Conversations in the halls throughout the State Capitol swung from pending legislation to planning for winter vacations as House and Senate leaders applied the brakes to the 2020 Legislative Session today. Driven by legislative concerns over the state budget proposals offered by Governor Kemp last month and currently under consideration by the House, both chambers adopted an adjournment resolution that gives legislators a 12-day break to focus on the State’s spending plans for AFY20 and FY21. While many lawmakers and lobbyists take the opportunity to return to their districts or squeeze in a typically unheard-of February ski trip, there will still be plenty to watch under the Gold Dome. The State revenue report for January is expected within the next week, and sparring between legislative leaders and the Second Floor is likely to continue. Your #GoldDomeReport isn’t going anywhere, and we will keep you posted on the latest developments.

In today’s Report:

• General Assembly Plans “Winter Break”, Sets Crossover Day for March 12
• Committee Reports
• New Legislation
• Rules Calendars for Legislative Day 13

While our team will be on the job during the legislative break, our daily Reports will pause until the chambers reconvene on February 18, 2020. In the meantime, follow us (George Ray, Helen Sloat, and Sam Marticke) or search for #GoldDomeReport on Twitter for all of the latest legislative news!

General Assembly Plans “Winter Break,” Sets Crossover Day for March 12

After a week of rumors on all floors of the State Capitol, legislative leaders finally unveiled an adjournment resolution today that will provide a 12-day “winter break” for legislators to sharpen their pencils on the State’s AFY20 and FY21 budgets. House and Senate members will not return to their respective chambers until Tuesday, February 18, to begin a sprint toward Crossover Day on March 12. During the break, many legislators will still be at work. While the House has suspended all committee meetings except for Appropriations Committee and Appropriations Subcommittee meetings, several Senate committees are making preparations to meet. The adjournment schedule is provided below, but we don’t plan to stray far from Capitol Hill!

Committee Reports

House Appropriations Committee -- Health Subcommittee

The Health Subcommittee of the House Appropriations Committee, chaired by Rep. Butch Parrish (R-Swainsboro), met today to hear testimony on the proposed FY21 budget. Dr. Kathleen Toomey, Commissioner of the Department of Public Health, opened testimony by providing an overview of Governor Kemp’s proposal for her department’s budget. She highlighted her priorities for the Department, which include maternal mortality and morbidity, infant mortality and morbidity, and HIV prevention and care, and emphasized that 65% of her funding goes to providing direct services. Nearly 60% of the Department budget consists of federal funds, and most of its State funds go to county health departments. Governor Kemp has proposed a $12.6 million reduction to the Department, of which the majority of which comes from county health department grants. Reductions will also affect further deployment of telehealth technology, funding to the Center for Oncology Research and Education and the regional cancer coalitions, and vacant positions in a number of programs.

Rep. Jesse Petrea (R-Savannah) asked how local health department services will be affected by the proposed $9.2 million reduction to the State grants they generally receive, to which Dr. Toomey stated that each health district will have “maximum flexibility” to determine how to best address their local needs. She also stated, however, that she did not anticipate many services being cut (although staffing may be affected). Chairman Parrish asked how often local food service establishments are being inspected, to which Dr. Toomey said inspections are expected to be conducted twice per year and that the proposed budget reductions will not affect the inspection schedule. Rep. Darlene Taylor (R-Thomasville) expressed concern about how the Department would be deciding how to divide up the reduction to local health district grants, to which Dr. Toomey stated it is a formula-based allocation and reduction. Rep. Pat Gardner (D-Atlanta) inquired whether every health department is required to provide prenatal care, to which Dr. Toomey said no. Dr. Toomey also fielded several questions about the Department’s response to coronavirus.

Frank Berry, Commissioner of the Department of Community Health, followed and presented the Governor’s budget recommendations for his department for FY21 to the Subcommittee. Department CFO Lisa Walker presented the actual budget proposal, noting that the Department has proposed reductions to programs like the Rural Health Systems Innovation Center while also seeing increases to Medicaid for benefit growth and FMAP.

Chairman Parrish asked if the Department is “comfortable” with the projections for growth in ABD Medicaid and declines in Low-Income Medicaid, to which Ms. Walker said yes and that it was updated in the fall with the Governor’s Office. Rep. Taylor asked about reductions through “projected expenditures” and “workforce adjustments”, to which Ms. Walker said many were elimination of vacant positions and statewide service and insurance cost adjustments. Rep. Taylor also asked about the reduction to the Rural Health Systems Innovation Center, to which Commissioner Berry noted that the Center is located at Mercer University, and the Department has been in discussion with Mercer about how to handle those reductions. Rep. Petrea asked about surveyors for nursing homes and the workload impact of increasing statutory requirements for these facilities that surveyors must review for enforcement, and he specifically inquired why there is not a request for additional surveyors (or salary increases for existing surveyors) to improve the survey process and individual safety. Commissioner Berry explained that the Department is working to determine whether the surveyor staffing issues stem from salary, workload, or other issues and is expected to come to the General Assembly next year with an “ask” to address the problem. Chairman Parrish asked for details on the Department’s partnership with Sharecare, and Commissioner Berry explained how the platform has driven health promotion among State Health Benefit Plan members. Rep. Lee Hawkins (R-Gainesville) asked how Commissioner Berry would respond if the Governor asked if ABD Medicaid should move to a managed care platform, to which Commissioner Berry said that the Department would be capable of making the transition if the Governor so directed.

LaSharn Hughes, Executive Director of the Georgia Board of Health Care Workforce, closed testimony to the Subcommittee with an overview of the proposals for her FY21 budget. Her budget includes, among other things, $2.5 million in new funds for 133 new primary care residencies and reductions to operating grants at Mercer University School of Medicine and Morehouse School of Medicine. There are also reductions to medical student capitation for Emory, Mercer, Morehouse, and Philadelphia College of Osteopathic Medicine.

Rep. Carolyn Hugley asked about a reduction in fellowships at Augusta University included in the proposal, to which Ms. Hughes said it was for three fellowships that have not yet been filled. Rep. Hugley also asked how many individuals would be affected by reductions to loan repayment awards, to which Ms. Hughes explained the $500,000 reduction reflects 13 physicians, 10 APRNs or physician assistants, and 3 dentists. Rep. Taylor expressed concern about the impact on rural health training like that occurring at PCOM South Georgia, to which Ms. Hughes said she would provide the impact statements presented by the medical schools relating to the proposed reductions.

House Appropriations Committee -- Education Subcommittee

The Education Subcommittee of the House Appropriations Committee, chaired by Rep. Robert Dickey (R-Musella), met to consider Governor Kemp’s proposal for the Department of Education’s FY21 budget. The interim CFO for the Department presented the proposal, which continues to fully fund the QBE formula and includes an additional $2,000 salary increase for certified educators. Chairman Dickey inquired about decreases to State Schools, to which the Department noted that the reductions are strategic and involve elimination of vacant positions. Rep. Mike Glanton (D-Jonesboro) pressed the Department on proposed reductions in FY21 for vacant positions and questioned whether they are truly appropriate to cut if the Department believes they may need to be funded in the future.

The Subcommittee heard public testimony on the FY21 budget. Yalanda Bell spoke on behalf of the Georgia Association for Career & Technical Education and asked that the Subcommittee fully fund the Construction-Related Equipment Grant program used to outfit CTAE labs across the state. Jennifer Diaz spoke on behalf of the Georgia School Counselor Association and asked that the Subcommittee ensure school counselors are included in educator raises and help fully fund the statutory 1-to-450 ratio. Juanita Stedman and Helen Sloat spoke on behalf of Together Georgia and called for legislators to reinstate funding to the Non-QBE Formula Grants for residential treatment facilities. The Subcommittee was continuing to hear public comment at our deadline.

House Insurance Committee

The House Insurance Committee, chaired by Sen. Eddie Lumsden (R-Armuchee), met this morning to consider several bills:

• HB 61, by Rep. Mike Glanton (D-Jonesboro), passed out of the committee by Substitute. The bill was originally brought in 2018 and solely applied to auto insurance policies sold to active military personnel who were 18-24 years of age. It required insurers to offer those individuals discounts. The new version is permissive and not a mandate insurers provide the discounts and will apply to all active military personnel and not just those ages 18-24. Rep. Glanton brought this bill because his daughter purchased a car and found the premiums for insurance were more than her payments. The Committee gave the bill a DO PASS.
   
• HB 583, by Rep. Noel Williams (R-Cordele), presented his bill by substitute addressing travel insurance. This bill got caught last year on sine die and has undergone several revisions and is still being tweaked. However, this bill received a DO PASS recommendation. 
   
• HB 716, by Rep. Shaw Blackmon (R-Bonaie), presented revisions to the law regarding agent commissions. A lot of discussion took place prior to this bill being taken up today and this addresses clean ups as to when agent commissions are to be collected on health benefit policies. The bill received a DO PASS.
   
• HB 842, authored by Rep. Rick Williams (R-Milledgeville), is Gracie’s Law and provides that insurers may not discriminate against an individual who needs an organ transplant. He noted he brought this bill as a result of a constituent with Downs Syndrome possibly needing a heart transplant. No action was taken at this meeting.

Senate Insurance Committee

The Senate Insurance Committee, chaired by Sen. Burt Jones (R-Jackson), met this morning to consider SB 303. The bill, being carried by Sen. Ben Watson (R-Savannah) for Lt. Governor Geoff Duncan, is known as the “right to shop” bill and will require the posting of procedure pricing by in network providers on insurers’ websites along with some quality of care indicators by procedure. The Committee adopted an amendment that would exempt health maintenance organization health plans from the price disclosure requirements because these plans have limited networks by their terms that don’t involve provider shopping opportunities. The Committee recommended the bill DO PASS by Substitute and be sent to the Rules Committee.

Senate Health and Human Services Committee

The Senate Health and Human Services Committee, chaired by Sen. Ben Watson (R-Savannah), began with words of remembrance for Greg Kirk. The committee also approved a small rule change to adjust the quorum of the committee after losing Sen. Kirk.

Next, the committee received a presentation from the Georgia Trauma Commission. Dr. Dennis Ashely, Chair of the Commission, began by introducing the new Executive -- Liz Atkins. Dr. Ashley also discussed the Commission’s successful Stop The Bleed training program and the work of trauma centers around the state.

Chairman Watson explained that there are no plans for the committee to meet during the next week’s break.

The committee then heard from Sen. Kay Kirkpatrick (R-Marietta) about SB 345 which provides for updates to the state’s food health and safety requirements. Sen. Kirkpatrick was joined by representatives of DPH and the Department of Agriculture. Sen. Kirkpatrick explained that a nonprofit organization in her district ran into an issue because their sandwiches for school children program was not statutorily allowed to prepare food. The bill adds cleanup language to the food health and safety areas of code along with specific changes to allow for these nonprofit entities to prepare food in non-approved areas; supposing they follow health guidelines as outlined in the bill.

Sen. Chuck Hufstetler (R-Rome) asked if these types of locations would be scored similarly to restaurants. These locations will simply receive a pass/fail rating with no actual score.

Dwight Reighard, president of CEO of Must Ministries, spoke briefly about the program that led to the bill’s creation.

The bill received a recommendation DO PASS.

Senate Judiciary Committee

The Senate Judiciary committee met to hear SB 335 by Sen. Matt Brass (R-Newnan). Sen. Brass characterized this as a general improvement to foster care. He began by addressing the need for the committee substitute. He explained that the original bill had the Judicial Council dictating the class of trial courts but the state Constitution. The bill also allows for free admissions to foster families to state parks. The bill also mandates deadlines for foster care decisions to help keep the system on track. Sen. Brass explained that this will require the juvenile courts to publish reports that document adherence to statutory guidelines. He noted that there are no punishments for failure to adhere to these guidelines. Instead this reporting is to allow the legislature to understand deficiencies so they may allocate resources to fix problem areas. The bill also contains language relating to the delaying of foster care cases. The bill will prioritize TPR cases over all other cases besides jury trials. There is additional language allowing DFCS to contract with child placement agencies which Sen. Brass explained should help relieve high caseloads for DFCS workers.

Currently, all foster families are required to have 15 hours of training per year and 26 hours of training before receiving any foster children. This bill would permit DFCS to reduce these requirements for families with extensive foster care experience.

Sen. Elena Parent (D-Atlanta) asked how state parks will be able to identify foster families for free admission. Sen. Brass explained that this bill would leave this up to the Department.

The committee recommended the bill DO PASS.

New Legislation

The following legislation of interest was introduced in the House today:

• HB 885, authored by Rep. Jesse Petrea (R-Savannah), amends O.C.G.A. 42-5-36 to allow District Attorneys access to information normally considered confidential when pertaining to individuals sentenced for violent felonies or sexual felonies against a person under 18. This information can be publicly disclosed at the discretion of the DA. This bill was referred to the House Judiciary Non-Civil Committee.
   
• HB 888, authored by Rep. Lee Hawkins (R-Gainesville), creates a new chapter in Title 33 called the Surprise Billing Consumer Protection Act. The bill begins by stipulating that any insurer that provides emergency benefits must pay for these services without prior authorization or retrospective denial of medically necessary services and regardless of if the provider of the services is a participating provider. If a covered person receives emergency treatment from a non participating provider the provider must bill the insurer directly and the bill must be paid at the greater of (1) The verifiable contracted rate paid by all eligible insurers. (2) A higher amount deemed appropriate by the insurer depending on the complexity of the procedure(s). Insurers are prohibited from denying claims based on a covered person’s failure to notify the plan because of the urgency of a medical emergency. All services provided to a covered person in a non participating facility must be treated by the healthcare plan as if they occurred in a participating facility including applying cost-sharing amounts, deductibles, and out-of-pocket maximums. These provisions also apply to non emergency medical treatment in O.C.G.A. 33-20E-5. Once a covered person is stabilized, an insurer may provide for the transfer of the covered person to a participating facility; however, if after 24 hours of a healthcare plan receiving notice of stabilization without arranging for transfer, the healthcare plan will be responsible for the entirety of the contracted rate of the non participating facility. The bill further stipulates that no healthcare plan can deny or restrict a covered person from receiving covered benefits solely because they received treatment from a non participating provider. The bill clarifies that the bill does not reduce the financial responsibilities of a covered person if they choose to seek out-of-network care. However, this can only occur with documentation of the covered person’s submitted desire to seek this care and after the person has received an estimate of costs.  The bill calls for maintenance of an all-payer health claims database by the Department of Insurance; subject to appropriations. If no appropriations are made, the Department must update information from other verifiable sources at least annually. The bill also provides for arbitration between insurers and providers if the provider concludes the payment is not sufficient based on the complexity of the services. This bill was referred to the House Special Committee on Access to Quality Healthcare.
   
• HB 891, authored by Rep. Matthew Gambill (R-Cartersville), amends O.C.G.A. 48-8-3 to remove a requirement that an organization’s primary mission is to advance the arts in order to receive a sales tax exemptions for ticket sales. This bill was referred to the House Ways and Means Committee.

The following legislation of interest was introduced in the Senate today:

• SB 359, authored by Sen. Chuck Hufstetler (R-Rome), creates a new chapter in Title 33 called the Surprise Billing Consumer Protection Act. The bill begins by stipulating that any insurer that provides emergency benefits must pay for these services without prior authorization or retrospective denial of medically necessary services and regardless of if the provider of the services is a participating provider. If a covered person receives emergency treatment from a non participating provider the provider must bill the insurer directly and the bill must be paid at the greater of (1) The verifiable contracted rate paid by all eligible insurers. (2) A higher amount deemed appropriate by the insurer depending on the complexity of the procedure(s). Insurers are prohibited from denying claims based on a covered person’s failure to notify the plan because of the urgency of a medical emergency. All services provided to a covered person in a non participating facility must be treated by the healthcare plan as if they occurred in a participating facility including applying cost-sharing amounts, deductibles, and out-of-pocket maximums. These provisions also apply to non emergency medical treatment in O.C.G.A. 33-20E-5. Once a covered person is stabilized, an insurer may provide for the transfer of the covered person to a participating facility; however, if after 24 hours of a healthcare plan receiving notice of stabilization without arranging for transfer, the healthcare plan will be responsible for the entirety of the contracted rate of the non participating facility. The bill further stipulates that no healthcare plan can deny or restrict a covered person from receiving covered benefits solely because they received treatment from a non participating provider. The bill clarifies that the bill does not reduce the financial responsibilities of a covered person if they choose to seek out-of-network care. However, this can only occur with documentation of the covered person’s submitted desire to seek this care and after the person has received an estimate of costs.  The bill calls for maintenance of an all-payer health claims database by the Department of Insurance; subject to appropriations. If no appropriations are made, the Department must update information from other verifiable sources at least annually. The bill also provides for arbitration between insurers and providers if the provider concludes the payment is not sufficient based on the complexity of the services. This bill was referred to the Senate Health and Human Services Committee. 
   
• SB 360, authored by Sen. Donzella James (D-Atlanta), requires at O.C.G.A. 33-29-59.27 that cost-sharing requirements for breast cancer diagnostic are no less favorable than those for breast cancer screenings. This bill was referred to the Senate Insurance and Labor Committee.
   
• SB 361, authored by Sen. Lester Jackson (D-Savannah), amends Title 31 at O.C.G.A. 31-7-23 to require that hospitals adopt, implement, and periodically update protocols for the early recognition and treatment of sepsis. Hospitals must also ensure that trained professional staff with direct patient care responsibilities are trained in these protocols. This bill was referred to the Senate Health and Human Services Committee.
   
• SB 367, authored by Sen. P.K. Martin (R-Lawrenceville), amends Title 20 to reduce the number of required assessments for k-12 students. Specifically, the bill removes language that suggests local boards of education develop programs of multiple formative assessments in reading and math for grade k-5. The bill also removes requirements for social studies assessments to be performed annually for grades 3-8; instead requiring these assessments only in the eighth grade. The bill also stipulates that the State Board of Education only require end-of-course tests for each of four core subjects. Writing performance tests would be required in grades three, five, eight, and once between grades nine through twelve. The bill also removes requirements for the score of an end of course test to be included in a student’s final grade. Lastly, the bill allows for the State Board to perform analyses of local assessments. Based on these analyses the Board shall determine systems to assist in the elimination of redundant assessments. This bill was referred to the Senate Education and Youth Committee. 

Rules Calendars for Legislative Day 13

The House is expected to consider the following measures when it reconvenes for Legislative Day 13 on February 18, 2020:

• HB 195 -- Georgia Firefighters' Pension Fund; increase benefit amount payable to beneficiaries after the member's death
• HB 538 -- Revenue and taxation; all questions of law decided by the Georgia Tax Tribunal be decided without deference to the rules, determinations, or interpretations of the Department of Revenue; require
• HB 759 -- Controlled substances; Schedule IV; change certain provisions
• HB 765 -- Courts; increase in the minimum compensation for chief magistrates; provide
• HB 781 -- Financial institutions; clarify and remove superfluous language; provisions

The Senate is expected to consider the following measure when it reconvenes for Legislative Day 13 on February 18, 2020:

• SB 295 -- Courts and Revenue and Taxation; cost-of-living and general performance based increases; revise