S.B. 8 stalls on House floor 
S.B. 8 – insurer-friendly legislation that would undermine Georgia’s health care system – stalled on the floor of Georgia House of Representatives late last week and has been sent back to the House Rules Committee. 
“While no legislation is ever dead until the gavel drops on the 40th day of the session (this Thursday), this was an important victory for physicians and patients in this state,” explains Medical Association of Georgia (MAG) Government Relations Director Derek Norton. “MAG’s legislative team genuinely appreciates the grassroots support that it has received from physicians across the state, and I can assure you that last week’s overwhelming grassroots response made all of the difference in this case.” 
MAG President Steven M. Walsh, M.D., adds that, “I would also like to applaud physicians in the state for the dramatic outpouring of phone calls and emails to legislators – and especially those who showed up to the Capitol – to voice their opposition to S.B. 8., which is legislation that would seriously undermine Georgia’s health care system.”  
Norton emphasizes that MAG will continue to promote legislative solutions (e.g., S.B. 277) to protect patients from the surprise health insurance coverage gap.  
House passes key health care bills
The Georgia House of Representatives passed some key health bills last week, including…
– S.B. 4, the ‘Enhancing Mental Health Treatment in Georgia Act,’ by Sen. Renee Unterman (R-Buford), which would create a Georgia Mental Health Treatment Task Force that would recommend ways to improve the state’s mental health care system. MAG does not have a position on this legislation. 
– S.B. 121, the ‘Jeffrey Dallas Gay Jr. Act,’ by Sen. Butch Miller (R-Gainesville), which would 1) make naloxone available on an over-the-counter basis under a standing order by a state health officer and 2) reclassify naloxone as a Schedule V controlled substance. MAG supports this legislation.
– S.B. 153 by Sen. Matt Brass (R-Newnan), which was amended to include legislation by Rep. Earl Ehrhart (R-Powder Springs) that would allow optometrists to inject pharmaceutical agents around the eye with the exception of sub-tenon, retrobulbar, peribulbar, facial nerve block, subconjunctival anesthetic, dermal filler, intravenous, intramuscular, intraorbital nerve block, intraocular, or botulinum toxin injections. The optometrist would have to 1) obtain a certificate that shows that they have successfully completed a minimum of 30 hours of training which is sponsored by a school or college of optometry that is credentialed by the U.S. Department of Education and the Council on Postsecondary Accreditation or 2) be able to document that they are enrolled in such a training program. They would also be required to conduct these procedures under the direct supervision of a board-certified ophthalmologist. MAG opposes this legislation. 
– S.B. 200 by Chuck Hufstetler (R-Rome), which would require insurers to cover prescriptions that are written for less than 30 days at a “prorated daily cost-sharing rate” when it is in the best interest of the patient or when it is for the purpose of synchronizing the insured patient's medications for chronic conditions. MAG supports this legislation.
– S.B. 201 by Sen. Unterman, which would require employers to allow their employees to use sick leave to care for immediate family members. MAG is neutral on this legislation.
– S.B. 206 by Sen. P. K. Martin (R-Lawrenceville), which would require health insurers to cover billed charges of up to one hearing aid per impaired ear – and not to exceed $3,000 per hearing aid every 48 months for covered patients who are 18 years old or younger. MAG is neutral on this legislation.
– S.B. 242 by Sen. Unterman, which would increase the number of advanced practice registered nurses (APRN) that a physician can delegate their authority to from four to eight – though no more than four at any single point in time. This measure would also add county and municipal emergency medical services that have a full-time medical director to the list of organizations that are exempt from limiting the number of APRN their physicians can supervise. MAG opposes this legislation, but it does support a provision that would require the patient and their primary care physician to be provided with the name of the APRN’s supervising physician. 
The Senate has to agree to changes that were made in the House before these bills can be sent to Gov. Nathan Deal for his consideration.
Senate passes PDMP omnibus bill
The Georgia Senate passed H.B. 249, an omnibus bill (i.e., legislation that covers diverse or unrelated topics) by Rep. Kevin Tanner (R-Dawsonville). One of this measure's provisions would require prescription drug dispensers to update the state’s Prescription Drug Monitoring Program (PDMP) every 24 hours – as opposed to the current seven-day requirement. MAG supports this provision. 
MAG also supports a H.B. 249 provision that would enable prescribers to have up to two practice staff access the PDMP on their behalf. These delegates could include 1) licensed physician assistants, advanced practice registered nurses, or registered nurses who complete a one-time registration process or 2) unlicensed practice staff who complete an annual registration process. It is also worth noting that the delegating prescriber or dispenser could be held civilly liable and/or criminally responsible for “the misuse of prescription information obtained by his/her delegates.”
And MAG supports a H.B. 249 provision that would codify the executive order that Georgia Gov. Nathan Deal issued in 2016 that made naloxone available on an over-the-counter basis. 
Finally, H.B. 249 would require every prescriber who has a U.S. Drug Enforcement Agency prescribing license to register as a PDMP user by January 1, 2018. The Georgia Drugs and Narcotics Agency (GDNA) would then query the database on a random basis. GDNA would be required to certify that the state’s PDMP meets industry standards in June. If that certification requirement goes into effect, prescribers would be required to check the PDMP before they prescribe benzodiazepines, opiates, opioids, opioid analgesics, or opioid derivatives. This provision includes exemptions for prescriptions that are written for three days or less, prescriptions that are written for 10 days or less following a surgery, inpatient care, and hospice care. The regulatory boards that oversee the respective prescriber groups would be responsible for enforcement. MAG took an active role in developing this compromise. The House must now agree to the Senate's changes before the bill can go to Gov. Nathan Deal.
Other bills in play going into the session’s final days
Other key health care bills that remain alive going into the final days of the 2017 legislative session include… 
– H.B. 165 by Rep. Betty Price (R-Roswell), which would prevent the state’s Medical Practice Act from being used to require Maintenance of Certification (MOC) as a condition of licensure or to require MOC to be employed by a state medical facility or for the purposes of licensure, insurance panels, or malpractice insurance. The bill – which is one of MAG’s legislative priorities for 2017 – has moved into the Senate Health and Human Services (HHS) Committee.
– H.B. 427 by Rep. Mark Newton, M.D. (R-Augusta), the ‘Physicians and Health Care Practitioners for Rural Areas Assistance Act,’ which would add dentists, physician assistants, and advanced practice registered nurses (APRN) to the list of practitioners who are eligible for the service cancelable loan program that is administered by the Georgia Board for Physician Workforce. These funds are already in the budget for FY 2018. MAG is watching this legislation, which is in the Senate Rules Committee.
– H.R. 282 by Rep. John Carson (R-Marietta), which would create a House study committee on distracted driving – keeping in mind that in 2017, MAG has been promoting a priority patient safety bill (H.B. 163) that would require drivers who make phone calls while operating a motor vehicle to do so on a hands-free basis. MAG would ask to be included in any H.R. 282 study committee, which would meet during the summer months. H.R. 282 is in the House Rules Committee. H.B. 163 did not pass.
– S.B. 16 by Sen. Ben Watson, which would modify the state’s medical cannabis law. As it was originally written, S.B. 16 would have reduced the amount of THC that is allowed in the cannabinoid oil and it would have added autism to the list of qualifying conditions. However, a new House/Senate compromise would leave THC at its current 5.0 percent level and it would add six qualifying conditions to the law, including 1) “severe” autism for people who are under the age of 18 and 2) autism for people who are 18 or older and 3) severe or end-stage cases of Alzheimer's disease and 4) AIDS or peripheral neuropathy and 5) severe Tourette's syndrome and 6) any case of epidermolysis bullosa. S.B. 16 would also make the oil available to people who are in hospice programs. MAG policy does not support expanding the number of conditions that are covered by state law. S.B. 16 is in the House Rules Committee. 
– S.B. 106 by Sen. Greg Kirk (R-Americus), which would allow certified registered nurse anesthetists (CRNA) to practice in pain clinics without direct supervision as long as 1) the patient has been examined by a physician who has issued a written order for the treatment or services and 2) the patient has given written consent to the treatment or services being provided by the CRNA. MAG opposes the legislation, which is in the House Rules Committee.
– S.B. 180 Sen. Dean Burke, M.D. (R-Bainbridge), which would 1) require rural hospitals to report payments to consultants to qualify for the state’s tax credit for rural hospitals and 2) increase the amount of tax-deductible donations individuals and married couples can make to rural hospitals and 3) allow IRS “S” corporation-eligible members to make tax-deductible donations to rural hospitals. MAG is neutral on this legislation, which is in the House Rules Committee. 
S.B. 193 by Sen. Renee Unterman (R-Buford) would eliminate a requirement for women to be medically indigent to receive services from the state’s ‘Positive Alternatives for Pregnancy and Parenting Grant Program.’ The measure would also prohibit the program’s contract management agencies from “referring, encouraging or affirmatively counseling” a person to have an abortion unless their physician diagnoses them with a condition that makes the procedure necessary to prevent the person’s death. An amendment added H.B. 360 by Rep. Sharon Cooper (R-Marietta), which would allow antibiotic drugs to be prescribed or dispensed to the sexual partner or partners of a patient who is diagnosed with chlamydia or gonorrhea without the need for a physical examination. While MAG is neutral on the original legislation, it does support the amendment. This bill is in the House Rules Committee.
– S.B. 125 by Sen. Rick Jeffares (R-McDonough), which would allow physician assistants to write hydrocodone prescriptions for up to five days. APRN asked to be removed from this legislation after it was amended to tie their prescriptive authority to the Georgia Composite Medical Board. MAG continues to monitor the legislation, which is in the House Rules Committee. 
– H.R. 464 by Rep. Betty Price, M.D. (R-Roswell), which would create a House study committee to assess the state’s readiness to contend with infectious disease, such as the Zika virus, and propose possible legislation to increase the state’s readiness. MAG has not taken a position on this legislation, which is in the House Rules Committee. 
S.B. 106 by Sen. Greg Kirk (R-Americus) would allow a certified registered nurse anesthetist (CRNA) to practice in a pain clinic without direct supervision as long as the patient has been previously examined by the physician, the physician has issued a written order for the treatment or services, and the patient has given written consent to the treatment or services being provided by the CRNA. MAG opposes the legislation, which is in the House Rules Committee. 
– H.R. 745 by Rep. Beth Beskin (R-Atlanta), which would create a House study committee on the surprise health insurance gap that leads to balance billing in emergency care settings. MAG supports this bill, which is pending a committee assignment.
Session scheduled to end this Thursday 
Georgia’s 2017 legislative session is scheduled to end this Thursday, March 30.
The Medical Association of Georgia (MAG) will include a comprehensive summary of the key developments from this year’s session in the next edition of its e-News from MAG newsletter, which will be distributed next Monday, April 3.
Contact MAG Government Relations Director Derek Norton at dnorton@mag.org or 404.274.4210 with questions related to the legislative session.
Thanking last week’s ‘Doctor of the Day’ volunteers
The Medical Association of Georgia (MAG) is thanking and applauding its ‘Doctor of the Day’ volunteers for the week of March 20, which include…
Gulshan S. Harjee, M.D.
Matthew A. Klopman, M.D.
Jason L. Smith, 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 www.mag.org/advocacy/take-action/dod for additional information on the MAG ‘Doctor of the Day’ program, including logistical details and FAQ.
Reserve a room for MAG’s summer seminar for $189/night
The Medical Association of Georgia (MAG) is encouraging its member physicians to reserve a room for MAG’s 2017 ‘Legislative Education Seminar,’ which will take place at the Brasstown Valley Resort in Young Harris on the evening of Friday, June 23 and Saturday, June 24.
MAG members can call 800.201.3205 and ask for the “Medical Association of Georgia” discount to reserve a room for $189 per night. The discount will be available until May 17 or until MAG’s block of rooms sells out. 
More than 25 state legislators attended this event in 2016.
Monitor www.mag.org for additional details, and contact Derek Norton at dnorton@mag.org or 678.303.9280 with any questions.
MAG’s 2017 state legislative priorities 
The Medical Association of Georgia’s priorities for the 2017 state legislative session include…
Out-of-Network Billing & Network Adequacy
MAG will 1) support reforms that will require appropriate network adequacy standards for health insurers and 2) call for health insurers to be more transparent in their contracts with physicians’ practices and 3) support legislation that will result in physician payment methodologies that are adequate and sustainable for out-of-network emergency care.  
Medicaid Payment Parity
MAG will be an advocate for the General Assembly to continue to fund the Medicaid parity payment program for all areas of primary care.
Maintenance of Certification (MOC)
MAG will 1) work to ensure that Maintenance of Certification is not a condition of licensure or a condition of hospital credentialing and 2) support efforts that will alleviate the costly and burdensome aspects of MOC for physicians.
Patient Safety
MAG will be an advocate for legislation that improves patient safety.
Contact MAG Government Relations director Derek Norton at dnorton@mag.org or 678.303.9280 with questions related to MAG’s legislative priorities for 2017.
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