One of the hottest topics under the Gold Dome came to a head today. Certificate of Need (“CON”) law revisions have been discussed in both chambers with proponents and opponents to change wrangling over various proposals. In the Senate Finance Committee, a new Substitute to HB 186 received a DO PASS recommendation with many CON reforms tacked onto the underlying legislation addressing hospital authorities. HB 186 now moves to the Senate Rules Committee for its review and determination on whether to place the bill on the Senate Rules Calendar for debate.

CON wasn’t the only hot topic of discussion today. School vouchers returned to the spotlight in the Senate Education and Youth Committee meeting late this afternoon, added as an amendment to HB 68. More on that development in tomorrow’s #GoldDomeReport.

In this Report:

• Committee Updates
• Rules Calendars for Legislative Day 34

Committee Updates

House Special Committee on Access to Quality Healthcare

Chairman Richard Smith (R-Columbus) preempted the hearing of SB 106 by explaining how important healthcare is to the state of Georgia. Sen. Blake Tillery (R-Videlia) The bill provides authorization for the Governor to submit Medicaid waiver proposals. The committee then heard public comment from a list of medical organizations and hospital systems. The majority of these comments were in support of SB 106, including why waivers are necessary to help patients receive affordable care along with how they will allow hospitals to increase their level of care without worrying about high uncompensated costs. Some speakers voiced concerns with the provision in the bill that would cap Medicaid eligibility at 100% of the poverty line instead of 138% as allowed under federal law. These speakers indicated this provision could prevent Georgia from receiving the full 90% match in federal funding along with creating a new coverage gap for individuals between 100-138% of the poverty line. Rep. Sharon Cooper (R-Marietta) indicated that President Trump has recently signaled an impending change to the federal match policy for states capping eligibility at 100%. The bill passed through the committee 8-3 and moves on to the House Rules Committee.

Senate Insurance and Labor Committee

The Senate Insurance and Labor Committee, chaired by Sen. Burt Jones (R-Jackson), held its final meeting of the legislative session today to hear two bills:

• HB 227, authored by Rep. Spencer Frye (D-Athens), amends Title 33 to provide that an insurer cannot refuse to an insure a person based on his or her status as a victim of family violence or sexual assault. The Committee recommended the bill DO PASS and be sent to the Rules Committee.
• HB 373, authored by Rep. Bill Werkheiser (R-Glennville), amends Title 34 to allow the Commissioner of Labor to require criminal background checks on Department of Labor employees. The Committee recommended the bill DO PASS and be sent to the Rules Committee.

Senate Finance Committee - Income Tax Subcommittee

This Subcommittee, chaired by Sen. Bill Heath (R-Bremen), met to take up the following:

• HB 287, by Rep. Matt Dubnik (R-Gainesville), addresses moving a tax deduction to a tax credit for preceptors in the training of physicians (MDs and DOs), physician’s assistants, APRNs.  Rep. Dubnik indicated that there was a fiscal note on the legislation and it was his intent to continue to strengthen rural healthcare.  Sen. Doc Rhett (D-Marietta) spoke about his participation on the Lt. Governor’s Task Force on Healthcare and understands the issues pertaining to rural healthcare.  Sen. John Albers (R-Roswell) noted he was against the proposal because of a number of factors including there is no sure return on investment; his communications with four physicians in his district who indicated that it would be “nice” to do this tax credit but it was not needed.  He further stated that no tax credits were provided for volunteer firefighters, teachers or IT workers.  He stated that this bill was a “slippery slope” and the legislation would essentially ask for all Georgia taxpayers to pay for this credit.  He suggested that universities pay for the training of these preceptors just like we would pay for gas at the gas pump.  Physicians did tell Sen. Albers that the training of physicians takes time and the training also creates a great network of future physicians and they learn from those that they teach.  Sen.  Albers stated that “in the Senate we like to have a clear return on investment.”  This legislation was moved forward to the full Senate Finance Committee without a recommendation from the Subcommittee at Chairman Heath’s direction.

Senate Finance Committee - Tax Expenditure Subcommittee

Sen. John Albers (R-Roswell) led discussions at this Subcommittee meeting.  They took up the following legislation:

• HB 446, authored by Rep. David Knight (R-Griffin), addresses the timber tax credits proposed in the wake of Hurricane Michael.  This initiative received unanimous support and moves to the full Committee with a DO PASS recommendation.
• HB 447, authored  by Rep. Dominic LaRiccia (R-Douglas), seeks to address the tax exemption on jet fuel tax which was implemented under executive order by former Governor Deal.  The legislation came before the Subcommittee, and to the surprise of Rep. LaRiccia who also serves as a Floor Leader to Governor Kemp, in the form of a new Substitute.  The new version adds Sen. Burt Jones’ (R-Jackson) legislation to create a new Atlanta Airport Authority for the oversight of Hartsfield-Jackson.  Rep. LaRiccia raised his opposition of including two subject matters in one proposal.  Sen. Bill Heath (R-Bremen) indicated that this has been clarified and the amendment was germane.  This legislation would provide a dedicated source of revenue for not only commercial airports but also general aviation airports.  It also proposed a new tax on the fuel; jet fuel currently has no tax.  This new bill will impose a $.10 per gallon excise tax which would be big for the industry per Rep. LaRiccia.   Rep. LaRiccia argued the “uniqueness” of the airline industry and the fact that it needed predictability on return on investment as well as recoupment of their investments.  Sen. Nan Orrock (D-Atlanta) noted that she was surprised that the City of Atlanta was not invited to provide testimony and the bill was overriding the business community and one of the State’s largest employers’ views on the legislation.  The bill received a DO PASS recommendation to move to the full Committee.

Senate Finance Committee

Sen. Chuck Hufstetler (R-Rome) led this Committee through the following:

• HB 221, authored by Rep. Terry Rogers (R-Clarksville), seeks to increase the bond authority for the Georgia World Congress Authority.  It moves the bond amount from $400 million to $500 million.  Sen. Bill Cowsert (R-Athens) asked about repayment; it will be made by the Authority per the author. There has been no pushback on the proposal and the hospitality industry has verbally supported the legislation.  This bill received a DO PASS recommendation, moving now to the Senate Rules Committee.
• HB 287, authored by Rep. Matt Dubnik (R-Gainesville), addresses the preceptorship tax credit outlined above in Chapter 7 of Title 48 .  Chairman Hufstetler noted that the bill received no recommendation from the Subcommittee.  Rep. Dubnik noted that 40 organizations supported this change from a tax deduction to a tax credit and it would help with the healthcare workforce shortages in the State, particularly when the shortages of physician’s assistants and APRNs continue to grow. The healthcare professionals require clinical training in community-based settings.  A preceptor is not compensated for his or her work in training these professionals.  Dubnik noted that there was competition with other states in how they facilitate training.  The cost to the State would be $1 million to $2 million annually, if preceptors take advantage of such credit.  Sen. Bill Cowsert (R-Athens) asked if these individuals being trained were residents; they are third-year students who require 160 hours of hands-on training.  Sen. Albers again noted that the universities or students could handle the needs of these preceptors’ training costs.  Chairman Hufstetler did note that a bill similar to this passed in 2018 out of the Senate.  Sen,. Butch Miller (R-Gainesville) stated that he had talked to the Medical College of Georgia and it explained that 72 percent of physicians from their institution train in Georgia and they find that if they train in Georgia that they will stay in the state.   Sen. Ellis Black (R-Valdosta) asked clarification about the money; Rep. Dubnik replied that the max to be received from the credit for the first through third rotations was $500; the fourth through tenth rotations would receive $1,000 - these amounts would be less for training of APRNs and physician’s assistants.  Sen. Rhett noted he wanted to be prudent when taxes were concerned.  The legislation received a DO PASS recommendation with a split vote of 5-4.
• HB 446, authored by Rep. David Knight (R-Griffin), seeks to amend O.C.G.A. 48-7-40.36 concerning the timber tax credit received a unanimous DO PASS recommendation.
• HB 186, authored by Rep. Ron Stephens (R-Savannah), came to the Committee in the form of a new Committee Substitute.  The legislation now has three parts: 1) original language to address hospital authorities and their investments of funds; 2) certificate of need law revisions; and 3) the creation of the Office of Health Strategy and Coordination (formerly a Senate bill passed and vetoed in 2018 by Sen. Dean Burke, MD).  Among the new CON revisions include transparency (e.g. requiring form 990s of nonprofit hospitals to be posted); revisions to address Cancer Treatment Centers of America (permitting it to seek to become an acute care hospital, but following the CON process); requirements for cardiology and psychiatric facilities to undergo the CON process; requires the Department of Community Health to post health surveys of facilities; directs the Department of Community Health to develop a standardized methodology for reporting indigent and charity care; increases to capital expenditures amounts for physical buildings and equipment; language on who can appeal (using 35 miles if the facilities have the same services or are in the same service area); and language on medical use rights.  There was testimony supporting the proposal by GHA, Cancer Treatment Centers of America, and Georgia Alliance of Community Hospitals.  Sen. Cowsert inquired if this new Office of Health Strategy and Coordination would grant the CONs; no the new Office does not deal with CON.  HB 186 received a unanimous DO PASS recommendation.
• HB 447, authored by Rep Dominic LaRiccia (R-Douglas), seeks to address the tax credit on jet fuel as described above.  Rep. LaRiccia again raised the concerns about the germaneness of the addition of the language proposing a new authority to oversee Hartsfield-Jackson Airport.  Sen. Tyler Harper argued for the new version of the legislation stating it would dedicate a source of revenues.  He also mentioned that the cheapest jet fuel he had found in Georgia was $3.00 per gallon.  Harper also mentioned the local government’s ability to impose a tax.  Sen. Heath stated that the State has endured years of corruption at Hartsfield-Jackson and it is important to ensure the airport is governed properly.  Further, it was pointed out that with the exemption provided on jet fuel that no ticket prices were reduced by the carriers.  This bill will be an important economic development component in rural areas and will compliment commercial services and support the secondary commercial airports.  The Committee gave the legislation a DO PASS recommendation with a 5-4 vote - after Sen. Lester Jackson (D-Savannah) asked for a germaneness ruling on the additional language of the Authority (Chairman Hufstetler stated he believed it to be germane).

Senate Health and Human Services Committee

Chairman Ben Watson, MD (R-Savannah) led this Committee through these bills:

• HB 290, authored by Rep. Sharon Cooper (R-Marietta), is a set of pilot projects to address the proliferation of HIV/AIDS cases.  This work will be done in conjunction with the Department of Public Health and will utilize a prophylactic drug which will be donated.  The Department of Public Health will work with the CDC areas which have been identified at risk for greatest numbers to be infected with the disease.  This legislation is a part of the proposed solution to curb new cases (the syringe exchange program is the other initiative).  It is anticipated that this pilot initiative will cost $50,000 in the first year and between $200,000 and $300,000 over three years.  Chairman Cooper indicated that these costs were minimal versus the astronomical costs associated with care of full-blown AIDS cases.  Devon Ward, with the Black Futures Group, testified in support of the legislation, noting that a disproportionate of individuals impacted are individuals of color.  Sen. Renee Unterman (R-Buford) asked about making this legislation effective upon appropriations; there is a section of the current legislation which tasks the Department of Public Health to look for grants for funding.  Sen. Nan Orrock (D-Atlanta) asked if that idea might conflict with the current language; Chairman Watson indicated that it was not mutually exclusive.  The Department of Public Health’s Meagan Andrews indicated that the Department would be fine with the amendment offered by Sen. Unterman.  Sen. Greg Kirk (R-Americus) moved DO PASS; the legislation received a unanimous DO PASS recommendation.  Sen. Kay Kirkpatrick, MD (R-Marietta) will carry the legislation forward in the Senate.
• HB 345, also authored by Rep. Sharon Cooper (R-Marietta), seeks to prohibit pregnant women from being shackled while in custody of law enforcement.  Rep. Cooper indicated it was the “humane” thing to do. She noted that the issue came to her attention at the legislative Biennial training in Athens.  She noted that when she talked to the sheriffs and institutions that they both indicated that they do not shackle pregnant women.  A number of folks testified for the legislation including nurse midwives; ACLU; Southern Center for Human Rights; and Healthy Mothers Healthy Babies.  However, some indicated that language needed to be added so as to prohibit the placing of a postpartum woman immediately after birth in solitary confinement.  The Georgia Sheriffs Association rose to speak to its concerns and the confusion which the legislation would cause their jails.  The bill was TABLED for further work and will likely come back next Monday.
• HB 323, authored by Rep. David Knight (R-Griffin), addresses Georgia’s laws in Chapter 64 of Title 33 on pharmacy benefit managers.  Rep. Knight indicated it would strengthen the current law on mandatory mail order prohibitions; add pharmacy benefit manager transparency; require reporting of pharmacy rebates; prohibit the sharing of information for commercial purposes and apply accreditation law on PBMs.  There was a question by Sen. Orrock on how the rebates’ process works; Rep. Knight indicated that was difficult because contracts are proprietary in nature.  A change was offered by Sen. Larry Walker, III (R-Perry) so as to move the effective date to January 1, 2020. The legislation as amended received a DO PASS recommendation, moving now to Senate Rules.

Rules Calendars for Legislative Day 34

The House will take up the following propositions on Thursday for Legislative Day 34: 

• HR 368 -- Interstate 14; construction; urge
• SB 17 -- Public Utilities and Public Transportation; authorize telephone cooperatives and their broadband affiliates; provide broadband services
• SB 55 -- Retirement; method and manner by which a member of the Employees' Retirement System of Georgia may purchase an annuity; revise
• SB 121 -- Prescription Drug Monitoring Program Database; length of time prescription information is retained from two years to five years; increase
• SB 97 -- Self-Service Storage Facilities; limit fees charged and collected by self-service storage facilities for the late payment of rent; provide
• SB 132 -- Insurance; modernization and updates; provide; Commission on the Georgia Health Insurance Risk Pool; repeal Article 2 of Chapter 29A
• SB 133 -- Insurance; modernization and updates; provide

The House is likely to add additional bills for consideration on Thursday in a Supplemental Rules Calendar to be adopted on Thursday morning.

The Senate will take up the following propositions on Thursday for Legislative Day 34:

• HB 225 -- Motor vehicles; reference date to federal regulations regarding the safe operation of commercial motor vehicles and carriers; update (PUB SAF-7th) Rich-97th
• HB 246 -- Evidence; revise manner by which depositions taken at the instance of state are paid (JUDY-18th) Silcox-52nd
• HB 325 -- Law enforcement officers and agencies; records of investigation of an officer by the Georgia Peace Officer Standards and Training Council shall be retained for 30 years; provide (PUB SAF-7th) Clark-147th
• HB 387 -- Property; liens in favor of private, nonprofit, volunteer fire departments for instances of fire services that are requested by property owners; provide (JUDY-53rd) Lumsden-12th
• HB 226 -- Courts; additional penalty for violation of traffic laws or ordinances under Joshua's Law; extend sunset (PUB SAF-17th) LaRiccia-169th
• HB 279 -- Revenue and taxation; certain law enforcement officers may use department vehicles relative to certain approved off-duty jobs; provide (Substitute) (PUB SAF-29th) Lumsden-12th
• HB 300 -- Health; redesignate continuing care retirement communities as life plan communities (H&HS-46th) Smith-133rd
• HB 471 -- Motor vehicles; implied consent notices; revise (PUB SAF-29th) Sainz-180th
• HB 514 -- Georgia Mental Health Reform and Innovation Commission; create (Substitute) (H&HS-13th) Tanner-9th