This Week’s Legislative Action
The General Assembly convened Tuesday – Thursday this week. The number of new bills introduced will continue to drop in the coming weeks while committee activity and floor votes will pick up. On Monday, legislative day 24, Senate Bill 99 will be on the floor for a vote. SB99 is Certificate of Need legislation allowing for establishment of hospital facilities in state-defined rural counties through an exemption to the current state health planning process. NGHS Government Affairs, GHA, and GACH continue our efforts with House and Senate leadership regarding this bill, and more information is forthcoming on what we may expect early next week. More detail is provided below on both CON-related bills (SB 99 and SB 106), as well as links to the current bill text on the legislative website.
Below you will find a list of new legislation introduced in the House and Senate this week that we are following, a summary of numerous committee meetings that were held to consider legislation, and floor passage of bills of interest to NGHS.
NEW BILLS INTRODUCED THIS WEEK
HB 445, introduced by Representative Karen Mathiak (R–Griffin), was assigned to House Health Committee. HB 445 would revise a provision relating to the administration of anesthesia by certified registered nurse anesthetists. This bill would allow certified registered nurse anesthetists (CRNAs) to administer anesthesia when ordered by a duly licensed physician, dentist, or podiatrist. Currently, CRNAs can only administer anesthesia under the direction of a duly licensed physician. This is the sister bill to SB 102 by Senator Larry Walker (R–Perry).
HB 448, introduced by Representative Kim Schofield (D–Atlanta), was assigned to House Insurance Committee. HB 448, the “Medication and Patient Safety Act”, relates to insurance to provide for a covered person to have safe and affordable access to a physician-administered medication. This bill would allow for a health insurer, pharmacy benefit manager, or their agent to arrange for an infused or injected medication to be administered to a covered person in such person’s home or healthcare facility when agreed it is a location that is in the best interest of the patient.
HB 451, introduced by Representative Devan Seabaugh (R–Marietta), was assigned to House Public Safety & Homeland Security Committee. HB 451 would require the provision of supplemental, illness-specific insurance to certain first responders diagnosed with occupational post-traumatic stress disorder and provide a tax exemption for benefits received from such insurance coverage for first responders. This bill would include the following professions as first responders: Communications officers, correctional officers, emergency medical professionals, emergency medical technicians, firefighters, highway emergency response operators, jail officers, juvenile correctional officers, peace officers, and probation officers.
HB 453, introduced by Representative Scott Hilton (R–Peachtree Corners), was assigned to House Public Health Committee. HB 453 would repeal a requirement that every ambulance service pay an annual license fee and that ambulance service annual license fees be deposited into the Indigent Care Trust Fund.
HB 470, introduced by Representative Sharon Cooper (R–Marietta), was assigned to House Judiciary Committee. HB 470, the “Georgia Candor Act”, allows hospitals and other health care providers to have open discussions with patients and their families about adverse outcomes while protecting such discussions from discovery in any later lawsuit as long as certain notice requirements are met. This program is entirely voluntary for health care providers. The legislation also contains revisions to Georgia’s law governing the costs for medical records to clarify that when records are stored in an electronic format, providers may not charge more than the federal law allows when records are requested in an electronic format. NGHS Government Affairs and GHA worked with the author and other interested parties to ensure that hospital and patient interests are protected in this legislation.
HB 487, introduced by Representative Mark Newton (R–Augusta), was assigned to House Judiciary Non-Civil Committee. HB 487 enhances punishment for aggravated assault and aggravated battery committed upon healthcare workers, was first read on the floor and assigned to House Judiciary Non-Civil. Currently, violence against health care worker penalties apply only to emergency workers, but this legislation would extend punishments to all employees or independent contractors of a hospital if the act occurred during the performance of their official employment duties. There are two bills working their way through the legislative process at this time, and NGHS Government Affairs is supporting and monitoring these efforts as work continues.
SB 223, introduced by Senator Ben Watson (R-Savannah), was assigned to Senate Health and Human Services Committee. SB 223 would authorize reimbursement of patient incurred expenses related to participation in a cancer clinical trial.
HB 493, introduced by Representative Matt Hatchett (R–Dublin), was assigned to House Health Committee. HB 493 would revise a provision regarding verification of competency relating to renewal, surrender, and restoration of registered professional nursing licenses and continuing competency requirements.
HB 496, introduced by Representative Emory Dunahoo (R–Gillsville), was assigned to House Public Health Committee. HB 496, the “Georgia Prenatal Equal Protection Act”, would provide for an exception for defendant mothers of unborn children relating to crimes committed when the victim believes that the performance of the crime is the only way to prevent his or her imminent death or great bodily harm. The defense of coercion section of this code will not apply to a murder charge unless the victim is an unborn child and the defendant is the child’s mother.
HB 520, introduced by Representative Todd Jones (R–South Forsyth), was assigned to House Governmental Affairs Committee. HB 520 is follow-up legislation to 2022’s HB 1013, the Georgia Mental Health Parity Act. Among other things, the bill requires the state to develop a uniform definition of “serious mental illness”; establish a clearinghouse of best practices and resources to handle individuals with serious mental illness who have frequent contact with criminal justice, homelessness or behavioral health systems; conduct a comprehensive study of behavioral health workforce in the state; create a task force to study access to inpatient behavioral health beds; study and make recommendations on ways to modernize the process for obtaining a professional license; allow psychiatric hospitals to enroll in the Medicaid program and provide services to children in fee-for-service Medicaid; seek a waiver to allow Medicaid funds to be used for housing supports, employment supports, and case management; create a Georgia Health Care Professional Data System; and establish a loan repayment program for mental health and substance use professionals.
HB 521, introduced by Representative Scott Hilton (R–Peachtree Corners), was assigned to House Public Health Committee. HB 521 would provide for Medicaid coverage of rapid whole genome sequencing.
HB 546, introduced by Representative Rick Jasperse (R-Jasper), was assigned to House Health Committee. HB 546, the “Georgia Pharmacy Practice Act,” would revise the definition of “pharmacy care” to include “adaption of a prescription drug order” into the code section.
HB 552, introduced by Representative Sandra Scott (D-Rex), was assigned to House regulated Industries Committee. HB 552 would provide for military spouses licensed in other states to practice certain professions and occupations to obtain a license by endorsement to practice in this state.
HB 557, introduced by Representative Ron Stephens (R-Savannah), was assigned to House Public Health Committee. HB 557 would authorize physicians to delegate the authority to prescribe Schedule II controlled substances to advanced practice registered nurses and physician assistants.
HB 558, introduced by Representative Todd Jones (R-South Forsyth), was assigned to House Special Committee on Healthcare. HB 558 would provide for the establishment of a pilot program to conduct a simulated exchange for hospitals to purchase and sell charity care credits to meet their charity care requirements (often referred to as healthcare “cap and trade.”)
COMMITTEE ACTIVITY
House Insurance Committee:
SB 65, introduced by Senator Ben Watson (R-Savannah), would allow the Commissioner of Insurance and Fire Safety to establish an advisory committee for the purpose of creating a state-based insurance exchange to take the place of the current federal-based insurance exchange that Georgia citizens utilize to purchase health insurance plans. This bill passed out of committee.
SB 27, introduced by Senator Matt Brass (R-Newnan), would add an addition to Georgia Code to prohibit a health care insurer from requiring an ophthalmologist or optometrist to extend any discount on services that are not covered eye care services in order to received increased payments, better reimbursements, or preferential treatment. This bill passed out of committee.
HB 295, introduced by Representative Lee Hawkins (R–Gainesville), known as the “Surprise Billing Consumer Protection Act”, would amend the law to revise certain procedures, timelines, and other matters concerning consumer protections against surprise billing. This bill requires that insurers cover out of network emergency services in facilities at the greater of 1) the verifiable contracted amount paid by all eligible insurers, 2) the most recent verifiable contracted amount agreed to by the insurer and the facility or, 3) another higher amount agreed upon by the insurer and the facility.These provisions are already in effect for providers, but do not currently apply to facilities. This bill also changes the request for arbitration from 30 days to 60 days, and gives the Commissioner of Insurance and Safety Fire the authority to dismiss certain requests for arbitration. This bill passed out of committee. NGHS Government Affairs and GHA have been working with the sponsor and other stakeholders and is supportive of this legislation.
HB 362, introduced by Representative Karen Mathiak (R-Griffin), would amend the law to require benefit providers to disclose certain payments, within 30 days of the written request, to a treating healthcare provider for personal injury cases. This bill defines “healthcare provider” as a person duly licensed or legally authorized to provide healthcare services and that has provided such services to an injured party. This bill passed out of committee.
The House Ways & Means Public Finance Policy Subcommittee:
HB 308, by Representative Mark Newton (R–Augusta), would revise a tax credit for certain medical preceptor rotations to add dentistry, which is currently not included in the category of eligible recipients. This bill would also change the credit for physicians and licensed dentists from $375.00 for the first through third preceptorship rotations and $750.00 for the fourth through tenth to $750.00 for each preceptorship rotation completed in one calendar year. This bill passed out of subcommittee.
The House Ways and Means Tax Revision Subcommittee:
HB 191, introduced by Representative Ron Stephens (R–Savannah), would amend Georgia law relating to taxes on tobacco and vaping products to increase the rate of the tax on each pack of cigarettes. The proceed of this tax increase are intended to be appropriated for healthcare issues affecting Georgia residents. Currently, the excise tax is 37¢ per pack of 20 cigarettes. This bill would increase the excise tax to 57¢ per pack of 20 cigarettes. No vote was taken.
HB 192, introduced by Representative Ron Stephens (R–Savannah), would also amend Georgia law relating to taxes on tobacco and vaping products to increase the rate of the tax on consumable vapor products. The proceeds from this tax increase are intended to be appropriated for healthcare issues affecting Georgia residents. Currently, the excise tax is 5¢ per fluid milliliter in a closed system vapor product and 7 percent of the wholesale cost price of a consumable vapor product in an open system. This bill would change the excise tax to 15 percent of the wholesale cost of a consumable vapor product in any system. No vote was taken.
The House Health Committee:
HB 414, introduced by Representative Shaw Blackmon (R–Bonaire), would provide for a grant program within the Department of Behavioral Health and Developmental Disabilities to provide behavioral health services to military service members, veterans, and their families. There was a substitute presented to clarify the language to include behavioral health and addictive disease. This bill passed out of committee as a substitute.
HB 416, introduced by Representative Deborah Silcox (R–Sandy Springs), would authorize qualified pharmacy technicians to administer certain vaccines (COVID-19 vaccines) at the discretion of a supervising pharmacist. This bill passed out of committee.
HB 343, introduced by Representative Mark Newton (R-Augusta), known as the “Low Prescription Drug Costs for Patients Act”, would amend the law relating to regulation and licensure of pharmacy benefits managers (PBMs). This bill would require PBMs to calculate defined cost sharing for insureds at the point of sale and report those annual amounts to the department. An amendment was presented in committee to be added to the end of the bill. An amendment was passed to clarify that this bill would not apply to self-funded employer sponsored health insurance plans regulated under the Employee Retirement Income Security Act of 1974. This bill passed out of committee as amended.
HB 441, introduced by Representative Katie Dempsey (R–Rome), would authorize and regulate teledentistry in this state by licensed dentists pursuant to permits issued by the Georgia Board of Dentistry. This bill was tabled, no vote was taken.
HB 434, introduced by Representative Lee Hawkins (R–Gainesville), would amend Georgia Code to provide for the licensing of radiologist assistants by the Georgia Composite Medical Board. This bill would also provide that radiologists may use the services of licensed radiologist assistants under the supervision of said radiologists. This bill was a hearing only.
The Senate Insurance and Labor Committee:
SB 76, introduced by Sen. Nikki Merritt (D–Grayson), would amend Georgia law relating to the state employees’ health insurance plan and post-employment health benefit fund to require state health benefit plans to cover insulin medication at a reduced rate. A substitute was introduced in committee that would add the language “or $105 for a 90-day supply” to anywhere that “$35 for 30-day prescription” is listed. This bill passed out of committee by substitute.
The Senate Health and Human Services Committee:
SB 141, introduced by Senator Clint Dixon (R–Gwinnett), would amend the law to prohibit health care providers from performing specified practices on minors relating to altering a person’s appearance relating to gender. This bill would prohibit school nurses and other employees and officials from engaging in certain conduct relating to a minor’s perception of his or her gender. This bill would prohibit the prescribing or administering of specific hormone related drugs such as testosterone, estrogen, or progesterone to a minor in an amount greater than would normally be produced in a healthy individual of that minor’s age and sex. This bill would prohibit health care providers from performing surgeries that sterilize or alter the appearance of the sex of a minor, including vasectomies, hysterectomies, metoidioplasty, and others. This bill was added to the agenda just before the committee meeting started. This bill was “hearing only” and no vote was taken.
SB 140, introduced by Sen. Carden Summers (R-Cordele), would amend the laws relating to regulation of hospitals and related institutions to prohibit certain surgical procedures for the treatment of gender dysphoria in minors from being performed in hospitals and other licensed healthcare facilities. This bill would prohibit sex reassignment surgeries or any other surgical procedures for the purpose of altering primary or secondary sexual characteristics performed on a minor, except for those deemed medically necessary and individuals born with medically verifiable disorders of sex development. This bill passed out of committee by substitute.
SB 102, introduced by Sen. Larry Walker (R-Perry), revises a provision relating to the administration of anesthesia by certified registered nurse anesthetists. This bill would allow certified registered nurse anesthetists (CRNAs) to administer anesthesia when ordered by a duly licensed physician, dentist, or podiatrist. Currently, CRNAs can only administer anesthesia under the direction of a duly licensed physician. The vote on this bill failed and SB 102 did not pass out of committee.
The House Regulated Industries Committee:
HB 155, introduced by Representative Chuck Martin (R – Alpharetta), would provide for the issuance of licenses by endorsement for certain licenses to spouses of firefighters, healthcare providers, and law enforcement officers who relocate to the State of Georgia. “Healthcare provider”, as defined in this bill, would include any physician or other person licensed or otherwise authorized in this state to furnish healthcare services, including the following: any dentist, podiatrist, optometrist, pharmacist, psychologist, licensed professional counselor, clinical social worker, registered professional nurse, advanced practice registered nurse, licensed practical nurse, registered optician, physical therapist, chiropractor, physician assistant, cardiac technician, emergency medical technician, or paramedic.
The Senate Regulated Industries and Utilities Committee:
SB 99 would provide a Certificate of Need (CON) exemption for acute care hospitals in rural areas established on or after July 1, 2023. An amendment was proposed to strike lines 23-25 and renumbers the following items. This amendment would eliminate the requirement that the hospital must be operated by a county or municipal authority from the bill, thus allowing for-profit hospitals to be eligible for the exemption. The amendment passed. The bill passed out of committee as amended. NGHS Government Affairs, GACH, and GHA are working with Senate leadership on this bill in an effort to make amendments that would clarify certain allowable services for these facilities, among other issues. As noted above, this bill is scheduled for Senate Floor consideration on Monday, February 27th.
SB 162, introduced by Senator Ben Watson (R-Savannah), would make foundational changes to Georgia’s Certificate of Need health planning process. A committee substitute to SB 162 was offered two hours before the committee meeting started. The committee substitute eliminates certificate of need (CON) requirements for all types of health care facilities and services, including long-term care facilities. Effective Jan. 1, 2024, new health care facilities, relocated health care facilities and single-specialty ambulatory surgery centers (ASCs) that convert to multi-specialty ASCs will need a special health care services license (“Special License”) to operate. This new license is in addition to any existing permit, license or certificate issued by the Healthcare Facilities Regulation Division of the Department of Community Health (DCH). Entities that have closed a health care facility or reduced services at a facility by more than 25% in the last 10 years are not eligible to apply for a Special License or oppose any applications for a Special License. Health care providers that obtain a special health care services license would be subject to indigent and charity care requirements with non-profit providers’ required amount being higher than investor-owned providers. Most of the current CON exemptions would also apply to special health care services licenses, with new or expanded exemptions for all clinical health services (perinatal services, open-heart surgery, cardiology procedures, etc.), multi-specialty ASCs, freestanding imaging centers, and behavioral health services. Two amendments were proposed, the first was to eliminate the requirement that exempt hospitals be operated by a county or municipal authority from the bill (to mirror the change made to SB 99.) The second amendment proposed was to strike “of $10 million or less” from line 483 related to capital expenditure thresholds. Both amendments passed and the bill passed out of committee as amended with a tied vote broken by the committee chairman. This bill is currently pending in the Senate Rules Committee.
PASSED BY THE HOUSE
HB 315, sponsored by Rep. Darlene Taylor (R-Thomasville), would grant the Commissioner of Insurance the ability to promulgate rules and regulations for cost-sharing requirements for diagnostic and supplemental breast screening examinations. This bill passed with a 173-1 vote.
HB 203, introduced by Representative Mark Newton (R–Augusta), would amend the law to adjust restrictions on the sale and dispensing of contact lenses with respect to physicians. This bill outlines the requirements for writing an initial prescription for contact lenses, including completing all measurements, tests and examinations necessary to satisfy his or her professional judgement. This bill also changes language in the law from allowing only optometrists or ophthalmologists to “prescribers”. This bill would only allow for a telehealth visit for contact lenses renewal if a patient has had an in person visit in the last 24 months. This bill passed by a 171-0 vote.
PASSED BY THE SENATE
Senate changes to the House’s changes to the Governor’s AFY2023 budget recommendation were approved on Thursday. Senate additions and other changes to the AFY2023 budget include:
Medicaid
Differing assumptions about the cost of Medicaid growth from utilization and Public Health Emergency-related enrollment. (Senate reduced House recommended funding by $21 million)
Recognition of additional federal matching funds. (Senate increased federal funds/reduced state funds by $47 million)
Added funding for Medicare Part D clawback payments. (Senate increased by $6 million)
Health Care Access and Improvement
Funds to support the psychiatric and internal medicine resident learning and work centers at St. Francis Hospital. (H: $778 thousand) (S: $1 million)
State Health Benefit Plan (SHBP)
New state funds to reflect a three-year phase-in of an increase in the employer contribution per-member per-month for non-certified school employees, effective January 1, 2024. (H: $100 million) (S: $34 million)
Medical Education
Funding for nursing program expansions. (S: $3.5 million) Note: this will expand current funding from $3 million to $6.5 million, which is expected to cover roughly 50 percent of funding requests by existing nursing programs seeking to expand.
Public Health
The House recommended the Georgia Coordinating Center (GCC) use existing funds to procure a HIPAA-secure multimodal software communication and patient logistics platform to provide multi-agency, multi-jurisdictional all-hazards response for emergency rooms and other critical care services statewide. The Senate recommended a $6.1 million reduction for non-utilization of funding by GCC.
Behavioral Health and Developmental Disabilities
The Senate agreed with the Governor to reduce direct care support services funds at Georgia Regional Hospital in Atlanta to reflect offline hospital beds. (G and S: -$2 million) (H: no reduction)
Human Services
The Senate added funding for technology improvements and security upgrades for federally provided benefits to reduce fraud. (S: $4 million)
The next legislative step for the AFY2023 budget is the appointment of a joint House-Senate Conference Committee to reconcile changes and reach agreement on the bill. Upon development of a Conference Committee Report (CCR), the CCR will be voted on by the House, Senate, and sent to the Governor. This same process will proceed regarding the FY2024 appropriations act (“the big budget”) and is generally approved by both chambers and sent to the Governor’s desk near the end of the legislative session.