In the Senate, Sen. Steve Thompson, the Governor’s Floor Leader, presented SB 394 to increase the numbers of persons serving on the Department of Human Resources’ Board in an effort to include one such person from each of the Congressional Districts. This addresses the increased population of Georgia and the two newly created Congressional Districts. Presently, there are 15 persons serving on the Board; this measure brings the total number of persons to 17. The bill passed by a vote of 52 to zero.

The Governor’s bill on Bioterrorism initiatives also was a point of discussion but the bill was not voted upon and dropped to the bottom of the Senate’s calendar. Sen. Seth Harp mentioned that a presentation aired on Georgia Public Television on the matter and encouraged each of the Senators to view such. The Governor’s bill, SB 385, is projected to reappear tomorrow.

HB 1364 – Rep. Rice and others have introduced this bill in an effort to create within the Department of Law, the Obscenity and Pornography Complaints Ombudsman in Article 2, of Chapter 15 of Title 45. This has been referred to the House Judiciary Committee.

HB 1369 – Rep. Boggs and others have offered this amendment to O.C.G.A. § 33-23-12 in an effort to provide a limited license for retail vendors of communications equipment (handsets, pagers, personal digital assistants, portable computers, automatic answering devices, cellular telephones, batteries, and other devices or their accessories used to originate or receive communications signals or service for individual customer use) and their employees who sell insurance coverages for the loss, theft, mechanical failure, or malfunction of or damage to communications equipment. The vendor would file a "written application for such limited license, signed by the applicant or an officer of the applicant, on such form or forms, and supplements thereto, and containing such information as the Commissioner may prescribe." This bill has been sent to the House Insurance Committee for review.

HB 1374 – Rep. Buck has introduced another bill relating to open public records. This bill proposes an amendment to O.C.G.A. § 50-18-72 concerning when public disclosure of public records is not required if records relate to local governmental employees. Such information which would be kept private would include "records that reveal the home address, the home telephone number, or the social security number of or insurance or medical information about employees of any local government." This has been referred to the House Judiciary Committee.

HB 1380 – This bill, authored by Rep. Bulloch and others, proposes to amend the Code at 15-14-6 relating to expenses and travel allowances for court reporters in an effort to provide for payment of premiums pertaining to certain programs for insurance, contracts of indemnity, or programs of self insurance for reimbursing court reporters for certain fees and expenses. It also has proposed amendments to O.C.G.A. § 45-9-1 regarding liability arising out of official duties and reimbursement of legal fees of public officers and employees in connection with unsuccessful criminal prosecutions and professional disciplinary proceedings – it would allow for provisions in the law while such reporters were acting as official court reporters for superior courts. This has been sent to the House Judiciary Committee.

HB 1400 – Rep. Skipper and Rep. Childers have authored this amendment to Title 37 concerning the provisions for transportation for the mentally ill, mentally retarded, and alcoholic and drug dependent individuals who are patients or clients in a facility The law still requires that a female patient be accompanied by another female, who is not a patient, unless the female patient is accompanied by her husband, father, adult brother, or adult son. Further, the bill gives the facility discretion in determining the type of vehicle to safely transport the patient and to make necessary arrangements for that transportation. It will allow physician restraints, in accordance with O.C.G.A. § 37-3-165. It will also allow expenses for transportation to be billed to the patient, if the transportation is not provided by the county sheriff.

HB 1402 – The Governor’s bill to create a prestige license plate for supporting certain breast cancer related programs for the medically indigent and to dedicate the revenue derived from the sales of those tags to the Indigent Care Trust Fund, as authorized by Article III, Section IX, Paragraph VI(i) of the State’s Constitution, has been introduced again. The bill will be engrossed tomorrow in an effort to prevent other types of tags to be created.

SB 451 – Sen. Jackson’s amendments to the Hospital Lien law found in Title 44 which would provide that hospital lines are liens against patients’ causes of action and not the actual patients nor their property or assets has now been referred to the Senate Judiciary Committee.

SB 458 – Sen. Nadine Thomas along with Sen. Tom Price and Sen. Ed Harbison have proposed an amendment to Article 1 of Chapter 24 of Title 33 relating to the requirement of a health benefit policy to cover off-label prescription drug use for life-threatening or chronic or disabling conditions or diseases. Life-threatening is defined as either 1) diseases or conditions with potentially fatal outcomes, where the end point of clinical intervention is survival, or 2) diseases or conditions where the likelihood of death is high unless the course of the disease is interrupted. Further, the bill states that no policy shall "limit or exclude coverage for a drug on the basis that the drug is prescribed for a use that is different from the use for which that drug has been approved for marketing by the federal Food and Drug Administration, provided that all of the following conditions have been met: 1) the drug has been approved by the federal Food and Drug Administration; 2(A) the drug is prescribed by a contracting licensed health care professional for the treatment of a life-threatening disease or condition; or (B) the drug is prescribed by a contracting licensed healthcare professional for the treatment of a chronic and seriously debilitating disease or condition, the drug is medically necessary to treat that disease or condition, and the drug is on the insurer’s formulary, if any; and 3) the drug has been recognized for treatment of that disease or condition by one of the following: (A) the American Medical Association Drug Evaluations; (B) the American Hospital Formulary Service Drug Information; or (C) the United States Pharmacopoeia Dispensing Information, Volume 1, "Drug Information for the Health Care Professional"; or (D) two articles from major peer reviewed medical journals that present data supporting the proposed off-label use or uses as generally safe and effective unless there is clear and convincing contradictory evidence presented in a major peer reviewed medical journal." Further the bill would require that the "prescriber" would have to submit to the insurer any documentation supporting compliance with the requirements mentioned. The insurer would have to cover any medically necessary services associated with the administration of the drug, subject to the conditions of the contract. The health insurer would not be required to cover 1) the treatment of a condition or disease that is excluded under the terms of the policy; 2) an experimental drug not approved by the FDA; or 3) a drug treatment by a drug not listed on the health benefit plan’s formulary. Finally, the benefits would not be subject to the same annual deductibles or co-insurance established for all other covered benefits within a given health policy.

SB 463 – Sen. Gingrey and others have proposed the amendment to O.C.G.A. § 49-5-273 regarding the creation and operation of the PeachCare for Kids Program. This would provide for healthcare coverage for children from conception through age 18 in families with incomes below 235% of the Federal poverty level.

Rep. Larry Walker, House Majority Leader, presented the recommendations from the "Green Door" Committee to the House Appropriations Committee, noting that there were no "special projects." There may be "special projects" left in the Budget which were funded last year but no new projects. Basically, the situation is grim – especially due to the news released in the media this morning about the need to "find" another $80 million. Here are some of the highlights of the recommendations which do include an additional $21 million in the bond package:

Court of Appeals:

- Governor’s recommendation was $83,809 (for additional personal service and operating expenses). House Appropriations Committee said zero.

Superior Courts:

- Governor’s recommendation was for $435,558 for funding for coverage of mandated training for prosecutors. Appropriations Committee reduced that to $217,779.

• Governor’s recommendation for $337,067 for the addition of 1 automation technology manager and three technicians and to fund a study to automate the district attorney offices was reduced from $337,067 to $20,000
• Governor’s recommendation for $303,408 for relocation of the State Bar Building was zeroed out.

Community Affairs:

• Governor’s proposed reduction of $106,443 for Contracts for Regional Planning and Development received an add so that the reduction will only be $53,540
• Two new items were proposed:

- Renovation of drivers’ license facility in Savannah for $100,00

- Funding for capital murder trial in Bacon County in the amount of $100,000

Community Health:

• Governor’s recommendation of a reduction of $319 million for increased contributions from governmental entities participating in Medicaid program by utilizing upper payment limit credits in order to obtain federal matching funds was reduced further to $329.5 million. [The UPL will not end until March; thus, there will be more federal dollars coming to the State.]
• Governor’s recommendation for removing Generic and Preferred Brand dispensing fee incentive in Medicaid and PeachCare for Kids in the amount of $1.5 million was zeroed out
• Restoration of the proposed decrease of $250,000 proposed by the Governor for the start-up grants for community and migrant health centers
• Three new items were proposed:

- $5 million for grants to Rural Hospitals for equipment and infrastructure as outlined in SB 195

- $100,000 for provision of funding for the assessment and planning for a community health center in Wheeler County (which must be affiliated with critical access or rural hospital in order to be funded)

- Language for provision of coverage for colorectal cancer screening as provided in HB 1100

Education:

• Governor’s recommendation of $250,000 for funding to conduct a statewide evaluation of staff development and development of new standards to effectively tie staff development to student achievement was increased to $1 million (this is for a coordinated study of staff development and teacher computer competency between DOE, Professional Standards Commission, the Board of Regents, RESAs, and the Leadership Academies)
• Governor’s recommendation for $195,000 for Kids Health Inc. project which uses a high-tech mobile classroom was zeroed out
• Governor’s recommendation for $89,886 for replacement of outdated textbooks and the purchase of 2 new vehicles at Atlanta Area School for Deaf for the Georgia PINES was increased to $200,257
• Governor’s recommendation for the elimination of funding, in the amount of $306,000, for the Georgia High School Graduation tests analysis software, Remedial/SIA evaluation, other miscellaneous contracts and a reduction in internet access ($498,615) and to add a RESA coordinator contract and a Plains High School teacher to staff at the Carter Information Center ($192,615) was reduced further so as to remove the RESA coordinator contract with the new reduction in the amount of $425,000

Georgia Bureau of Investigation:

- Governor’s recommendation of a reduction in the amount of more than $1 million for regular operating expenses, equipment, per diem and fees, travel and computer charges received an addition so the reduction will only be $500,000 (Appropriations Committee restored the regular and operating expenses of $528,441 and the per diem and fees in the amount of $240,441.)

Governor’s Office:

• Governor’s recommendation for an addition of $122,720 was increased to $355,720 for GEMA in order to cover necessary disaster-related expenditures

Human Resources:

• Governor’s recommendation for additional funding, to cover increasing costs of vaccinations for uninsured children, including the cost of a new pneumococcal conjugate vaccine, which protects against bacterial meningitis and ear and blood infections, in the amount of $873,354 and the Appropriations Committee did not recommend such
• Governor’s elimination of dollars for Babies Born Healthy in the amount of $2.5 million had money restored so that the reduction is only $1.9 million
• Governor’s reduction of contract funding in the Division of Public Health had a number of changes:

a) Life Flight at GA Baptist Hospital (Governor recommended $100,000 reduction and Committee restored the dollars)

b) Savannah Memorial Hospital Trauma Helicopter (Governor recommended $50,000 reduction and Committee restored the dollars)

c) Purchase of clotting factor by Hemophilia of Georgia (Governor recommended a reduction of $131,000 and Committee restored the dollars)

d) Visiting Nurses Services (Governor recommended a reduction of $222,805 and Committee added $50,000 to bring reduction to $172,805)

e) Scoliosis Screening by Children’s Healthcare of Atlanta (Governor recommended reduction of $43,000 and Committee restored the dollars)

• Governor’s recommendation of elimination of a contract within the Division of Children and Family Services for the Hope House transitional home for homeless men in the amount of $100,000 was restored by the Committee
• Under miscellaneous contract reductions, the Governor had proposed $27,324 to be reduced and the House Appropriations Committee restored some dollars for the Center for Children and Young Adults, Inc. so the reduction will be only $25,068
• Governor’s elimination of funding in the Division of Mental Health, Mental Retardation, and Substance Abuse in the amount of $600,000 for residential treatment services for adolescents with mental retardation found incompetent to stand trial or deemed inappropriate for the Juvenile Justice System had a restoration of $150,00 so the reduction will only be $450,000
• Governor’s reduction of contract funding within the Division of Mental Health, Mental Retardation, and Substance Abuse had changes:

a) Restored the $100,000 cut proposed for the Emory Autism Resource Center

b) Restored the $10,000 cut for the Georgia Council for the Hearing Impaired

Human Resources – Tobacco Dollars:

• Governor’s recommendation of $5.7 million for the new contract funding for the Unite Georgia smoking prevention and cessation media campaign was zeroed out by the Committee and the dollars were moved to increase the funding for the Cancer State Aid treatment program to provide medical benefits to uninsured persons with certain types of cancer

Industry, Trade and Tourism:

• Governor’s recommendation for cut of $50,000 for the funding for Tri-Rivers Waterway Development was restored
• Governor’s recommendation for a reduction of $300,000 in the Yamacraw marketing funds was reduced further to $500,000
• Additions were made:

funds for the Georgia Shrimpers Association in the amount of $50,000

transfer of $150,000 from GA Technology Authority for the Connect Georgia Project

Juvenile Justice:

• A number of changes in the funding reductions proposed with various contracts and grants:

a) Augusta Mini-Theater, Inc. (Governor recommended reduction of $87,500 and Committee recommended reduction only of $37,500)

b) Wholistic Stress Control (Governor recommended reduction of $57,500 and Committee recommended zero)

c) Alternate Life Paths, Inc. (Governor recommended reduction of $35,586 and Committee recommended none)

[Note: a-c were ‘special projects’ funded in 2001.]

Natural Resources:

• Two additions were made:

a) Transfer the more than $1 million in per diem and fees to contracts

b) $250,000 to rebuild the boat ramps in St. Marys

Public Safety:

• Committee restored $400,000 in order that Governor’s proposed reduction of $1.7 million would only be $1.3 million for motor vehicle purchases due to increasing mileage replacement rate

Board of Regents (parts A and B):

• Additions were proposed by the Committee:

a) $645,000 for improvement of social studies curriculum for teacher education

b) $150,000 for funding the creation of a Public Service Institute for the Advanced Wood Products Industry of Georgia

c) $750,000 for provision of funds for the Special Initiative Funding for the implementation of the Military/Leadership program at North Georgia University

d) $72,500 for a transfer of one position from GA Technology Authority to Regents

e) $78,000 for a Formosan Termite program

f) $250,000 for funds for personal services, operating expenses and equipment for the Poultry Veterinary Labs

g) $30,000 for funds for the renovation of the Sutton Dining Hall at Rock Eagle 4-H Center

Revenue:

• Governor’s recommendation to add $395,367 for an expected personal services shortage in the Information Systems division was eliminated by the Committee
• Governor’s recommendation for $3 million for funding contract technology support for departmental tax system and local area networks was reduced to $2 million by the Committee
• Governor’s recommendation of more than $1.8 million for funding hardware and software maintenance contracts which cover services such as application updates and vendor technical support was reduced to $1.5 million

Soil and Water Conservation Commission:

• Addition of $150,000 for increased funds to recover past shortfalls from water planning programs

Technical and Adult Education:

• Two additions proposed:

a) $589,121 for Quick Start funding

b) $50,000 for expansion of the SHARE program at Altamaha Tech

Bond – Sinking Fund:

- Added $21 million (This includes the reduction which the Georgia Research Alliance had – the Governor had recommended it receive $.5.2 million and the House Appropriations Committee only recommended $4.9 million so as ‘to share the pain’. It also includes the elimination of the $3.3 million for the expansion of the golf course at Gordonia Altamaha State Park to 18 holes – Rep. Walker stated that the Committee did not want to send the wrong message presently due to the economic situation even though the State’s golf courses were profitable. There was also an increase in funds in order to purchase a new Bell 407 helicopter as the old one was nine years old and needed $900,000 in repairs – this new helicopter will cost $452,000 in bonds. The overall increase in the bond package was 3%, which is supposedly well within the Constitutional limits on debt the State can have.)

As for the 2003 Budget, Rep. Sinkfield’s Subcommittee on Human Development from House Appropriations Committee met this afternoon to hear more from Commissioner Jim Martin. Basically, he went through each item in the Governor’s recommendations on the FY 2003 Budget to the Subcommittee.

The House Judiciary Committee’s Subcommittee studying SB 214 met this afternoon to hear more about the database bill which Sens. Lamutt and Polak have introduced. After much discussion concerning the substitute, when it came time to call the question on whether to vote the bill up or down out of the Subcommittee – no motion was made. Thus, the bill will be held in the "busom" of the Subcommittee. It is believed that Sen. Polak is trying to perfect the bill and asked that the Subcommittee hold the bill. It would appear that the Georgia Chamber of Commerce is still neutral on the legislation, due to the fact that it is still unclear what impact such might have on business. Additionally, an entity known as CheckFree is opposed to the bill.

In another Subcommittee meeting of the House Judiciary Committee, HB 1253, which is an amendment to last year’s re-write to the Uniform Commercial Code law, was up for consideration. This bill clarifies the letters of credit portion of the law to make it compliant with federal law concerning custom and practice of such. Additionally, it took up SB 253 which amends the law relating to limited liability companies. This bill also clarifies changes made in the 1999 amendments to the law. Both of these bills now move to the full House Judiciary Committee.

In a crowded room today, the Senate Health and Human Services Committee met and took up HB 585 and SB 145. SB 145, which would prohibit private physicians’ offices from using a clinical lab employee in their offices, sailed out of Committee. We believe that the Medical Association of Georgia and others are still working on this bill.

HB 585, presented by Rep. Graves, received the greatest amount of time and attention. HB 585 proposes to require that "pharmacy benefit managers or PBMs" would be required to be licensed as a pharmacy or pharmacist in Georgia if they were conducting any business other than processing pharmaceutical claims (such as drug selections, establishing formularies, drug utilization review, etc.).

Wayne Oliver with the Georgia Pharmacy Association rose in support of this bill and asked that the Committee provide for regulation of these entities. He stated that his pharmacies were concerned that PBMs were making clinical decisions about healthcare and were coming between the pharmacist and the patient. He threatened that perhaps the Department of Insurance should be contacted about the issue. He claimed that decisions by PBMs may be far reaching. No other states are requiring PBMs to be licensed – Mr. Oliver stated that Georgia would be a leader and since the introduction of this bill in 2001, other states have similarly proposed such.

There were several persons who testified such as Dr. Jay Kulkin, the former medical director of Blue Cross Blue Shield of Georgia. He explained his interest in the bill and his expertise as a physician on a national PBM. Dr. Kulkin noted the economics of the uses of PBMS and explained that such entities make comparisons on drugs, review safety, efficacy, cost, etc. In his experience, physicians are consulted about such drug uses and help formulate recommendations based upon sound knowledge. He stressed that PBMs help with cost and quality of care. He also noted that the PBMs administer the actual health plan policies and were not practicing as pharmacies.

The lobbyist for Express Scripts, the PBM for the State Health Benefit Plan, noted that another large PBM in Georgia was operated by Merck. His argument was that if a PBM is found to operating as a pharmacy, then the Attorney General can prosecute. Thus, there is no need for a new piece of legislation.

After hearing the testimony, the bill was held for more information and study.

The Senate Insurance and Labor Committee also met this afternoon and passed out HB 461 concerning an effort to amend Chapter 9 of Title 45 so as to provide temporary disability compensation for officially recognized or designated members of a legally organized volunteer fire department who are injured in the line of duty.

Additionally, the Insurance and Labor Committee passed out Rep. Sally Harrell’s bill, HB 525, relating to maternity benefit notices, which health plans must provide to patients about their rights concerning hospital lengths of stay following delivery of a baby. The health plan insurer must provide a notice to the expectant mother, within 30 days "following the date the insurer first learns that the expectant mother covered by the health benefit policy is pregnant in substantially the following form:"

"The Newborn Baby and Mother Protection Act (Code Section 33-24-58.2 of the O.C.G.A.) requires that health benefit policies which provide maternity benefits must provide coverage for a minimum of 48 hours of inpatient care following a normal vaginal delivery and a minimum of 96 hours of inpatient care following a cesarean section for a mother and her newborn child. The care must be provided in a licensed health care facility. A decision to shorten the length of stay may be made only by the attending health care provider after conferring with the mother. If the stay is shortened, coverage must be provided for up to two follow-up visits with specified health care providers with the first visit being within 48 hours after discharge. After conferring with the mother, the health care provider must determine whether the initial visit will be conducted at home or at the office and whether a second visit is appropriate. Specified services are required to be provided at such visits."

The final bill the Committee addressed was SB 378, Sen. Price’s bill, which resulted from the Study Committee he chaired over the summer relating to exclusionary hospital contracting. The bill proposes to require that health plans obtain an acknowledgement from enrollees about the (1) number, mix, and distribution of providers; (2) the limitations on choice of providers; and (3) financial incentives provided to providers. A couple of amendments were made to the bill in Committee – the first was to eliminate any acceptance to these ‘limits’ by the enrollee and the second was to change the affirmative consent being requested to a signed acknowledgement that the enrollee has been provided information on the three areas of information.

Finally, Sen. Brown noted that he would be holding SB 179 in the Committee, as the bill was originally scheduled for the agenda. SB 179, which relates to the disclosure of claims history by an insurer, had its language incorporated in SB 177.

The House Health and Ecology Committee met and passed out the Subcommittee’s recommendation to HB 69. Rep. David Graves, the author of the bill, presented the bill which would establish a new group of professionals to be licensed in the State – this would be ‘clinical perfusionists’ (the persons who operate the heart-lung machines in open heart surgical procedures). According to Rep. Graves, there are only 93 clinical perfusionists in the State, and there is currently no available training in Georgia. This bill moves to the House Rules Committee for its consideration.

SB 364, Sen. Walker’s changes to the Code relating to the Brain and Spinal Injury Trust Fund, crossed over to the House and has been sent to the Health and Ecology Committee. Additionally, SB 393, Sen. Meyer von Bremen’s amendment to Title 5 relating to appellate practices, has also crossed over to the House and is now in the House Judiciary Committee.