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2018 Georgia General Assembly
Updated: Wednesday, April 4, 2018
Last Thursday, about 12:10 am the State Legislature finished up its 2018 session and adjourned “sine die” to end this year’s session. For the Chapter, the last few days were for the most part, devoid of any of the drama that the General Assembly usually displays on the final hours of the final days. Question: why does the state legislature wait until the last minute to pass important legislation that has been worked on for 39 days prior? Answer: Only Heaven knows.
The other news impacting last week was the death of former Governor Zell Miller, who passed away at age 86 on Friday, March 23. His funeral is at a Methodist Church in Buckhead was held last Wednesday morning, attended by no less than 3 past US. Presidents—George Bush, Bill Clinton and Jimmy Carter. He laid in state on Tuesday afternoon in the Capitol rotunda as the Capitol was buzzing with typical day 39 activity and both Chambers in session. Some day it was befitting of a Governor who tangled frequently with the legislative branch.
During the last days of the session, many bills who had not “moved” were inserted into other bills which were further along in the process—a common tactic to get your bill passed when you run into opposition. This was done in deluxe fashion during this session, perhaps it’s an election year with vacancies in both Governor’s chair and Lt. Governor’s ahead in the November election. Following is the list of the bills we followed and their final disposition.
ADOPTION — HB 159 by Rep. Bert Reeves (R-Marietta) introduced legislation in the 2017 session to substantially revise Georgia’s adoption laws. This issue has received widespread coverage in the media. There are two issues at play: the right to allow parents to assign guardianship of their children to a person or organization without any government oversight, and a provision sought by some to allow religious affiliated adoption agencies to reject same-sex couples on belief grounds. Passed both Houses and signed by the Governor on Monday, March 5th at the Capitol. (See photo below.)
APRN SCOPE OF PRACTICE — SB 351 by Sen. Renee Unterman (R-Buford). This bill was radically amended in Committee. It now allows APRN’s to order imaging without it being a “life threatening situation” and increases the number of NP’s a physician may supervise from 4 to 8. The later was done as an accommodation to “minute clinics.” Failed.
BUDGET FY 2019—HB 684 by Rep. Terry England (R-Auburn). The only thing the General Assembly HAS to do each year is pass a state budget. The state operates on a fiscal year of July 1 to June 30, so the next fiscal year is FY 2019. The state budget has a bill number like other bills. The FY ’19 budget is House Bill 684, and its sponsor is always the chair of the House Appropriations Committee who is Rep. Terry England Rep. England, btw, has been an outstanding supporter of primary care physicians in the Medicaid program and the critical role physicians play in maintaining a sound economic climate in rural Georgia. The conference committee completed work on the budget this morning and this will be passed on Thursday by both chambers.
DISTRACTED DRIVING — HB 673 by Rep. John Carson (R-Marietta) would limit the use of mobile devices while operating a vehicle. The bill provides for fines with the intent to use the fine revenue for trauma care. Passed.
EMERGENCY ROOM, RETROACTIVE POLICIES – HR 1194 by Rep. David Knight, R-Griffin. Would create a House Study Committee to study “retroactive emergency room policies” which “conflict with goals for access to care and discriminate against patients with lower health literacy” to see if action is needed to “mitigate the problem.” This is in response to recently announced policies of Blue Cross, and last week United Healthcare, regarding ED visits. Passed House Health committee, now in-House Rules Committee trying to get on the final calendars. Passed.
HEALTHY HOUSING – HB 954 – Rep. Hilton, of the 95th: Would prohibit a landlord for retaliating against a tenant who complains about health or sanitation issues in their rental housing. This stemmed from instances in which rental housing would be unhealthy (mold, lead, other environmental triggers present) and yet tenants will reluctant to complain least they be evicted. Was converted into a House Study Committee bill, as HR 1431 by Rep. Cooper, which at least keeps issue in front of legislators. In House Special Rules Committee. Support. Passed.
HEALTH SYSTEM INNOVATION CENTER – SB 357, would create a Health System Innovation Center, headed by a director of health care policy & strategic planning, whose purpose would be to “unite major stakeholders and components of the state’s health system under a strategic vision….by establishing a state-wide coordinating platform.” Passed.
MEDICAL CANNABIS —HB 65 by Rep. David Clark (R-Buford) would expand the Low THC Oil Program to add PTSD (if 18 or older) and “intractable pain. Passed House. Now in Senate HHS Committee. We will urge an amendment that would limit “intractable pain” pts to be aged 18 years or old; just as PTSD is limited in the bill. In the final hours, to our disappointment, this bill passed and without the age restriction on “intractable pain” which we had sought. Passed.
OPIOD CRISIS — SB 352 by Sen. Renee Unterman (R-Buford) Attempts to address the opioid crisis in three ways by imposing broad restrictions on health care providers making it illegal for the “solicitation, acceptance of payment, or offer to pay a commission, benefit, bonus, rebate, kickback or bribe—directly or indirectly and on a cash or in kind basis—or to engage in any split-fee arrangement; establish a Commission on Substance Abuse and Recovery to confront the state-wide addiction and substance abuse crisis”; and finally, expanding the definition of insurance fraud to include the billing of multi-substance drug tests separately for each type of drug tested. Passed Senate. In House Health and Human Services Committee, where it was heard yesterday but no vote taken. Failed despite being added as a rider on a number of bills.
PHYSICIAN COMPACT — SB 325 by Sen. Kay Kirkpatrick (R-Marietta) the Interstate Medical Licensure Compact Act aims to provide streamlined process for licensure of physicians in Georgia if a physician is licensed in another state. Passed Senate. Now in-House Health Committee. HB 519, the “Step Therapy” bill, see below, was amended on to SB 325 in the House last week. Failed.
RURAL HEALTH– HB 769, by Rep. Rick Jasperes, would create a Rural Health System Innovation Center to carry out several recommendations by the House Rural Development Council including a grant program for rural physicians for “medical malpractice premium assistance “for those practicing in counties of 50,000 or less. Passed.
SUDDEN CARDIAC ARREST PREVENTION—HB 743 by Rep. Clark (98th). Requires schools to post information about “nature and warning signs of SCA and hold informational meetings, have parents sign a form to acknowledge they have received the information, etc. Passed House. Failed.
SURPRISE BILLING — HB 678 by Rep. Richard Smith (R-Columbus) is the newest version of legislation aimed at addressing the “surprise medical billing” issue. The proposal places certain disclosure requirements on hospitals, physicians, and insurance companies for non-emergency services. Failed. (As did the alternate version SB 359, as below.)
SURPRISE BILLING — SB 359 by Sen. Chuck Hufstetler (R-Rome) is sponsoring the MAG’s solution to address surprise billing. The legislation proposes to promote greater transparency for elective procedures, establish a patient/physician arbitration process for “unexpected events” that take place during elective medical procedures, and establish a standard physician payment model for out-of-network emergency care at the 80th percentile of the independent/neutral ‘FAIR Health’ database. Failed.
SMOKING IN CARS, BAN — HB 274 by Rep. Sandra Scott (D-Rex) introduced legislation in the 2017 session to prohibit smoking in vehicles when a person under the age of 13 is present in the vehicle. The bill failed to move out of Committee. Failed.
STEP THERAPY — HB 519 by Rep. Sharon Cooper (R-Marietta) requires health benefit plans to utilize certain clinical review criteria to establish step therapy protocols for prescription drugs. The bill also creates four exceptions to override step therapy protocols, allowing an override of a protocol where (1) a drug is contraindicative or may do harm to the patient, (2) a drug in the protocol is expected to be ineffective, (3) the patient has already failed on a specific drug in the protocol, or (4) the patient is on a drug that is already working. Failed.
TOBACCO TAXES – by Rep. Chad Nimmer (R-Blackshear) would reduce the taxes on tobacco produce by up to 50% for “modified risk” tobacco products. Failed.
PROVIDER PAYMENT — HB 818 by Rep. Lee Hawkins (R-Gainesville) requires health insurers that use payer issued electronic credit cards to reimburse providers to allow providers to choose whether or not to utilize this payment option. While this method of payment can be fast and convenient for providers, it often requires providers to pay the credit card fees associated with the transactions, therefore decreasing their reimbursement. Passed.
LEVELS OF CARE — HB 909 by Rep. Deborah Silcox (R-Sandy Springs) would allow the Department of Public Health to designate perinatal facilities providing maternal or neonatal care. The legislation requires the department to create designation criteria and procedures, as well as post a list of designated centers. Passed.
PRECEPTOR TAX DEDUCTION — SB 432 by Sen. John Albers (R-Roswell) proposes to repeal numerous tax exemptions and credits currently in existence, including Physician Preceptor Tax Deduction. Bill modified by Senate Committee to implement economic analysis of certain tax credits and exemptions, not including the Physician Preceptor Tax Deduction. HB 301 now includes last year’s tax deduction bill. Failed.
MANDATED BENEFITS FOR AUSTISM TREATMENT, EXPAND AGE TO 12 – HB 118 Sen. Renee Unterman’s bill would increase the age limit for mandated benefits from its current 6 years to thru age 12 years old. Passed full Senate and is now in the House Insurance Committee. In a pleasant surprise, this amended in House committee to increase age to 21 years old, and increase the ABA cap to $35,000, all at the request of the committee chairman. Passed.
MEDICAID ATTESTATION PROBLEM REMAINS: We believed we had this problem fixed last spring when the legislature passed the FY 2018. It was intended that those physicians (and NP’s and PA’s) in primary care who had been the denied the ability to Attest to the Enhanced Medicaid Rate Schedule due to Medicaid policy, would be allowed to do so. However, as noted above, last week on March 1, Medicaid verbally informed us that they were moving to correct the Attestation problems due to Location, effective immediately. If you are in this situation, we advise you to watch your reimbursement to see if in fact this problem is corrected. For more information, Click here for the BlastE from Jan. 25. Also, last month, Georgia Health News, an on-line health newsletter, published a story about this “bizarre” situation for some pediatricians and family physicians. Click here to read it.
Location scenarios corrected by Ga. Medicaid effective March 1, i.e. Medicaid will “re-attest” providers who were “de-attested” due to a location issue as below:
- Those who failed to attest (in ’13 or ’14) at all their office locations.
- Those who closed an attested location (after 12-31-14) and opened another; or moved to a new practice.
- Those attested providers who opened new locations (after 12-31-14.)
- We also learned that providers who received their Georgia license on 1-1-15 or later, are eligible to attest under current Medicaid policy. The Medicaid website did not permit some providers to do that, so we are working with Medicaid to get them attested on an individual basis.
STATE BUDGET: The only thing the General Assembly HAS to do each year is pass a budget. They consider two: the mid-year adjustments to the FY 18 budget—that’s the budget year we’re in right now. And secondly, they pass the next year’s budget, FY 2019—which will begin on July 1, 2018.
Scenes from Legislative Day at the Capitol, Feb. 15, 2018
Gov. Nathan Deal, shown with chapter president Ben Spitalnick, MD, Savannah (at right) & Legislative Committee chair Melinda Willingham joined the Governor and our Family Medicine colleagues after the Governor addressed the crowd. Dr. Spitalnick with Chapter vice-president Terri McFadden, MD; and at far right, Jeff White, MD, Dalton, and his colleague confers with his Senator Chuck Payne, R-Dalton.
At left, Saira Ali-Mohammad, MD of Emory and two medical students enjoyed Legislative Day. At right, Senator Horcenia Tate, (center) is joined by Morehouse residents during one of their trips to the State Capitol.
House Appropriations Committee Leadership
Terry England, Auburn
Rep. Butch Parrish, Swainsboro
Chair, Sub-committee on Community Health/Medicaid
Rep. David Ralston, Blue Ridge
Speaker of the House
Senate Appropriations Committee
Sen. Jack Hill, Reidsville, Chair
Sen. Dean Burke, MD, Bainbridge
Chair, Subcommittee on Community Health & Medicaid
Lt. Gov. Casey Cagle, Gainesville
Sen. Bill Cowsert, Athens
Senate Majority Leader
Sen. Butch Miller, Gainesville
Senate President Pro Tem
Sample Letter to Email to Legislators re Medicaid-Medicare parity payment issue
House & Senate Appropriations Medicaid sub-committees which will consider state Medicaid budget
For a complete text of any these bills you can visit the Georgia General Assembly website: www.legis.state.ga.us. For more information on these or other bills, contact Rick Ward, at the Chapter office, at email@example.com. Thanks to the members of the Legislative Committee for their efforts during the session and to all our members who contacted their legislators about our issues. Your support and participation in the legislative process is vitally important to our advocacy.