February 14, 2001

For more information contact:

Stanley S. Jones, Jr.

404-817-6133

          Today, Valentines’ Day, was celebrated by many – the flowers, candies, cards and other treats were still being delivered to Legislators and Staff late into the day.  

Floor Activity 

Sen. Nadine Thomas’s bill, SB 82, the one allowing for direct insurance reimbursement to be made to Registered Nurse First Assistants, passed out of the Senate.  The bill came to the Floor by Committee Substitute after revisions to the bill were made in the Senate Insurance and Labor Committee.  Sen. Thomas explained that this bill, or some similar version, had already been passed in six other states.  These Registered Nurse First Assistants serve as assistants to surgeons. Sen. Thomas asked that no additional amendments be made to the bill.  The vote on the passage of the bill was 51 yeas to zero. 

          The House took up several bills and resolutions.  Some included the passage of HB 115 authored by Rep. Jamieson which amends O.C.G.A. § 36-37-6 relating to disposition of municipal property generally, so as to authorize certain transfers of property to bona fide nonprofit resource conservation and development councils.  The bill passed by a vote of 163 to zero.  

          Rep. Terry Coleman’s bill, HB 302, relating to the minimum salaries for county officers, passed by Floor Substitute by a vote of 162 to 2 – Reps. Sinkfield and Turnquest were the dissenting votes. 

          HB 317 passed by Committee Substitute by a vote of 166 to zero.  The bill amends Chapter 26 of Title 50 of the Code concerning the “Georgia Housing and Finance Authority Act,” so as to authorize retailing and signage as authorized enterprises and projects.  It also adds new definitions for the terms “community development” and “enterprise.” 

          April was designated as “Ovarian Cancer Awareness Month” in a Resolution adopted by the House.  Rep. Dorothy Pelote had authored Resolution HR 143 in an effort to raise awareness of the silent killer. 

          In a vote of 170 to zero, the House passed a measure which will offer property tax relief to those 62 years of age and older.  The bill, HB 229, would not take effect, if passed and signed into law, until January 1, 2002.  Some of the bill’s provisions include a new section at O.C.G.A. § 48-7-29.8 on tax credits for green space donations: 

“(a) As used in this Code section, the term:

(1)   'Greenspace purposes' means real property which is suitable for and which will be used for:

(A) Public beach access or use;

(B)  Public access to public waters or trails;

(C)  Fish and wildlife conservation;

(D) Public parks;

(E)  Preservation of natural areas; or

(F)   Any other similar such purpose.

(2)   'Qualified donation' means the fee simple conveyance to the state, a county, or a municipality of 100 percent of all right, title, and interest in the entire parcel of donated real property, which donation is accepted by the state, county, or municipality. Any real property which is otherwise required to be dedicated pursuant to local government regulations or ordinances or to increase building density levels shall not be eligible as a qualified donation under this Code section.

(b) A taxpayer shall be allowed a state income tax credit against the tax imposed by this chapter for each qualified donation of real property for greenspace purposes, in an amount not to exceed 25 percent of the fair market value of the donated real property as established in accordance with Chapter 5 of this title.

(c) No tax credit shall be allowed under this Code section unless the taxpayer files with the taxpayer's income tax return a copy of a certification by the Department of Natural Resources that the donated property is suitable for greenspace purposes.  The Department of Natural Resources shall promulgate any rules and regulations necessary to implement and administer this subsection.

(d) In no event shall the total amount of any tax credit under this Code section for a taxable year exceed the taxpayer's income tax liability.  In no event shall the aggregate lifetime total amount of the tax credit granted to a taxpayer under this Code section exceed $250,000.00.  Any unused tax credit shall be allowed to be carried forward to apply to the taxpayer's succeeding years' tax liability.  No such tax credit shall be allowed the taxpayer against prior years' tax liability.

(e) The commissioner shall promulgate any rules and regulations necessary to implement and administer this Code section.” 

          Chairman Jimmy Lord’s bill, HB 352, also passed out of the House by a vote of 169 to zero.  The bill had been engrossed previously and deals with the licensing of insurance agents.  It would permit out-of-state agents to have reciprocity of licensing.  The bill follows some of the federal law provisions enacted in the Gramm-Leach-Bliley law.  

          Some legislation to help keep Georgia’s children safe also passed.  HB 248 passed in an amended form by a vote of 172 to zero.  It would require that children ages four years and younger be required to use safety restraints in an automobile, van, or truck.  The bill amends current law at O.C.G.A. § 40-8-76 and was authored by Rep. Alan Powell.  Rep. Lynn Westmoreland added an amendment whereby the child would not use such a restraint unless the parent or guardian “reasonably determines a physical or medical condition of the child prevents placing or restraining him or her in any such child passenger restraining system.”

Newly Introduced Legislation 

SB 166 – This bill was introduced by Sens. Tate and Thomas and proposes to amend Chapter 4 of Title 49 concerning public assistance by creating a Georgia Pharmacy Assistance Program for Low-Income Elderly Citizens.  It proposes to help Georgians who are 65 years of age and older and who have annual incomes of $14,000 (individual) or $30,500 (couple) or less.   Specifically, the bill proposes to provide a “pharmaceutical assistance program for qualified elderly citizens of Georgia” which is to be established within the Department of Community Health.  Further, the program would be administered by the Department.  “The program shall consist of payments by the department to pharmacies for the reasonable cost of prescription drugs dispensed to eligible recipients minus a copayment charge of $10.00 for each prescription filled.  The copayment charge shall be collected by the pharmacy at the time of each purchase of a prescription drug.  No pharmacy shall waive, discount, or rebate in whole or in part any copayment charge.  Payments pursuant to this program shall be made from funds appropriated to the department for the operation of the program or otherwise available to the department for such purpose.”  The legislation has now been referred to the Senate Health and Human Services Committee. 

SB 173 – Sen. Harp has authored this measure to amend Chapter 2 of Title 20 pertaining to elementary and secondary education by providing for an increase in State salaries for school psychologists who earn national certification.  This proposal would be a five percent increase in the State salary.  This bill has been forwarded to the Senate Appropriations Committee. 

SB 178 – Sens. Harbison, Kemp, and Dean have introduced this bill amending Chapter 9 of Title 33 relating to the regulation of rates, underwriting rules, and related organizations in an effort to provide a time period in which hearings must be requested as well as procedures for those hearings.  Specifically, the bill states that “any insurer aggrieved by the Commissioner's disapproval of any rate filing may petition the Commissioner for a hearing within ten days of the notification of such disapproval, unless otherwise specifically provided by law.  A hearing conducted pursuant to this Code section shall be in accordance with the provisions of Chapter 2 of this title.”  This measure has been forwarded to the Senate Insurance and Labor Committee. 

SB 179 – Sens. Harbison, Kemp, and Dean have also authored this bill amending Article 1 of Chapter 30 of Title 33 pertaining to group or blanket accident and sickness insurance.  It would provide that insurers, health care corporations including provider sponsored health care corporations, and health maintenance corporations furnish claims experience to group policyholders and provides for an alternative group claims experience reporting to policyholders as approved by the Commissioner of Insurance.   The bill also allows the Commissioner of Insurance to approve the fees to be charged for the provision of such claims experience reports.  Some of the bill’s provisions in amending O.C.G.A. § 33-30-13.1 are: 

“(a) As used in this Code section, the term 'insurer' means an accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation, health care corporation, provider sponsored health care corporation, health maintenance organization, or any similar entity.

(b)(1) All insurers shall furnish, regardless of the rating methodology used, claims experience to group policyholders within 30 days of any policyholder's request unless such information has been furnished to the group policyholder within the preceding six months.  Such claims experience shall be furnished for all groups of 51 or more covered employees, members, or enrollees, not including dependents, and shall include, but shall not be limited to:

(A)   Earned premiums separated by policy year for at least the last two policy years, if applicable;

(B)    Total incurred claims, inclusive of any high amount or pooled claims, including both capitated and noncapitated expenses set forth in the same manner as premiums; and

(C)   Any amounts in excess of the individual pooling or stop-loss point applicable to the group.

(2) Insurers that utilize provider contracting methods including financial devices such as global fee arrangements to cover all medical expenses may make application to the Commissioner for approval of the use of an alternative form of claims experience reporting.  The insurer must still provide Georgia experience on a group-specific basis or on such other reasonable basis as the Commissioner may approve for such insurer, in advance, based upon a submission of an explanation and supporting documentation.  Any insurer that received approval for an alternative form of group claims experience reporting to policyholders shall be required to seek the Commissioner's advance approval of a proposed response letter to group policyholders who request experience reporting.  Such letter should describe the insurer's reasons for seeking an alternative reporting process and describe the alternative form of reporting approved by the Commissioner.
(3) Insurers may charge a reasonable fee for providing this information to group policyholders.  The schedule or amount of fees to be charged group policyholders for providing this information shall be filed by each insurer with the Commissioner.
(4) In providing claims experience to group policyholders under this Code section, insurers shall adhere to all state and federal laws regarding disclosure of protected health or personal information.” 

SB 181 – Sens. Tate and others have introduced this to amend Chapter 33 of Title 43, the “Georgia Physical Therapy Act,” in an effort to change the definitions, practice of physical therapy and physiotherapy, and provide for disciplinary sanctions.  The bill adds the term of physiotherapy which would mean the “care and services provided by or under the direction and supervision of a licensed physical therapist.”  It has now been forwarded to the Senate Health and Human Services Committee. 

SB 186 – Sens. Golden and others have offered this legislation amending Article 11 of Chapter 9 of Title 34 pertaining to drug-free workplace programs.  The bill also changes the provisions pertaining to the insurance premium discount offered to employers.  Specifically it states at O.C.G.A. 34-9-415(b):

“An employer is required to conduct the following types of tests in order to qualify for the workers' compensation insurance premium discounts provided under O.C.G.A. 34-9-12 and Code Section 33-9-40.2.
(1) An employer must require job applicants to submit to a substance abuse test after extending an offer of employment.  Testing at the employer worksite with on-site testing kits that satisfy testing criteria in this article shall be deemed suitable and acceptable postoffer testing.  Limited testing of job applicants by an employer shall qualify under this paragraph if such testing is conducted on the basis of reasonable classifications of job positions;
(2) An employer must require an employee to submit to reasonable suspicion testing;
(3) An employer must require an employee to submit to a substance abuse test if the test is conducted as part of a routinely scheduled employee fitness-for-duty medical examination that is part of the employer's established policy or that is scheduled routinely for all members of an employment classification or group;
(4) If the employee in the course of employment enters an Employee Assistance Program or a rehabilitation program as the result of a positive test, the employer must require the employee to submit to a substance abuse test as a follow-up to such program.  However, if an employee voluntarily entered the program, follow-up testing is not required.  If follow-up testing is conducted, the frequency of such testing shall be at least once a year for a two-year period after completion of the program and advance notice of the testing date shall not be given to the employee; and
(5) If the employee has caused or contributed to an on the job injury which resulted in a loss of worktime, the employer must require the employee to submit to a substance abuse test.” 

SB 189 – In an effort to address campaign contributions, Sen. Jackson and others have introduced this bill amending O.C.G.A. § 21-5-33 relating to the disposition of campaign contributions in order to make it unlawful for any member of the General Assembly, any candidate for election to the General Assembly, or any campaign committee of such a member or candidate to disburse any campaign contributions or proceeds thereof to or for the benefit of a member of the immediate family of such General Assembly member or candidate.  There are some exceptions to such disbursements to family members: (i) goods or other tangible consideration is supplied by the family member to the candidate or campaign and a detailed list of such goods or other consideration is included in the campaign contribution disclosure report; or (ii) services are supplied to the campaign by the family member based upon a written job description which contains a detailed list of the duties to be performed and contemporaneous records of the hours worked and the duties performed by such family member are maintained and included in the campaign contribution disclosure report.  No consulting services shall be included within the meaning of the term 'services' as used in this division.”  Immediate family members are defined as “that person's parents, wife or husband, children, and brothers and sisters.”  The bill has been sent to the Senate’s Ethics Committee. 

SB 192 – Sens. Brush, Crotts, and Thomas have authored this amendment to O.C.G.A. § 40-6-315 relating to headgear and eye-protective devices for riders of motorcycles.  There is an exception being proposed for those persons who are 18 years or older from wearing such.  The bill has been forwarded to the Senate Insurance and Labor Committee. 

HB 615 – Rep. Childers has introduced this amendment to Article 6 of Chapter 5 of Title 44 relating to anatomical gifts in an effort to require that written communications of permissible givers of such gifts contain certain disclosures.  The bill would require that companies which receive such gifts notify the givers that they are a for-profit company or a subsidiary of a for-profit company.  The bill has been forwarded to the House Health and Ecology Committee. 

Committee Activity

 Health and Ecology Committee 

          The House Health and Ecology Committee held a meeting with a number of items on its agenda.  One of the issues that the Committee addressed was the coverage of the drug Carnitor for dialysis patients.  Apparently, this is a Medicare issue and the local office of the Health Care Financing Administration has not provided for the oral form of the drug.  Here in Georgia, the third-party payor for Medicare claims is Blue Cross Blue Shield of Georgia.  Testimony was given by a number of persons on this drug’s benefit.  There are approximately 9,200 patients in Georgia impacted.  The drug’s cost is $27.50 per microgram.  Chairman Buddy Childers instructed Blue Cross to meet with the various entities involved and try and work out a resolution to this issue.  He stressed that this was of grave importance to him and he would make this issue known to the Department of Insurance in its review of the Wellpoint acquisition of Blue Cross.  The National Kidney Foundation is also supportive of both types (oral and intravenous) of this medication to be used with dialysis patients.  

          Chairman Childers had previously placed HB 510 in a Subcommittee.  Rep. David Graves, a pharmacist from Macon, explained the bill to the Committee which is the State’s annual update of dangerous drugs listed in the Code.  In Section 2 of the bill, HB 510 added some language whereby prosecuting attorneys and State Crime Labs had some recourse on dealing with hazardous waste materials.   This would make such ‘clean-ups’ necessary for meta-amphetamine labs to be a violation.  Presently, it costs the State approximately $30,000 for such clean-up measures.  This bill was not directed to the manufacturers of pharmaceuticals.  HB 510 passed out of the Committee and now proceeds to the House Rules Committee. 

          The next bill under the Committee’s consideration was HB 383 concerning the number of physician’s assistants under the control of one physician.  Presently, Georgia allows that a physician may have two physician’s assistants under his or her control and supervision.  This law would expand such to four.  It was explained that this would help rural Georgia where there are limited numbers of healthcare providers.  This bill also passed out of Committee and now makes its way to the House Rules Committee. 

          The final measure under consideration by the Health and Ecology Committee was HB 356 pertaining to the centralized credentialing of healthcare providers.  Rep. Nan Orrock, author of the bill, is pushing this legislation for an entity known as MAG Mutual – a subsidiary of the Medical Association of Georgia.  This bill would allow physicians to submit their core credentials to a central data bank or credential verifications organization in an effort to help eliminate the duplication and repetitive nature of submitting data in order to participate in the various health plans and be granted hospital privileges.  The bill was introduced last Session and was killed in the final hours of Sine Die.  In this year’s version, the physicians were originally submitting the data and hospitals and health plans would be paying for such data (which they currently do not pay for).  Hospitals were taken out of the bill after Grady Memorial Hospital raised some significant costs concerns.  Now, only health plans are left responsible for paying for this data.  The problem with the bill is that there is no actual verification of the data once it is submitted – thus, the health plans and hospitals would still need to verify the information, using secondary sources, as health plans and hospitals cannot go back to ask the physicians directly about their responses to the core data.  One new amendment helped this issue slightly.  In addition, the credential verification organization does not need to be actually credentialed by all three major credentialing organizations used nationally such as the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the American Accreditation Healthcare Commission/Utilization Review Accreditation Committee.  The bill passed out of the Committee with only one dissenting vote.  It now will go to the House Rules Committee. 

House Appropriations Committee 

          There were also budget hearings held late in the day.  The House Appropriations Subcommittee on the Department of Community Health held a public hearing on the FY 2002 Budget.  Numerous groups testified about their needs from the State.  

          Healthy Mothers, Healthy Babies asked Chairman Mickey Channell and members of the Subcommittee if they would consider $2.1 million for the folic acid project and an additional $200,000 for breast pump reimbursement.  Folic acid has been proven to reduce the numbers of birth defects if women take folic acid supplements in their child-bearing years.  Also, it was argued that women who nurse typically have healthier children. 

          The Georgia Nursing Home Association also asked the Subcommittee for additional monies for nursing homes.  Gayle Sexton testified before the Subcommittee with the aid of a video taken at a local nursing home.  She has been working on a salary increase for nursing home staff in the amount of $.15 to $.20 per hour.  She pointed out that nursing homes receive 85% of their revenue from the Medicaid program – the other 15% comes from private pay patients.  Further, she pointed out that a ‘growth allowance’ requested would impact 38,500 employees across Georgia.  Last year, nursing home staff worked 53,000,000 hours with an average of 145,000 hours per facility.  In the current budget proposal, the numbers show the cost report plus one year of growth rather than two years.  Ms. Sexton also pointed out that there are 5,000 documented job vacancies in nursing homes across the State – many of which are due to poor pay and lack of nursing staff available. 

          Ray Williams spoke on behalf of the non-emergency transportation providers.  The numbers in the Governor’s budget do not adequately reflect the numbers needing to be served due to the transfer from the Department of Human Resources to the Medicaid program. 

          The rural hospitals also made another plea for help.  Jimmy Lewis, on behalf of Home Town Health – a group of rural hospitals across Georgia, asked that the Subcommittee do what it could to help these facilities.  The $100 million cut in the State’s budget a couple of years ago along with the Balanced Budget Act passed by Congress have been devastating to hospitals.  There have been $764,000, bottom line, cash cuts.  Forty-five hospitals lost money last year.  In a recent meeting with Mr. Lewis, many CFOs of these hospitals explained that they had no cash or reserves available.  Due to reimbursement complexity, there is total confusion by the hospitals on payments.  Also, payables are usually over 100 days old.  Some hospitals have been working on accelerated payments with the State and federal governments in an effort to meet payrolls.  These rural hospitals are in 50 communities but only 600,000 Georgians are impacted.  Mr. Lewis pointed out that there was a new “prompt payment” problem with insurance companies.  Rather than denials of claims, many claims were being held for additional information.  Mr. Lewis pointed out several hospitals in dire straits – Hancock County’s hospital, Effingham County’s hospital (which is experiencing a shortfall from the State Merit system), and others.  Last year, there were three facility closures.  

          A representative from the Centers for Disease Control, Dr. Oakley, gave the Subcommittee a presentation on folic acid and what such treatment can do to lessen the numbers of birth defects.  He pointed out that these birth defects could be eliminated, much like polio was eliminated, with the use of folic acid. 

          The Georgia Dental Association’s representative Christy Perkele, asked that the Subcommittee fund prevention opportunities for pregnant women.  She asked that money be placed in the Budget as it was originally recommended by the Department of Community Health.  However, the Governor did not include such in his recommendations.  She pointed out that oral health is good for physical health. 

          Mercer University School of Medicine also asked for help.  Last year approximately $7.7 million was cut from being annualized in the Budget.  Doug Skelton explained that he was grateful for the inclusion of the $1 million dollars but that did not fix the problem.  He pointed out that Mercer was a private institution but it was committed to providing physicians to all of Georgia as well as supporting primary care. 

          David Cook, with the Medical Association of Georgia, asked that the Subcommittee look at the computer problem for the “dual eligibles.”  The treating of Medicaid patients by physicians is expensive.  Physicians are not paid what it costs to treat those patients – they only receive a percentage of the RBRVS.  The Balanced Budget Act cut a significant portion of the reimbursement to physicians.  Further, Medicaid payments have been tied to Medicare payments.  Also, Mr. Cook explained that managed care had ‘ratcheted down’ costs in the private market.  He explained that physicians could not subsidize these costs.  Thus, he asked that the Subcommittee propose funding of reimbursement for Medicaid patients at 100% of the Medicare rate.  He also asked that the Subcommittee support the Composite State Board of Medical Examiners request of $214,000 and the proposed Physicians' Well-Being Program. 

          A representative of the March of Dimes also asked that the Subcommittee fund the folic acid program. There are 100 birth defects annually in Georgia attributed to the lack of folic acid.  Rep. Shaw asked if it would not be cheaper to just buy the folic acid and distribute it.  Purchasing the drug is not the answer; education of women of child-bearing years is also necessary. 

          Rick Ward, with the Georgia Chapter of the American Academy of Pediatrics, also praised the use of folic acid.  He stated that his pediatricians were supportive of the Medical Association of Georgia’s requests.  Two-thirds of the patients that pediatricians see are Medicaid patients.  Also, Mr. Ward asked that the early prevention screening checks be supported in the budget. 

          The Georgia Hospital Association also asked for any relief possible.  Ms. Holly Bates Snow explained that the hospital situation in Georgia was critical – currently, there are a number of emergency rooms which are overcrowded as a recent segment by ABC news displayed.  Ms. Nancy White made a similar request on behalf of the HCA hospitals. 

          Karen Frazier of Grady Memorial Hospital asked that the Subcommittee look at its reimbursement.  Previously, Grady received approximately $7,200 dollars per stay on average.  It now is receiving an average payment of $4,600 per patient.  It is now losing $.20 on each dollar it spends. 

          Pat Reid, with Visiting Nurse Health System, asked for better reimbursement for home health agencies serving medically fragile children at home.  Her agency lost almost $800,000 in 2000 by serving approximately 1,200 children and is already losing approximately $300,000 this year from the carry-over children from last year.  Visiting Nurse primarily serves the Atlanta-metro area and is the preferred provider for Egleston and Scottish Rite Hospitals.  She asked that the Subcommittee consider a one-time grant to her agency of $500,000 and adjustments to the reimbursement rates for pediatric home health visits.  She explained that visits are currently being reimbursed around $82 per visit – for both adults and children.  Costs to serve children are around $220 per visit on average.  Several Representatives asked questions of Ms. Reid – they specifically wanted to know about the agency’s corporate status, types of patients the agency served, the reasons for the increased costs of a pediatric visit versus an adult home health visit, the costs of home health versus costs of hospitalization, etc. 

          Linda Lowe also asked the Subcommittee for better home health rates for children as well as help with the Medicaid Waiver programs and EPSDT program.  

          Clay Campbell, with Archbold Health System, also raised the needs of home health providers.  He explained that not only were pediatric home health visits losing money but adult home health visits were also losing money.  There are many agencies around Georgia which are not receiving $75 dollars per visit – his hospital’s home health agency is only receiving $62.50 per visit.  The money in the Governor’s budget for an additional $44,000 in State funds is for only those providers which participate in the State’s CCSP program and which also provide at least 5% indigent care. 

House Committee on Children and Youth 

          This Committee heard a presentation by the Department of Juvenile Justice.  Commissioner Martinez appeared before the Committee and explained what his Department had been accomplishing for the last year.  He also discussed the juvenile delinquency issue.