Gold Dome Report - February 2019 #16

by Nelson Mullins Riley & Scarborough LLP

Nelson Mullins Riley & Scarborough LLP

Wednesday marked Legislative Day 23 under the Gold Dome and presented another buffet of policy debate and action for legislators and lobbyists alike. After a substantial first course consisting of the House’s version of the FY 2020 Budget, which was fully unveiled and detailed at an early morning meeting, the House and Senate moved on to several bite-size propositions on their Rules Calendars that were relatively quickly and easily disposed. Among those items were Sen. John Albers’s (R-Alpharetta) “Keeping Georgia’s Schools Safe Act,” which, despite some tough questions, passed by a substantial margin. This afternoon, insiders and onlookers were offered a selection of committee meetings, our choices of which are detailed below in today’s #GoldDomeReport. The General Assembly returns tomorrow for Legislative Day 24.

In this Report:

  • House Appropriations Committee Signs Off on FY 2020 Budget
  • Senate Passes "Keeping Georgia's Schools Safe Act"
  • House Approves Obesity Pilot; Re-Authorizes Rural Development Council
  • Committee Updates
  • New Legislation
  • Rules Calendars for Legislative Day 24       

House Appropriations Committee Signs Off on FY 2020 Budget

The House Appropriations Committee, chaired by Rep. Terry England (R-Auburn), met today to put its stamp of approval on its version of the FY 2020 Budget and send it to the full House for consideration. After recognizing the contributions of former Rep. Mickey Channell (R-Greensboro), who passed away yesterday, on the State’s budget and appropriations process, Chairman England presented the budget proposition, which includes the following notable changes from Governor Kemp’s proposal:

  • Behavioral Health and Developmental Disabilities

    • $500,000 addition for the HomeFirst public-private partnership to provide behavioral health services in permanent homeless supported housing in Fulton County (line 15.4.12).
    • ($2,212,611) reduction due to delayed start date for 40 forensic beds in Columbus (line 15.3.7).
    • ($10,000) reduction in one-time funds for Rockdale Cares (line 15.2.11).
    • ($30,000) reduction in start-up funds for the mental health crisis services and suicide prevention mobile application (line 15.8.6).
  • Community Health

    • $500,000 increase in funds for Federally Qualified Health Center start-up grants for a primary care center in Screven County and for behavioral health services in Chatham County (line 17.4.6).
    • $256,500 increase to serve medically fragile children through the Champions for Children program (line 17.4.5).
    • $184,940 increase to the Georgia Drugs and Narcotics Agency for a data management system to track and manage investigations (line 17.18.3).
    • $150,000 increase to the Composite Medical Board for a medical director to improve the complaints process (line 17.17.3).
    • ($750,000) reduction in one-time start-up funds for FQHCs (line 17.4.4).
    • ($250,000) reduction in one-time funds for the analysis of the Medicaid delivery system (line 17.1.1).
    • New language requiring DCH to evaluate the cost of Medicaid inpatient payment parity for hospitals with specialized units (line 17.1.12).
    • New language requiring DCH to include language in all managed care contracts and SHBP contracts requiring the plan sponsor to annually report all external pharmacy claims (line 17.1.13).
    • ABD Medicaid

      • $10,568,880 increase for nursing homes for a direct care rate enhancement (line 17.7.10).
      • $330,000 increase for nursing homes to support enhanced background checks (line 17.7.8).
      • $200,762 increase for the second installment of a two-year plan to increase the personal needs allowance for nursing home residents by $2.50 to meet $17.50 of the $20 per month (line 17.7.7).
      • $172,321 increase for supplemental payments to general acute care hospitals with inpatient child and adolescent behavioral health units to achieve a $750 per diem (line 17.7.9).
      • $109,342 increase for a 3% increase in the nursing home ventilator reimbursement rate (line 17.7.11).
    • Board of Physician Workforce

      • $4,999,870 increase to Morehouse School of Medicine to offset a reduction in federal matching funds for graduate medical education.
      • $890,820 increase for a medical student capitation rate of $6,363 for 100 students at the Philadelphia College of Osteopathic Medicine (PCOM) Georgia and 40 students at PCOM South Georgia (line 17.16.1).
      • $828,042 increase for 54 slots in OB/GYN residency programs to reach a total of 36 slots at Emory University School of Medicine, 20 slots at Medical College of Georgia, 16 slots at Memorial University Medical Center, 16 slots at Morehouse School of Medicine, and 16 slots at Navicent Health Care Macon (line 17.12.4).
      • $500,000 increase for a Center of Excellence on Maternal Mortality at Morehouse School of Medicine (line 17.14.1).
      • $381,470 increase for Augusta University for child and adolescent psychiatry slots. (line 17.12.6).
      • $352,968 increase for Augusta University for the Rural Surgery Initiative.
      • $125,000 increase for the second year of the gynecological oncology fellowship at Augusta University (line 17.12.3).
      • $90,000 increase for a start-up grant for the South Georgia Medical Center residency program (line 17.12.8).
      • $41,875 for the Georgia Statewide Area Health Education Centers (AHEC) Network program office to expand statewide certification training for health professions students as Mental Health First Aid trainees (line 17.12.7).
      • New language allowing Board to utilize existing funds for malpractice insurance premium assistance for physicians and dentists with a practice in underserved counties (line 17.15.2).
  • Early Care and Learning

    • $2,775 salary increase for each certified teacher and employee (line 22.3.8)
    • $300 per Pre-K classroom for supplies (line 22.3.8).
    • ($5,299,090) reduction to reflect projected need (line 22.3.7).
    • ($357,718) reduction of start-up funds for the DECAL Foundation to reflect self-sustainability (line 22.1.3).
  • Education

    • $2,775 salary increase for each certified teacher and employee.
    • $1,285,575 redirection of funds to GNETS for existing behavioral and therapeutic services contracts (line 24.11.4).
    • $717,210 increase to Technology/Career Education for Extended Day/Year (line 24.25.7).
    • $500,000 increase to Non-QBE Formula Grants for grants to schools for feminine hygiene products for low-income students (line 24.14.8)
    • $329,714 increase to Agricultural Education for Extended Day/Year (line 24.1.6).
    • $323,000 increase to Technology/Career Education for life science industry certification to rural school districts in collaboration with Georgia Youth Science and Technology Centers (line 24.25.9).
    • $229,216 increase to Agricultural Education for camp personal services and operations (line 24.1.7).
    • $110,468 restoration to QBE for school nurses (line 24.20.4).
    • $110,000 increase to Technology/Career Education for systems and schools to reach and maintain industry certification in the field of construction (line 24.25.8).
    • $83,462 increase to Agricultural Education for local law enforcement security at youth camps when students are present (line 24.1.8).
    • $35,294 restoration to QBE for differentiated pay for newly certified math and science teachers (line 24.20.3).
    • ($4,786,001) reduction to GNETS for enrollment and training and experience decline (line 24.11.4).
    • ($500,000) reduction to Audio-Video Technology and Film Grants (line 24.2.1).
    • ($1,437) reduction to Non-QBE Formula Grants based on attendance (line 24.14.4).
    • Governor’s Office of Student Achievement -- ($600,000) reduction for discontinued programs (line 27.7.8).
  • Human Services

    • $2,687,860 increase to increase the Division of Family and Children Services (DFCS) relative caregiver daily per diem rate by $1.00 (line 28.14.3).
    • $460,277 increase for home-delivered meals to reduce the waitlist in each Area Agency on Aging (line 28.10.5).
    • $398,786 increase for 17 adult protective services caseworkers (up from 12 in Governor’s proposal) to investigate reports of abuse, neglect, and/or exploitation of seniors and adults with disabilities (line 28.9.5).
    • $250,000 increase to the Court Appointed Special Advocates (CASA) to enhance statewide capacity (line 28.6.12).
    • $53,997 increase for the second installment of a two-year plan to increase the personal needs allowance for nursing home residents by $2.50 to meet $17.50 of the $20 per month requirement (line 28.8.8).
    • Georgia Vocational Rehabilitation Agency

      • $149,733 increase to expand outreach of independent living for disabled citizens in underserved areas (line 28.25.5).
      • ($20,000) reduction of one-time funds for Friends of Disabled Adults and Children (FODAC) equipment (line 28.25.4).
  • Public Health

    • $2,349,649 increase for newborn screening to include four additional disorders that have been approved by the Georgia Newborn Screening Advisory Committee (line 38.8.4).
    • $1,047,540 increase for maternal mental health to screen, refer, and treat maternal depression and related behavioral disorders in rural and underserved areas of the state (line 38.1.4).
    • $500,000 increase for feminine hygiene products to be provided to low-income clients at county health departments (line 38.1.9).
    • $500,000 increase for two satellite perinatal support sites in Jenkins and Wilcox counties (line 38.7.6).
    • $300,000 increase for regional cancer coalitions to enhance screening, awareness, prevention education, care coordination, and navigation (line 38.1.7).
    • $200,000 increase for the Maternal Mortality Review Committee (line 38.1.5).
    • $150,000 increase for a nurse peer assistance program to support nurses recovering from substance abuse (line 38.1.6).
    • $150,000 increase for the Sickle Cell Foundation of Georgia for sickle cell outreach offices to improve access to care, reduce unnecessary emergency room costs, and expand physician training and community education in underserved areas (line 38.1.8).

The full House will consider the FY 2020 Budget proposal on Thursday.

Senate Passes "Keeping Georgia's Schools Safe Act"

After a lengthy floor debate, the Senate passed SB 15, the Keeping Georgia’s Schools Safe Act by a vote of 47-8. Sen. John Albers (R-Roswell), the bill’s author called upon his work as Chairman of the Senate School Safety Study Committee. He noted that the bill was a conglomeration of the testimony heard by the Study Committee from experts, school officials, parents, and students. After explaining how the bill will proactively address school safety concerns and creates new requirements for school districts to perform threat assessments, he also explained that the bill strives to address the mental health of students. He received targeted questions from Sen. Jen Jordan (D-Atlanta) about the bill’s lack of language related to guns in light of the recent tragic school shootings. He addressed these concerns by explaining that this is one of the bills coming from the Study Committee and it attempts to provide a fix for school safety generally, going beyond school shootings to encompass mental health and suicide prevention as well. After a few words from supporters of the measure the bill received passage from the Senate.

House Approves Obesity Pilot; Re-Authorizes Rural Development Council

The House today passed two non-controversial measures ranging from a reauthorization of the House Rural Development Council to an authorization of a pilot program addressing obesity treatment within the State Health Benefit Plan. HR 214, authored by Rep. Sam Watson (R-Moultrie), which reauthorizes the House Rural Development Council passed 164-1 after receiving no debate on the floor. The second measure, HB 187, authored by Rep. Katie Dempsey (R-Rome) amends Title 31 to require DCH create a three-year pilot program to provide coverage for the treatment and management of obesity and related conditions under a state health insurance plan. The pilot program, which will be limited to 250 participants, will provide coverage for all FDA-approved medications for chronic weight management, as well as obesity prevention, screening, and counseling benefits. The bill also allows DCH to enter into an agreement with a postsecondary institution for pilot program management, data collection, patient engagement, and other activities related to the pilot program. After Rep. Dempsey’s explanation in the well, the bill received no debate and passed the House 148-14.

Committee Updates

Senate Education & Youth Committee

The Senate Education & Youth Committee, chaired by Sen. P.K. Martin IV (R-Lawrenceville), met to consider several propositions today:

  • SB 60, authored by Chairman Martin, is intended to help educate coaches and teachers about the threat of sudden cardiac arrest. The bill requires schools to post information on the warning signs of sudden cardiac arrest, hold an informational meeting for parents, and obtain informed consent before participation in sports. The bill also creates a protocol for responding to students who faint or pass out while participating in sports, and it requires medical clearance before a student who passes out or faints returns to participation. Chairman Martin presented a substitute that has changes on lines 20 and 23 adding definitions for “athletic association” and “health care provider.” Sen. Elena Parent (D-Atlanta) also offered an amendment that would require professional health care providers be held to the same standards as in the concussion protocol in Code, and the amendment was accepted. The Committee recommended the bill DO PASS as amended and be sent to the Rules Committee.
  • SB 83, authored by Sen. Jeff Mullis (R-Chickamauga), expands the curriculum that public schools may offer relating to the Bible and other religious texts. Georgia law currently allows courses in Old Testament and New Testament history and literature, and this bill would expand available courses to those relating to law, morals, government, art, music, culture, and custom from religious texts. The Committee considered a substitute of the bill that changes lines 48 and 50 to read “content standards” instead of “curriculum.” Sen. Ellis Black (R-Valdosta) asked whether this legislation might open the door to allow other religious texts into schools and expressed concern that extremist religious content might creep in. The Committee unanimously recommended the bill DO PASS and be sent to the Rules Committee.
  • SB 86, authored by Sen. Jeff Mullis (R-Chickamauga), amends Title 20 to prohibit high schools that receive public funds from participating in interscholastic sports conducted under any athletic association that does not have separate regions and playoffs for public and private schools. Sen. Mullis noted that he was not particularly interested in passing this bill this year, but he intended to send a message to GHSA about allowing private schools (who may recruit students) to compete at an advantage against public schools. The Committee took no action on the bill.
  • SB 102, authored by Sen. Emmanuel Jones (D-Decatur), amends Title 20 to provide for a pilot program to plan, implement, and improve sustainable community schools. Cindy Morley of Communities in Schools spoke of proposed changes to the bill, including adding the four pillars of community schools to the legislation. PAGE and Voices for Georgia’s Children rose in support of the bill. The bill was held for further work.
  • SB 163, authored by Sen. Bruce Thompson (R-White), amends Title 20 to allow homeschooled students to participate in extracurricular and interscholastic activities sponsored by his/her resident school system. Sen. Elena Parent (D-Decatur) asked whether the author might consider bifurcating the bill to allow rural areas to be treated differently than urban areas. Beth Garcia, a homeschool mom of eight children (including Sen. Randy Robertson’s wife), spoke in favor of the bill, stating that she has paid property taxes in Muscogee County, but her children have not benefited from any of them since they cannot participate in high school sports. Sen. John Wilkinson (R-Toccoa) asked whether a student could participate in a public or private school’s sports (leading to potential recruiting) or whether a student would have to go to a specific school, to which Sen. Thompson deferred to a later speaker. Sen. Elena Parent (D-Atlanta) asked why the bill should not be expanded to include private school students who do not have access to certain sports, to which Cole Muzio of Family Policy Alliance of Georgia said he had no opposition, but the bill was limited to homeschool for simplicity. Sen. Parent asked whether inability to participate in a sport or certain sport is simply a “con” for the choice of homeschool or private school that individuals are trying to avoid with this bill. Sen. Jesse Stone (R-Waynesboro) also questioned where and how to draw the line on allowing access to activities. Sen. Freddie Powell Sims (D-Dawson) talked about the consequences that come with choices, and lack of access to high school sports is a consequence of choosing home school. Sen. Sally Harrell (D-Atlanta) sent the Committee a letter in support of the bill. A motion Do Pass was made, but the vote FAILED by a 4-5 vote (with Chairman Martin voting to create a 5-5 vote). However, the bill will still not move forward without a majority vote.

All other bills, including SB 108, were deferred until the Committee’s next meeting, which is expected on Friday or Monday.

Senate Health and Human Services Committee

Chairman Ben Watson, MD (R-Savannah) held a Committee meeting with the following proposals on the agenda:

  • SB 109 - Sen. Larry Walker, III (R-Perry) spoke to this initiative addressing physician and provider shortages in the State.  A study committee was held in 2017, and it looked at scope of practice of APRNs and a Committee Substitute of 33 7824S was offered for the Committee’s consideration today. Now these nurses can offer radiological tests under emergency situations and this would allow the ordering of such test whether an emergency or not if they have been practicing for a minimum of five years. Only state not allowing them this broader permission.  An argument was that it would cause a proliferation of tests;  insurers would review these tests and determine if they are being over ordered.  Chairman Watson inquired about continuing education.  Desiree Clement, Coalition of APRNs, a professor at Emory and coordinator of dual midwifery program at Emory, testified.  She thanked the author for bringing the bill.  There were changes made and some at the request by Chairman Watson.  This bill will help with access to care.  Chuck McMullen spoke on behalf of the Georgia Academy of Family Physicians which is against the proposal.  Georgia Alliance of Community Hospitals supported the initiative. Becky Ryles, on behalf of the Management Services Network (Radiological services) as there is already an “over ordering” of tests and more exposure to radiology. Ms. Ryles indicated it would not address rural access to healthcare.  Sen. Kirkpatrick asked about the protocol agreement and what is required of the radiologist to review those studies; she also asked about liability issues as to whether the nurses are covered by malpractice coverage or if it would fall under the physician’s malpractice coverage.  Ms. Clement can already order in life-threatening situations.  They have follow up with their physician.  There are national guidelines for screening (such as mammography screenings with MRI).  APRNs are libel but under blanket coverage if the nurse is with a large group. There are timing requirements with consultations with physicians.  All APRNS are board trained to do these tests.  A motion was made DO PASS by Sen. Steve Henson (D-Tucker); the bill received a DO PASS with dissent.
  • SB 168 - Sen. Greg Kirk (R-Americus) offered this legislation which is a “compact” bill.  Last year’s nurse compact legislation added language; this bill is the Compact without the added language previously passed.  Anna Adams, from Georgia Hospital Association, spoke in favor of the legislation.  Julie Windom, from Navicent Health, spoke in favor of the legislation.  191 nurses which are operating under the Compact; they have 200 vacancies and some of the positions from $8-11 million if not under the Compact it would double their costs.  Tim Kibler, Georgia Alliance of Community Hospitals, spoke in favor of the legislation.  A motion was made DO PASS by Sen. Chuck Hufstetler (R-Rome).  The bill received unanimous DO PASS.
  • SB 184 - Sen. Greg Kirk (R-Americus) outlined this bill addressing Chapter 18 of Title 45 adding FQHCs to the State Health Benefit Plan to be reimbursed at Medicare rates.  It would allow such costs to be borne by SHBP and provide greater access to care.  Sen. Kirk explained that FQHCs have wrap around services, including case management and access to medications.  An amendment was also offered by the author.  Sen. Renee Unterman (R-Buford) inquired about the rates proposed to be paid for services at the FQHCs; she also asked if the FQHCs have contractual issues with the State. Sen. Unterman asked if mental health services were covered, and Sen. Kirkpatrick wanted to know if that should be made clear (pointing out that there is not always parity between physical and mental health services).  Shea Ross Smith rose to spoke on behalf of Kaiser Permanente and Kaiser Foundation Health Plan and its exclusive contract with physicians.   The amendment is to address Kaiser’s contract with the State Health Benefit Plan for 32 counties in metro Atlanta so that it is excluded from the requirements of this bill.  Kaiser is not a part of FQHCs and Kaiser Permanente members would not go to FQHCs.  Sen. Kirkpatrick understood that FQHC took all individuals.  Kaiser Permanente has no network for primary care according to Josh Mackey, a lobbyist for Kaiser.  Rebecca Chamberlain Ryles spoke on behalf of the Primary Care Association (FQHCs).  They provide a medical home for the uninsured and underinsured; they take all patients regardless of their ability to pay but based upon their household income.  As for behavioral health, would do assessments to determine risk factors. Ms. Ryles supports the legislation and has no problem with the Kaiser amendment.  Amendment was proposed as presented but due to unrest a motion to table was made..  The Chairman said he would take up the issue at 8:00 a.m. on February 28.
  • SB 189 - Sen. Bill Cowsert (R-Athens) presented this legislation. It deals with statutes regarding health records of patients.  OCGA 31-33-2 requires records be kept for ten years but does not address litigation and parties to litigation.  In federal rules, there is a HIGH Tech Act regarding storage and protection of records but it does not contain permissions for third-parties to get records. It too addresses production of medical records.  Georgia allows patients to obtain their records with certain HIPAA provisions.  The law does not address legal representatives for patients to obtain records. Most providers now store health records electronically and bill allows records to also be produced electronically. Bill does contain language around costs - not to exceed $50 for retrieval of records.  At page 2 at line 54, there has been push back on penalties for not producing the records - it says the provider must comply within thirty-days from the date of the request or otherwise they may be assessed penalties.  Sen. Kirkpatrick inquired about instances where data behind the records is required to be pulled by a third party at a cost of $50,000 to her practice at Resurgens. Sen. Renee Unterman asked about getting records moved to a physician referral and whether there were timing requirements for such.  Chairman Watson indicated that he believed that to be 30 days. Misty Holcomb, on behalf of Ciox Healthcare, nation’s largest medical records’ copies and headquartered in Alpharetta and they do business in all 50 states.  It opposes SB 189 due to legislation pending at the federal level and ONC proposed Rules which will alter access to patient’s records. The 60-day comment period for the 724 pages of proposed Rules is going on now. Trey Reese, a partner with Hall Booth and outside counsel to MAG, spoke to safeguards for production of records.  Mr. Reese spoke against the penalties -need legal authority to act and valid authorization - to determine if person can make a request. Oftentimes, there are disputes over whether the person making the request for records as to whether they can receive the records.  There are HIPAA provisions concerning “exposure” for producing records. The legislation is contrary to those provisions. He also mentioned the carve outs for psychiatric and mental health records which exist. There is nothing in the bill addressing denials of production of records. David Hanson is a lawyer who does medical practice and on behalf of Resurgens which has concerns about the bill.  His concerns were in part about Metadata on records and not just merely the medical records.  Ethan James, GHA, spoke of the challenges and costs to recover for the copy fees. Tim Kibler, the Alliance of Community Hospitals, also spoke to the concerns about the bill and echoed the costs issue raised by GHA and what information is to be shared with the redaction of records. Andrew Kahn, an attorney from Savannah, spoke in favor of the proposal which is trying to fix an antiquated law. All records now are electronic and access if more available. There is nothing in here addressing Metadata - that’s not addressed in the proposal.  This is about medical records.  The 30 day requirement is already current law per Mr. Kahn. Greg Reybold, with the Georgia Pharmacy Association,  echoed some concerns already raised. This bill does not mesh with the third-party production act in the Civil Practice Act at line 37 and interferes with any ability to raise objections to records.  This needs to be subject to the Civil Practice Act. Sen. Unterman asked if covers other providers - chiropractors, dentists, and other providers.  A motion was made to table; the motion carried and the legislation was TABLED.
  • SB 121 - Sen. Larry Walker, III (R-Perry) presented this initiative which was “hearing only” today.  This legislation drawn in Chapter 13 of Title 16  is brought at the request by the Attorney General and addresses Georgia’s Prescription Drug Monitoring Program.  Shelia Pierce from the Department of Community Health spoke to the period of record retention from two years to five years by the PDMP system.  All states have a PDMP and other states have similar retention periods.  A representative from the Attorney General asked for change to allow fraud control unit would have ability to do investigations and obtain access to the PDMP database.

Meeting on February 28, 2019 at 8:00 a.m. in the Mezzanine.

House Insurance Committee

The House Insurance Committee, chaired by Rep. Richard Smith (R-Columbus), met today to consider a number of propositions:

  • HB 84 - This bill was tabled at the last Committee meeting addressing consumer protections for scheduled procedures - not emergency procedures - and bills associated around those for noncovered services.  The bill was removed from the table and Chairman Smith presented a new Substitute on his bill.  LC 46 0114S was the new version adding language in Chapter 20E of Title 33.  Lines 209 initiation arbitration was addressed so as to impose alternative dispute resolution will go through the Department of Insurance and the Commissioner will develop such rules and regulations with parties to share the cost. MAG remains opposed; GHA approves the bill and they have to do the majority of the work. Rep. Cannon asked for the Senate readiness on the issue - Chairman Smith said that they have SB 56 but it has constitutional issues.  Rep. Williamson thanked Chairman Smith for his efforts on the bill and made the motion DO PASS.  That motion carried with one no vote.
  • HB 227 - Rep. Spencer Frye (D-Athens) presented his legislation which he announced would have an amendment to be considered.  The legislation addresses family violence victims which are now addressed in the law and also includes victims of sexual assault.  Chairman Smith asked a constituent in Columbus which helps women with sexual assault issues and they support the proposal.  39 other states address sexual assault with many in the South.  A motion was made to adopt the amendment at line 120, addressing notification around to all so this clarifies that no insurer has to send out such notices of the change in the law.  A motion was made DO PASS as amended was made - bill received that DO PASS.
  • HB 323 - Rep. David Knight (R-Griffin) has worked with the pharmacies and pharmacy benefit managers on the proposal which addresses claims administration.  Pharmacy Protection Act passed in 2017 so as to protect the patient; it had provisions around the clawback clause.  This legislation clarifies and strengthens the mail order provisions and report information on pharmacy rebates to the DOI Commissioner.  There would be no sharing of patient information. I will apply to all pharmacies and dispensers.  LC 33 7811 S, Committee Substitute, was the bill at issue addressing Chapter 64 of Title 33.  Rep. Cannon inquired if this impacts a provider of medicine in her district relating to HIV medications and when the pharmacy is within the organization and disclosure of the rebates.  The rebates reports are more around the manufacturing making the report according to Rep. Knight.  The purpose is for the bill to help take care of the patients. The bill received a DO PASS recommendation.
  • HB 353 - Rep. Kasey Carpenter (R-Dalton) codifying an insurance accident as insurance fraud.  It is costly to insurers and individuals.  It sets penalties for these fraud instances of staging a motor vehicle accident.  It should lower car insurance premiums if passed.  How do you prove that an individual has staged an accident?  It is up to evidence presented. There were 43 cases which happened to UHaul where accidents are staged so as to collect large settlements. Felony penalties are established for other types of fraud - two year minimum - is included in other types of insurance fraud.  Rep. Darlene Taylor (R-Thomasville) indicated that a small trucking entity in her district has issues with this type of behavior.  Many of the Democrats on the Committee raised a number of concerns around the mandatory minimum penalties proposed in the initiative.  Rep. Chuck Efstration (R-Dacula) asked if the prosecutors have looked at this and made comments - his concern was in a situation when a death occurs as a prosecutor could not impose a higher charge.  He asked if he could work with Rep. Carpenter on the proposal.  Chairman Smith asked to table the bill; will schedule another meeting next week on the issue after more discussions.TABLED.
  • HB 367 - Rep. Darlene Taylor (R-Thomasville) presented LC 46 0065 NAIC regulation so as to maintain accreditation.  It will require a new annual filing rather than every five years. Corporate Governance Annual Disclosure is the name of the legislation. It will require a review of assets, loss ratios and determination of whether the insurer is financially sound. It will usually apply to large carriers but other insurers will also be required to file. The bill received a DO PASS recommendation.
  • HB 368 - LC 46 0117ERS was before the Committee.  It addresses a plan of division of insurers and how the interests are allocated - original and new entities.  It is a plan of a division distinct from merger for instance. Both entities must qualify to be domiciled in the State. DOI is required to review standards.  DOI has reviewed the legislation. Similar legislation was passed in 2018 but Governor did not sign. The version this year’s provides more authority to the Commissioner.
  • HB 491 - Rep. Darlene Taylor (R-Thomasville) affects holding company systems.  26 states have adopted the model.  This is another requirement from NAIC so as the state retains accreditation. Technicality according to Rep. Taylor and must be in place by January 1, 2020.  DOI will monitor the carriers of insurance.  The Commissioner will have the ability to be a group-wide supervisor.  If not passed, it will impact international carriers and Georgia could lose that business. The bill received a DO PASS recommendation. 

House Juvenile Justice

Chairman Mandi Ballinger (R-Canton) held a meeting of her Committee this afternoon taking up these proposals:

  • HB 79 -- Rep. Carl Gilliard (D-Garden City) presented his legislation which received a DO PASS recommendation. The bill seeks to prohibit a court, the Department or child placing agency from denying a party child placement of a child, child custody, visitation, guardianship, foster care or adoption solely or primarily because the party is blind. Where a party or prospective parent’s blindness is alleged to have a detrimental impact on the child, the party raising the allegation has the burden of proving by clear and convincing evidence that the parent or prospective parent’s blindness is endangering or will likely endanger the child’s health, safety or welfare.
  • HB 472- Rep. Bert Reeves (R-Marietta) brought this measure for the Division of Family and Children’s Services.  Director Rawlings outlined the bill’s provisions in  LC 48 0094S.  The legislation gives judges more authority to keep children out of foster care by allowing temporary alternatives for the children. Judges can enter an ex parte order to address these situations.   It will help Georgia implement Family First Prevention Services Act and permit the State to use Title IVE funds for the prevention work in order to keep children from going into foster care.  Placements will need to be assured for safety and place requirements to look at the home, review Department of Corrections and Community Supervision data, conduct criminal records checks, etc.   This  assessment is to be 72 hours before a placement is made of a child.  There are other timing requirements outlined in the bill.  It also looks at a CHINS situation (line 173-175) so that the court is to consider whether to place the child with a relative or fictive kin.  Rep. Thomas asked about placing children with friends - could be fictive kin - what measures does the State have to prevent a child from being physically  around the parent (if the child is being taken from the parent).  Director Rawlings said the background check will address that and the court may impose other temporary protective order language.  Within five days of placement, all will be in court to make certain that such actions were taken to protect the child’s safety. Moved DO PASS from Rep. Mary Margaret Oliver; amendment was proposed after line 113 and add a new subsection(5) if DFCS is conducting an assessment, a search of the child abuse registry (strike word and at line 110).  The amendment was approved by the Committee. Passed the Bill as amended; the bill received the DO PASS recommendation.

House Health and Human Services

The House Health and Human Services Committee, chaired by Rep. Sharon Cooper (R-Marietta), met late Tuesday to consider several propositions:

  • HB 233, authored by Rep. David Knight (R-Griffin), amends Title 26 to create the “Pharmacy Anti-Steering and Transparency Act”. The bill prohibits nonresident pharmacies from sharing patient and prescriber data with affiliates for commercial purposes, presenting a claim for a service provided based on referral from an affiliate, or mailing a prescription to a patient when the prescriber calls for an in-person consultation. It also requires such pharmacies to file an annual disclosure statement of its affiliates. Rep. Knight noted that the bill is aimed at providing “patient care and support” in light of pharmacies affiliated with PBMs and insurers using their relationships to steer patients. He stated that these practices threaten patient care and choice, and pointed to the large number of co-signers on his bill. Two pharmacists spoke in favor of the legislation. The Committee recommended the bill DO PASS and be sent to the Rules Committee.
  • HR 261, authored by Rep. Mark Newton (R-Augusta), creates the Joint Study Committee on Evaluating and Simplifying Physician Oversight of Midlevel Providers. Rep. Newton noted that training varies between provider but there is a desire to look at the efficiency of delivering health care in the state. The Committee would look at delegation of tasks and the appropriateness of such delegation.  An amendment was offered that strikes midlevel providers in its place inserts physician assistants and APRNs. The Committee recommended the bill DO PASS and be sent to the Rules Committee.
  • HB 345, authored by Rep. Sharon Cooper (R-Marietta), bars the shackling of women in jails and detention centers during their second and third trimesters of pregnancy, as well as in post-partum. Chairman Cooper condemned the practice but noted that she had heard stories of it happening.  Representatives of Motherhood Beyond Bars, the Healthy Mothers Healthy Babies Coalition of Georgia, Women on the Rise, and Unite for Reproductive and Gender Equity spoke in favor of the bill, with several asking for it to go further. Representatives of the Department of Corrections fielded questions from the Committee, noting that it is against state prison policy to shackle under the circumstances. The Sheriffs’ Association also spoke to the bill, noting concerns, to which Chairman Cooper stated she had never heard from them until this meeting. The Committee recommended the bill DO PASS and be sent to the Rules Committee.

New Legislation

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

  • HB 483, by Rep. Ron Stephens (R-Savannah), is the annual update to Georgia’s dangerous drug list in Chapter 13 of Title 16.  In part, it adds epidiolex (a drug which is FDA approved and contains cannabidiol derived from cannabis and contains no more than .1 percent tetrahydrocannabinols). This bill was referred to the House Judiciary Non-civil Committee.
  • HB 484, by Rep. Andy Welch (R-McDonough), proposes to address Georgia’s lien laws in Chapter 14 of Title 44 so as to provide for the resolution of disputes in which a medical funding provider has provided payment to a consumer’s health care provider.  It would be known as the “Georgia Medical Funding Act,”  It also outlines what a medical funding provider is prohibited from doing (pay or offer to pay commissions, referral fees or other forms of consideration to any attorney, law firm or health care provider or any of their employees for referring a consumer to a specific health care provider or attorney; refer a consumer or potential consumer to a specific attorney, law firm or health care provider or any of their employees; provided, however, that if a consumer does not have legal representation, the medical funding provider may refer the consumer to a local or state bar referral service; fail to promptly supply, upon request, copies of any and all complete medical funding contracts regarding payment for services rendered to the consumer and any attorney representing the consumer upon request; accept any commissions, referral fees, rebates, or other forms of consideration from an attorney, law firm or healthcare provider or any of their employees; or make a decision relating to the conduct, settlement or resolution of the underlying legal claim, the power of which is to remain solely with the consumer). This bill was referred to the House Judiciary Committee.
  • HB 492, by Rep. Bonnie Rich (R-Suwanee), amends Chapter 7 of Title 44 regarding dispossessory proceedings to require applications for execution of a writ of possession be made within 30 days of the issuance of the writ  unless good cause is shown for the delay in applying for such writ. This bill was referred to the House Judiciary Committee.
  • HB 495, by Rep. Jimmy Pruett (R-Eastman), proposes changes to Chapter 8 of Title 34 to change the definition of employment to include services which are performed by an individual for wages unless the Department of Labor makes a contrary determination based upon evidence that such individual has been, and will continue to be, free from control or direction over the performance of such services.  The Department would be required to look at whether the individual is not prohibited from working for other companies or holding other employment contemporaneously; free to accept/reject work assignments without consequences; is not prescribed minimum hours to work or, in the case of sales, does not have a minimum number of orders to be obtained; has discretion to set his/her own work schedules; receives only minimal instructions and no direct oversight or supervisions regarding the services to be performed (e.g. location where services are to be performed and any requested deadlines); when applicable, has no territorial or geographical restrictions; and is not required to perform, behave, or act or, alternatively, is compelled to perform, behave, or act in a manner related to the performance of services for wages which is determined by the Commissioner to demonstrate employment. This bill was referred to the House Industry and Labor Committee.
  • HB 496, by Rep. CaMia Hopson (D-Albany), seeks to add a new Code section at O.C.G.A. 20-2-14.3 to require a course of study in personal financial literacy and money management in middle school and high school.  It would require that students be provided instruction on such things as types of bank accounts; balancing a checking account; principles of money management (credit scores, managing debt, etc.); completing a loan application and etc. This bill was referred to the House Education Committee.
  • HR 369, by Rep. Matthew Wilson (D-Brookhaven), proposes an amendment to Georgia’s Constitution which would be known as the “Democracy Act.”  Amendments would be to Article II of the Constitution so as to provide that legislative and congressional reapportionment be done by an independent nonpartisan 14 member commission instead of the General assembly. It proposes an outline on the commission appointments as well as their duties and responsibilities. This resolution was referred to the House Legislative and Congressional Reapportionment Committee.

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

  • SB 190, by Sen. John Kennedy (R-Macon), seeks to make changes to Georgia’s Child Custody Intrastate Jurisdiction Act in Chapter 9 of Title 19.  It provides that a party may bring a counterclaim for contempt or enforcement of a child custody order or for modification of legal (which is the responsibilities for major decisions concerning the child, including but not limited to the child’s education, healthcare, extracurricular activities and religious training) or physical custody in response to a complaint seeking a change of legal or physical custody. This bill was referred to the Senate Judiciary Committee.
  • SB 192, by Sen. Burt Jones (R-Jackson), seeks to extensively revise Chapter 41 of Title 33 regarding captive insurance companies. This bill was referred to the Senate Insurance and Labor Committee.
  • SB 195, by Sen. Chuck Hufstetler (R-Rome), addresses Title 33 in an effort to provide for consumer protections and freedom of information relating to prescription drug benefits in health policies.  The purpose is to provide consistency and clarity in the disclosure of prescription drug formularies so as to allow consumers make informed decisions relating to their healthcare.  The proposal applies to all licensed insurance carriers which provide accident and sickness products (individual, group or blanket); TPAs, and pharmacy benefit managers.  It requires that an insurer and PBM provide no later than October 1, 2019 on a public website maintained by the insurer or PBM formulary information.  It also requires a direct electronic link to the formulary information on the website home page of insurers and PBMs. there are also requirements for the insurer and PBMs to update their formulary information and formulary disclosure requirements within seven days of any change, alteration, modification of amendment to the formulary.  It also makes requirements for a Uniform Prior Authorization Form.  It also empowers the Commissioner of the Department of Insurance to appoint a committee to be known as the Advisory Committee on Uniform Prior Authorization and it would recommend to the Commissioner the standard form for requesting prior authorization of prescription drug benefits. This bill was referred to the Senate Health and Human Services Committee.
  • SB 199, by Sen. Nikema Williams (D-Atlanta), seeks to require the testing of drinking water in child care learning centers in Chapter 1 of Title 20.  The purpose is to look for lead contamination and provide for notice and reporting of test results and any remediation plans necessary. This bill was referred to the Senate Health and Human Services Committee.
  • SB 201, by Sen. Jeff Mullis (R-Chickamauga), proposes to provide that any person who is undertaking to promote or oppose a matter before a local coordinating entity regarding the Emergency Medical Systems Communications Program are subject to transparency and lobbyist disclosures in Chapter 5 of Title 21. This bill was referred to the Senate Ethics Committee.
  • SB 202, by Sen. William Ligon, Jr. (R-Brunswick), seeks to allow title insurance to be procured on a lender’s security interest in personal property taken by the lender as collateral for a commercial loan in O.C.G.A. 33-7-8. This bill was referred to the Senate Insurance and Labor Committee.
  • SB 203, by Sen. John Kennedy (R-Macon), addresses Georgia’s Civil Practice Act in Title 9 and addresses specific periods of limitation so as to prohibit retroactive application of certain limitations of actions.  It further makes changes pertaining to written jury charges, exceptions, and filing of written jury charges.  It also addresses the Evidence Code, O.C.G.A. 24-9-921 concerning the identification of medical bills and expert witnesses unnecessary so as to revise the standard of “reasonableness” regarding medical bills. This bill was referred to the Senate Judiciary Committee.
  • SB 204, by Sen. Gloria Butler (D-Stone Mountain), addresses Chapter 4B of Title 43 pertaining to the Georgia Athletic and Entertainment Commission, changing provisions relating to boxing, wrestling, an martial art associations and federations. This bill was referred to the Senate Economic Development Committee.
  • SR 263, by Sen. Jeff Mullis (R-Chickamauga), seeks to create a Senate Emergency Medical Services Study Committee. This resolution was referred to the Senate Rules Committee.
  • SR 264, by Sen. Jeff Mullis (R-Chickamauga), seeks to create a Joint Emergency Medical Services Committee. This resolution was referred to the Senate Rules Committee.

Rules Calendars for Legislative Day 24

The House is expected to consider the following measures on Thursday for Legislative Day 24:

  • HB 31 -- General appropriations; State Fiscal Year July 1, 2019 - June 30, 2020 (Substitute)(App-Ralston-7th)
  • HB 64 -- Parent and child; require child welfare agencies to make efforts to determine whether a parent or guardian of a child who is the subject of abuse allegations is on active duty in the military (Substitute) (JuvJ-Prince-127th)
  • HB 68 -- Education; prohibit certain entities from being student scholarship organizations (Ed-Carson-46th)
  • HB 134 -- County law libraries; repeal a population provision regarding the disposition of law library funds in certain counties (Judy-Rich-97th)
  • HB 197 -- Office of Planning and Budget; provide for the establishment of the Strategic Integrated Data System (Substitute)(B&FAO-Dempsey-13th)
  • HB 257 --Council of Magistrate Court Judges; organization and provide for officers; increase authority (Judy-Scoggins-14th)
  • HB 277 -- Insurance; allow good will from insurer acquisitions to be treated as an asset (Substitute)(Ins-Carson-46th)
  • HB 321 -- Health; hospital Medicaid financing program; extend sunset provision (App-Lott-122nd)

The Senate is expected to consider the following measures on Thursday for Legislative Day 24:

  • SB 127 -- Motor Fuel Tax; electronic filing of certain reports; require (FIN-52nd)
  • SB 128 -- Income Tax Payment; person required to submit a statement of taxes withheld shall be assessed a late penalty after the due date; provide (FIN-52nd)
  • SB 137 -- Tuskegee University; specialty license plate; establish (PUB SAF-26th)
  • SB 149 -- Motor Vehicles; retain custody of the vehicle under certain conditions; valid number license plate without required revalidation decal affixed; permit (PUB SAF-29th)
  • SB 156 -- Insurance; division of a domestic insurer into two or more resulting domestic insurers; provide (Substitute) (I&L-9th)
  • HB 183 -- Ad valorem tax; right to appeal for any taxpayer that fails to file a property tax return or whose property tax return was deemed returned; provide (FIN-52nd) Harrell-106th


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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Updated: May 25, 2018:

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