Advocacy

MEDICAL ASSOCIATION OF GEORGIA
GEORGIA GENERAL ASSEMBLY (2018)
KEY BILLS SUMMARY

MAG Priority: Health Insurance

H.B. 314 by Rep. Jason Shaw (R-Lakeland), which was stripped down and replaced with the provisions of a bill (S.B. 359) that was introduced by Sen. Chuck Hufstetler (R-Rome) that would have 1) resulted in greater transparency for elective procedures and 2) established a patient/physician arbitration process for “unexpected events” that take place during elective medical procedures and 3) established a standard physician payment model for out-of-network emergency care – the 80th percentile of the independent/neutral ‘FAIR Health’ database. MAG’s Position: Supported. Outcome: Did not pass.

H.B. 519 by Rep. Cooper (R-Marietta), which would have added four step therapy exemptions into law. MAG’s Position: Supported. Outcome: Did not pass, although the bill’s provisions ended up in S.B. 325 – which also did not pass

H.B. 678 by Rep. Richard Smith (R-Columbus), which was designed to eliminate “surprise bills” for out-of-network medical care, including 1) requiring physicians to provide patients with certain information before elective procedures, including the physician’s status with the patient’s health insurer’s network, the names and other information related to other physicians who will provide services during the procedure, and an estimate of the bill that the patient will receive after the procedure and 2) subjecting hospitals and insurers to greater transparency requirements and 3) requiring physicians and hospitals to send initial bills to patients within 90 days – while the Georgia Department of Insurance would establish a patient arbitration process to resolve any billing disputes. MAG’s Position: Supported greater transparency, but it wanted a more comprehensive solution. Outcome: Did not pass, although the bill’s provisions ended up in S.B. 8 – which also did not pass.

H.B. 799 by Rep. Sharon Cooper (R-Marietta), which would have required hospitals to contact a patient’s health insurer to get its authority before administering any post-stabilization care. Under this measure, if an insurer wanted one of its beneficiaries to be transferred to another facility for post-stabilization care, they would be responsible for making the arrangements for the transfer and bearing the costs. MAG’s Position: Neutral. Outcome: Did not pass.

H.B. 818 by Rep. Lee Hawkins (R-Gainesville), which will prohibit insurers from restricting how health care providers get reimbursed (e.g., requiring credit card payment). MAG’s Position: Supported. Outcome: Passed.

H.B. 872 by Rep. David Knight (R-Griffin), which would have established 1) standards for health insurers to select, deselect, and tier physicians and 2) an appeals process for physicians who are deselected or tiered by a health insurer. Under this measure, patients would have also been able to see a physician at an in-network rate for the entire plan year if the insurer deselects that physician during the plan year. MAG’s Position: Supported. Outcome: Did not pass.

H.B. 873 by Rep. David Knight (R-Griffin), which would have 1) established transparency standards for formularies and 2) streamlined the prior authorization process by requiring the use of a standard form, setting timelines for insurers to respond to the form, and ensuring the continuity of care when a patient switches health insurance plans. MAG’s Position: Supported. Outcome: Did not pass.

S.B. 8 by Sen. Renee Unterman (R-Buford), which addressed “surprise medical bills.” When this bill got to the House, Rep. Richard Smith (R-Columbus) replaced its provisions with the language from a bill (H.B. 678) that would have 1) required physicians to provide patients with certain information before elective procedures, including the physician’s status with the patient’s health insurer’s network, the names and other information related to other physicians who will provide services during the procedure, and an estimate of the bill that the patient will receive after the procedure and 2) subjected hospitals and insurers to greater transparency requirements and 3) required physicians and hospitals to send initial bills to patients within 90 days – while the Georgia Department of Insurance would establish a patient arbitration process to resolve any billing disputes. MAG was calling for greater transparency, but it was part of a coalition of medical societies that wanted to see a more comprehensive solution for surprise medical bills – like S.B. 359, which would have 1) resulted in greater transparency for elective procedures and 2) established a patient/physician mediation process for bills that arise from “unexpected events” that take place during elective medical procedures and 3) established a standard physician payment model for out-of-network emergency care – the 80th percentile of the independent/neutral ‘FAIR Health’ database. MAG’s Position: See H.B. 678. Outcome: Did not pass.

S.B. 118 by Sen. Renee Unterman (R-Buford), which will raise the age for mandatory insurance coverage for treatment for children who are autistic and raise the age for mandatory insurance coverage for applied behavior analysis from six to 20 years. MAG’s Position: Neutral. Outcome: Passed.

S.B. 325 by Sen. Kay Kirkpatrick, M.D. (R-Marietta), which was originally designed to clear the way for Georgia to join the Interstate Medical Licensure Compact – making it easier for physicians to obtain licenses in other participating states. The bill was eventually stripped-down and replaced with the provisions of a bill (H.B. 519) that Rep. Sharon Cooper (R-Marietta) introduced and a bill (H.B. 646) that Rep. Katie Dempsey (R-Rome) introduced. MAG supported H.B. 519, which would have added four exemptions to the state’s step therapy statute. And MAG was neutral on H.B. 646, which would have extended a pilot program to offer bariatric surgery through the State Health Benefit Plan. There is a good chance that lawmakers will revisit the Interstate Medical Licensure Compact legislation in 2019. MAG’s Position: Supported. Outcome: Did not pass.

S.B. 359 by Sen. Chuck Hufstetler (R-Rome), which would have 1) resulted in greater transparency for elective procedures and 2) established a patient/physician arbitration process for “unexpected events” that take place during elective medical procedures and 3) established a standard physician payment model for out-of-network emergency care – the 80th percentile of the independent/neutral ‘FAIR Health’ database. MAG’s Position: Supported. Outcome: Did not pass, though its provisions ended up in H.B. 314 – which also did not pass.

H.R. 1194 by Rep. David Knight (R-Griffin), which will establish a House Study Committee to evaluate health insurer policies to review claims on a retrospective basis – like the one that Anthem/Blue Cross Blue Shield of Georgia now has in place for ER care. MAG’s Position: Supported. Outcome: Passed.

H.R. 1592 by Rep. Karen Mathiak (R-Griffin), which would have called for health insurers to provide coverage for less-addictive opioids, opioid addiction treatments, and opioid alternative treatments. MAG’s Position: Supported. Outcome: Did not pass.

S.R. 772 by Sen. Bruce Thompson (R-White), which would have created a Joint Study Committee to evaluate health insurer policies to review claims on a retrospective basis – like the one that Anthem/Blue Cross Blue Shield of Georgia now has in place for ER care. MAG’s Position: Supported. Outcome: Did not pass.

MAG Priority: Patient Safety

H.B. 65 by Rep. Allen Peake (R-Macon), which will create a ‘Joint Study Commission on THC Medical Oil Access.’ This bill was amended to add post-traumatic stress disorder (PTSD) and intractable pain to the list of conditions that allow patients to possess low THC oil in the state. The Georgia Composite Medical Board is required to review the list of conditions that are covered by this law on an annual basis and to recommend additional conditions that have been shown through medical research to be effectively treated with low THC oil. MAG’s Position: Neutral. Outcome: Passed

H.B. 161 by Rep. Betty Price, M.D. (R-Roswell), which would have allowed harm reduction organizations that are designed to “reduce the harm associated with the use of psychoactive drugs in people unable or unwilling to stop” to sell, lend, rent, lease, give, exchange or otherwise distribute a syringe or needle. The Senate amended this measure with language from a bill (S.B. 352) that would have 1) made it illegal for the “solicitation, acceptance of payment or offer to pay a commission, benefit, bonus, rebate, kickback or bribe – directly or indirectly and on a cash or in kind basis – or to engage in any split-fee arrangement to induce the referral of a patient or for the acceptance or acknowledgment of treatment of a patient to another provider or health care facility for the purposes of obtaining mental health or substance abuse treatment; it would also be illegal to aid, abet, advise, or otherwise participate in the conduct prohibited by this law and 2) created a director of Substance Abuse, Addiction, and Related Disorders who would report to the governor and lead a new Commission on Substance Abuse and Recovery and 3) prohibited physicians from billing a patient or insurer for excessive, high-tech (i.e., “where billing for drug tests is not limited and tests are ordered for a number of different substances whereby the health benefit plan is billed separately for each substance tested”) or fraudulent drug testing in the treatment of the elderly, the disabled, or any individual affected by pain, substance abuse, addiction, or any related disorder. This would include, but not be limited to, upcoding that results in billing for more expensive services or procedures than were actually provided or performed, unbundling of such billing whereby drug tests from a single blood sample that detect a variety of narcotics is separated into multiple tests and billed separately, or billing an individual for multiple co-pay amounts or for services that are covered by such individual's health benefit plan. MAG’s Position: Supported the syringe/needle provisions; neutral on the balance. Outcome: Did not pass.

H.B. 673 by Rep. John Carson (R-Marietta), which will make it illegal for drivers to use a cell phone on anything other than a hands-free basis. This measure also includes a schedule of escalating fines and “points” for multiple violations – and a person can avoid a conviction for first offense by proving that they have obtained hands-free equipment to use in their vehicle. This was one of MAG’s patient safety priorities for the 2018 legislative session. MAG’s Position: Supported. Outcome: Passed.

H.B. 782 by Rep. Trey Rhodes (R-Greensboro), which would have eliminated a requirement for non-licensed Georgia Prescription Drug Monitoring Program (PDMP) user delegates to register for the PDMP on an annual basis and allow the Georgia Department of Public Health to share data from the Georgia PDMP with other states. The Senate added the provisions of another bill (S.B. 352) that would have 1) made it illegal for the “solicitation, acceptance of payment or offer to pay a commission, benefit, bonus, rebate, kickback or bribe – directly or indirectly and on a cash or in kind basis – or to engage in any split-fee arrangement to induce the referral of a patient or for the acceptance or acknowledgment of treatment of a patient to another provider or health care facility for the purposes of obtaining mental health or substance abuse treatment; it would also be illegal to aid, abet, advise, or otherwise participate in the conduct prohibited by this law and 2) created a director of Substance Abuse, Addiction, and Related Disorders who would report to the governor and lead a new Commission on Substance Abuse and Recovery and 3) prohibited physicians from billing a patient or insurer for excessive, high-tech (i.e., “where billing for drug tests is not limited and tests are ordered for a number of different substances whereby the health benefit plan is billed separately for each substance tested”) or fraudulent drug testing in the treatment of the elderly, the disabled, or any individual affected by pain, substance abuse, addiction, or any related disorder. This would include, but not be limited to, upcoding that results in billing for more expensive services or procedures than were actually provided or performed, unbundling of such billing whereby drug tests from a single blood sample that detect a variety of narcotics is separated into multiple tests and billed separately, or billing an individual for multiple co-pay amounts or for services that are covered by such individual's health benefit plan. MAG’s Position: Supported the PDMP provisions; neutral on the balance. Outcome: Did not pass, but the PDMP provisions were added to S.B. 407, which did pass.

H.B. 895 by Rep. Sharon Cooper (R-Marietta), which would have prohibited the sale to and by minors of drug products containing dextromethorphan. MAG’s Position: Neutral. Outcome: Did not pass.

S.B. 318 by Sen. Michael “Doc” Rhett (D-Marietta), which would have allowed for the execution of a physician's certificate for emergency examination of a person for involuntary evaluation and treatment for mental illness or alcohol or drug abuse based on consultation with an emergency medical technician or paramedic. The bill was amended to create a pilot project as a first step. MAG’s Position: Neutral. Outcome: Did not pass.

MAG Priority: Medicaid

H.B. 669 by Rep. Bob Trammel (D-Luthersville), which would have enabled the state to appropriate the funds that are needed to expand its Medicaid program. MAG policy is that the state should explore a waiver option for its Medicaid program. MAG’s Position: Neutral. Outcome: Did not pass.

H.B. 675 by Rep. Clay Cox (R-Lilburn), which would have provided employers with an income tax credit for up to three years for each Medicaid-eligible employee they have who participates in the employer’s health insurance plan. MAG’s Position: Neutral. Outcome: Did not pass.

S.B. 300 by Sen. Michael “Doc” Rhett (D-Marietta), which would have requested a Medicaid waiver from the Centers for Medicare & Medicaid Services to establish a “premium assistance” program to enable eligible individuals to obtain health care coverage through a federal health insurance exchange. MAG’s Position: Neutral. Outcome: Did not pass.

MAG Priority: Scope of Practice

H.B. 927 by Rep. Chad Nimmer (R-Blackshear), which originally dealt with Georgia Department of Family & Children’s Services issues. In the Senate, this bill’s language was replaced with the provisions of a bill (S.B. 351) that would have 1) increased the number of advanced practice registered nurses (APRNs) a physician can oversee with a protocol agreement at one time from four to eight and 2) allowed physicians to delegate the ordering of radiographic images to APRNs. MAG’s Position: Opposed. Outcome: Did not pass.

S.B. 166 by Sen. Renee Unterman (R-Buford), which would have allowed emergency medical services systems with full-time medical director to have a protocol agreement with eight APRNs and only supervise four APRNs at any one time. APRNs operating under this statute would only be able to prescribe drugs that are not Schedule II or benzodiazepines for minor illnesses for 14 days at a time. The APRNs would have been required to make every reasonable effort to facilitate the patient's return to the care of the patient's primary care physician or medical home. MAG’s position: Neutral. Outcome: Did not pass.

S.B. 351 by Sen. Renee Unterman (R-Buford), which would have increased the number of APRNs a physician can oversee with a protocol agreement at one time from four to eight and 2) allowed physicians to delegate the ordering of radiographic images to APRNs. MAG’s Position: Opposed. Outcome: Did not pass, though these provisions ended up in H.B. 927 – which also did not pass.

S.B. 364 by Sen. Chuck Hufstetler (R-Rome), which will allow primary supervising physicians to have up to eight anesthesiologist assistants licensed under them – though they would only be allowed to supervise up to four of them at any given time. MAG’s Position: Neutral. Outcome: Passed.

S.B. 382 by Sen. P.K. Martin (R-Lawrenceville), which will require the Georgia Department of Public Health to oversee any Georgia Board of Optometry-approved training programs that would allow optometrists to inject pharmaceutical agents. MAG’s Position: Neutral. Outcome: Passed.

S.B. 422 by Sen. Renee Unterman (R-Buford), which will allow pharmacists to help patients perform and interpret any over-the-counter tests. MAG’s Position: Neutral. Outcome: Passed.

S.B. 434 by Sen. Renee Unterman (R-Buford), which would have 1) changed the name of the Georgia Board for Physician Workforce to the Georgia Board for Health Care Workforce and 2) added a Georgia Nursing Leadership Coalition representative to the Board. MAG’s Position: Neutral. Outcome: Did not pass.

Other

S.B. 31 by Sen. Joshua McKoon (R-Columbus), which would have 1) changed the definition of a “destination cancer hospital” to a “hospital facility” for the purpose of the state’s CON requirements and 2) required any such hospital to pay $1 million or one percent of its adjusted gross revenue – whichever is lower – to the Indigent Care Trust Fund and 3) create a new collocated children’s beds category for CON purposes. MAG’s Position: Neutral. Outcome: Did not pass

H.B. 301 by Rep. Jodi Lott (R-Evans), which would have 1) created an income tax credit for taxpayers who are licensed physicians, advanced practice registered nurses or physician assistants who provide uncompensated preceptorship training to medical students, advanced practice registered nurse students or physician assistant students and – having been amended to include S.B. 334 by Sen. Renee Unterman – would have 2) moved the administration of the Georgia Board of Nursing from the Secretary of State’s office to the Georgia Department of Community Health to operate on an independent basis, much like the Georgia Composite Medical Board does. MAG’s Position: Neutral. Outcome: Did not pass.

H.B. 636 by Rep. Deborah Silcox (R-Sandy Springs), which would have created a licensure for genetic counselors. MAG’s Position: Neutral. Outcome: Did not pass.

H.B. 646 by Rep. Katie Dempsey (R-Rome), which would have extended a pilot program to offer bariatric surgery through the State Health Benefit Plan. MAG’s Position: Neutral. Outcome: Did not pass, although the bill’s provisions ended up in S.B. 325 – which did not pass

H.B. 647 by Rep. Katie Dempsey (R-Rome), which would have created a pilot program for members of the State Health Benefit Plan for the treatment and management of obesity, including medications and counseling. MAG’s Position: Neutral. Outcome: Did not pass.

H.B. 769 by Rep. Rick Jasperse (R-Jasper), which will 1) “relax certain restrictions on remote order entries for hospital pharmacies” and 2) require the Georgia Department of Community to streamline the billing and credentialing process for new physicians and 3) establish a rural center for health care innovation and sustainability under the umbrella of the existing Office of Rural Health to provide leadership training and health data analysis for rural hospitals and allow for the easier creation of micro-hospitals (i.e., have two to seven beds that provide stabilization services 24/7) and 4) create a grant program to provide insurance premium assistance for physicians practicing in medically underserved areas. MAG’s Position: Neutral. Outcome: Passed.

H.B. 847 by Joyce Chandler (R-Grayson), which would have allowed Georgia to join the Psychology Interjurisdictional Compact – which “facilitates telehealth and temporary in-person, face-to-face [care] across jurisdictional boundaries.” MAG’s Position: Neutral. Outcome: Did not pass.

H.B. 909 by Rep. Deborah Silcox (R-Sandy Springs), which will task the Georgia Department of Public Health with creating a state designation system – comparable to ones for strokes, trauma, and cardiac care – for perinatal facilities. MAG’s Position: Neutral. Outcome: Passed.

H.B. 992, which was an omnibus bill that included most of the health care bills for the 2018 legislative session (e.g., step therapy). MAG’s Position: Opposed certain provisions (e.g., expansion of APRNs' scope of practice). Outcome: Did not pass.

S.B. 81 by Sen. Renee Unterman (R-Buford), which would have created a new collocated children’s beds category for certificate of need (CON) purposes – though it wouldn’t have represented a CON exemption or created a special process. MAG’s Position: Neutral. Outcome: Did not pass.

S.B. 184 by Sen. Chuck Hufstetler (R-Rome), which would have funded an ‘Integrated Population Health Data Project’ to collect population health data from various agencies to improve health outcomes in Georgia. MAG’s Position: Neutral. Outcome: Did not pass.

S.B. 334 by Sen. Renee Unterman (R-Buford), which would have moved the administration of the Georgia Board of Nursing from the Secretary of State’s office to the Georgia Department of Community Health. MAG’s Position: Neutral. Outcome: Did not pass.

S.B. 352 by Sen. Renee Unterman (R-Buford), which would have 1) made it illegal for the “solicitation, acceptance of payment or offer to pay a commission, benefit, bonus, rebate, kickback or bribe – directly or indirectly and on a cash or in kind basis – or to engage in any split-fee arrangement to induce the referral of a patient or for the acceptance or acknowledgment of treatment of a patient to another provider or health care facility for the purposes of obtaining mental health or substance abuse treatment; it would also be illegal to aid, abet, advise, or otherwise participate in the conduct prohibited by this law and 2) created a director of Substance Abuse, Addiction, and Related Disorders who would report to the governor and lead a new Commission on Substance Abuse and Recovery and 3) prohibited physicians from billing a patient or insurer for excessive, high-tech (i.e., “where billing for drug tests is not limited and tests are ordered for a number of different substances whereby the health benefit plan is billed separately for each substance tested”) or fraudulent drug testing in the treatment of the elderly, the disabled, or any individual affected by pain, substance abuse, addiction, or any related disorder. This would include, but not be limited to, upcoding that results in billing for more expensive services or procedures than were actually provided or performed, unbundling of such billing whereby drug tests from a single blood sample that detect a variety of narcotics is separated into multiple tests and billed separately, or billing an individual for multiple co-pay amounts or for services that are covered by such individual's health benefit plan. MAG’s Position: Neutral. Outcome: Did not pass, though its provisions ended up in H.B. 161 and H.B. 782 and H.B. 992 – which also did not pass.

S.B. 357 by Sen. Dean Burke, M.D. (R-Bainbridge), which will create a health coordination and innovation council, action that was recommended by Georgia Lt. Gov. Casey Cagle’s Health Reform Task Force. MAG’s Position: Neutral. Outcome: Passed.

S.R. 1063 by Sen. Ben Watson, M.D. (R-Savannah), which will create a Senate Study Committee on CON reform. It is worth noting that MAG’s Board of Directors will be studying a number of CON issues, something MAG’s House of Delegates called for when it met in 2017. MAG’s Position: Neutral. Outcome: Passed.

 

MAG tracked more than 200 bills during the 2018 legislative session. 

Contact Derek Norton at dnorton@mag.org or 678.303.9280 with questions related to the General Assembly.

Call 678.303.9261 or go to www.mag.org/membership to join MAG.