Greetings from the Gold Dome!  Legislators returned to work today after dealing with several Budget meetings.   

Newly Introduced Legislation  

HB 711 – Rep. Morris has introduced this amendment to O.C.G.A. § 16-5-60 concerning reckless conduct causing harm to or endangering the bodily safety of a peace officer or correctional officer.  This establishes a felony charge for an HIV infected person or hepatitis infected person who, after obtaining knowledge of such infection, commits an assault using his or her body fluids (blood, semen, or vaginal secretions), saliva, urine, or feces.  

HB 716 – Rep. Martin and others have proposed changing the law concerning the furnishing, purchase of, or possession by persons under 21 years of age of alcoholic beverages so that there is a rebuttable presumption that a person selling or otherwise furnishing an alcoholic beverage to a person under 21 without verifying proper identification to determine age has acted knowingly.  This amends O.C.G.A. § 3-3-23 (h).  

HB 717 – Rep. Orrock and others have authored this bill which authorizes certain psychologists to prescribe drugs, under certain circumstances.  It broadens the definition in the pharmacy code for the meaning of “practitioner” or “practitioner of the healing arts” to include a psychologist certified to prescribe.  It also adds a new definition for “psychologist certified to prescribe” to mean “an individual who is certified by the State Board of Examiners of Psychologists to administer, order, and prescribe drugs for the diagnosis, care, and treatment of mental or nervous disorders or illnesses, including the ordering and review of laboratory tests in conjunction with the prescription, as provided in Code Sections 43-39-5.1 and 43-39-21.”  It also addresses liability issues in O.C.G.A. § 26-4-31: “nothing in this chapter shall be construed to create a presumption of liability, either civil or criminal, on the part of a pharmacist who is duly licensed under this chapter and who in good faith fills a prescription drug ordered or prescribed by a psychologist certified to prescribe.”  The psychologist certified to prescribe may also be able to order and review laboratory tests.  See O.C.G.A. § 31-7-160(2).  The definition “to practice psychology” is also amended in O.C.G.A. § 43-39-1(3).  It now adds that such “shall include the administering, order, and prescribing of drugs by a psychologist certified to prescribe for the diagnosis, care, and treatment of mental or nervous disorders or illnesses.”  Additionally, the “psychologist certified to prescribe” must be a licensed psychologist who meets the criteria of training and experience as provided in O.C.G.A. § 43-39-5.1 and is certified by the board to administer, order, and prescribe drugs, including the ordering and review of laboratory tests in conjunction with the prescription, as authorized by the board pursuant to Code Sections 43-39-5.1 and 43-39-21.  The Board must develop rules in order to implement the following requirements:  

1) Successful completion of 320 hours of post-doctoral pharmacological training from an institution of higher education approved by the Board;

2) Three hundred hours of supervised clinical experience in psychopharmacology treating at least 100 patients.  This supervised clinical experience must be approved by the Board; and

3) Passage of the Psychopharmacology Examination for Psychologists or a similar certification examination in psychopharmacology approved by the Board.  

It also amends O.C.G.A. § 43-39-22 so that a registered professional nurse and a licensed practical nurse shall have the authority to execute an order for the administration of drugs issued by a psychologist certified to prescribe, provided that the nurse may confer with the psychologist prior to executing the psychologist’s order.  This law, if passed, would become effective on January 1, 2004 .  

HB 720 – Rep. Jenkins and Rep. Buckner have co-signed this amendment concerning a definition for “conviction” for the purposes of punishment of family violence battery.  It specifically amends O.C.G.A. § 16-5-23.1: “as used in this subsection, the term ‘conviction’ means a plea of guilty, a finding of guilt by a court of competent jurisdiction, the acceptance of a plea of nolo contendere, or the affording of first offender treatment by a court of competent jurisdiction irrespective of the pendency or availability of an appeal or an application for collateral relief.”  

HB 721 – Rep. Jenkins and others have authored this bill amending the State’s law on health insurance identification cards in O.C.G.A. § 33-24-57.1.  This change prohibits the use of an insured’s social security number for any purpose or in any manner on such card.  This would be a requirement for such cards issued on or after July 1, 203 .  

HB 731 -  Rep. Franklin and others have proposed amending O.C.G.A. § 34-8-194 to add an additional ground for the disqualification for a person to receive unemployment benefits.  This basically adds that if a discharge was the result of intentional conduct constituting a felony (which basically resulted in a conviction of a felony or a plea of first offender, nolo contendere, or other plea or pretrial deferred prosecution which would indicate guilt) or if the individual admitted to the wrong which took place while on the job, then that person would be disqualified from receiving benefits.  If the individual is acquitted or the charges are dismissed (other than a plea of first offender or pretrial deferred prosecution), then that person would be eligible for benefits.  

HR 385 – Reps. Purcell and James have proposed March 13, 2003 as Disabilities Day at the Capitol.  

SB 264 – Sens. Stokes and Balfour have offered this amendment to Titles 31 and 37 to provide for actions against community living arrangements and drug abuse treatment and education programs licensed by the Department of Human Resources.  The bill also allows for emergency relocation of patients or residents from community living arrangements subject to licensure or from a drug abuse treatment and education program.  Such relocation would be to the next closest arrangement or program.  This emergency placement would be the result of the arrangement or treatment and education program not being licensed; received a denial of an application for a permit or license; the arrangement, treatment or educational program intends to close; or the health, safety, security, rights, or welfare of the patients or residents cannot be adequately assured.  The bill also states that the Department of Human Resources must classify, in O.C.G.A. § 37-1-20, community living arrangements.  To be eligible for licensing, the residence and services provided must be integrated within the community.  

SB 265 – Sens. Nadine Thomas and Don Thomas have proposed amending O.C.G.A. § 31-11-53.2 regarding the use of automated external defibrillators by lay rescuers.  This would require registration of the automated external defibrillators with the Emergency Health Section of the Public Health Division of the Georgia Department of Human Resources within 30 days of receipt of same.  Rules would be promulgated by the Emergency Health Section regarding the placement and registry of these devices.  

SB 266 – Another bill has been introduced concerning meningococcal meningitis.  This version is by Sens. Meyer von Bremen and Price.  It would insert a new Code Section at O.C.G.A. § 31-12-3.2 so that a post-secondary educational institution must provide detailed information on the risks associated with this disease and the availability, effectiveness, and contraindications of any required or recommended vaccine against this form of meningitis. This would be provided to each student or the student’s parent or guardian (if the student is a minor) who has been accepted for admission at the institution.  Those students living on-campus must provide documentation of vaccination against meningococcal meningitis or if the student is 18 years or older sign a waiver provided by the institution stating that he or she has received and reviewed the information provided and has opted not to be vaccinated.  If the student is a minor, then his or her parent or guardian would be permitted to execute this waiver.  The institution would not be required to either provide or pay for the vaccinations.  

Committee News  

Appropriations’ Committees  

          On March 10, 2003 , the Senate Appropriations’ Subcommittee on the Department of Community Health met to discuss the FY 2004 Budget.  It looked at a number of items in the Budget.  During the discussions, it appeared that perhaps combining or eliminating some of the various ‘offices’ would be a potential cost savings – such as Offices of Women’s and Minority Health and Commission on Men’s Health.   The group also looked at these various ‘legislative’ initiatives.   

It also looked at the various contracts that the Department has with outside vendors – such as the contract to determine Medicaid eligibility.  The Healthy Mothers, Healthy Babies program appears to be on its last ‘legs’ as there have been studies that show there is no correlation between the program and low birth weight babies.   

The Pharmacy Services Program was the piece that got the most discussion.  The Subcommittee looked at the drug rebate program (rebates are based upon utilization).  DCH utilizes a contract with First Health which handles disputes concerning drug rebates by manufacturers.  First Health’s contract is for $1 million.   First Health would also be involved with the proposed supplemental rebates.  Sen. Williams would like to see the implementation of a disease state management program.   

Many of the Senators expressed that they would like for more usage of generics rather than brand drugs in order to generate more savings.  Georgia already has a program in place for driving Medicaid recipients to use more generic drugs and has one of the highest ‘fill’ rates in the country.  Senators asked about the Express Scripts which gets its contract paid with 75% federal funds.  Senators also asked about use of prior authorization procedures and other cost saving procedures.  Georgia ’s Medicaid program has the lowest average cost per recipient among its neighboring states.  DCH’s cost is $698.00.  Of course, the co-payment process was also discussed (see more on this below).  One of the largest contracts that DCH has is the aging and community services’ contract which approves the appropriate level of care for nursing home residents (as required by the federal government).   

The Senators also inquired about the State Health Benefit Plan.  Its contracts are funded through use of premium dollars paid by enrollees.  

Some believed that the State was not purchasing affordable healthcare for Georgians due to the numbers of uninsured (1.3 million) in the State. Eligibility questions were also raised.  

          On March 11, 2003 , the Conferees conferred and heard from the Board of Regents about its needs.  Dr. Meredith made a presentation about what additional cuts would mean to Georgia ’s university system.  He reported that the system had record enrollment but with the proposed cuts 1,000 staff would have to be cut.   

Another presentation was made by the Department of Technical and Adult Education.  Ken Breeden reported that his Department would make do with proposed cuts.  In the last few years, Georgia has built a ‘world class technical college system.’  It has also been named by consultants recently as the number 1 system.  88.8% of the monies it gets goes to the operation of the technical schools.  

On March 12, 2003 , the Senate Human Development Subcommittee of Senate Appropriations met to discuss the various contracts that the Department of Human Resources manages.  Commissioner Jim Martin answered a number of questions about each of the contracts. It was clear that the Senate planned to try and eliminate some of these contracts, especially any that might have duplication of services.  

Budget Conferees also met again last Wednesday.  This time they heard from the experts – presentations were made by two economists from Georgia State and Kennesaw State .  Both seemed to believe that the war with Iraq , both its beginning and its conclusion, would have an impact on the economy.  The period of uncertainty was causing folks to not spend – this includes business.  

The House Appropriations Committee again had groups working on Wednesday and Thursday.  The meetings were another effort to get closer to finding resolutions to the big ticket items such as pharmaceutical expenditures.  On March 13, the Medicaid program was again an issue in the House.  It discussed rebates and managed care.  It also looked at disease state management programs for diabetes, asthma, and heart diseases.  A former HCFA employee, Don Muse, made a presentation about the State’s Medicaid program and its expenditures.  He noted that the aged population expended 19.6% of the State’s drug budget; the disabled community utilized 57.2% of the State’s drug budget; children only expended 12.7% and other adults used 6.8%.  Long-term care in Georgia , like other states, is a huge driver of costs as 12% of Georgia ’s drugs are used there.  

On March 18, the House Department of Community Health Subcommittee met to hear more about the offices that the Department oversees: Office of Minority Health; Division of Health Planning; and Office of Women’s Health.  

Valerie Hepburn explained the Division of Health Planning’s function to Legislators and especially its role in workforce shortages and monies provided by the General Assembly.  She explained that HB 652 established a mechanism so that the State could track through the licensure process of healthcare professionals where those professionals were (what type of setting each practiced, etc.).  This is an effort to get data so that retention and workplace environment issues; recruitment and marketing of the professionals; and education and education financing issues may be addressed.   

Carol Crawford explained more about the role of the Office of Minority Health.  It is to work on education of folks with respect to the documented disparities in healthcare of populations of color.  

Dr. Dee Baldwin talked about the Office of Women’s Health which was created three years ago to look at women’s health issues, to create a comprehensive plan to address such, to provide a clearinghouse of information, and to address program issues.  One of its biggest functions is to host the Women’s Health Summit.  

On March 19, the Pharmacy Workgroup of the Department of Community Health Subcommittee met to discuss various issues.  One issue is that limiting the number of prescriptions that a Medicaid recipient will receive may actually cost the State more – with more hospitalizations.  Rep. Sally Harrell encouraged the Workgroup’s Chair, Rep. Ron Stevens, to look at data on this issue before making this recommendation to the Budget Committee.  In the end, the Workgroup agreed to a four prescription (brand) drug limit with “carve outs” for HIV, cancer, mental health, and Hepatitis C drugs.  After four, prior approval will be required.  The Department looked at moving this to five but the Workgroup agreed to four.  This apparently will save $5.2 million.  

The House Human Development Subcommittee met on March 19 to hash out their recommendations.  Approximately $14 million was offered as ‘cuts’ by the Department of Human Resources; the Subcommittee agreed with a little more than $12 million of these proposals.  In the end, the group agreed to such things as closure of ten offices within the Division of Family and Children Services and reduce State conferences within this same Division by 50% and eliminate all out-of-state travel.  The Division of Family and Children Services would also create a savings by centralizing its payroll.  Under the Division of Public Health, the Subcommittee agreed to reductions in the Cancer State Aid monies and the Parent-to-Parent program.  Also, many Legislators felt that due to the predatory lending bill there was some retribution needed so they agreed to eliminate the use of checks and utilize debit cards – this will apparently save more than $3 million.  Legislators shied away from any cuts which would call for legislative action (changes).  

House Human Relations and Aging  

          This Committee met on March 11, 2003 .  HB 357 was assigned to a Study Committee composed of Reps. Mable Thomas, Sally Harrell, and Vance Smith.  The Committee also discussed working more with the Silver Haired Legislature and decided to make a trip to Milledgeville in an effort to determine more about the group’s needs including a meeting place.  The Committee also discussed the recently released Study by Rep. Jeff Brown on Access to Prescription Drugs.  This Study came about after legislation was proposed by Rep. Jim Stokes for a state-issued prescription drug plan card and at the same time the State was trying to implement the GeorgiaCares program.  As a result, manufacturers agreed to strengthen discount programs.  Rep. Harrell urged the Committee to continue to work on this issue in some capacity.  

          On Wednesday, a Subcommittee met to hear several bills.  This Subcommittee was chaired by Rep. Mike Boggs.   One bill it heard was the bill dealing with the licensure of massage therapists.  It seems that there are two factions – those who want licensure and those who don’t.  Rep. Boggs stated that licensure usually lends credence to a profession by establishing education requirements, etc.  However, registration of massage therapists would be less expensive to administer.  There was concern by some massage therapists that the bill was trying to compare massage therapy to prostitution.  In the end, the bill was held and a study will be conducted over the summer.   

          Rep. Boggs also heard from Rep. Anne Purcell concerning HB 304 on water well standards.  This bill was passed and heads to the full Committee.  

          Another bill before Rep. Boggs’ Subcommittee was HB 628 which deals with the Georgia Occupational Review Council.  This Council is to review any legislation which proposes to license new professions.  Rep. Hugley brought the bill to the attention of the Legislature which adds some additional folks to the Council such as representatives from the Department of Community Health and Department of Insurance.  The bill also allows some flexibility in items to be reviewed by the Council rather than a strict check-off list.  The Georgia Hospital Association continues to work with Rep. Hugley on its concerns.  The last ‘new’ profession created by this Council was clinical perfusionists.  The bill was amended in order to address some issues raised by the Secretary of State’s Office and passed by Committee Substitute to the full Committee.  

          HB 597 was also addressed by this Subcommittee.  Rep. Jackson presented the bill.  The pharmacy board was added as one of the boards which will receive a reduction in the number of members.  Such reductions will allow a cost savings for the Secretary of State.  Any Boards over six or more members will be reduced by one person.  Some professions will not be affected, such as construction, athletic trainers, podiatrists, and landscapers.  This could be an annual cost savings of $50,000-$60,000.  This too passed by Substitute to the full Committee.  

House Health and Human Services  

          The General Health Subcommittee of this Committee met with Rep. Nikki Randall presiding as Chair on March 13.  Rep. Hembree presented SB 85 concerning changing penalties for persons practicing optometry without a license from a misdemeanor to a felony.  This bill passed.  Similar penalties are imposed for persons engaging in conduct similar to such for chiropractors, doctors, dentists, and podiatrists.  

House Insurance Committee  

          Rep. Stan Watson conducted a Subcommittee meeting on March 13.  HB 598, a bill by Rep. Harbin on insurance fraud, passed.  This bill was brought by Rep. Harbin at the request of the Department of Insurance.  This bill is different from the RICO bill as it deals with property and casualty issues.  This Subcommittee was also to take up HB 619 but that bill was held.  HB 619 proposes to allow franchise group plans to write insurance plans with perhaps no oversight by the Department of Insurance.  

Budget News  

          HB 122, the FY 2003 Supplemental Budget, cleared the Senate prior to the break.  Conferees were then appointed.  For the House, those Conferees are:  Reps. Buck, Smyre, and Parrish.  For the Senate, the Conferees are:  Sens. Hill, Price, and Cheeks.  During the last two weeks, Legislators worked on both the Supplemental and "big" budgets.  On Friday, March 21, a compromise was reached on the Supplemental Budget.   

          Here are a few highlights of the Supplemental Budget as it cleared the Senate, which relate to the Department of Community Health.  It will now take resolution of the 'differences' between the Senate, House and Governor.  

·        To eliminate nursing home liability insurance adjustments effective February 1, 2003 (Total Funds $6,468,669).  The House exempted critical access hospital-based nursing homes for total funds of $81,643.  In the Governor’s recommendation, the elimination would cause a reduction of $2,620,458;  with the add-back done by the House, it would bring the reduction to $2,587,458.  The Senate agreed with the House position.

·        To reduce the Georgia Board for Physician Workforce funding for the Mercer School of Medicine operating grant by 3%.  The Governor proposed that this would be a savings of $1,558,607.  The House, which has members on Mercer’s Board disagreed, and added back some funds so that the cut would be only $640,411.  The Senate returned to the Governor’s position on this cut.

·        To reduce the Georgia Board for Physician Workforce funding for the Morehouse School of Medicine operating grant by 3%.  The Governor proposed this savings as $250,553; the House agreed with the Governor on this item.  The Senate, however, proposed only a 1% cut which would be $80,000.

·        To eliminate the Georgia Board for Physician Workforce student preceptorship.  The Governor and House agreed that this could be a savings of $100,000.  The Senate added back these dollars so that the preceptorships would not be eliminated.

·        To provide for an austerity adjustment.  The Governor proposed a cut of $1,663,964.  The House and Senate agreed to a larger austerity adjustment of $1,683,964.

·        To increase State funding for Medicaid Benefits to fund the projected cost of incurred claims for prior years and the projected cash need for FY 2003 claims (this would be $594,663,555 total funds with federal dollars).  The Governor and House agreed to add $259,178,360 for this item.  The Senate changed this by reducing this number to $232,752,544 (this would change the total funds to $528,983,054).

·        To adjust DRI inflation factor applied to FY 2001 cost reports for nursing homes such that FY 2003 expenditures do not exceed the FY 2003 appropriation provided for an inflation adjustment.  The Governor had only added language – that “yes” this would be the approach.  The House made an exception for critical access hospital-based nursing homes.  In doing so, it added $253,000 which would bring federal dollars for a total of $625,928.  The Senate made an exception for 85% Medicaid nursing homes and changed the add to $300,000 which would provide $742,207 in total funds.

·        The Senate also made some additions which neither the Governor nor House proposed:

·        To increase co-pay for pharmacy program from a low of $.50 to $1.00 per prescription under the Medicaid program effective June 1, 2003 .  This would be a savings of $141,667 in State funds (federal dollars would bring this to $366,667).

·        To authorize a pharmacy re-use policy (this would particularly apply to nursing home medications).

·        To authorize a supplemental pharmacy rebate program.

·        To renegotiate computer contract owing to delayed implementation.

The Department’s proposed budget for FY 2003 was projected as follows:  

Governor:      $1,675,404,535

House:          $1,676,613,731

Senate:          $1,649,420,605  

As for Tobacco Dollars, the Governor and House proposed to utilize tobacco dollars to partially fund the projected cost of incurred charges for past years and the projected cash need for FY 2003.  The Senate placed $10,120,551 for this by using the OneGeorgia reserves in the Department of Industry, Trade, and Tourism Budget.  

Under PeachCare for Kids, here were the differences:  

·        To limit enrollment in PeachCare for Kids such that FY 2003 expenditures do not exceed the FY 2003 appropriation provided for PeachCare for Kids benefit or administrative costs.  The Governor proposed this; the House said “no” to this item.  The Senate agreed with the House.

·        To add funds to cover increases in the PeachCare for Kids eligibility determination contract.  This item was put in by the House with an add of $200,000.  The Senate concurred.  This would be a total of $707,214 funds.  

In all, the Governor’s recommendation for PeachCare was $60,873,226.  The House and Senate totals were $61,073,226.  

Conferees agreed to the following changes from the differences in the Budget:  

·        3% funding reduction for Mercer School of Medicine operating grant.  The Governor had proposed a reduction in the amount of $1,558,607 as did the Senate.  However, the House proposed only a reduction of $640,411.  In the end, Conferees agreed that a reduction of $591,000 would be taken.

·        3% funding reduction for Morehouse School of Medicine operation grant.  The Governor had proposed a reduction of $250,553; the House proposed a reduction of $225,553.  The Senate however, only proposed a reduction of $80,000.  Conferees agreed that a $200,000 reduction would be made.

·        The Governor had proposed the elimination of the Georgia Board for Physician Workforce student preceptorship which would be a reduction of $100,000.  The House concurred.  The Senate, however, restored the dollars to the program.  Conferees allowed the Senate’s position to win.

·        The Governor proposed an increase of $259,178,360 in state funds for Medicaid Benefits to fund projected cost of incurred claims for prior years and projected cash need for FY 2003.  The House agreed to this number.  The Senate reduced this to $232,752,544.  Conferees agreed with the Governor’s position.

·        Governor Perdue proposed to adjust DRI inflation factor applied to FY 2001 cost reports for nursing homes such that FY 2003 expenditures would not exceed the FY 2003 appropriation provided for an inflation adjustment.  The House provided an exception for those critical access hospital-based nursing homes  This would have required an addition of $253,000.  The Senate added an exception for all nursing homes with 85% Medicaid which would have proposed an increase of $300,000.  The Conferees went with the Governor’s original proposal.  Thus, nursing homes will not be getting the financial help they had hoped.

·        The Senate had proposed an increase of the co-pay for pharmacy program from a low of $.50 to $1.00 effective June 1, 2003 (this would have a projected cost savings of $141,667).  The Senate Conferees proposed that the amount saved not be included in the final document but only the language for this to be included.  Conferees finally agreed.

·        Senate Members also proposed to authorize a re-use policy.  Conferees agreed that no such proposal should be included.

·        Senate Members also proposed to authorize a supplemental pharmacy rebate program.  Conferees did not agree.

·        Senate Members proposed to renegotiate the computer contract owing to delayed information.  The House Conferees did not agree.  The Senate Conferees wanted DCH to deal with the delay.  Thus, in the end, Conferees agreed that language would be included in the final document for the Department to deal with such delay.

·        The Governor had proposed to utilize Tobacco Funds to partially fund the projected cost of incurred Medicaid claims for past years and projected cash need for FY 2003.  The House liked this idea.  However, the Senate had added in more than $10 million from OneGeorgia.  Conferees finally agreed with the Governor’s original proposal.  

In the Department of Human Resources, there was an item which was problematic that ended in Conference.  The Governor had proposed an austerity reduction for the Division of Administration in the amount of $1,818,958.  The House had agreed with an austerity reduction but had excluded a reduction for the Intergenerational Resource Center .  This would have been a reduction in the amount of $1,718,958.  Meanwhile, the Senate had included monies for the Intergenerational Resource Center but had made additional austerity reductions for a total of $2,000,000.  Conferees sided with the Governor.