2009 Georgia General Assembly Wrap-Up

April 6, 2009

On Friday, April 3^rd at midnight the Georgia Assembly concluded its 2009 day session. Like many sessions, the 2009 version was a mixed bag of wins and disappointments for the Chapter. Our major “win” was avoiding the Governor’s 6% proposed cuts in Medicaid reimbursement. Thanks to the many members who contacted their representative to express their concerns at what we thought was an unfair and unreasonable action.

Other positives included passing a physical fitness bill that should help address, however modestly, the childhood obesity problem; and an updated version of the Medical Practice Act that makes clear that MA’s have the right to give injections. Disappointments included a bill which would have prohibited teens from using cell phones while driving, which failed to clear the Senate in time; a measure to require pickup truck drivers to use seat belts, killed again in the House.  A bill that would give pharmacists the right to give flu shots was also passed however, we successfully amended the bill to exempt children 0-12 from the bill.

Here’s a summary of the bills we followed:

FY 2010 Budget

FY 2010 Medicaid Budget:  The FY 2010 budget was $2.2B short of original expectations due to low tax revenue collections.  In early March the Governor proposed cutting Medicaid rates to hospitals by 10% and to physicians by 6%, unless the hospitals agreed to a tax on themselves. The House reversed cuts to physicians and hospitals; and the Senate sustained them so we will see no change in reimbursement in FY 2010, which begins July 1, 2009.  Under the dire circumstances of the economy, we consider this a win. (However, we have to remember that last year we passed an increase in reimbursement of about 2.5% only to have it postponed to July 1 of 2009 when the state’s revenue began to slide down in late summer and then have it disappear altogether in the January proposal.)

All in all, the federal stimulus funds helped the state avoid a major deficit crisis and most of it was drawn down from the Medicaid program.

House Bills: 

HB 23, (Ramsey, 72^nd), Would prohibit use of cell phones by teens while driving. Passed the House, but died in Senate Rules Committee.

HB 24, re-write of state’s “evidence code” for tort cases.  This bears watching as it may have implications for tort reform. Watch.

HB 39, (Stephens, 164^th), increase in tobacco tax, would increase tax on cigarettes from .37 to $1.37 a pack and on smokeless tobacco from 10% to 25% of the wholesale cost price.  Failed to get even a House Committee vote, as House leadership was unwilling to raise any taxes this year, no matter what kind.

HB 217, (Pruett, 144^th), Would allow pharmacists and nurses to give flu vaccines under a protocol order from a doctor. Passed. We successfully amended children (0-12) out of this bill.

HB 228, (Cole, 125^th), Reorganization of the Department of Human Resources, Passed. The Division of Public Health will move to the Dept. of Community Health, and the Division of Mental Health will be spun into its own department. The other divisions in DHR, including DFCS, will remain.

HB 229, (Coleman, 97^th) Childhood fitness, Requiring schools to do annual standardized fitness tests (e.g. FitnessGram) on children K-12 enrolled in PE classes and report results to state.  Also, reminds districts of current requirement to have 30 minutes of PE for all students K-6. Now this is routinely ignored by districts and not enforced by the state DOE.  Passed

HB 426, (Dempsey, 13^th), Requires Insurance Coverage for Autism. Died in House and Senate version (SB  161) failed to clear Senate Rules Committee. Fierce opposition from health plans and business interests were too much to overcome.

HB 509, (Cooper, 41^st), re-write of Medicine Practice Act, Passed.  Some of it was just updating the law, but also addressed scope of practice issues for PA’s, and also gave MA’s explicit permission to giving injections if under the supervision of a physician, or PA or NP.  This was a gray area of the law and we wanted to be sure this was addressed in the bill.

Senate Bills:

SB 5, (Thomas, 54^th), Require the use of seat belts in pick-up trucks & SUVs. Passed Senate, but died in the House, again.

SB 8, (Murphy, 8^th), Requires school districts to adopt policies authorizing students to carry and self-administer prescription auto-injectable epinephrine, if parents provide “written statement by a physician with name of medication, method, amount, and time schedules.” Passed .

SB 50, (Hudgens, 47^th),  MAG’s rental network bill, would prohibit plans from “renting” existing networks, without disclosure and transparency to providers. The bill failed; but was converted into a Study Committee measure (SR 628).

SB 62, (Hudgens, 47^th), would subject Third Party Administrators to the state’s prompt pay law. A major agenda item for MAG this year.  Passed Senate; but died in House.

SB 92, (Hill, 33^rd), would provide "Premium Assistance" in Medicaid Program. Two hearings have been held and another will be set for March 3. While the AAP supports the concepts of employer-sponsored insurance with public subsidies; many questions remain about the scope and impact of this bill. Passed Senate Insurance Committee, but died in Senate Rules Committee.

SB 132, ( Fort, 39^th), would have raised mandatory school age requirement from 16 years to 17.  Failed to move out of Senate.

SB 161, (Grant, 25^th), Autism, mandated benefits. Would mandate insurers to cover certain benefits for treatment of autism spectrum disorders. Passed Senate committee but died in Senate Rules Committee.  Same bill as HB 426 above.

SB 163, (Balfour, 9^th), Would require DHR to designate a Diabetes Coordinator department wide. Passed.

SB 165, (Goggans, 7^th) Would permit, but not require, DCH to submit names of those applying for Medicaid and Peachcare to Dept. of Revenue to ensure they meet income guidelines. Passed.

SR 300, (Goggans, 7^th) Urging DCH to work with the Chapter in providing information regarding care and service for premature infants.  Passed Senate.  HR 316 (Channell) was identical to SR 300 in the House.

SR 664, (Thomas, 54^th) creates Study Committee on the Patient-Centered Medical Home. Brought by the Ga. Academy of Family Physicians and to include a representative of the Ga. Chapter AAP.  Passed Senate.

                    2009 Legislative Agenda       

1)      Improved Medicaid reimbursement for pediatricians and pediatric sub specialists. Medicaid reimbursement to physicians was increased to 80% of 2007 Medicare rates in the 2008 General Assembly, the first increase in seven years. However, due to the economic slowdown in the state and looming budget deficits, the state delayed implementation of the approximately 2.5% increase to physicians and hospitals.  The Governor has proposed a 1.5% tax on HMOs and hospitals to fund the FY 2010 and restore the increases passed in 2008.

Talking Points:

1. Georgia Medicaid currently pays just about 70% of the Medicare rate—the rate that physicians caring for adults get paid for seeing seniors and other adults.  For many pediatricians this is inadequate to cover the cost of seeing these children.

2. We believe the medical care of the child is as important as the medical care of our seniors and that Medicaid rates should be the equal of Medicare rates.

3. The Medicaid rate has not increased in 7 years and a 2.5% increase passed in 2008 by the General Assembly has been put on hold due to the state’s budget problems.

4. Poor reimbursement is causing many pediatricians to stop or limit seeing Medicaid children, which will reduce access and force these children to get care in hospital ERs, the most expensive form of care, vs. in their “medical home” that is, their primary care doctors office—their pediatrician.

5. We urge the General Assembly to move to restore the Medicaid fee increase passed last year.  Many options exist for the source of such funds, and at this point, we remain neutral on these other funding questions. What is key however, is that no further cuts be made to Medicaid physicians rates in the 2010 budget.

2)      Tobacco Tax: Support initiative to increase Georgia’s relatively low tax on tobacco products to produce twin benefit of lower youth smoking rates (proven by studies in other states) and providing additional revenue to support the state’s healthcare system.  HB 39 has been introduced by Rep. Ron Stephens, R-Garden City, and would increase the tax on a pack of cigarettes by $1 to $1.37 cents and is expected to curtain smoking consumption by 10% (or about 80,000 to 100,000 smokers) and raise $350M in revenue.

 3)      Other Medicaid issues: Maintain appropriate ongoing oversight of Medicaid HMO program by the General      Assembly; improved access to care is needed for children eligible for Medicaid and PeachCare; as well as improved    ways to quickly credential providers who are willing to provide care to Medicaid patients. Additionally,  preserve

Medicaid & PeachCare eligibility standards and benefits at current levels.

4)      Childhood Obesity:  Support legislation that will begin to address the problem of childhood obesity in Georgia. For the 3^rd year in a row last year, the General Assembly failed to pass even a single measure, even though bills were introduced, to address this critical problem for our children; and its future impact on costs to our healthcare system.

5)      Mental Health:  Support initiatives to improve access to mental health care for children, and to improve resources to primary care physicians. A House Study Committee, chaired by Rep. Judy Manning was created in 2008 and its report may provide opportunities for legislation in this arena.

6)      Support adequate funding for the state prenatal system to ensure timely and adequate care for sick newborns wherever in the state they happened to be born.

7)      Driving Safety:  Make improvements to Georgia’s Teen Driving law to reduce teen deaths & injuries in car accidents, including banning cell phone use by teens while driving. And support mandatory use of seat belts in pickup trucks.

8)      Retail-based Clinics: Consider legislative oversight of these newly emerging entities, in which nurse practitioners deliver routine care in clinics based in retail outlets like large supermarket or drug store chains.

List of Key Committees & Members

Mickey Channell, Greensboro - Vice Chair
404-656-7856
mickey.channell@house.ga.gov
 

Donna Sheldon, Dacula - Secretary
404-656-5025
donna.sheldon@house.ga.gov

Mark Burkhalter, Alpharetta
404- 656-5072
mark.burkhalter@house.ga.gov

Ed Rynders, Albany
404-656-7855
erynders@bellsouth.net

Jay Shaw, Lakeland
404-656-7859
jay.shaw@house.ga.gov

Ron Stephens, Savannah
404.656.5099
quickrxdrugs@aol.com

Pat Gardner, Atlanta
404-656-0265
pat@patgardner.org 
 

Mark Bulter, Carrollton - Vice Chair
404-463-2247
email@markbutler.org
 

Buddy Carter, Pooler - Secretary
404-656-0213
bcarter331@aol.com

Keith Heard, Athens
404- 656-0220
keith.heard@house.ga.gov

Mary Margaret Oliver, Decatur
404-656-0265
mm@mmolaw.com

Greg Morris, Vidalia
404-656-0152
 

Bobby Reese, Sugar Hill

bobby.reese@house.ga.gov

Ed Setzler, Acworth
404-656-0177
ed.setzler@house.ga.gov
 

Len Walker, Loganville
404-656-5139
lwalker107@gmail.com