February 20, 2007
Legislators Were Hard at Work on Fat Tuesday
Happy Mardi Gras! Legislators were hard at work today under the Gold Dome, but let's hope they don't give up that determination for Lent!
Floor Activity
Senate
The Senate met today and passed out Senate Bills 81, 97, 70, and 92. The Senate also voted to reconsider SR 20, a Constitutional Amendment limiting State taxation and expenditures.
The Senate and House both helped celebrate Italy Day in Georgia with addresses from the Honorary Consul of Italy for the State of Georgia, Angela Della Costanza Turner.
House
The House convened this afternoon to take up several Bills. Before the Representatives addressed the General Calendar for today, Senator Saxby Chambliss (R-Georgia) spoke to the House to lay out key goals of the Georgia Congressional Delegation. Key topics include:
- Military base closures;
- Reauthorization of “No Child Left Behind Act”; Sen. Chambliss noted that Congress understands the problems with the Act, and there is an effort to fix those problems;
- Identification issues and immigration
- PeachCare; Sen. Chambliss noted that he and fellow Senator Johnny Isakson (R-Georgia), are working to redirect the money from those 33 states with surplus S-CHIP Funds to those 17 states (including Georgia) with funding shortfalls.
- Iraq; the 800 Georgia National Guard soldiers are doing Georgia proud with their exemplary service in Iraq.
The House voted on Bills today; those that passed out include House Bills 134 (local government bonding permission), 168 (juvenile court judge appointments), 239 (Board of Natural Resources and additional penalties for certain violations), 153 (deprivation of juveniles and placement of children in DFACS custody), and 136 (insurance contracts and indemnification provisions).
Legislation
HB 492, introduced by Rep. Keown (R-Coolidge) would amend O.C.G.A. Article 2 of Chapter 34 of Title 43. This Legislation relates to the Board of Medical Examiners of the State of Georgia, requiring the Composite State Board of Medical Examiners to be made up of 15 members. In this number 13 members must be practicing physicians. The addition of the two non-physician members and the additional physician member shall become effective July 1, 2007.
HB 497- Offered by Rep. Sheldon (R-Dacula), this Bill amends O.C.G.A. § 19-8-4, relating to adoption. The Bill states that pre-birth surrender to the Department of Human Resources or private child-placing agency must be signed and executed prior to the birth. The biological father may surrender his rights before the birth for the purpose of an adoption; such surrender will relinquish the father's rights to the child and waive the right to be notified of any proceeding with respect to an adoption.
HB 505- Offered by Rep. Butler (R-Carrollton), this Bill amends O.C.G.A. § 49-5-7, relating to adult day centers. This Bill authorizes the Department of Human Resources ("DHR") to charge reasonable application, license, renewal, or other similar fees relating to the licensure of adult day centers.
HR 322- introduced by Rep. Harbin (R-Evans) would create the Joint Study Committee on Continuing Education and Collegiate Sports Programs for Students with Disabilities.
SB 132- introduced by Sen. Shafer (R-Duluth) amends O.C.G.A. Chapter 34 of Title 33. This amendment adds language that allows any person "who has been granted a valid certificate of self-insurance pursuant to the laws of another state may qualify as a self-insurer by obtaining a certificate of self-insurance from the Commissioner of Insurance."
SB 183- Offered by Sen. Rogers (R-Woodstock), this Bill amends O.C.G.A. § 33-23-1, relating to insurance agents, agencies, subagencies, etc. This Bill allows insurance agents to charge and collect administrative fees directly from consumers. The Bill includes a schedule of fees ranging between $5.00 and $10.00. These fees, if collected by the insurance agent, will be a separate bill than the insurance premiums; these charges will also be disclosed to the consumer before any services are rendered.
SB 184- Offered by Sen. Rogers (R-Woodstock), this Bill amends O.C.G.A. § 48-7-21.1, relating to income taxes. This Bill provides definition of "basic pilot program" as it relates to immigration. The "basic pilot program" is defined as:
electronic verification of a work authorization program of the Illegal Immigration Reform and Immigration Responsibility Act of 1996, P.L. 104-208, Division C, Section 1324a note, and operated by the United States Department of Homeland Security.
The Bill states that no payment or compensation totaling $600.00 or more in a taxable year may be claimed and allowed as a deductible business expense. Employers are exempt from this Bill if they are implementing the "basic pilot program".
SB 188- Offered by Sen. Thompson (D-Marietta), this Bill amends O.C.G.A. § 49-5-14, relating to the foster parent bill of rights. The Bill adds language that applies these rights to foster parents using private placing agencies.
SB 189- Offered by Senator Thomas (R-Dalton), this Bill amends O.C.G.A. § 31-6-2, relating to state health planning and development. The Bill provides additional definitions of "new institutional health service." Specific language from the Bill reads as follows:
(G) Clinical health services which are offered in or through a diagnostic, treatment, or rehabilitation center which were not offered on a regular basis in or through that center within the 12 month period prior to the time such services would be offered, but only if the clinical health services are any of the following….(iii) Surgery in an operating room environment, including but not limited to ambulatory surgery; provided, however:Prior to July 1, 2007, this provision shall not apply to surgery performed in the offices of an individual private physician or single group practice of private physicians if such surgery is performed in a facility that is owned, operated and utilized by such physicians who also are of a single specialty and the capital expenditure associated with the construction, development, or other establishment of the clinical health service does not exceed the amount of $1,610.823.00; andOn and after July 1, 2007, this provision shall not apply to surgery performed in the offices of an individual private physician or single group practice of private physicians if such surgery is performed in a facility that is owned, operated, and utilized by such physicians who also are of a single specialty, including general surgery, regardless of the amount of capital expenditures associated with the construction, development, to other establishment of the clinical health service;
SB 190- Offered by Sen. Harp (R- Midland), this Bill amends O.C.G.A. § 17-7-6.2, relating to issues of insanity and mental incompetence in pretrial proceedings. If a defendant is found to be insane or mentally incompetent to stand trial, he/she will be transferred to the Department of Human Resources, provided that the court has the option to retain jurisdiction over the defendant if he/she is charged with a misdemeanor offense or a nonviolent felony offense. The court will also require or allow evaluation of the defendant to be done on an outpatient basis; if the court allows outpatient valuation and the defendant is in custody, the court shall release the defend and on a recognizance bond.
Based on consideration of all evidence and all reports, the committing court may:
- allows for the dismissal of criminal charges and refer the case to the probate court for commitment proceedings
- retain jurisdiction of the person and hold a hearing determine whether the state has provided evidence that the person meets the criteria for involuntary civil commitment as an inpatient or outpatient.
- If the person is found to meet the criteria for such civil commitment, the judge may issue an order committing the person for a period not to exceed one year
- a person committed and charged with a violent felony may only be released by order of the committing court and the burden of proof in these cases will lie on the State.
- DHR must annually report to the committing court on whether the civilly committed person continues to meet criteria for involuntary commitment.
Committee Activity
House
House Regulated Industries Committee
Rep. Jill Chambers (R-Atlanta) presented her bill regarding licensing of opticians and a provision for an apprenticeship for those opticians. Last Session, a similar bill cleared the House but stalled on Day 40 of the Session. There was opposition to this bill by Exotica Retail (which is composed of Target, Sears, LensCrafters, and others) who argued that many states do not regulate opticians. After a good bit of discussion, this bill was suspended and a Subcommittee appointed to look further at the legislation. This Subcommittee is composed of Reps. Tumlin, Bearden, and Shaw.
Rep. Reece (R-Sugar Hill) presented HB 144 concerning certain exceptions concerning the sale or advertising of used motor vehicles displayed or parked on property and the practice of "curbstoning" and moving the current law from Title 43 to Title 40. This Legislation passed out of the Committee without discussion.
HB 224, presented by Rep. Smith (R-Watkinsville) presented his legislation concerning State Licensing Board for Residential and General Contractors as a Committee Substitute. One change was made to correct the effective date from July 1 to January 1, 2008. This Substitute, as amended, was passed.
Rep. Ron Stephens (R-Garden City) presented HB 330 which permits the registration of pharmacy technicians. This Legislation will permit the State to determine where a pharmacy technician is employed and is an effort to crack down on the problem of "drug diversion" as drug dealers often "employ" these individuals to aide in their efforts in sales of drugs. This initiative will not "license" these pharmacy technicians. This Bill passed without opposition from the Committee.
Rep. Stephens (R-Garden City) also had the wine shipping bill for "farm wineries." One of the major provisions in this Bill is that it will require that the winery to see an adult person's identification at the time they order their first shipment/purchase and sign for the purchase with certain limits. This Legislation also cleared the Committee.
House Judiciary Subcommittee 1
The Subcommittee met today to discuss HB 369, by Rep. Rice (R-Norcross), relating to child custody in a divorce proceeding. The Bill provides for “frequent and continuing” contact with both parents. The Bill also outlines that as a part of the divorce paperwork, each parent must create a parenting plan.
There were several opponents to this Bill. Concerns raised from these opponents include allowing a judge to decide custody without knowing the intimate workings of each family, the weak language and lack of consequences for not following the parenting plan set forth in the Bill.
This was a hearing-only meeting on HB 369.
Regulatory & Utilities Subcommittee of the Committee on Energy, Utilities & Telecommunication
The Subcommittee met today and passed out two Bills back to the full Committee:
- HB 228; by Rep. Graves; this Bill allows for deposits to be returned to the consumer from public utilities and transportation;
- HB 109; by Rep. Jones; this Bill requires itemized fees on bills. This practice is currently required only for cable companies; this Bill extends that requirement to public utilities.
Additionally, HB 22 was heard today in Committee and was held over to allow members to discuss and amend the Bill with the author, Rep. Keown.
House Ways and Means
- HB 78, relating to bona fide conservation use property, so as to provide for additional acts which shall not constitute a breach of a conservation use covenant, introduced by Rep. Royal (R-Camilla) was passed out of the full Ways and Means committee.
- HB 128, relating to exemptions from state sales and use tax, so as to provide for an exemption with respect to the sale of certain school supplies, clothing, footwear, computers, and computer related accessories for a limited period of time; to provide for an exemption from sales and use tax with respect to certain sales of certain energy efficient products for a limited period of time, introduced by Rep. Smith (R-Newnan) passed out of the full committee.
- HB 162, relating to exemptions from sales and use taxes, so as to provide for an exemption for a limited period of time with respect to sales of certain tangible personal property used in direct connection with the construction of a performing arts amphitheater facility, introduced by Rep. Martin (R-Alpharetta) passed out of the full committee.
- HB 357, relating to revenue and taxation, so as to define the terms "Internal Revenue Code" and "Internal Revenue Code of 1986" for certain taxable years and thereby incorporate certain provisions of the federal law into Georgia law, introduced by Rep. O'Neal (R-Bonaire) also passed out of the full committee.
The Committee First readers were assigned to the following subcommittees:
- SB 58, Taxation; payment of taxes where property lies in more than one county; repeal certain provisions. This Bill was assigned to Public Policy Subcommittee.
- HB 404, Certain health plans; state and local insurance premium taxes; provide additional exemptions. This Bill was assigned to the Income Tax Subcommittee.
- HB 434, Regional sales and use tax; transportation; provisions. This Bill was assigned to Sales Tax Subcommittee.
- HB 400, Student Scholarship Organization and Education Improvement Organization Board; provide. This Bill was assigned to the Income Tax Subcommittee.
- HB 407, Sales and use tax; certain fuels; dairy production; provide exemption. This Bill was assigned to Sales Tax Subcommittee.
- HB 410, Municipal Option Sales Tax Act; enact. This Bill was assigned to the Sales Tax Subcommittee.
- HB 438, Income tax credits; business property; renewable energy property; provide. This Bill was assigned to the Income Tax Subcommittee.
- HB 453, Farm owners; agritourism activities; provide limited liability. This Bill was assigned to the Ad Valorem Tax Subcommittee.
- HB 450, Sales and use tax; maintenance contracting; provisions. This Bill was assigned to the Sales Tax Subcommittee.
- HB 322, Ad valorem tax; certain business aircrafts; provide exemption. This Bill was assigned to the Ad Valorem Tax Subcommittee.
- HB 351, Georgia Council for the Arts; Georgia Arts Trust; create; provide tax credit. This Bill was assigned to the Income Tax Subcommittee.
- HB 441, Income tax; federal obligations; taxable income; revise provisions. This Bill was assigned to the Income Tax Subcommittee.
- HR 199, Sales and use tax; off-premise food and beverage sales; create trust fund – CA. This Bill was assigned to the Sales Tax Subcommittee.
- HB 439, Income tax credits; film, video, or digital productions; increase amount. This Bill was assigned to the Income Tax Subcommittee.
- HB 447, Taxation; real estate investment trusts; dividends; clarify state conformity. This Bill was assigned to the Income Tax Subcommittee.
House Ways and Means Comprehensive Tax Reform Subcommittee
Chairman O'Neal (R-Bonaire) had a host of bills to present to the Committee today; however, no action was taken on any of the legislation as the meeting was a public hearing only. HB 353 amends O.C.G.A Title 48 by adding language in relation to property liens. This language would allow subpoenas to be served by mail or by overnight delivery with a return service requested. Additionally, notification of a property lien can be transmitted through means of the Statewide Uniform Property System. Notification of seizure shall also be sent first to the taxpayer's financial institution. The public had no comment on this Bill.
HB 357 would allow Georgians to continue to enjoy tax credits that have been extended by Congress. Last year the General Assembly passed legislation in anticipation of the expiration of these tax credits; however in December 2006, Congress decided to extend them. Now to retroactively correct the legislation from last year, HB 357 is needed or the cost to Georgians will be significant. There was also no public comment on this bill.
HB 354 requires local governments to notify the Department of Revenue within a year of creating homestead exemptions of such exemptions. As Chairman O'Neal stated this is a conformity bill. There was no discussion on this Bill.
Finally, HB 361 relating to income tax credits for retraining was heard. The intent is to provide tax relief when the retraining of employees is necessary, under defining terms. This Legislation would apply to all business enterprises. There was concern among the audience because retailers are excluded from these credits. Many members of the committee also expressed concern that this language would drive good businesses out of Georgia and fail to entice more into the State.
House Ways and Means Sales Tax Subcommittee
HB 193 introduced by Rep. Burkhalter (R-Duluth) would extend the sunset on a measure that is currently benefiting Delta. This measure of allows the exemption of sales tax on jet fuel. The sunset provision would be extended until 2010. Rep. Lewis (R-White) offered an amendment that would change the sunset to 2009. This amendment passed the Subcommittee. HB 193 passed the Subcommittee unanimously as a committee substitute.
HB 148 also introduced by Rep. Burkhalter (R-Duluth) would extend the sales tax break that was granted the building of the Georgia Aquarium. The Aquarium is looking to add on an additional one-third of the space it is currently housed in. This Legislation would allow sales tax exemption to any tangible personal property for the aquarium. This Bill also passed unanimously out of subcommittee.
HB 264 introduced by Rep. Millar (R-Dunwoody) would change the way that homestead exemptions are dispersed in Dunwoody. Instead of exemptions being dispersed to DeKalb County, they would be given directly to the City of Dunwoody. This Bill passed unanimously out of Subcommittee.
HB 272 introduced by Rep. Lewis (R-White), relating to exemptions from sales and use taxes, so as to provide for a phased-in exemption with respect to state sales and use tax for the sale of natural or artificial gas, electricity, or any other energy used directly or indirectly in the manufacture or processing of tangible personal property, was also passed out of Subcommittee.
House Special Committee on Certificate of Need
February 19, 2007 CON
The House Special Committee on Certificate of Need held a three-hour plus meeting on Monday to hear final explanation of HB 210, the bill containing various recommendations made by the State Commission on the Efficacy of Certificate of Need, by Rep. Scott (R-Tifton). After Rep. Scott concluded his remarks, Rep. Chambers (R-Atlanta) presented her Bill, HB 263, which proposes to repeal in its entirety the current Certificate of Need law (this idea of repeal was not amongst the recommendations proposed by the Commission).
Rep. Chambers noted that her interest in the issue of Certificate of Need ("CON") generated from the experience that her mother had at a hospital while needing an emergency hysterectomy. Rep. Chambers provided a lot of detail in the poor care and complications which her mother experienced and described the CON process as costly and convoluted. Her Bill's goal is to provide patients choice with their providers. She asked fellow Legislators to put the patients' interests first and help ensure cost, service and access to care. She also questioned why government needed involvement in a business's decision to make an investment in a new program or facility. In the questions posed, there were questions regarding the indigent care provided by hospitals. Rep. Chambers recited portions of the Department of Justice/Federal Trade Communications reports on pricing, cross-subsidies, bulk purchasing, price discrimination, and price shifting. Rep. Chambers stated that fourteen states had repealed CON laws and that there was no evidence that CON lowered healthcare costs. Rep. Chambers also noted two hospital closures in DeKalb County, but one of those recent closures was the relocation of a facility.
A presentation on the Indigent Care Trust Fund was provided to the Committee by Carie Summers, CFO for the Department of Community Health which oversees this program. Ms. Summers explained that this Fund was created in the State's Constitution in 1990. It serves as "umbrella" for a number of moneys: Disproportionate Share Hospital funding; nursing home provider fees; care management organization quality assessment fees; ambulances/EMS licensure fees; CON penalties for indigent care performance; breast cancer specialty license plate fees; intragovernmental transfers by hospitals; and federal funds.
Ms. Summers explained in more detail about the Disproportionate Share Hospital ("DSH") funding which helps offset hospitals which serve a disproportionate share of Medicaid or other low-income persons in inpatient settings. In FY 2006, hospital DSH payments were $417.7 million (but there were $880 million in uncompensated care). The DSH funds do not help with folks who are underinsured. Ms. Summers also explained about last year's efforts to help the private DSH facilities which cannot make intragovernmental transfers and the State's efforts to fund $14 million in order to draw down additional federal dollars for those facilities. Ms. Summers also explained the criteria (both State and federal) which must be met in order to qualify for DSH funds.
The State also collects nursing home provider fees. These fees are currently $13.11 per day which is the maximum amount permitted by federal law. However, there are a few nursing homes which are exempt from paying these fees (such as those in Continuing Care Retirement Communities and those facilities which have the top 10 Medicaid days).
In FY 2006, the State received $54.7 million in CMO quality assessment fees, which is the maximum 6% permitted by federal law. Also, in FY 2006, ambulances and EMS providers paid licensure fees in the amount of $2500.00 per entity to the total of $5.2 million. There were also $3 million in CON penalties paid into the Indigent Care Trust Fund in FY 2006. Finally, the breast cancer specialty licensure plate raised $1.1 million for the Fund.
In questions posed to Ms. Summers, one was whether physicians participated in this Fund. Physicians do not get moneys from this Fund. Ms. Summers was also queried about the FY 2005 issues where certain hospitals questioned the data reported by some facilities.
A long line of persons were interested in making public testimony at this meeting. Several physicians testified on their issues from either not being able to build their own surgery center to being general surgeons and not being recognized by State's CON laws as a "subspecialty" and eligible for the State's current "letter of non-reviewability."
Dr. Cowles, a urologist from Greensboro area, testified that he had received an LNR for a CT scanner but which was still being appealed by the Georgia Alliance of Community Hospitals even though 30 days had passed since that LNR was awarded by the State's Department of Community Health. Dr. Cowles also mentioned that one year alone his practice gave away $253,000 in indigent care.
Tommy Chambless, a former Lawmaker from Albany and presently a lawyer representing the Georgia Alliance of Community Hospitals, provided a legal overview of CON since its inception in 1978. Mr. Chambless stated that physicians wanted regulation of ambulatory surgery centers in order to get facility fees. At the time, the Department of Human Resources, which is the State's licensure arm for healthcare facilities, would not provide a license to a facility (which was necessary in order to bill for services) unless the facility also had a CON. Thus, ambulatory surgery centers were added in 1990 to "level the playing field." Mr. Chambless noted that there were approximately 250 ambulatory surgery centers now in Georgia; not all of those have CONs.
Rep. Tom Graves also presented his bill, HB 337. His legislation includes in the definition of "new institutional health service" general surgeons so that they are treated the same as other subspecialties.
Chris Smith, M.D. also testified on behalf of the Georgia Society of General Surgeons. Dr. Smith spoke in favor of HB 337 and spoke of the current unfair disadvantage that general surgeons experience in Georgia. He also stated that fees charged for procedures performed in ambulatory surgery centers were 60% less than those same procedures performed in inpatient hospital settings. Dr. Smith mentioned the joint venture surgery center proposed in Albany with a local hospital and physicians; that CON for that proposal was denied. Dr. Smith stated that he and fellow physicians had to take call at their local hospitals and that he was required to be board certified by his local hospital.
Ted Perry, M.D., a general surgeon from Cartersville, also testified in support of HB 337. Dr. Perry recited the need for ambulatory surgery center rooms to help lessen the volume of patients needing elective procedures which were taking up valuable operating room time in the hospitals.
William L. Weaver, M.D., a professor at the Morehouse School of Medicine and surgeon at Grady Memorial Hospital, testified about the need to be designated as a sub-specialist. Dr. Weaver explained more about the intensive training that general surgeons undergo, including five years of specialty training.
John Harvey, M.D., also a general surgeon, asked for support of the General Assembly in including general surgery as a subspecialty area. Dr. Harvey also asked the Committee to support a bill to help create better funding for trauma hospitals.
Ron Bachman, CEO for Health Care Visions and a board member for the Georgia Free Clinic Network, testified about the services provided for free. The Network saw 90,000 patients annually and saved Georgia $200-$400 million. Georgia has a total of $2 billion in care provided to the uninsured.
Larry Sanders, CEO of Columbus Regional Hospital, talked about the comprehensive community planning which is a part of the CON process. Mr. Sanders did agree that the CON process needed modification but it did not need to be repealed. CON was necessary due to the numerous federal requirements placed on hospitals. Only a handful of states do not have a CON process; Mr. Sanders stated that healthcare cannot operate as a free market due to the federal mandates.
Jack Chapman, M.D., an ophthalmologist from Gainesville and president-elect of the Medical Association of Georgia, testified in support of the general surgeons being considered as a single specialty. Dr. Chapman also talked about the indigent care that physicians perform - $45 billion nationally. Dr. Chapman argued that physicians are actually the "safety net" in the healthcare arena. Dr. Chapman also talked about one initiative undertaken in Gainesville in an effort to lower healthcare costs, the Health Access Project modeled after a project in Asheville, North Carolina serving diabetics. Dr. Chapman also countered that with more ambulatory surgery centers there would not be over utilization because utilization is determined by Medicare or private insurance and that was not an issue.
Melvin Deese, M.D., the physician from Sea Island, stated he was "just a country doctor" and that his greatest accolade was serving on the State Commission on the Efficacy of Certificate of Need. Dr. Deese explained that five of the eleven CON Commission appointees had roles which were in some way protected by CON (either being a hospital, nursing home, home health or some other industry covered by the CON law). Dr. Deese talked about the Commission's final meeting where recommendations were made and argued that only the matters which were decided unanimously would be included in the Commission's Final Report. He also argued that the question relating to ambulatory surgery centers was also "knocked out" by a 5-3-2 vote. Dr. Deese gave personal examples of how his area was a one-hospital town which needed an ambulatory surgery center to give more operating rooms. He stated that ambulatory surgery centers saved Medicare in 2005 $1.1 billion. He argued that physicians do not "cherry pick" patients as they see all patients regardless of their ability to pay. Dr. Deese also discussed the emergency room situation, noting that physicians can only take those level of patients in ambulatory settings as permitted by law and otherwise those patients must go to hospital. Dr. Deese stated that hospitals will not close if the law changes (he recited remarks made by Dr. Cleverly on pricing of procedures) and stated that hospitals would close because of bad service and high prices. Dr. Deese also stated that the current cost threshold for an ambulatory surgery center is arbitrary (with no science involved). Dr. Deese also stated that Georgia has 250 ambulatory surgery centers, the third highest number of any state in the nation. Georgia is also the sixth lowest in per capita healthcare costs in the nation. He argued that Georgia's hospitals were not closing. He asked Lawmakers to throw out Georgia's antiquated law. He did state that 34 states have CON but there were many that only limited numbers of items covered by the process.
February 20, 2007 CON Meeting
A number of presenters were on hand today to present more the hospital point of view on CON. Some of these presenters included Earl Rogers with the Georgia Hospital Association, Jimmy Lewis from HomeTown Health, Temple Sellers from Georgia Hospital Association, Deb Bailey from Northeast Georgia Medical Centers, and Dr. Stephen M. McCollam from Piedmont Hospital and Peachtree Orthopaedics.
Mr. Lewis made remarks relating more to the impact of CON on rural hospitals, quoting numerous statistics. Some of these included that there are 80 rural hospitals in Georgia. There are 64 of those hospitals in counties which have populations of 35,000 or less persons and out of those 44 had net financial losses (based on 2004 Cost Reports) of $42 million. There are also 35 Critical Access Hospitals and 29 of those facilities lost moneys in 2004. Critical Access Hospitals have certain rules in order to receive that designation, including that they cannot keep patients longer than 72 hours and that they must have 25 or fewer beds. Mr. Lewis that these hospitals definitely had no "free market" due to government controls and requirements placed on those facilities. Mr. Lewis also talked about the patient payor mix at these facilities which have significant Medicare, Medicaid, uninsured and State Health Benefit Plan persons. Mr. Lewis was also asked about days of cash that the rural hospitals typically keep on hand and he stated that it could possibly be between 150 and 180 days but it would depend on the hospital's long-term debt. The services of a hospital that make money for these rural facilities are surgery, imaging, and laboratory.
Ms. Sellers focused her remarks on what was in the patient's best interest and how CON related to that. Ms. Sellers stated that EMTALA (Emergency Medical Treatment and Active Labor Law) requires that hospitals take all patients; hospitals' missions also require them to treat all patients without regard of the patients' ability to pay. Ms. Sellers stated one of the difficulties that hospitals had was the inability to show the patients who are treated in ambulatory surgery centers as not all of those centers report data to the State. Ms. Sellers stated that GHA had obtained some national data with 2005 information on some ambulatory surgery centers reporting and found that those types of facilities provide more care to commercial-paying patients, very low amounts of care (approximately 3%) to self-pay patients, and a high percentage of Medicare patients. Further, this national data reflected that charity and professional courtesy care for these centers was at .33%.
Ms. Bailey noted that her facility, Northeast Georgia Medical Center, had $500 million in bond debt and $250 in reserves. The bonds for the facility were backed by the county if the facility cannot make the payments. Ms. Bailey stated that if the losses were to occur based on projected changes to Medicare, Medicaid, UPL, DSH, paying cancer surgery and cardiac caths, then it would be difficult for the facility to repay the bond debt. Ms. Bailey stated that the facility did make money last year on its reserves but not on the operating margin for the facility. She also discussed the hospital's plan to get a better bond rating and the cost cutting measures in order to achieve that to goal (including a cut of $20 million out of the operating budget and more than 250 employee layoffs). In total, this facility provided $47 million in indigent and charity care but received only approximately $12 million in UPL and DSH funds. There were questions raised on whether physicians employed at the hospital billed directly for their services or if the hospital bundled those services in a patient's bill.
Dr. McCollam, the orthopaedic surgeon, testified that while on a hospital board, he wanted to see less restrictive laws on ambulatory surgery centers. He stated that it would be a better for recruiting of new physicians, especially when there was a shortage of physicians.
Senate
Senate Health and Human Services Committee
The Committee held a hearing on SB 150, one of the several bills proposed by Sen. Hill (R-Marietta) in an effort to transform Georgia's healthcare. There are numerous provisions in this Legislation including that pharmacies are to submit certain performance and cost data to the Department of Community Health and the creation of the Georgia Health Insurance Exchange. Sen. Hill presented the Bill and answered various questions raised by the Committee. No action was taken on the Bill and no public testimony was made. Sen. Hill stated that healthcare needed real change and not minor tweaks.
Senate Special Judiciary Committee
The Committee met today to address several Bills. First, the Committee passed out the yearly “general revisory bills” created by the Office of Legislative Counsel. The Bills clean up the language that has been written into the Code during the previous General Assembly. The Bills are SB103, SB104, and SB 124.
The Committee also passed out SB 128, relating to confidentiality of records in the Office of the Child Advocate (“OCA”). OCA collects DFACS and criminal records, in addition to other records (such as medical records), relating to cases undertaken by the Office. The records, while in the custody of the issuing agencies remain confidential; however, once the records are transferred to OCA, they are subject to the Open Records Act. This Bill is aimed at including OCA under the confidentiality umbrella in order to protect the parents and children represented by the Office.
Education and Youth Committee
The Committee held a hearing-only meeting today on SB 85, a Bill by Sen. Nancy Schaefer (R-Turnerville) that would allow home-schooled children to participate in after-school non curricular activities in public schools. The Bill would allow such home-schooled children to participate in those after-school activities in their zoned public school.
The Professional Association of Public Educators (“PAGE”), the Georgia High School Association (“GHSA”), and the Georgia Association of Educational Leaders (“GAEL”) all oppose this Bill.
Senate Science and Technology Committee
The Senate Science and Technology Committee heard a presentation today from Dr. Robert Matheny on the topic of Adult Stem Cells. Dr. Matheny centered his presentation on two fundamental questions of adult stem cells. First, what type of cells are needed for regeneration and secondly, the condition and environment required for regeneration.
As the research in the field of stem cells is ever-changing, Dr. Matheny noted that the more research that is performed more areas of the body can house regenerative stem cells. Stem cells can currently be taken from muscles, fat, cord blood, bone marrow, fetal, embryonic and messenchymal cells. Stem cells can also create almost any tissue under the right environment. Under the wrong environment the cells can form multiple types of tissue. The major plus with adult stem cells lies within their plasticity ability. Dr. Matheny also stated that with the advancement of stem cell research he believed that embryonic stem cells were not needed, especially with the proof that adult cells can regenerate.
Other News
We would like to send our deepest sympathies to Sen. Steve Thompson (D-Marietta) and his family for the loss of his nephew.
Please contact Stanley S. Jones, Jr. or Helen Sloat at 404-817-6000 for further information on legislative happenings. Gold Dome Reports will be available daily during the Session at www.nelsonmullins.com.
The articles published in this newsletter are intended only to provide general information on the subjects covered. The contents should not be construed as legal advice or a legal opinion. Readers should consult with legal counsel to obtain specific legal advice based on particular situations.