By Andy Miller
Georgia Health News
The battles over hospital regulation and financial disclosure appeared to be finished last week at the Georgia Legislature.
But on Tuesday, as the 2019 General Assembly session was wrapping up, these prickly issues proved they weren’t dead after all.
An attempt to allow a sports medicine and training center in Alpharetta failed to clear the House Rules Committee on Tuesday. The proposed Legacy Sports Institute, endorsed by many sports VIPs, was included in some initial certificate-of-need bills but ran into roadblocks along its legislative journey.
Hospital industry opposition defeated the resurrected proposal, said a sponsor of the Legacy effort, Rep. Chuck Martin (R-Alpharetta). The industry, he said, “always opposes anything that brings health care’’ into the state. Hospitals are protecting their turf, Martin added.
But in a setback for the industry, a state budget item surprisingly surfaced that would pay for a consultant to review nonprofit hospitals’ executive compensation and lobbying activity.
This funding for a “comprehensive study’’ followed the passage of a bill to require thorough disclosure of these hospitals’ financial assets and charity care.
The last-minute activity Tuesday put a cap on a General Assembly session that is potentially the most consequential for Georgia health care in decades. From Medicaid coverage to medical marijuana to fighting the HIV epidemic, bill after bill passed with solid majorities.
”This is turning out to be a big health care year,’’ said Sen. Kay Kirkpatrick, a Marietta Republican who’s also a physician. “The dam has broken.’’
It wasn’t a clean sweep for health care proposals. Legislation to curb surprise medical billing hit familiar snags, with lawmakers divided as in past years about how to address the problem. And a proposal that would require more transparency for EMS services and ambulance response times didn’t yield a compromise.
Gov. Brian Kemp must sign any bill that passes the Legislature.
Here’s a rundown of many big-ticket items:
WAIVERS Kemp has already signed the high-profile Senate Bill 106. The legislation has two parts, each hinging on future federal approval of a waiver to state health care rules. One would potentially add people to the Medicaid rolls. The other would allow Georgia to revise the framework of the state health insurance exchange, created by the Affordable Care Act for people who don’t have coverage from employers or government programs.
Democrats fought the legislation, arguing that a full Medicaid expansion — which under the ACA is an option for states — would cover more Georgians at a lower cost than would the Kemp proposal. But with Republicans holding strong legislative majorities, the vote was not close in either chamber.
“Gov. Kemp has made health care a priority,’’ said state Rep. Jodi Lott (R-Evans) as she presented the waiver proposal.
CON For the first time in a decade, significant changes were approved in the state’s certificate-of-need program, which regulates health care facilities and services. These included giving Cancer Treatment Centers of America a pathway to expand its bed capacity and accept more Georgia patients at its Newnan facility. House Bill 186 would limit the rival entities that can object to a health care provider’s CON application to those within a 35-mile radius of the proposed project. Currently there are no geographic restrictions on who can object.
Other provisions include increasing financial thresholds for hospital construction and medical equipment; and prohibiting hospitals from purchasing or holding ‘‘medical use’’ rights of properties.
TRANSPARENCY Breaking off a major piece of an earlier CON reform package, the General Assembly approved tough new financial disclosure rules on nonprofit hospitals. These hospitals would have to disclose their audited financial statements, including those of their affiliates; their ownership in businesses, subsidiaries and captive insurance companies; the salaries and benefits of their 10 highest paid administrators; terms of their debt and properties owned; and their community benefit report and patient debt collection practices.
Those requirements are now supplemented by the budget item on analyzing hospital compensation and lobbying.
PROVIDER FEE The General Assembly agreed to renew the hospital provider fee that fills a nearly $1 billion hole in the state Medicaid budget. The program is scheduled to “sunset” (expire automatically) next year.
The state collects about $311 million from hospitals through the fee, and that money is matched with $657 million in federal funds, said Rep. Lott, the legislation’s sponsor.
The funding is then returned to the hospitals through reimbursements. Individual hospitals are reimbursed differing amounts, based on how much Medicaid business they do.
Under the federal rules governing the financing mechanism, hospitals come out as either “winners” or “losers.” The winners net a higher amount than the fee they paid, while the losers get back less than they paid out.
MEDICAL MARIJUANA Lawmakers reached a deal late Tuesday to let medical marijuana patients to buy the drug that they’re already allowed to use.
The AJC reported that Kemp helped broker the agreement between House and Senate leaders, who had struggled to strike a balance between providing access to patients while preventing illegal marijuana distribution.
The compromise provides several ways for Georgia’s 8,400 registered patients to buy medical marijuana oil, including through six private growing companies, state universities and pharmacies, according to the AJC.
SCHOOL RECESS Kids love recess – and so do public health advocates, who say the activity and stress relief improve students’ ability to learn. A proposal requiring elementary school students to have daily recess has failed in recent years, but in this General Assembly session, House Bill 83 sailed through. The bill “encourages’’ schools to make recess 30 minutes long.
Rep. Demetrius Douglas (D-Stockbridge), a former Georgia Bulldog linebacker and currently a Henry County high school football coach, pointed to the high child obesity rate in the state. One-third of Georgia children ages 10-17 were overweight or obese in 2017.
HIV Georgia has an enormous HIV challenge. The state is No. 1 for new HIV infections, and metro Atlanta is the third-leading metro area for new diagnoses. The Legislature agreed to a proposal facilitating needle exchange programs, to help prevent new HIV and other infections among intravenous drug users. Another successful bill would set up a pilot program for distribution of a pill known as PrEP to people at high risk of HIV. The pill, whose name is short for pre-exposure prophylaxis, can lower their chances of getting the virus if taken daily.
MENTAL HEALTH A state commission has been approved to analyze Georgia’s behavioral health services and recommend improvements.
The commission would be authorized to take ‘‘a very deep dive’’ into the state’s mental health system, said Rep. Kevin Tanner (R-Dawsonville), lead sponsor of House Bill 514. He told GHN that the panel can focus on the rising suicide rates among Georgia youths; the high dropout rate for teenagers with mental health issues; shortages of providers; challenges faced by the homeless; and the burden of mental health services on jails across the state.
STEP THERAPY Health insurers often have drug protocols for patients taking certain medications. These rules, known as “step therapy,’’ require that a patient “try and fail” on one or more meds before insurers provide coverage for a drug that was originally prescribed.
A similar bill passed the House last year, but went no further. “This is one small step for patients in Georgia to get the medicines that their doctors think they should have,’’ said Rep. Sharon Cooper (R-Marietta), who sponsored the bill.
HEALTHY HOUSING Late last week, the two chambers agreed to a bill aimed at preventing landlord retaliation against tenants who complain about unhealthy housing conditions,including mold and rodent infestations.
“It’s the right thing to do – people should not be retaliated against,’’ state Sen. Jesse Stone (R-Waynesboro) told lawmakers Thursday about House Bill 346. He also noted that the state’s many honest landlords are different from the “slumlords’’ who provide unhealthy housing.
LICENSURE COMPACT Physicians licensed in other states may now have a streamlined pathway to be licensed here in Georgia. Sen. Kirkpatrick said 25 states currently participate in this Interstate Medical Licensure Compact.
Physicians who do not have ‘‘a clean slate’’ – such as those who have received disciplinary action elsewhere – would be excluded from the streamlining process and would have to be vetted thoroughly in the current format, Kirkpatrick noted.
She said that under the current system, it can take months to get a qualified physician credentialed in Georgia.
SENIOR SERVICES Several items in the state 2020 budget will help seniors, said the Georgia Council on Aging.
Vicki Johnson, chair of the council, said the budget “includes extra money to combat elderly abuse, to deliver meals to older Georgians and to help our seniors stay in their homes as long as possible.”
Additional funding addresses a waiting list of about 7,000 older Georgians seeking support services such as personal assistance, transportation and home modifications. The extra $2 million is projected to fund an additional 1,053 slots.
Among the provisions, the council cited more funding for the Aging and Disability Resource Connection; and the Senate adding $157,000 for “assistive technology” to help older Georgians continue to live in their homes and communities.
In the midst of an opioid epidemic, the Georgia Legislature voted to weaken enforcement of one of the investigative tools used against it, the AJC reported.