Gov. Kemp addresses federal waivers & surprise bills in ‘State of State’
In his State of the State address on Thursday, Gov. Brian Kemp discussed the ‘Georgia Pathways’ Section 1115 and ‘Georgia Access’ Section 1332 health insurance waivers applications that he recently submitted to the federal government. The ‘Georgia Pathways’ waiver would allow Georgia to expand the groups who are eligible for Medicaid coverage to those at or below 138 percent of the federal poverty level, while the ‘Georgia Access’ waiver would allow Georgia to subsidize the purchase of private insurance for eligible citizens who are between 138 percent and 400 percent of the federal poverty level.

He believes that, “While these reforms will provide a new pathway for 408,000 Georgians to access affordable care and lower insurance premiums for millions more, this is only the beginning.”

Gov. Kemp also addressed out-of-network billing, stating that, “We will implement long overdue reforms that put our families first. Working with patients, providers, and the private sector, we'll craft a legislative remedy to reduce surprise medical billing. We will demand transparency, embrace empathy, and insist on fairness. We will take care of each other – in sickness and in health.” 
Lawmakers begin to address surprise bills in session’s first week
Sen. Chuck Hufstetler (R-Rome) introduced a bill that would address out-of-network billing. Under S.B. 293, the “initial” payment for out-of-network emergency care would be 1) the average contracted amount or – if that doesn’t exist – 2) the average contracted amount of all of the eligible insurers that are in an “all-payers health claims database” that would be created or an amount that the insurer deems appropriate given the complexity and circumstances of the services that were provided, whichever is greater. This payment would be made without the need for prior authorization and without the physician risking having the payment denied on a retrospective basis. And the patient would not be required to pay more than their normal in-network cost-sharing amount, and that payment would be applied to their deductible and out-of-pocket limits.
For any non-emergency care that a patient receives out-of-network, S.B. 293 would require insurers to pay physicians 1) the average contracted amount or 2) the average contracted amount for all eligible insurers [based on the aforementioned all-payers database] or 3) an amount that the insurer deems appropriate given the complexity and circumstances of the services that were provided – whichever is greater – without the need for prior approval and without having the physician risk having the payment denied on a retrospective basis. And under S.B. 293, the patient would not be required to pay more than their normal in-network cost-sharing amount, and that would be applied to their deductible and out-of-pocket limits – although this would not be applicable when a patient chooses to receive out-of-network care and documents in writing that they acknowledge that the provider is out-of-network and that they will be responsible for the out-of-network provider’s billed charges.
S.B. 293 would enable physicians who believe that their payment is insufficient given the complexity and circumstances of the services they provide to submit an arbitration request to the Georgia Insurance Commissioner. The physician and applicable insurer would then each submit a final offer payment amount, and the arbitrator would choose between the two amounts – with the party that fails being responsible for the costs associated with the arbitration process.
MAG supports some of S.B. 293’s provisions, as currently written, including the arbitration and retrospective denial protections. But MAG also opposes certain provisions in the bill, including the average contract amount and some inconsistent and unclear language surrounding elective procedures. MAG will continue to work with lawmakers and a coalition of state medical specialty groups to enhance this legislation, which has been assigned to the Senate Insurance and Labor Committee. It is also worth noting that a comparable bill is expected to be introduced in the House.

Other key bills that were introduced this week include…

S.B. 279 by Sen. Jen Jordan (D-Atlanta), which would require “informed consent” to perform a pelvic exam on an unconscious or sedated female patient – emergencies notwithstanding. These exams would also be required to be within the scope of care that is ordered for the patient and be medically necessary for diagnosis or treatment purposes or when a court has ordered a pelvic exam to collect evidence. MAG is evaluating this legislation, which has been assigned to the Senate Health and Human Services Committee.
H.B. 744 by Rep. Mike Wilensky (D-Dunwoody), which would prohibit prescribers from 1) prescribing any combination of opioid medication that is an aggregate amount in excess of 100 morphine milligram equivalents of opioid medication per day and 2) writing a prescription for more than a 30-day supply of an opioid medication within 30 days for patients who are being treated for chronic pain and 3) writing an opioid prescription for a patient who is being treated for acute pain that is more than a seven-day supply within a seven-day period unless the medication has an FDA label that says it should only be dispensed in a stock bottle that exceeds a seven-day supply as prescribed, in which case the amount dispensed may not exceed a 14 day supply.
These limits would not apply to opioid prescriptions that are for: pain associated with active and aftercare cancer treatment; pain associated with a fracture or compound fracture; post-operative pain management resulting from a surgical procedure; palliative care for an advanced and progressive disease; hospice care if terminally ill; or medication assisted treatment for a substance abuse disorder. The limits would also not apply to 1) directly ordering or administering a benzodiazepine or opioid medication to a patient in an emergency room setting, an inpatient hospital setting, or a long-term care facility or 2) a surgical procedure. Under H.B. 744, prescribers would be subject to a fine of $250 per violation – up to $5,000 per calendar year. MAG opposes this legislation, which has not yet been assigned to a committee.

H.B. 731 by Rep. Ron Stephens (R-Savannah), which would raise the state’s tobacco tax from 23 percent to 42 percent for wholesale cigars, from $.37 to $1.87 per pack of 20 cigarettes, and from 10 percent to 42 percent of the wholesale price for loose or smokeless tobacco. MAG supports this legislation, which has been assigned to the House Ways and Means Committee.
H.B. 739 by Rep. Rick Jasperse (R-Jasper), which would prevent a hospital or ambulatory surgery center from hiring or retaining surgical technicians who don’t have a “certified surgical technologist” credential – as defined by the legislation. This bill also includes continuing education requirements for the affected technicians. MAG is evaluating this legislation, which has been assigned to the House Health and Human Services Committee. 
MAG reminding members to support ‘Tort Reform Fund’
MAG is reminding its members to support MAG’s ‘Tort Reform Fund’ with a donation – keeping in mind that tort reform is one of MAG’s priorities for this year’s state legislative session.  

Along with being the leading advocates for the tort reform that was enacted in Georgia in 2005, MAG and MagMutual are protecting physicians in the state by…

– Promoting legislation that will eliminate “phantom damages,” which are based on how much a medical provider bills versus what they’re actually paid – something that can lead to much higher awards

– Advocating for the modernization of Georgia’s ‘Civil Practice Act’ to improve and streamline the med-mal process

– Providing lawmakers with benchmarking and other data they need to make good decisions

But MAG needs your help to avoid a full-blown emergency that forces physicians to cut back on high-risk services, retire early, or leave Georgia because they can’t afford or obtain medical malpractice insurance.

Note that…

– Georgia ranks sixth on the ‘Judicial Hellholes’ Top 10 list for 2019-2020

– Five of Georgia’s top 25 2018 verdicts were for med-mal – including $31 million for a case in Clayton County and $18 million for a case in Chatham County

– Georgia now ranks 9th in the U.S. for med-mal payment severity, and it is much higher than neighboring states

– The number of paid med-mal claims in Georgia have increased by 50 percent since 2016

– Georgia is ranked 41st in the U.S Chamber’s 2019 Lawsuit Climate Survey

– The average payout for Georgia medical liability cases reported to the NPDB increased from $476,000 in 2016 to $495,000 in 2018

Click to support MAG’s Tort Reform Fund
MAG thanks & applauds this week's ‘Doctor of the Day’ volunteers
MAG is thanking and applauding its ‘Doctor of the Day’ volunteers for the week of March 18, which include…

Robert S. Kaufmann, M.D.
Andrew B. Reisman, M.D.
Rana K. Munna, M.D.
Saida Omarova, M.D.

MAG Doctor of the Day volunteers work in the Medical Aid Station at the state Capitol, where they provide free minor medical care to legislators and their staff members.

Go to for additional information on the MAG ‘Doctor of the Day’ program, including logistical details and FAQ. 

MAG encouraging members to register for ‘Physicians' Day at the Capitol’ 
The Medical Association of Georgia is encouraging its members to register for the 2020 'Physicians’ Day at the Capitol,' which will take place at the State Capitol in Atlanta from 8 a.m. to 2 p.m. on Wednesday, February 19.
Physicians and legislators will be invited to attend a lunch that will be served at a venue that is at or within walking distance of the Capitol as soon as the General Assembly adjourns.
Contact Christiana Craddock at or 678.303.9271 with questions.
Register for ‘Physicians' Day at the Capitol’
MAG’s 2020 state legislative priorities 
The Medical Association of Georgia’s (MAG) priorities for the 2020 state legislative session include… 
Tort Reform
– Addressing the state's declining tort environment
Tax Credits for Uncompensated Care
– Creating tax credits for physicians who provide uncompensated care
– Continuing to support the waiver process to ensure Georgians have access to health insurance
Scope of Practice
– Addressing issues that undermine patient safety
Health Insurance
– Developing a solution for “surprise medical bills”        
– Streamlining and improving the prior authorization process
– Promoting insurance coverage for non-narcotic alternative therapies        
– Ensuring patients have access to every physician who is advertised as “in-network” for the duration of a contract year to ensure the continuity of care
Contact MAG Government Relations Director Derek Norton at or 678.303.9280 with questions related to MAG’s legislative priorities for 2020.
Early bird discount available for MAG’s annual legislative seminar
The Medical Association of Georgia (MAG) is encouraging members to reserve a room for MAG's 2020 ‘Legislative Education Seminar’ meeting, which will take place at the Brasstown Valley Resort & Spa in Young Harris on May 15-17. 
Call 800.201.3205 and mention the “MAG Legislative Education Seminar” to receive a discounted room rate of $199 per night plus taxes and fees. The discount will be available until May 10 or MAG’s block of rooms sells out.
Contact Carolyn Jones at with questions related to lodging.
Monitor MAG’s communications and for additional details, and contact Derek Norton at or 678.303.9280 with any questions related to the seminar.  
Follow MAG at the Capitol 24/7 
Whether you are using a laptop or a tablet or a handheld device, you can always get the latest state legislative news in Georgia by following MAG on Twitter at, on Facebook at, or by visiting
MAG’s Government Relations Team 
Derek Norton – Director or 404.274.4210  
Bethany Sherrer – Legal Counsel & GAMPAC Manager or 404.354.1863  
Christiana Craddock – Legislative Assistant or 678.303.9271
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