Week 7 Legislative Report

This was a very eventful week at the State Capitol. Lawmakers held lengthy Committee meetings in an effort to get bills sent to the House and Senate floors. Crossover Day will take place next Friday, March 3. Legislators must have their bills passed out of their respective chambers in order for them to be considered by the opposite chamber by Day 40. Bills that do not make it across are not considered "dead", but will not be considered again until the 2018 legislative session.

We also had a successful 'CSB Day' event at the Capitol on Thursday. CSB members were able to meet with various lawmakers, as well as hear a detailed presentation provided by the Department of Behavioral Health and Developmental Disabilities (DBHDD). Thank you to all everyone who attended.

Also note that Rep. Trey Kelley (R-Cedartown) presentedHB 206, also known as the Pharmacy Audit Bill of Rights, and it passed unanimously by a vote of 166-0. It is now bring considered in the Senate.

Fiscal Year 2018 State Budget Analysis

On Friday, the House passed its version of the FY 2018 Budget,HB 44, with a vote of 167-1. The only dissenting vote came from Rep. Matt Gurtler (R-Tiger). This $25 billion budget is different from that which was proposed by Governor Deal in January. Chairman Terry England (R-Auburn), and his Committee, came up with these recommendations, which is now under review by the Senate. We have included analysis of the Department of Community Health's (DCH) and DBHDD's budget under the House proposal:

Department of Behavioral Health and Developmental Disabilities

This Department has funding for FY 2017 of $1.2 billion (with federal funds attached) and the House version for FY 2018 places this Department's funding at $1.268 billion.

Adult Addictive Diseases Services

The House eliminated one-time funds for the Highland Rivers Health CSB Home Again Pilot Program in the amount of $715,980. The Governor had not proposed this reduction to this program, moving this program to be receiving $45.5 million in State funds and a total of $90.2 million with federal funds attached.

Adult Developmental Disabilities Services

In the House version, it proposed an elimination of one-time funds for Rockdale Cares in the amount of $10,000 and further proposed an addition of $100,000 to increase funding for the Georgia Options program to comply with the new Fair Labor Standards Act requirements. Otherwise, the House agreed to other items proposed by the Governor which includes:

  • annualization of the cost of 250 NOW and COMP waiver slots for the developmentally disabled to meet the requirements of the Department of Justice (DOJ) Settlement in the amount of $12.1 million State funds
  • annualization of the cost of a provider rate increase for the Comprehensive Supports Waiver Program (COMP) in the amount of $11.7 million
  • increase of State funds to reflect the loss of the Balancing Incentive Payment Program (BIPP) funds in the amount of $8.4 million
  • increase of funds for 250 additional slots for the NOW and COMP programs for the developmentally disabled to meet the requirements of the DOJ Settlement in the amount of $6.05 million
  • annualization of the cost of 100 NOW waiver slots in the amount of $1.09 million, and
  • reduction of the State funds to reflect the increase in the Federal Medical Assistance Percentage (FMAP) from 67.89 percent to 68.50 percent.

Child and Adolescent Forensic Services

The House proposed a $300,000 elimination of one-time funds for the instrument development associated with the Juvenile Code rewrite, bringing this program funding to $6.2 million in State funds.

No changes were proposed by the House, from those offered by the Governor, for these programs: Adult Forensic Services (funded with $98.6 million in State funds); Adult Mental Health Services (funded with a total of State funds of $385.7 million); Child and Adolescent Addictive Diseases Services (funded with a total of State funds of $3.3 million); Child and Adolescent Developmental Disabilities (funded with a total of $9 million in State funds); and Child and Adolescent Mental Health Services (funded with a total of $50.2 million in State funds).

Department of Community Health

For FY 2017, this Department is utilizing State funds of $3.2 billion and a total of $14.3 billion with federal funds attached. For FY 2018, the House version set this at $3.1 billion State funds and a total of $14.8 billion with federal funds attached.

Departmental Administration and Program Support

The House transferred funds from the Medicaid: Aged, Blind and Disabled program to initiate contract services with an external audit firm for mandatory nursing home audits in the amount of more than $1.1 million. This change brings this program's funding to $64.6 million in State funds and a total of $395.3 million with federal funds.

Health Care Access and Improvement

The House eliminated one-time start up funds for Federally Qualified Health Centers in the amount of $500,000. It then provided funds for two Federally Qualified Health Center community start-up grants for Cook and Lincoln Counties of $500,000. It also added $250,000 for the Center for Rural Health Support and Study at Augusta University. In all, this program is proposed to receive $11.8 million in State funds and a total of more than $28.3 million with federal funds attached.

Healthcare Facility Regulation

The House reflected the transfer of funds from the Medicaid: Aged, Blind and Disabled program to provide an increase in the salaries for nurse surveyors in the amount of more than $2 million in State funds and a total of $4.3 million with federal funds. This brings this program to $13.2 million in State funds and more than $25 million with federal funds.

Indigent Care Trust Fund

The House added language in this program, "in accordance with O.C.G.A. § 31-8-179.2(a), fees assessed for the Hospital Provider Payment Program shall not exceed 1.45 percent of net patient revenue." No money is added. In all, this program is proposed to receive $399.6 million in federal funds (as no State funds are included drawing down any added match).

Medicaid: Aged, Blind and Disabled

In all, the funding for this program is proposed at $1.66 billion in State funds with a total of $5.6 billion with federal funds attached. The House made no changes to these items (note State funds are reflected):

  • Provide State funds to support increased waiver rates and slots previously funded by BIPP - $ 4 million State funds
  • Reduce funds to reflect an increase in the FMAP from 67.89 to 68.5 percent - $16.9 million
  • Reduce funds for the hold harmless provision in Medicare Part B premiums - $2.9 million
  • Provide funds to reduce the waiting list in the Community Care Services Program (CCSP) waiver - $1.37 million
  • Increase funds for an adjustment to congregate and home-delivered meals' rates for Medicaid waivers for the elderly - $250,000
  • Reflect additional revenue from the hospital provider payments - $2.8 million
  • Utilize $33.6 million in Tenet Settlement Agreement funds for growth in Medicaid based on projected need
  • Utilize $11 million in Tenet Settlement Agreement funds to reflect a projected increase in the Medicare Part D Clawback payment
  • Evaluate options to ensure mental health coverage parity for Medicaid and Children's Health Insurance Program beneficiaries with that of the commercial market
  • Utilize $3.1 million in Tenet Settlement Agreement funds to increase reimbursement rates for select primary care and OB/GYN codes to 100 percent of 2014 Medicare levels

Within this program, the following changes were offered by the House:

  • Reflection of the $1.1 million reduction in State funds for the transfer to the Departmental Administration and Program Support program to initiate contract services with an external firm for mandatory nursing home audits
  • Reflection of $2 million transfer to the Healthcare Facility Regulation program to provide an increase in the salaries for nurse surveyors
  • Addition of $11.7 million from the Medicaid Low-Income Medicaid program for a three percent inflation rate adjustment on the nursing home cost report (this is more than $37 million with federal funds)
  • Reflection of an addition of $336,641 as a result of a transfer of funds from the Medicaid: Low-Income Medicaid program for a three percent rate increase for the SOURCE case management fee (total with federal funds of more than $1 million)
  • Utilization of $307,226 in existing State funds to match with federal funds for a five percent reimbursement rate increase for select dental codes
  • Reflection of addition of $1.1million from a transfer of funds from the Medicaid: Low-Income Medicaid program for a new period of attestation for increased reimbursement rates for select primary care codes with rates effective on January 1, 2018 (this is more than $3.5 million with federal funds)

Medicaid: Low-Income Medicaid

The House made no changes to these items proposed by the Governor:

  • Reduce funds to reflect an increase in the FMAP from 67.89 percent to 68.50 percent - $29.9 million
  • Replace $12 million in State general funds with Tobacco Settlement funds
  • Reduce funds of more than $32 million for one year Hospital Insurance Fee moratorium
  • Reflect more than $24 million as additional revenue from the Hospital Provider payments
  • Utilize $4.8 million in Tenet Settlement Agreement funds for growth in Medicaid based on projected need
  • Utilize $1.6 million in Tenet Settlement Agreement funds to comply with federal Hepatitis C treatment access requirements
  • Utilize $14.7 million in Tenet Settlement Agreement funds to increase reimbursement rates for select primary care and OB/GYN codes to 100 percent of the 2014 Medicare levels
  • Utilize $20.7 million in Tenet Settlement Agreement funds to cover behavioral health services for children under 21 who are diagnosed as autistic
  • Utilize $2.5 million in Tenet Settlement Agreement funds for behavioral health services to children ages 0-4
  • Evaluate options to ensure mental health coverage parity for Medicaid and Children's Health Insurance Program beneficiaries with that of the commercial market

The House did propose these changes:

  • Eliminate $200,000 in one-time funds for the evaluation of ADHD cost-saving measures
  • Utilize $2.3 million in existing State funds to match with federal funds for a five percent reimbursement rate increase for select dental codes
  • Utilize $5.2 million in existing State funds to match with federal funds for a new period of attestation for increased reimbursement rates for select primary care codes with rates effective on January 1, 2018
  • Transfer of $1.13 million to the Medicaid: Aged, Blind and Disabled program for a new period of attestation for increased reimbursement rates for select primary care codes with rates effective on January 1, 2018
  • Transfer of $11.7 million of funds to the Medicaid: Aged, Blind and Disabled program for a three percent inflation adjustment to the nursing home cost report
  • $338,641 transfer of funds to the Medicaid: Aged, Blind and Disabled program for a three percent rate increase for the SOURCE case management fee
  • $21.8 million reduction of funds to reflect projected expenditures

In total this program is projected to have $1.3 billion in State funds, and a total of more than $4.3 billion with federal funds attached.

PeachCare for Kids

This is Georgia's SCHIP program which is now totally federally funded with more than $425 million. The House version reflects the five percent reimbursement rate adjustment for select dental codes and the funds for the new period of attestation for increased reimbursement rates for select primary care codes with rates effective on January 1, 2018.

The House did not make any added changes to the State Health Benefit Plan, Georgia Board of Dentistry, and Georgia Board of Pharmacy from the Governor's position.

Under the Georgia Board for Physician Workforce: Graduate Medical Education, the House proposed to utilize $219,684 in existing funds to expand the Family Medicine Accelerated Curriculum training program at Memorial University Medical Center. It also proposed adding $153,330 in State funds for ten slots total in OB/GYN residency programs with two slots each at Emory, Medical College of Georgia, Memorial University Medical Center, Morehouse, and Navicent Health Care Macon. The House also proposed adding in $360,000 in State funds for Memorial University Medical Center to partner with Gateway Behavioral Health to start a psychiatry residency program. The Governor had proposed 126 in new residency slots in primary care; the House agreed with funding 97 such slots, moving the total funds of $1.9 to $1.3 million.

Committees

Setzler Subcommittee of House Judiciary (Non Civil)

The Subcommittee considered two bills, but spent its most time onHB 249by Rep. Kevin Tanner (R-Dawsonville) which primarily deals with the use of the Prescription Drug Monitoring Bill by dispensers, pharmacists, and prescribers, doctors and physician assistants, of prescription pain medicines. Rep. Tanner brought a substitute to the Committee which had been worked out with the Medical Association of Georgia, the Georgia Hospital Association, and the Georgia Pharmacists Association. Rep. Tanner was joined by Rep. Sharon Cooper, Chairman of the House Health and Human Services Committee who had helped craft the compromise on behalf of physician groups. They both accented the goal of the bill to increase the policing of misuse, overuse or illegal distribution of opioid drugs contributing to the opioid epidemic facing Georgia.

Dispensers already report the scripts they fill for Schedule substances to the PBMP. This obligation was accelerated to within 24 hours and the subcommittee defeated an amendment to delay this period to the next business day. The checking obligation is limited to certain drugs that have been the subject of abuse rather than to all Schedule I and II drugs, including benzodiazepines, opioids, opiates, opioid analgesics or opioid derivatives. It contains a set of exemptions from the obligation to check and report to the data base in selected settings, such as health care facilities and outpatient hospice programs and in circumstances when fewer than three days' supply or 26 pills are part of the prescription. This language was amended slightly during the meeting

When the PDMP reaches a performance standard of 99.5% of the random test of its operability, prescribers will be required to register with the data base after January 1, 2018 and then to check the data base on each patient by July 1, 2018. Dispensers and prescribers can delegate this task to 2 delegates per dispenser present in a pharmacy per shift or 2 per physician per shift. The Tanner version of the bill has been preferred by physician groups because it refers violations of this reporting requirement to the professional Board of Medical Examiners for disciplinary action and excuses most violations from any civil or criminal liability except in limited cases of intentional misuse. The bill also offers civil immunity for most causes of action relating to misuse.

The bill also expands use of naloxone for heroin or prescription drug overuse.

After extensive discussion and vetting, the bill unanimously passed the subcommittee.

House Judiciary Non-Civil Committee

The House Judiciary Non-Civil Committee, chaired by Rep. Rich Golick (R-Smyrna), heard HB 213 today.

  • HB 213, authored by Chairman Golick, adds fentanyl to the list of controlled substances under Georgia's drug trafficking statute. The bill was previously heard by the Committee and discussion suspended pending questions from Rep. Betty Price (R-Roswell), regarding the impact on derivatives and analogs of fentanyl. The legislation was amended to include these derivatives and analogs and provide a more comprehensive approach to fentanyl control. The Committee recommended the bill DO PASS by committee substitute and the bill will be sent to the Rules Committee.

Legislative Tracking

Bill / Committees / Status / Analysis
HB030 / HC: Judiciary Non-Civil / Jan/11/2017 - House Second Readers / Rep. Kevin Tanner (R-) proposes to amend O.C.G.A. § 16-13-25 by adding a synthetic opioid to the list of Schedule 1 substances. The synthetic opioid added to the list is"(RR) 3,4-dichloro-N-(2-(dimethylamino)cyclohexyl)-N-methylbenzamide (U-47700)".
HB035 / HC: Insurance / Jan/23/2017 - House Second Readers / Rep. Bruce Broadrick (R-Dalton), would create a new Code Section relating to the licensure of pharmacy benefit managers at O.C.G.A § 33-64-10. The new language requires pharmacy benefit managers to provide notification of receipt of a request for prior approval for a prescription drug to a pharmacy or contracting representative within 48 hours of receipt of such request. Such notification must also include a claim reference number and return contact phone number for follow up. This new code section shall only apply to health insurance plans established under Article 1 or Chapter 18 of Title 45 or under Article 7 of Chapter 4 of Title 49.
HB055 / HC: Regulated Industries / Jan/23/2017 - House Second Readers / Rep. Rick Williams (R-Milledgeville), would add a new code section at O.C.G.A § 43-1-14.1 which provides that any members of a professional licensing board who are appointed to a term beginning on or after July 1, 2017, shall serve no more than eight consecutive years on such licensing board.
HB071 / HC: Insurance / Feb/17/2017 - House Committee Favorably Reported By Substitute / Rep. Richard Smith (R-Columbus), would add a new chapter (Chapter 20E) to Title 33 of the Official Code of Georgia Annotated relating to insurance. This bill requires health care providers, group practices, diagnostic and treatment centers and health centers to inform patients of the various health benefit plans and hospitals that it contracts with. If the provider is out of network for a patient and the patient is receiving nonemergency services, the provider must, upon the patient's request, provide the patient with the estimated cost of such services in writing. The bill also requires physicians to make certain disclosures to patients regarding referrals, such as the name and address of the referred physician or provider. Hospitals would be required to post information about its health benefit plans, physician groups contracted by the hospital, and a statement regarding the physician's services that are not included in the hospital's charges. Further, this legislation requires hospitals to enter into credentialing agreements with health benefit plans insurers. Finally, O.C.G.A. § 33-20E-3 and O.C.G.A. § 33-20E-5 of this bill create disclosure requirements for insurers.