News was breaking all over "Capitol Hill" today.  The Report below contains news from the Department of Transportation, Department of Community Health and Department of Human Services.

Elsewhere, rumors are circulating that Mary Norwood is in the lead for the Atlanta Mayor's job - meanwhile Lisa Borders and Kasim Reed trail behind. 

On Georgia's national front, healthcare forums continue across the State with a recently held one in Rome hosted by Congressman Phil Gingrey, M.D.(R).  Georgians are airing their concerns about the push to reform the national system on healthcare.  Congressman Jim Marshall (D) (who is also considered as a "Blue Dog") has stated that he has not decided how he feels about the healthcare proposal; he has stated that any proposal must address "long-term fiscal problems" as costs of healthcare continue to mount throughout the country.  Congressman Marshall is very concerned about government inefficiencies which might occur with a public system but he also has concerns about our nation's current system with the for-profit insurance companies and their denials of coverage in many instances.

Department of Transportation

Todd Long, who was appointed by Governor Perdue, was confirmed unanimously by the House Transportation Committee today as the Director of Planning for the Department of Transportation.  Mr. Long told the Committee that he would work closely with the Department, newly elected Commissioner Vance Smith and Governor Sonny Perdue to ensure that transportation issues facing the State were addressed properly and that all entities were "on the same page."  Presently, Mr. Long said that there are three "Georgias" when referencing transportation problems; the metro area, the "doughnut counties" outside the metro area, and the rest of Georgia.  As Director of Planning, Mr. Long will seek to combine the "three Georgias" into one.  While rapid transit is in Georgia's future, Long said that such a project is still in the distant future because of funding issues. While the Federal Government has earmarked money to provide high speed rail lines, it is not enough money to cover every state's needs.  Mr. Long also stressed that the solution should not solely be addressed by expanding capacity; it must be solved by a multi-pronged approached such as using rail lines, air travel and transit.

Department of Community Health - Medical Advisory Committee Meeting

The Department of Community Health hosted a Medial Care Advisory Committee Meeting focusing on the Department's Medicaid transplant policy and coverage of fluoride varnish coverage for children. 

This Committee's members include: Dave Blanchard; Gloria Chen, Ed.D., M.D.RN.; Jacinto Del Mazo, M.D.; Samuel Gulley, D.D.S.; Kim Hazlewood; C. Thomas "Tommy" Hopkins, M.D.; William P. Kanto, M.D.; Martin C. Michaels, M.D.; Lynn B. Mullis, D.D.S.; Patricia Puckett; Fred Sharpe, D.D.S.; Jules Toraya, M.D.; Richard A. Wherry, M.D.; and Ellen Jaeger.  Attending the meeting today was the newly named Commissioner for the Department of Behavioral Health and Developmental Disabilities Frank Shelp, M.D.

Medicaid presently covers all transplants for children under the age of 21 unless they are experimental or investigational.  Persons over the age of 21 and enrolled in the Georgia Medicaid program and wanting a transplant are covered by different rules.  Today's meeting focused on looking at the Department's current rules for those individuals over the age of 21. 

One comment made immediately by the Committee was clarifying the current wording in the Rules concerning the coverage of the costs of acquisition of the transplant donation when a live donor is used. 

The Committee discussed how Medicare's policies were different than Medicaid's policies on transplants.  Basically, Medicare covers transplants as long as they are not otherwise excluded.  States have the ability to limit their Medicaid transplants.

Dr. Mazo expressed that he believed that experts in the area of transplantation needed to be consulted before policy could be written.  The Department, however, stated that it would look at peer review information and seek insight from the Georgia Medical Care Foundation.  The Department is interested in the costs of care versus the costs of transplants - looking at the medical outcomes as well as the economic costs.

Dr. Shelp noted that he found the language "non-experimental" to be somewhat tricky because in the case of bone marrow transplants, there are rare conditions which do not produce enough studies to have good data. 

Dr. Mazo raised another issue with the Department: access to Medicaid - particularly the Hispanic population.  He believes that not enough is done to promote ways in which persons can gain access to the Medicaid system.  Dr. Jerry Dubberly, the Director for Medicaid, stated that it is the State's responsibility to "market" Medicaid and not the Medicaid Care Management Organizations.  Additionally, the Department has a contract with Maximus for "outreach" and it engages the Division of Family and Children's Services through the Department of Human Services to raise awareness of Medicaid and PeachCare.  Dr. Mazo asked that the Department make a presentation on what is currently done to promote Medicaid so that the Department can have feedback on what works and what does not work.  The Department currently utilizes a website for Medicaid enrollment and conducts health fairs.  Dr. Mazo claimed that one outlet to raise awareness in the Hispanic community was to have messaging played on Hispanic radio.

Dr.  Elizabeth Lense, Georgia's State Oral Health Director, provided a presentation to the Committee on "Childhood Caries" which can be prevented with fluoride varnish.  Childhood Caries is caused by a primary infection, streptococcus mutans with a prolonged dietary exposure to sugar - such as juice in children's sippee cups.  Enamel issues take place and tooth decay begins. 

This disease tends to happen more frequently in low-birth weight babies or pre-term babies; however, maternal factors are also a factor.  Mothers with poor oral health place babies at risk for the disease. For instance, the mother can transmit this streptococcus mutans to the child through kissing the child or sharing drink or food with the child.  There are many symptoms to this disease such as abscessed teeth or infraorbital swelling.  Dr. Lense indicated that children with the most decay tend to be Caucasians just below the poverty level.  Untreated children with this disease can die.

Head Start shows that 40% of children have dental decay and 28% actually need immediate care. 

Dr. Lense explained that the American Dental Association found that fluoride varnish is most effective in preventing dental caries and can actually stop or reverse the disease, if used early enough. The current form of this fluoride varnish apparently is easy, quick to use; inexpensive; has a pleasant taste; lasts for months; and it is dose dependent.  For instance, if a child receives two doses in one year, that child will have a 40% reduction in decay. 

Only 25% of children under the age of six see a dentist despite EPSDT, AAP, etc.  Dr. Lense would like for Georgia to consider Medicaid reimbursement for physicians who are trained in looking for dental caries and other oral health problems so that they can be reimbursed for their services. 

North Carolina has begun a training program for physicians (Smart Smile); now 25 states reimburse for oral health paying $12-$53 for fluoride varnish applications.  North Carolina's success has seen a 37% reduction in the cost of restorative treatment for anterior teeth; North Carolina provides for four treatments by the age of three.  Alabama is also now reimbursing whereas Georgia does not provide for this type of reimbursement.   Dr. Lense asked that Georgia consider providing coverage for twice per year beginning at the age of one for high-risk children.

What else can be done?  Mothers need oral health education; risk assessments need to be conducted on children; six-month check-ups on children need to take place; and dental homes need to be established.

The Department is receptive to coverage; however, the State's Budget has become an issue and it may not be able to afford this service reimbursement.  Amerigroup, one of the Medicaid Care Management Organizations, has indicated that it may initiate a pilot program in order to look at "value" of such treatments, looking at the positive economic benefit including all procedure codes which might be impacted.

The American Academy of Pediatrics Georgia Chapter has a "task force" which deals with dental issues and it is training physicians on dental issues. 

Department of Human Services

The newly named and configured Department of Human Services (formerly a part of the Department of Human Resources) Board met today.  It named a new Chair to the Board, Robertiena Fletcher from Perry.   Other Board members at today's meeting were Lisa Alexander, Ann White, Monica Walters (Secretary), and Frank Auman (Vice Chair).  There are nine seats on this Board and four seats remain unfilled by Governor Perdue.  This Board will meet the third Wednesday of every month (with the exception of December and that meeting will be held on December 9, 2009).

The Board adopted a new set of Bylaws which can be amended at any Board meeting.  These Bylaws will be posted for the public's review.

The meeting focused on the Budget proposals to be submitted to Governor Perdue for the FY 2010 (Amended) and FY 2011 submissions.  With the spiraling downward economy, the Department is presently under a 5% reduction as the Department is having their quarterly federal allotments reduced by that amount.  To reach that amount of reduction, the Department will take three furlough days; suspend non-critical hires; have a moratorium on non-essential travel; and have a moratorium on new equipment purchases.

On July 28, 2009, employees were told that the Department would take furlough days on September 4, 2009; November 25, 2009; and December 31, 2009.  On each of those days, the Department would be closed to the public.

Children in the Department's care are the top priority.

Commissioner B.J. Walker explained the 4%, 6%, and 8% reductions that the Department would undertake to achieve the Governor's directives.  An additional nine furlough days will be taken; if the Department does not utilize furloughs, it will have to let go 450 people.  Commissioner Walker explained that there was no "fat" left - it came down to cutting essential services or jobs.  These additional furlough days will be taken one day per month for the months of January through June with two days taken in May and June of 2010.  The Department will also take these furlough days on Fridays, although it is not releasing those precise days as of yet.

Much of the federal funding that the Department receives is tied with State funding.  Thus, there are certain areas which cannot be cut.  Overall, the Department is funded in FY 2010 with a $477 million budget.  Respective cuts will be reductions of $19.3 million (4%); $28.7 million (6%); and $38.2 million (8%).  These reductions will be on top of a $23.9 million cut already underway. Some items cannot be cut including a reduction to the State Health Benefit Plan and child support as that money is tied with "ARRA" (federal stimulus) money.

Some of the grim news from the 4% reduction proposal included:

Aging

• Eliminations of two positions in the CCSP and Georgia Cares programs
• A $177,000 cut to the Center for Visually Impaired contract
• $20,000 cut to Senior Connections (DeKalb)
• A cut of $1.4 million for respite services (equating to 135,000 units of service)
• A cut of $478,000 for Kinship Cares
• $1.8 million cut to "money follows the person" transitioning folks from nursing homes to the community (the Department will continue its work transitioning 36 individuals already in the queue).

Family and Children's Services

• Elimination of one position in licensing of residential child care (this will result in Title IV-E money being impacted)
• Reduction in travel costs for residential child care (resulting in delays in surveys and responses to investigations)
• $4 million cut to Welfare to Work (SSI benefits based on utilization)
• Wrap around and assessment services (a TANF expenditure) will have a $2 million cut

Family Violence

• Four special projects will be eliminated, leaving $6 million in this Budget

Reaching the 6 % and 8% cuts will require large job cuts for FY 2010 (Amended).  Commissioner Walker explained that FY 2011 looked pretty much like a mirror to FY 2010 (Amended).

While the Department is receiving some ARRA money, it is using a portion of that funding for current "holes" in its Budget - approximately $80-$90 million (with child support).  Some of the ARRA money is funding information systems' upgrades and meals and unemployment assistance for older Georgians.  The money is also assisting with Food Stamps by providing administration dollars to keep the program viable through September 2010.