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| Governor expected to sign landmark ‘surprise billing’ measure into law
The Senate passed a landmark “surprise billing” measure (H.B. 888) by Rep. Lee Hawkins (R-Gainesville) that would set the price that is paid for out-of-network emergency care and unanticipated out-of-network non-emergency care at the previously contracted rate between the provider and the insurer or the 2017 median contracted rate, adjusted annually according to the Consumer Price Index (CPI) – whichever is greater – and without the need for prior authorization and without any retrospective payment denials. This bill would also allow patients to choose out-of-network elective care by consenting in writing and orally at least 48 hours in advance with an estimate of the charges, it would require insurers to use the most recent in-network contract rates as the initial payment for a physician/provider when a contract is terminated without cause by the insurer or with cause by a physician/provider within one year of the effective date of the legislation, and it would establish a “baseball-style” arbitration system – whereby the insurer and physician/provider would each submit a payment amount, an arbitrator would choose one of the numbers, and the “loser” would pay all of the costs associated with arbitration. Finally, this bill would allow the bundling or batching of claims without any thresholds. This legislation is one of MAG’s priorities for 2020. The House passed this bill as well, and Gov. Brian Kemp is expected to sign it into law in the next several days.
The Senate also passed a bill (H.B. 752) by Rep. Dave Belton (R-Buckhead) that addresses inadequate language that is in state law that is related to the background checks that are conducted before Georgia can operate as a “home state” for physicians wishing to gain licensure under the Interstate Medical Licensure Compact and physical therapists can gain licensure under the Physical Therapy Compact. MAG supports this legislation, which must pass the House before it can be sent to Gov. Kemp.
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| MAG calling for members to contact lawmakers ASAP to oppose APRN radiographic imaging bill
The Medical Association of Georgia (MAG) is encouraging its members to contact their state representatives as soon as possible to urge them to oppose S.B. 321 by Sen. Chuck Hufstetler (R-Rome). This bill will would 1) increase the physician PA supervision ratio from 4-to-1 in a group practice and 2-to-1 in a solo practice to 4-to-1 for all and 2) allow APRNs to order radiographic imaging in non-life-threatening situations if it is included in their protocol agreement.
This bill is scheduled to be considered by the House in the next several days.
Contact MAG Government Relations Director Derek Norton at dnorton@mag.org with questions.
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| House passes bills addressing number of jurors & allowing pharmacists to fill 30-day Rx early during emergencies
The Georgia House of Representatives passed a bill (S.B. 405) by Sen. Lindsey Tippins (R-Marietta) that would allow for a reduction in the number of jurors that are required to have a trial between July 1, 2020 and June 30, 2021. In civil actions in state courts, a civil action can be tried with less than 12 jurors – but not less than six – at the discretion of the trial judge or by consent of the parties. In civil actions in superior courts, the parties can consent to a panel of 12 jurors from which to select a jury. The attorneys may then strike jurors alternately until a jury of fewer than 12 jurors, but not fewer than six, remain. The bill would also require the superior court to impanel a sufficient number of jurors so that no fewer than six jurors are qualified to try the case when a person is indicted for or accused of a felony offense. MAG opposes this legislation because it has the potential to increase the number of verdicts against physicians in malpractice cases due to the reduced jury size. The bill now must go to the Senate for agreement or disagreement.
The House also passed S.B. 391 by Sen. Kay Kirkpatrick, M.D. (R-Marietta), which would allow pharmacists to fill a 30-day supply of a prescription medication early when a state of emergency has been declared or when a hurricane warning has been issued – Schedule II medications notwithstanding. This would only apply when a pharmacist determines that the prescription is 1) essential to the maintenance of life or the continuation of therapy for a chronic condition and 2) the interruption of such therapy might reasonably produce undesirable health consequences or cause physical or mental discomfort. The pharmacist would have to let the prescriber know about the early prescription request within 48 hours. And insurers would be required to cover these early prescriptions. MAG is neutral on this legislation, which goes to the House Rules Committee.
And the House passed S.B. 303 by Sen. Ben Watson, M.D. (R-Savannah), which would require health insurers to make certain patient cost comparison information available on an interactive and publicly accessible website. This would allow patients to 1) see how much in-network physicians are paid by insurers and 2) see the average amount that in-network physicians actually agree to be paid by insurers and 3) get an estimate for how much out-of-pocket money they will owe their physicians/providers and 4) compare quality metrics for the physicians/providers that are in their network in major diagnostic categories, adjusted for risk and severity. MAG supports this legislation, which is moving into the House Rules Committee.
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| MAG working to minimize budget cuts to key health care programs
The Senate passed its version of the FY 2021 state budget. The governor’s office had originally called for every agency to cut its budget by 14 percent as a result of the COVID-19 pandemic, but that was reduced to 11 percent after the state increased its revenue projections.
The Senate proposal calls for cuts of nearly $10 million from the Georgia Board for Health Care Workforce budget for 1) loan repayment awards for rural health care providers and 2) medical schools, residency, and fellowship programs.
The Senate is also calling for the Georgia Department of Public Health and the Georgia Department of Behavioral Health and Developmental Disabilities to cut their budgets by $27.4 million and $122 million, respectively.
In a positive development, federal funds are expected to offset some of the state budget cuts for Georgia’s Medicaid program, including eligibility, benefits, and provider payments.
The budget will likely go to a conference committee with members of the House and Senate before final passage by both chambers before adjournment.
MAG will continue to work with lawmakers to minimize budget cuts for these and other key health care programs.
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| Senate committees pass tobacco tax, COVID-19 liability & PBM practices bills
The Senate Finance Committee passed an amended version of H.B. 882 by Rep. Houston Gaines (R-Athens) that would allow vaping products to be taxed and increase the tobacco tax from 37 cents per pack to $1.35 per pack. MAG supports this legislation, which will go to the Senate Rules Committee as a next step.
The Senate Insurance Committee passed a bill (H.B. 167) by Rep. Darlene Taylor (R-Thomasville) that would make physicians, other health care providers, and health care facilities immune from civil liability where they were arranging for the provision of COVID-19 health care services or where the arrangement or provision of services were impacted decisions or activities in response to or as a result of the COVID-19 pandemic. These protections would not apply in cases of gross negligence, willful or wanton misconduct, or intentional infliction of harm. The legislation also states that there is “no civil liability for [the] transmission of, contraction of, or exposure to COVID-19 unless it was caused by willful or wanton misconduct or an intentional infliction of harm.” MAG supports this legislation, which is headed to the Senate Rules Committee.
The Senate Insurance Committee also passed a bill (H.B. 946) by Rep. David Knight (R-Griffin) that would address pharmacy benefit managers (PBMs) practices – such as “steering” (i.e., forcing patients to use PBM-owned pharmacies) and pharmaceutical manufacturers’ rebates. This measure includes language from a MAG 2019 House of Delegates resolution that calls for establishing requirements for physicians who are involved with prior authorization and step therapy determinations, formulary development, and formulary management. These physicians would have to be seeing or having seen patients in the last five years and be practicing or having practiced in the last five years in the same specialty for which they are providing advice. Under this legislation, the Georgia Department of Community Health would be encouraged to require the use of Georgia-licensed physicians for prior authorization or step therapy appeals or determinations in its future contracts with PBMs. MAG supports this legislation, which will now go to the Senate Rules Committee.
The Senate Public Safety Committee passed a substitute version of H.B. 216 by Rep. Teri Anulewicz (D-Smyrna) that would make physicians, other health care providers, and health care facilities immune from any civil liability for “any injury or death alleged to have been sustained because of the facility's or provider's acts or omissions undertaken in good faith while providing health care services in support of this state’s response to COVID-19.” This immunity would not apply in cases of gross negligence, willful and wanton misconduct, reckless infliction of harm, or intentional infliction of harm. MAG supports this bill’s immunity provisions, but it believes that the legislation should be more comprehensive. This bill will go to the Senate Rules Committee as a next step.
And the Senate Regulated Industries and Utilities Committee passed a bill (H.B. 932) by Rep. Houston Gaines (R-Athens) that would allow physicians and podiatrists to form professional corporations together. MAG is neutral on this legislation, which has been sent to the Senate Rules Committee.
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| Senate HHS passes important health care bills
The Senate Health and Human Services (HHS) Committee passed four important bills this week, including…
H.B. 789 by Rep. Mark Newton, M.D. (R-Augusta), which would address “surprise bills” by creating a “star” rating system to highlight which health insurance plans include both certain medical specialties (i.e., emergency medicine, radiology, anesthesiology, and pathology) and hospitals in the same networks. It would also require health insurers to make this information available on their websites and in their printed directories. MAG is neutral on this legislation, which is moving into the Senate Rules Committee.
H.B. 791 by Rep. Ron Stephens (R-Savannah), which would allow pharmacists to convert a maintenance medication prescription from a 30-day supply to a 90-day supply up to the quantities that have been authorized through refills by the physician – although this would not be permitted on the initial prescription or whenever the physician specifies that the refills should not be combined. MAG is neutral on this legislation, which is headed to the Senate Rules Committee.
H.B. 991 by Rep. Matt Hatchett (R-Dublin), which would create a ‘Healthcare Transparency and Accountability Oversight Committee’ that would have the authority to review the performance and conduct of all state health care plan contractors, their affiliate subcontractors, and their subcontractor pharmacy benefits managers. MAG supports this legislation, which has been sent to the Senate Rules Committee.
H.B. 1114 by Rep. Sharon Cooper (R-Marietta), which would extend postpartum Medicaid coverage from two months to six months and require Medicaid to cover lactation care and services – contingent on money appropriated by the legislature to pay for the extended coverage. MAG supports this legislation, which is headed to the Senate Rules Committee.
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| House HHS passes scope & claims data base measures
The House Health and Human Services (HHS) Committee passed a bill (S.B. 306) by Sen. Valencia Seay (D-Riverdale) that would create a licensure and telemedicine compact for audiologists and speech language pathologists. MAG is neutral on this legislation, which is going to the House Rules Committee as a nest step.
The House HHS also passed a bill (S.B. 482) by Sen. Dean Burke, M.D. (R-Bainbridge) that would create a ‘Georgia All Payer Claims Database’ (GAPCD) to collect claims data from insurance companies, the Georgia Department of Community Health, Medicaid care management organizations, Medicare plans, entities that contract with institutions of the Georgia Department of Corrections to provide medical, dental, or pharmaceutical care to inmates, the State Board of Workers' Compensation, and the Georgia Access to Medical Cannabis Commission. This measure would also establish a GAPCD Advisory Committee to make recommendations about the GAPCD framework and develop a plan to facilitate the “reporting of health care and health quality data resulting in transparent and public reporting of safety, quality, cost, and efficiency information at all levels of health care.” MAG is neutral on this legislation, which is headed to the House Rules Committee.
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| House Special Committee passes M.D. legislator-sponsored bills
The House Special Committee on Access to Quality Health Care passed…
S.B. 313 by Sen. Dean Burke, M.D. (R-Bainbridge), which would address pharmacy benefit managers (PBMs) practices – such as “steering” (i.e., forcing patients to use PBM-owned pharmacies) and pharmaceutical manufacturers’ rebates. This measure includes language from a MAG 2019 House of Delegates resolution that calls for requirements for physicians who are involved with prior authorization and step therapy determinations, formulary development, and formulary management. These physicians would have to be seeing or having seen patients in the last five years and be practicing or having practiced in the last five years in the same specialty for which they’re providing advice. The bill encourages the Georgia Department of Community Health to require the use of Georgia-licensed physicians for prior authorization or step therapy appeals or determinations in its contracts with PBMs. MAG supports this legislation, which now goes to the House Rules Committee.
S.B. 483 by Sen. Matt Brass (R-Newnan), which would provide for Medicaid reimbursement for patients who are treated by a hospital pursuant to a behavioral rehabilitation joint venture. The bill was amended to include some H.B. 1032 provisions exempting certain facilities that perform medical procedures “only in non-sterile procedure rooms” from certificate of need (CON) requirements and exempting those facilities from having to have an operating room or an operating room environment or from having to have any minimum physical plant and operational standards, as specified in the rules of the Georgia Department of Community Health for the purposes of CON. MAG is neutral on this legislation, which goes to the House Rules Committee.
In another important development, the House Insurance Committee passed a bill (S.B. 28) by Sen. Lester Jackson (D-Savannah) that would require health insurance copays to be “reasonable in relation to covered benefits to which they apply” and would “require that copays be used as an incentive rather than a barrier to accessing appropriate care.” MAG supports this legislation, which is going to the House Rules Committee.
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| Lawmakers to continue meeting over weekend
The Georgia General Assembly was still considering some key health care bills when this edition of e-News from the Capitol was distributed, including ones related to regulating pharmacy benefit managers (S.B. 313 & H.B. 991), the creation of a Georgia All Payer Claims Database (S.B. 482) and the expansion of post-partum Medicaid (H.B. 1114). Lawmakers are also expected to meet tomorrow and possibly Sunday. MAG will send updates as warranted.
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| HHS activates ‘CARES Act’ Relief Fund application portal
The American Medical Association (AMA) reports that the U.S. Department of Health and Human Services (HHS) has activated an application portal to distribute $15 billion in ‘CARES Act’ Provider Relief Fund payments to eligible Medicaid and CHIP physicians and organizations.
AMA explains that, “The payment will be at least two percent of reported gross revenue from patient care, and the final amount will be determined based on submitted data, including the number of Medicaid patients served. Eligible physicians and organizations have until July 20, 2020 to submit their application and report other necessary information, such as annual patient revenue data.”
AMA also notes that HHS is hosting webcasts at 2 p.m. EST on Tuesday, June 23 and 2 p.m. EST on Thursday, June 25 for physicians and other health care professionals who are interested in learning more about the application process. Registration is required.
AMA has also flagged two key questions that were posted on the HHS Cares Act FAQ web page on June 12…
Why is there a new Provider Relief Fund Payment Portal?
[The] portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund starting Wednesday, June 10, 2020. At this time, this portal will serve as the point of entry for providers who have received Medicaid and CHIP payments in 2017, 2018, 2019 or 2020 and who have not already received any payments from the $50 billion Provider Relief Fund General Distribution.
What is the difference between the first Provider Relief Fund Payment Portal and the Enhanced Provider Relief Fund Payment Portal for the Medicaid Targeted Distribution?
The first Provider Relief Fund Payment Portal was used for providers who received a General Distribution payment prior to Friday, April 24. These providers were required to submit financial information to receive approximately two percent of gross revenues derived from patient care. HHS has developed the new Enhanced Provider Relief Fund Payment Portal for providers who did not receive payments under the previous General Distribution, including those providers who bill Medicaid and CHIP (e.g., pediatricians, long-term care, and behavioral health providers.)
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| AU Health MAG members to staff Medical Aid Station for rest of session
Due to concerns and safety measures that are related to COVID-19, MAG’s ‘Doctor of the Day’ program at the State Capitol in Atlanta has been modified for the last several days of this year’s legislative session.
MAG member physicians who are with Augusta University Health (AUH) will staff the MAG Medical Aid Station at the Capitol for the rest of the session. AUH staff is also conducting COVID-19 tests in a mobile unit outside the Capitol.
Finally, MAG is applauding the physicians from AUH for donating an array of medical supplies for the Medical Aid Station.
Contact Christiana Craddock at ccraddock@mag.org or click here for details on MAG’s ‘Doctor of the Day’ program, which will resume in 2021.
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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
Medicaid
– 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 and requiring insurers to be transparent about how they develop their networks, their standards of participation, and the process they employ to select/de-select physicians for their networks
Contact MAG Government Relations Director Derek Norton at dnorton@mag.org or 678.303.9280 with questions related to MAG’s legislative priorities for 2020.
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Follow MAG at the Capitol 24/7
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| MAG’s Government Relations Team
Bethany Sherrer – Legal Counsel & GAMPAC Manager
bsherrer@mag.org or 404.354.1863
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