Quietly but significantly, the General Assembly marked the halfway point of its 2019 Legislative Session today by giving final approval to the Amended FY 2019 Budget. With relatively few differences between the House and Senate versions of the spending plan for the rest of the current fiscal year, budget leaders in both chambers worked quickly to reconcile their differences behind closed doors and introduce a compromise plan today without the need of a formal conference committee.

Legislators return to the State Capitol on Monday for Legislative Day 21, where all eyes will be on the House as the Appropriations Committee is expected to act on the FY 2020 Budget and the House Special Committee On Access to Quality Health Care votes on HB 198, Rep. Matt Hatchett’s (R-Dublin), comprehensive Certificate of Need repeal and replacement. Get the key details on the Amended Budget adopted and prepare for next week in today’s #GoldDomeReport.

In this Report:

• House, Senate Agree to Compromise Amended FY 2019 Budget
• Committee Updates
• New Legislation
• Rules Calendars for Legislative Day 21

House, Senate Agree to Compromise Amended FY 2019 Budget

After the Senate voted yesterday to approve its version of the Amended FY 2019 Budget, legislative leaders wasted no time negotiating a compromise between the House and Senate versions. Less than 24 hours later, House Appropriations Chairman Terry England (R-Auburn) was in the well presenting a House Amendment to the Senate Substitute to HB 30, which would serve as the de facto conference committee report for each chamber. Notable items from the compromise include:

• Addition of $2M in funds for the Georgia Development Authority to provide low-interest loans to farmers impacted by Hurricane Michael (for a total of $20M, up from the $10M originally added by the House and $8M added by the Senate);
• Inclusion of $2M added by the Senate for the Department of Community Health to compensate rural hospitals impacted from Hurricane Michael (for a total of $2M);
• Inclusion of $1M added by the House and removed by the Senate for generators at the Georgia School for the Blind and Georgia School for the Deaf;
• Inclusion of $600,000 added by the Senate for the Department of Community Health to review and analyze Medicaid and Section 1332 waiver options (for a total of $1.6M, up from the $1M proposed by Governor Kemp limited to exploring Medicaid waiver options);
• Inclusion of $350,000 added by the Senate for GBI to expand the scope of the “See Something, Send Something” App (for a total of $350,000); and
• Reduction of $100,000 added by the Senate for Graduate Medical Education to reflect unused fellowships; and
• Removal of a $161,295 reduction in funds by the Senate to the Department of Education for Non-QBE Formula Grants (for a total $0 reduction).

The House amendment passed the House by a 155-10 vote and the Senate by a 40-0 vote. The complete list of compromise items can be found here.

Committee Updates

House Special Committee On Access to Quality Health Care

The House Special Committee On Access to Quality Health Care, chaired by Rep. Richard Smith (R-Columbus), met today to hear additional testimony and review a substitute to HB 198, Rep. Matt Hatchett’s (R-Dublin), comprehensive Certificate of Need (“CON”) repeal and replacement. The Committee first heard from two sets of presenters from South Georgia who were unable to attend the last meeting:

• Chris Dorman of Tift Regional Health System spoke in opposition to the bill, stating that it would burden rural health care systems like his rather than helping them. He noted that the 10-mile radius in the bill would not even cover his county, and his hospital needs a large catchment area to stay afloat. Mr. Dorman also spoke of Tift Regional’s plans for a potential emergency department in Cook County that has stalled because of the bill and would likely be abandoned if the bill passes.
• Maureen Yearta of Colquitt Regional Medical Center expressed an interest in helping reform CON but with acknowledgement of the parts of the system that are working. Dr. Yearta highlighted her facility’s community contribution and economic impact as examples of how the system is working. She thanked legislators for the Rural Hospital Tax Credit, which she noted has allowed Colquitt Regional to build an oncology center to keep patients closer to home. Michael Brown, the hospital’s Chief Medical Officer, spoke of the hospital’s physicians commitment to the community and preference of receiving care in a hospital rather than an ambulatory surgery center (“ASC”). He stated that the implication that ASCs improve quality of care is incorrect, and that adverse events will always flow back to the hospital. Justin Baker, the hospital’s chief of staff, told a story of an ASC patient who was handed off from the ASC after a complication and spent weeks recovering in the hospital. He expressed support for transparency provisions and some CON reform allowing expansion of services and beds. Rep. Sharon Cooper (R-Marietta) scolded Drs. Brown and Baker for speaking broadly against ASCs. Dr. Yearta reiterated that their testimony was based on their experience in Moultrie. Rep. Ed Rynders (R-Albany) expressed concerns about hospitals serving the communities where they are located but not necessarily all the communities from which they draw patients. Rep. Randy Nix (R-LaGrange) expressed embarrassment that members of the Committee would disparage the speakers’ commitment to their local community and applauded the speakers’ commitment and work. Rep. Mark Newton (R-Augusta) asked whether the reason ASCs are reimbursed less for the same procedures in a hospital is because the hospital still has to provide backup. Chairman Smith, referencing the speakers’ call to be part of the CON reform conversation, noted that legislators have been working on this for a while and that perhaps their representation should have let them know and invited their participation earlier.

Chairman Hatchett presented the substitute to the bill, noting the changes:

• Allows hospital-owned freestanding emergency departments (lines 1769-1779);
• Provides Grady Memorial Hospital the 10-mile radius protection provided to non-Region 3 facilities, as requested by Grady (lines 2115-2120);
• Allows for a physician who owns or has an ownership interest in an ASC to get credit for indigent care provided outside of the ASC and apply to the ASC’s indigent care requirement (lines 2165-2170);
• Clarifies calculation of Medicare rate for indigent care requirement and allows 15% of Medicaid payments toward indigent care requirement (2204-2206);
• Waives penalty for failing to meet indigent care requirement for 25 most-needy hospitals (line 2209); and
• Changes certain reporting requirements to annual (at end of fiscal year) rather than continuous (line 2424).

The Committee will meet on Monday at 8AM to vote on the measure. Chairman Smith advised Committee members that if they are not present at Monday’s meeting, they will be removed from the Committee.

Senate Regulated Industries Committee

Late yesterday, the Senate Regulated Industries Committee, chaired by Sen. Bill Cowsert (R-Athens), met to consider two of the Senate’s bills relating to the Certificate of Need (“CON”) program.

• SB 74, authored by Sen. Matt Brass (R-Newnan), amends Title 31 to essentially repeal and replace the CON Program. Sen. Brass introduced the bill by noting its drafting had been a process and intended to be a solution to a general problem. After giving an overview of CON, he stated that the program was ineffective at containing cost and that Georgia ranks low on access and affordability despite the program. Sen. Brass highlighted three examples of CON causing issues: denial of patients by CTCA, denial of a CON for an entity that wants to put mental health services in an empty hospital, and denial of open heart services at Tanner Medical Center. Sen. Brass then gave an overview of the sections of the bill: (1) repeal of CON except for long term care; (2) establishment of a new licensing program that retains all current CON exemptions and adds mental health, cardiology, ASCs, and multi-specialty ASCs with separate specialty ASC but precludes protests in Health Region 3 and outside 10 mile radius; (3) transparency provisions; (4) rural hospital tax credits (which will be removed in a substitute to come); (5) clean up; and (6) effective date. The bill mirrors HB 198.
• SB 114, authored by Sen. Dean Burke (R-Bainbridge), was presented as an alternative option to complete repeal and replacement of CON. The bill would reinstate the Health Strategies Council, increase capital expenditure thresholds, create a new definition for specialty cancer hospital, and provide additional exemptions from CON. Sen. Burke noted that repealing CON would be devastating to rural Georgia and urged caution and awareness for unintended consequences. He agreed that there is a need to focus on transparency, consumer information and quality, but again emphasized watching for unintended consequences.

There were numerous speakers on the CON proposals, including:

• Robert Highsmith, representing Northside Hospital, who spoke to the transparency provisions in SB 74 in context of public records and current litigation.
• Chris Dorman, representing the Georgia Alliance of Community Hospitals, spoke to the indigent responsibilities and financial challenges of rural hospitals and noted that repeal of CON would be “devastating.”
• Brian Looby, representing the Independent Doctors of Georgia, spoke in support of SB 74, stating that it would provide more choice and provide for more affordable healthcare.
• Tony West, representing Americans for Prosperity, spoke in support of SB 74, stating that it would help improve access to care and create a patient-centered healthcare system.
• John Evans, representing Central Georgia Heart Center, spoke in support of SB 74, noting that it would allow provider to be more creative in bringing financial opportunity and investment.
• Ray Williams, representing Cancer Treatment Centers of America, thanked Sens. Brass and Burke for the opportunity to work for more access to cancer care in Georgia and introduced a cancer survivor who spoke to CTCA’s care.
• Ethan James and Keri Conley, representing the Georgia Hospital Association, spoke to the Association’s efforts to find and propose compromises to change CON and expressed support for SB 114 and opposition to SB 74.
• Julie Windom, representing Navicent Health, spoke in support of SB 114 and transparency reform.
• Deb Bailey, representing Northeast Georgia Health System, spoke about her system’s commitment to the local community.
• Gina Lee, representing Legacy Sports, spoke in favor of SB 74 and gave an overview of her group’s proposed ASC facility.
• Kathy Palvino, representing the Alliance of Community Hospitals, spoke in favor of SB 114 as a way to fix CON rather than eliminating it.

No vote was taken in the Committee meeting on Thursday, but Chairman Cowsert noted that he expected to take a vote on Tuesday, February 26.

House Regulated Industries Committee -- Occupational Professional Licensing Subcommittee

In a brief early morning meeting, Chairman Jason Ridley (R-Chatsworth) called on Rep. Lee Hawkins (R-Gainesville) to present two bills. HB 253 would amends Title 43 to update and revise provisions in the Occupational Therapy Licensing Act. Specifically, the bill modernizes the Act and provides for the use of telehealth in occupational therapy. Rep. Hawkins explained the bill was introduced on behalf of the Board of Occupational Therapists and not an association. He also stated that there was no known opposition. No members had questions and the bill received a recommendation DO PASS.

Next, Rep. Hawkins, flanked on both sides by representatives of the American Massage Therapy Association, presented HB 242 which amends Title 43 to provide for the regulation of massage therapy education programs, applying to the programs both inside and outside of the state. It also defines what is a “massage therapy business.” There are also requirements for the State Board overseeing this profession such as: it requires it to periodically evaluate board recognized educational programs and develop and enforce standards for continuing education courses required of licensed massage therapists. It further requires licensed massage therapists to maintain liability insurance. Rep. Hawkins entertained a few questions from members of the committee; mainly about the distinction between licensed massage therapy facilities and unlicensed massage parlors not covered by the bill. The committee also heard public comment from representatives of the Association of County Commissioners, the Georgia Municipal Association, and Columbia County; all of whom explained that they agree with the bill generally but would like to work on a few small updates to tweak language about distance requirements. Nevertheless, the bill received a motion DO PASS which was approved unanimously. Both bills now head to the full Regulated Industries Committee on Tuesday.

New Legislation

The following legislation of interest was introduced in the House today:

• HB 6, authored by Rep. Bob Trammell (D-Luthersville), amends Title 21 to remove language requiring the Secretary of State to remove inactive electors from the active voter list. This bill was referred to the House Governmental Affairs Committee.
• HB 409, authored by Rep. Alan Powell (R-Alan Powell), amends Title 43 to remove life threatening situation radiographic imaging testing from the list of approved nurse protocol agreement procedures. The bill also increases the number of advanced practice nurses a physician can enter into nurse protocol agreements with from four to eight. However, the bill stipulates that a physician can only supervise four advanced practice nurses at any given time. This bill was referred to the House Special Committee on Access to Quality Healthcare.
• HB 414, authored by Rep. Gregg Kennard (D-Lawrenceville), amends Title 20 to require that all children must attend a year of kindergarten before entering first grade. The bill also lowers the age of compulsory school attendance to five. This bill was referred to the House Education Committee.
• HB 415, authored by Rep. Gregg Kennard (D-Lawrenceville), amends Title 40 to require that the Department of Driver Services issue an identification card to any persons that has completed a sentence of incarceration and does not have a driver’s license, personal identification card, or other identification card. This bill was referred to the House Public Safety and Homeland Security Committee.
• HB 416, authored by Rep. Rick Williams (R-Milledgeville), amends Title 31 to establish the State Vaccine Consumer Protection Office. The bill also creates a State Vaccine Information Sheet. This bill was referred to the House Health and Human Services Committee.
• HB 418, authored by Rep. Teri Anulewicz (D-Smyrna), amends Title 9 to extend the statute of limitations for childhood sexual abuse. This bill was referred to the House Judiciary Committee.
• HB 421, authored by Rep. Ron Stephens (R-Savannah), amends Title 20 to prevent any local board of education from beginning their school calendar prior to the second week of August. This bill was referred to the House Education Committee.
• HB 426, authored by Rep. Chuck Efstration (R-Dacula), amends Title 17 to provide a more specific definition of “bias or prejudice” for sentencing of crimes as referenced in the code section. The bill also revised the penalties to include a sentence of not less than three months and not more than 12 months and fine no greater than $5,000. This bill was referred to the House Judiciary Non-Civil Committee.
• HR 305, authored by Rep. Jason Ridley (R-Chatsworth), creates the House Study Committee on Special License Plates. This bill was referred to the House Special Rules Committee.

The following legislation of interest was introduced in the Senate today:

• SB 151, authored by Sen. Dean Burke (R-Bainbridge), amends Title 31 to make sweeping changes to Georgia’s healthcare system through the establishment of a new Office of Health Strategy and Coordination. The office is granted power to bring together experts from academia and industry along with elected and appointed leaders in an information sharing forum. The agency will also serve as a forum for new ideas along with evaluating the effectiveness of previously enacted and ongoing health programs. The agency will collaborate with both health related and nonhealth related agencies. Authority is granted to the agency to evaluate proposed CON and State Health Benefit Plan updates. This bill was referred to the Senate Health and Human Services Committee.
• SB 155, authored by Sen. Bill Cowsert (R-Athens), amends Title 51 to stipulate that in an action to recover damages resulting from death or injury, only actual amounts paid for health care services or treatment shall be recoverable. This bill was referred to the Senate Judiciary Committee
• SB 158, authored by Sen. Brian Strickland (R-McDonough), amends Titles 9, 15, 16, and 17 to create the “Anti-Human Trafficking Protective Response Act”. Provisions in the bill include mandates that law enforcement and/or DFCS must refer any child suspected of being a victim of commercial sexual exploitation or trafficking to a certified victim services organization. The bill also amends the code section relating to crimes of human trafficking to include individuals that benefit financially or by receiving anything of value from sexual servitude of another. Current law is amended to remove the language creating penalties for individuals convicted of prostitution while under the age of 18. This bill was referred to the Senate Judiciary Committee. 

Rules Calendars for Legislative Day 21

The House Rules Committee did not meet today. They will set the calendar for Legislative Day 21 on Monday morning.

The Senate is expected to consider the following measures on Monday for Legislative Day 21:

• SB 43 -- Revenue Bonds; definition of the term "undertaking" as it relates to electric systems; revise (RI&U-54th)
• SB 66 -- "Streamlining Wireless Facilities and Antennas Act" (Substitute) (RI&U-51st)
• SB 68 -- Local School Systems; financial management; strengthen provisions (ED&Y-12th)
• SB 73 -- Peace Officers' Annuity and Benefit Fund; fees collected in criminal and quasi-criminal cases prior to adjudication of guilt; provide (RET-7th)