While the 2023 Legislative Session has had a somewhat breezy start over the last month, lawmakers returned to the State Capitol on Monday to meet a gale-force flurry of legislative activity. With Rules Calendars in both chambers and full committee agendas on Monday afternoon, it certainly feels as if the winds of the legislature have picked up. It could be the rapid approach of the halfway mark of the legislative session, or it could be the reintroduction of SB 145, the LEAF Act, protecting the right for gas-powered leaf blowers across the state to continue waking Georgians on Saturday mornings with their superior air velocity for cleaning up leaves and legislative dockets. We may need one to tidy up the overflowing  #GoldDomeReports to come.

In this Report:

• Floor Action
• Committee Reports
• New Legislation
• What’s Next

Floor Action

The House took up the following measures on the floor on Legislative Day 17:

• HB 129 - Public assistance; expand temporary assistance for needy families' eligibility criteria to pregnant women (PH-103rd). The Executive Council Substitute passed by a vote of 173-1.
• HB 139 - Criminal procedure; restrictions of disclosure of personal information of nonsworn employees; provisions (JudyNC-118th). This bill passed by a vote of 174-0.

The Senate took up the following measures on the floor on Legislative Day 17:

• SB 21 - Georgia Veterans Service Foundation, Inc.; revise operations (Substitute) (VM&HS-32nd).  The Committee Substitute passed by a vote of 52-0.
• SB 44 - Street Gang Terrorism and Prevention Act; mandatory minimum penalties for violations; provide (Substitute) (Judy-50th).  This bill was on the floor with amendments offered by the Minority party. Amendment 1, sponsored by Senator Kim Jackson (D-Stone Mountain), includes language to prevent minors who are victims of sex trafficking from being subjected to the mandatory minimum. Senator Derek Mallow (D-Savannah) also offered an amendment to the legislation. Both amendments failed, and the Committee Substitute passed with a vote of 31-22.
• SB 60 - Secondary Metals Recyclers; it shall be illegal for certain persons to purchase, possess, obtain, or sell or attempt to purchase, possess, obtain, or sell; provide (Substitute) (Judy-50th). The Committee Substitute passed by a vote of 50-2.

Committee Reports

House Education Committee – Policy Subcommittee

The Policy Subcommittee of the House Education Committee, chaired by Representative Scott Hilton (R-Peachtree Corners), met to hear the following legislation on Monday. No action was taken on either measure.

• HB 51, authored by Representative Clay Pirkle (R-Ashburn), amends Title 20 to authorize local boards of education to use vehicles other than school buses for the transport of all students to and from school and school-related activities.

Representative Pirkle presented the bill to the Subcommittee, explaining that the legislation comes from his conversations with one of his local school systems. This legislation expands upon recent legislation that opened up access to this transportation for special needs and homeless students to allow for transportation of any students. Representative Todd Jones (R-Cumming) asked whether the legislation needed to be amended to provide that these vehicles “shall” be marked for the transportation of school children. Representative Miriam Paris (D-Macon) expressed an interest in including some provision for electronic monitoring of the vehicles like that provided with cameras on school buses. Erica Long of Atlanta Public Schools appeared in support of the legislation.

• HB 141, authored by Representative Mesha Mainor (D-Atlanta), amends Title 20 to require local school systems to conduct suicide screenings on all students ages eight through 18.

Representative Mainor presented the bill to the Subcommittee, noting that she originally dropped the legislation for discussion purposes only, but there has been substantial outside interest in the bill since its introduction. Representative Mainor recited extensive statistics on student mental health and suicide for the Subcommittee. Representative Chris Erwin (R-Homer) asked how referrals would be handled when screening indicated further evaluation is appropriate, to which Representative Mainor said parents would ultimately have the final say on what next steps are pursued. Representative Lauren Daniel (R-Locust Grove) asked whether students would be screened for other mental health conditions like depression and anxiety. Representative Mainor responded that this is focused solely on suicide prevention and screening. Representative Daniel also asked about the starting age of eight, expressing concern about planting ideas in younger children, to which Representative Mainor responded that the questions do not mention suicide. Representative Miriam Paris (R-Macon) also expressed concern about planting the idea of suicide in students’ minds if all students are screened, citing the spike in suicides after the release of the “13 Reasons Why” miniseries. Representative David Wilkerson (D-Powder Springs) asked the author to consider amending the legislation to identify the individuals who should provide referrals specifically.

Joe Fleming of the Georgia Association of Educators spoke on the legislation, highlighting the high ratio of students to school social workers and school psychologists and calling for the State to fund more of these professionals. Mary Clawson of Protect Student Health Georgia expressed concern that universal suicide screening could result in substantial false positives, and the lack of training of screeners would be a major issue.

House Education Committee – Curriculum Subcommittee

The Curriculum Subcommittee of the House Education Committee, chaired by Representative Bethany Ballard (R-Warner Robins), met to consider one measure on Monday:

• HB 32, authored by Representative Demetrius Douglas (D-Stockbridge), amends Title 20 to require that high school football championship games have instant replay for review of calls.

Representative Douglas presented the bill to the Subcommittee, explaining that the replay will be paid for by gate receipts at the championship games. Representative Segun Adeyina (D-Grayson) asked what technology will be used, to which Representative Douglas said that would be left up to GHSA. Representative Douglas further noted that Alabama already has this. Representative Karlton Howard (D-Augusta) asked about the accountability for the replay decisions, to which Representative Douglas said that was up to the implementers.

Robin Hines of the Georgia High School Association spoke to the legislation, explaining that his Board of Trustees has already voted to implement video review, and GHSA is in the process of determining implementation details. The Subcommittee recommended the bill DO PASS and be sent to the full Education Committee.

House Human Relations & Aging Committee

Chairman Jesse Petrea (R-Savannah) and the Human Relations & Aging Committee met this afternoon to address the adoption of the committee rules for the session (these rules with a quorum now at 10 members were approved for 2023-2024) and to hear presentations from the following to look at stresses which have occurred during the COVID-19 pandemic:

• Department of Human Services - MaryLea Boatright Quinn, Assistant Deputy Commissioner, spoke to the Committee offering an introduction to aging services. Older Georgians are growing in the state with the Baby Boomers turning 65. 1 in 5 in 2030 will be 65 and older. Nine percent are food insecure, 41 percent have a disability, and more than 30 percent live alone. DHS funds the network AAAs and the services for the Older Americans Act. Co-Age serves as the advocacy organization required by the Older Americans Act. Title III is the largest amount of services received (nutrition services, adult day care, caregiver respite, etc.). They also receive Title VII funds. Other services are administered by the Division of Aging (Medicare counseling, nursing home transitions, money follows the person, dementia team (all state funded), adult protective services, and public guardianship office. Aging and Disability Resource Connection is the opening for the services. There are 12 AAAs in the State; two of these are standalone nonprofits. The pandemic created many workforce issues, and thus, staffing is impacting the network presently. Elder Abuse, Neglect, and Exploitation investigate all allegations of abuse, neglect, or exploitation - this is different from Child Protective Services. APS case records are confidential by state law and APS will acknowledge receipt of a report and explain the role of APS but cannot provide case details or updates. Adults can refuse services despite the situation involved. Adult Protective Services are the bulk of Division of Aging employees, with 28 openings. There has been a 25 percent increase in openings since the pandemic. The pandemic also caused a cease of in person case investigations, causing a backlog of cases. Allegations reported by type were also shared - financial exploitation is the number one abuse. Georgia is one of the few states with financial exploitation as the highest abuse issue.  Guardianship - DHS is the guardian of last resort in the state - the numbers under guardianship increased by 34 percent from FY 2017 to FY 2022.
• Georgia Health Care Association - The Association CEO, Chris Downing, presented information on behalf of skilled facilities, assisted living communities, and home and community-based services providers. Long-term care communities work to meet the needs of those who they serve - the pandemic, inflation, regulations, etc. have impacted nursing centers. The governor included $83 million for the industry, and the Association is grateful for that support. Pam Clayton, Vice President of Clinical and Regulatory Affairs, also spoke to the Committee. Visitation policies impacted facilities - traumatic to patients as well as families and staff. Surveys, however, were positive towards the facilities. Screening, testing, and isolation still continue in the facilities. As of February 7, 2023, 257 cases of COVID-19 were statewide. Several facilities lost large numbers of employees, and workforce issues remain. Challenges, aside from staffing, remain, including waivers, 3-day hospital stay requirement ends, and several other temporary provisions will cease with the end of the Public Health Emergency.  Medicaid presumptive eligibility will also end. President Biden’s nursing home reform is also looming and will impact facilities - minimum staffing requirements will likely be forthcoming in April or May 2023 (a cost of $11 billion nationally to implement).  Representative Spencer Frye asked about the general salary for a CNA in a facility. It is likely $15-$18 per hour, which is advanced from years. There are some instances where facilities pay $60 for an hour for an assistant. For-profit versus nonprofit skilled nursing facilities was asked but no answer - there are more for-profit than nonprofit per. Clayton. Ethica is the second largest chain, and it is a nonprofit entity. Rep. Edna Jackson asked about salaries of the aides - what is being done to help these individuals so that they may become certified as nurses. Providers are offering benefit packages according to. Clayton and they have been working with education to get individuals on pathway for improved opportunities.
• Georgia Alliance of Community Hospitals - Monty Veazy spoke to the Committee.  Post-pandemic state: number one problem is workforce shortage and continues to worsen. Surveyed hospitals indicated that staffing shortages are being experienced impacting operations. They have closed beds and, in some instances, an entire wing.  Post-acute patients’ placements are problematic. There are increased financial pressures on hospitals. Use of traveling nurses is causing high salary levels which are unsustainable and also impacts culture at hospitals. 200-400 percent more paid for nurses with travel nurses. 2006 the University System of Georgia had an ambitious plan to increase nurses. The state helped to underwrite costs, but prices remain high for these nurses. Bedside nurses are particularly short. Increased instances of violence have also caused nurses to leave the profession. Primary care doctors, all healthcare technologists, respiratory therapists, and others are experiencing shortages. CNAs are often entry level positions working at the bedside with nurses. Representative Frye pointed out that no one should fault someone to try to be paid more. Representative John LaHood also commented the staffing crisis is “real.” Direct care workers are short - management and supervisors are also burning out.
• Georgia Hospital Association - Anna Adams spoke to the Committee, representing 141 facilities across Georgia. Incredible workforce challenges remain. 15,691 hospital positions are open in Georgia as of today. 42 percent of the jobs require high school diploma or an associate degree. Solutions are needed but not the means to get there. Reimbursement for hospitals has not increased with inflation - the charge is the same. Margins have been absorbed and hospitals make difficult decisions sometimes closing beds or limiting emergency room access. Economic impact to hospitals $15.2 billion in FY 2020 in salaries and benefits were paid by Georgia hospitals. Behavioral health is a big priority for GHA’s members, but their ERs are full (many are uninsured). They lack access to psychiatric services and facilities struggle for an appropriate bed. Daily COVID update is no longer being provided - 42,169 deaths from COVID-19 (6,949 new cases last week). Flu and RSV also have been seen in facilities. Now they are seeing more advanced chronic diseases as folks did not receive care during the pandemic. Dual enrollment, added funding for tax credits for preceptors, and it might be helpful to address violence against healthcare workers.
• Georgia Senior Living Association - Katie Ramp spoke to the Committee outlining issues for licensed personal care homes and assisted living facilities in the state. Burdensome regulations have caused financial burdens. These are private pay facilities. These entities are a way to allow seniors to age in place. The direct care workforce was hit the hardest in the pandemic.

Several new bills have been introduced and placed into this Committee. Hearings on those will be scheduled soon.

New members of the committee were accented Representatives Lisa Campbell, Tish Naghise, Gabe Okoye, and Karen Lupton.

House Appropriations Committee – Human Resources Subcommittee

Department of Veterans Services presented its changes proposed for FY 2024 budget. Again, they outlined the shortages of cemetery workers, including new salary adjustments proposed by Governor Kemp. Veterans’ nursing homes. There were no questions raised.

Georgia Council on Developmental Disabilities’ Darcy Robb spoke about its budget proposal. The agency is focused on social and policy changes to allow individuals to live in their communities. 60 percent of the council have developmental disabilities or within their families.. Robb mentioned IPSE, which allows individuals to attend college. These programs are life-changing with huge employment outcomes. Many graduates are employed 90 days out from completion. 13,000 get waivers; 7,000 are on the waiting list for waivers. Georgia has a high bar for those receiving or waiting to get waivers. The direct personnel service workers are being paid $10.63 per hour but it was unclear if the 5 percent increase made last year was included in this rate. Shortages of employees for direct personnel services workers was unknown but “significant.” The turnover rate is around 50 percent for these workers.

Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner addressed the Subcommittee. He began with an update on 9-8-8 for the call-in for the suicide crisis line. Georgia has been ahead of this as it has GCAL’s access line whereas many states have no such line. 9-8-8 is a massive construction project for those who need mental health and substance abuse help. Mass marketing of the line has not begun yet. DBHDD is now looking at enhanced marketing for a few key areas of the state to determine where key investments should be made. They anticipate 90 percent increase in crisis contact centers; 80 percent of individuals will have access to mobile crisis services. $21.3 million has been invested in 9-8-8 over the last 24 months. GCAL began rising at the beginning of the pandemic. In 2020-2021, more than 200 seconds was needed for an answer, and this has been dramatically decreased, improving response times. 45 new beds will be brought online with the General Assembly’s funding.  Last month 15 percent of crisis adult beds were offline.. 28 percent of children and adolescent beds were offline on January 11, 2023. The opioid settlement was also discussed - $636 million will be received by Georgia over the course of 18 years. According to Commissioner Tanner, decisions on the use of the funds will be methodical, strategic, and informed. He also outlined the state’s use and dependence on Jackson Healthcare, which has reduced since last year - so progress. $1.6 million is now being expended and paid to Jackson Healthcare to support staffing, mostly nursing services. The “trust” has received some initial funding from the opioid settlement - if there are law enforcement agencies in need, they need to contact DBHDD, who can get the Narcan drug. When does the appropriations bill incorporate the $92 million for the rates; DCH has already had public comment, and then it will be submitted to CMS - making it late winter or early spring of next year (FY 2024 budget). Liability will be coming the next fiscal year per Commissioner Tanner and to implement the increases, funds are needed for the state portion. There are a number of ways in which the money could be appropriated (including the governor changing the state’s revenue estimate). Hospital positions to come to market average were also outlined - $50 million to be at DOAS market rates. There are large vacancy rates at the state’s facilities. DBHDD has opened 90 beds since March of last year. There have been targeted pay increases in some positions - nurses, psychologists, and physicians remain difficult recruits. Turnover rates have slowed in hospitals with salary increases - the lower positions are those which turnover more. In the FY 2024 budget, there is not enough funds to fund the 24 hour 16 beds with the allowed drop off enhancement. Dublin, Fulton, and Augusta do not have child beds in their crisis bed - only adult beds. There are no increases for child crisis beds at Dublin, Fulton or Augusta. There are some private contracted beds which take children and adolescents at the DBHDD’s request. In the discussion about the NOW and COMP waivers and need for 2400 waivers at a cost of $65 million, that funding does not account for the rate study. Commissioner Tanner cautioned that there are not enough workforce individuals to handle 2400 folks. The Commissioner is looking at other ways in which to address workforce concerns and the Department needs to grow the numbers of providers online. He suggested keeping the waivers at 500-513. Representative Mike Cameron noted the difficulties his area of the state has. A “bed study” is being conducted by the DBHDD to look at needs, capacity, and distances so it will perhaps help prioritize needs. 

Public Comment:

• Chris Johnson - Georgia Mental Health Consumer Network. He noted the passage of the Mental Health Parity Act but surprised that funding restored to the agency was not fully restored. Two respite centers will close if funding is not restored. Peer supports will be dramatically impacted. He asked the Subcommittee for $2.7 million.
• John McCain - Easterseals. The entity serves a 60-county area and he spoke directly about family support (folks with disabilities and autism who do not receive waiver services). Caseload for his agency is around 1,000 individuals. Easterseals is the only provider of overnight respite south of Atlanta. He asked the Subcommittee to increase the cap allowed for family supports - especially due to inflationary costs. Now it is $3000 per family, and he asked for a 5 percent increase for the budget is $765,000 - and move the cap to $3500 annually for these individuals. Most families spend less but those who reach the limit can be a huge question for families.
• Sally Buchanan - Together Georgia. She spoke to the children who are aging out of the DFCS care and the 7100 who are waiting on NOW/COMP waivers. Children once they reach adulthood do not have access to services - some end up homeless and often risk death.
• Elizabeth Appley - Georgia Supportive Housing Association and others. She asked for significant funding for housing so that 500 more vouchers could be funded. She also asked a 10 percent increase in the size of the voucher due to the tight housing market.  Finally, she asked for a landlord incentive. There is also a need for additional caseworkers to help vulnerable individuals in stable housing with requisite supports.  SOAR staff also needs an increase (such as assistance with identification, benefits, etc.).

House Public Health Committee

Chairman Lee Hawkins (R-Gainesville) called the Public Health Committee Meeting to order to discuss four measures, two of which were hearing only.

• HB 203, authored by Representative Mark Newton, seeks to amend Chapter 12 of Title 31 of the O.C.G.A. This measure includes an assessment mechanism in code, which would allow the use of technology to be used to make eye assessments which could be included during a telemedicine visit. It also redefines eye examination to include telemedicine and does not require an in-person assessment.

Nick Schillago representing 1-800-CONTACTS and Aubrey Villines from the Georgia Optomology Alliance expressed support for the measure.

The measure received a DO PASS recommendation.

• HB 215, authored by Representative Alan Powell (R-Hartwell), amends Chapter 26 of Title 43 of the O.C.G.A. This would allow the Nursing Board to license Advanced Practice Registered Nurses (“APRNs”). The Georgia Occupational Regulation Review Council (“GORRC”) has approved this bill. Todd Jones (R-South Forsyth) asked about the compact licensure. Currently, there is a registered nursing licensing compact but not an APRN since the APRNs are not licensed in this state.

Aubrey Villines from the Alliance of Advanced Practice Nurses, Michelle Nelson Tim Davis from the Georgia Nurses Association expressed support for the measure.

The measure received a DO PASS recommendation.

• A hearing only was held for HB 278, authored by Representative John LaHood (R-Valdosta), which amends Chapter 5 of Title 43. The measure cleans up the code section and replaces ‘injury’ with ‘condition’ to clarify that treatment does not necessarily result from an injury during an athletic event. Representative Kim Schofield (D-Atlanta) asked for specific examples of a condition they cannot currently treat. Representative Trey Kelley (R-Cedartown) asked about the languages being stricken in lines 21-25 and the lines that strike those grandfathered in at lines 70-72. Legislative Council spoke up to refer the committee elsewhere in the bill. Representative Mark Newton (R-Augusta) asked about the Board of Certification. Representative LaHood noted there had been changes to the way they have been licensed in the past. Representative Karen Mathiak (R-Griffin) asked if there was a board under the Secretary of State. Currently, the Board of Certification is a national board.

Aubrey Villines from the Chiropractor Association and Dr. Kathleen Geist from the  American Physical Therapy Association expressed concern on the measure. 

• HB 214, authored by Representative Alan Powell, was held until the next committee meeting.

New Legislation

The following legislation of interest has been introduced in the House:

The following legislation of interest has been introduced in the Senate:

What’s Next

The General Assembly will reconvene for Legislative Day 18 on Tuesday, February 14, at 10:00AM.

The House is expected to consider the following measures on Legislative Day 18:

• HB 76 - Professions and businesses; education, experience, and training requirements for licensure in marriage and family therapy; revise provisions (RegI-33rd)
• HB 176 - Courts; increase amount of court reporters’ monthly contingent expense and travel allowance (Judy-8th)

The Senate is expected to consider the following measures on Legislative Day 18:

• SB 27 - Unfair Trade Practices; healthcare insurer from requiring an ophthalmologist or optometrist to extend any discounts on services that are not covered eye care services; prohibit (I&L-28th)
• SB 41 - Watercraft; completion of a boater education course for registration of a watercraft; require (PS-25th)
• SB 42 - Human Trafficking Hotline Information; model notice requirements; increase the fine for failure to comply (PS-3rd)
• SB 65 - Commissioner of Insurance; general provisions; establishing an advisory committee; provisions; authorize (I&L-1st)
• SB 69 - Honorable Clarence Thomas; placement of a monument in his honor within the capitol building or grounds; provide (Rules-1st)
• SR 65 - Greater Georgia Action Inc.; former United States Senator Kelly Loeffler; recognize (Rules-18th)