakeholders, provides a series of recommendations to assist regulators, lawmakers, and the NAIC on ways to promote access, affordability, nondiscrimination, transparency, and meaningful oversight of prescription drug coverage. The report includes examples of existing state and federal approaches to addressing these issues as well as recommendations for consumer-protective policies to be considered by state and federal policymakers. The report was made possible with support from the Robert Wood Johnson Foundation.
Provider directories, or the listing of health care providers that are participating in a particular health plan, are intended to inform patients and consumers about which doctors are in their plan and how they can contact them to set up an appointment. For these directories to serve as the tool that consumers need, they must be accurate and up-to-date. A secret shopper survey conducted by the statewide consumer health advocacy organization Georgians for a Healthy Future, however, found these directories to be error-ridden, a problem that places consumers at risk when they seek to access an appropriate in-network health care provider. An analysis of four provider directories associated with plans offered by three of the state’s largest insurers found:
» Three-quarters of the listings had at least one inaccuracy (not in-network, not accepting new patients, not practicing at the location listed, inaccurate or inoperable phone number, or languages spoken inaccurately listed)
» One in five health care providers listed as participating in a plan’s network were not; in one directory forty percent of the providers listed were not actually participating in the plan » Among the providers who were confirmed to be in-network, thirteen percent were not accepting new patients; in one directory one in four confirmed in-network providers were not accepting new patients
» Fifteen percent of telephone numbers associated with providers listed in the directories were inaccurate or inoperable
These inaccuracies and usability limitations make it difficult for health care consumers, particularly those who haven’t had insurance before, to find and access an appropriate medical care provider. Setting basic standards for provider directories and protections for the consumers who rely upon them would go a long way towards making provider directories the tool that patients and consumers need when they shop for and use their health insurance.
Download the full set of findings here.
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.
GHF and Georgia Watch host policy forum on network adequacy, surprise out-of-network billing, and provider directory accuracy.
Early in February, GHF and Georgia Watch partnered to host policymakers, stakeholders, and advocates at a policy panel on important health insurance consumer protections. The event opened with remarks from Senator Dean Burke and included presentations from Consumers Union’s Julie Silas, Georgia Watch’s Beth Stephens, and GHF’s Meredith Gonsahn. If you missed the event, you can find presentations and materials below!
Julie Silas’s presentation: Finding Policy Solutions for Provider Directories and Surprise Medical Bills
Meredith Gonsahn’s presentation: Improving Network Adequacy and Provider Directory Standards in Georgia
Who was there? Check out the photo album.
As consumers navigate the new landscape of increasingly narrow networks and high deductibles, they need the right tools and information to choose a health insurance plan that best fits their medical needs and their household budgets. Provider directories are the primary tool available to consumers to determine whether the plan they are selecting has a narrow or broad network and to identify which providers are in their plan. As such, these directories should be accurate, up-to-date, and should truly function as a tool. Despite the important role directories play, they are notorious for being rife with errors and for lacking the functionality to help consumers make optimal choices in the market. By drawing upon model legislation from the National Association of Insurance Commissioners (NAIC) and best practices from other states, Georgia can take steps to improve directories. This policy brief:
– explains the role provider directories play as a tool for consumer decision-making
– describes current provider directory provision in Georgia
– describes common problems with provider directories
– outlines recent policy activity around provider directories
– highlights other state examples of provider directory improvements
When consumers enroll in a health insurance plan, they gain access to a network of medical providers. This network must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. While network adequacy is not a new concept, it has a new urgency in light of the sheer number of newly insured Georgians enrolled in individual plans; the move on the part of insurance companies toward narrow networks and tiered networks, which limit the number of providers plan enrollees can access; new federal standards; and a new model act from the National Association of Insurance Commissioners (NAIC) that provides updated guidance for states. Georgia health care consumers need and deserve clear standards and protections that ensure their coverage translates to access to care without financial hardship. Georgians for a Healthy Future released today at a public policy form held in Atlanta a new policy brief on network adequacy. This policy brief:
– explains the importance of network adequacy for access to care
– outlines current network adequacy standards in Georgia
– summarizes recent policy activity around network adequacy
– sets forth consumer-oriented principles for network adequacy standards in Georgia
– provides policy recommendations to achieve network adequacy in Georgia.
Week three was a very exciting one for Georgia health care consumers! The introduction of SB 302 signaled true movement on consumer priorities, like insurer provider directory transparency. Check below to see what happened and how you can get involved.
If you’re looking for a list of all the bills we’re tracking and their status in the legislature, click here.
What Happened This Week
Improving Provider Directories
We are very excited to share with you that last week Senator P.K. Martin (R-9th) introduced legislation to address provider directory inaccuracies and usability limitations. Senators Burke (R-11th), Watson (R-1st), Parent (D-42nd), and Unterman (R-45th) are also co-sponsors of SB 302. The bill has been assigned to the Senate Insurance Committee and we expect it will receive a hearing within the next week. Read SB 302.
Please join us in thanking Sen. Martin for introducing such an important piece of legislation! You can email him here or call him at 404-656-3933.
Rep. Stacey Abrams has sponsored HB 823, the Expand Medicaid Now Act. While we don’t expect this legislation to receive a hearing this year, it is sparking important conversations about the coverage gap in Georgia. Read more here.If you want to get involved in the movement to close Georgia’s coverage gap you can share this video with your social network and sign this petition.