A Study Committee chaired by Sen. Connie Stokes, created by SR 910, met on Monday, August 12, 2002 to take up three subjects: SOURCE; GeorgiaCares; and scope of practice. Three presentations were made, one on each topic. Members of the Legislature, in addition to Sen. Stokes, present to hear these discussions were Sens. Carol Jackson; Gloria Butler; Ed Harbison; and Don Balfour.

Sen. Stokes opened the meeting stating that she and her Committee were working with the National Conference of State Legislatures, various State Departments, and others in trying to assemble ideas on the healthcare needs of Georgians and what the future holds. She asked for the public to forward telephone calls and electronic messages to her about their ideas.

Department of Community Health Commissioner Gary Redding was on hand to introduce Medicaid Division Director Mark Trail. Mr. Trail explained the SOURCE, which stands for stands for Service Options Using Resources in Community Environments, program to Legislators. SOURCE came up in the Committee’s discussions at its last meeting. Through SOURCE, the Department of Community Health provides primary care to those elderly and disabled Georgians who need assistance.

The program was actually implemented in some test sites in 1997. Now, the Department has ten sites through its expansion efforts with hospitals, nursing homes, and Department of Human Resources’ Areas of Aging Offices (including Augusta, Savannah, Albany, Blue Ridge, Gainesville, Waycross, and Butler). Five of these sites were brought ‘on line’ this year.

Many of the SOURCE recipients are dual eligible meaning that they qualify for both Medicare and Medicaid dollars. In addition to primary care, SOURCE also provides for case management in an effort to keep patients out of nursing homes and hospitals.

Each person in the SOURCE program receives a comprehensive examination. Sen. Stokes asked about the "comprehensive" definition and what that meant. There were also questions concerning the numbers of patients assigned to each case manager. There are approximately 50 patients assigned to each. Some case managers have more difficult case loads than others based upon the types of patients that each sees. In all instances, providers’ performances are reviewed to determine effectiveness. Casepaths are reviewed with physicians every 90 days.

SOURCE is also similar to the CCSP program. Medicaid dollars are expended for both programs.

A question was also raised about how patients made it to their SOURCE program appointments. Mr. Trail explained that the patients utilized the State’s NET program or Non-Emergency Transportation System.

Maria Greene, the Department of Human Resources’ Division of Aging Director, presented to the Committee information on the GeorgiaCares program. This is the result of the Governor’s initiative on trying to get prescription drugs to the elderly. The official implementation and announcement of this program will be in September. Presently, the program will be administered through the Division of Aging and will essentially use the Georgia HiCares program. Each of the Areas of Aging Offices around the State will have staff trained to provide information to the elderly on how each can access discount drugs through the various pharmaceutical discount cards and Patient Assistance Plans (which are donated drugs through the pharmaceutical companies).

GeorgiaCares will attempt to serve the poor who are not otherwise eligible for Medicaid. An appropriation in the Budget will help with this initiative. Additionally, the Division of Aging has been partnering with a number of entities in an effort to lessen the costs to the State associated with this implementation. Major pharmaceutical companies, hospitals, and others are working with the Division on this program. There will be training for Areas of Aging staff and volunteers in various locations around the State. Two have been established for the Macon area on August 15 and 16. The Division is currently also looking for additional partners in this program initiative.

MedBanks will continue to play a role in this program. There, however, is limited charity for free drugs. GeorgiaCares will attempt to get the charity drugs to those persons who need them most. Each of the pharmaceutical companies have ceilings on enrollment and other requirements such as age. For instance, Pfizer requires that a person’s income be 200% of the Federal Poverty Level in order to qualify. Generally, the GeorgiaCares program will help those age 60 and older. Pfizer indicated that it does not know what the costs associated with its "Share Card" will be, but the program was begun in January 2002.

In 2001, Patient Assistance Plans donated more than $82 million in drugs to Georgians.

Karen Minyard, from the Georgia Health Policy Center, made a presentation on scope of practice. There have been five regional studies on workforce including some conducted in California, Illinois, Washington, and New York. Turf battles are involved with this issue, and therefore, there is limited data. Some changes have been warranted due to technology, alternative medicine, costs, access, and manpower shortages. Therefore, while the healthcare environment has changed, regulation has remained the same.

Ms. Minyard noted that quality, cost and access end up as the drivers. States want the most access for the least cost with the highest quality provided. The General Assembly is charged with protecting scope of practice for the professions. Physicians have the most inclusive scope of practice with all other healthcare professions falling underneath. There are competition and control issues and liability fears involved with the discussion of scope of practice.

Ms. Minyard also mentioned that scope of practice deals with the health status of the individual. By this, she meant that the person’s behavior (such as does the person smoke or drink, etc.), genetics, and the environment impacts their general healthcare and physical well being.

Some think that the best approach would be to have a federal overhaul of the licensure process. This would help establish the same practice patterns nationally. It would also allow a person to move freely from state to state without licensure issues. Thus, there are political battles within the states over this concept.

Currently state governments are being bogged down by the numbers of pieces of legislation being introduced. In 1995, there were 800 bills introduced involving scope of practice. In 1997, the number had risen to 1,600. Perhaps the best approach would be to have "template" legislation. Each state may feel differently about such approach. In the end, it involves patient outcomes and whether there should be a discussion of "de-skilling" or "multi-skilling" professionals.