The final day of the Georgia General Assembly brought last-minute approval of some health care bills Thursday – along with disappointment over pieces of legislation that didn’t pass.
The failures included the high-profile effort to halt “surprise’’ medical bills, and a proposal to require Georgia schools and day care centers to test their drinking fountains and sinks for lead contamination in the water.
Bills that passed on “Sine Die” included raising the tax credits for individuals and companies who donate to Georgia rural hospitals; an expansion of medical conditions that qualify a patient to possess medical marijuana; and a proposal allowing optometrists to administer drug injections into patients’ eyelids.
And dental hygienists will be allowed to practice in safety-net settings, school clinics and nursing homes without a dentist being present. A compromise on this legislation was reached weeks ago, but it took to the last day to get final passage.
Early in the session, surprise billing legislation had plenty of momentum, with Sen. Renee Unterman, a Buford Republican, and Rep. Richard Smith, a Columbus Republican, backing differing proposals to prevent the problem.
In these situations, patients who receive care at a facility in their health network may get additional, unexpected bills from providers outside the network who were involved in the care. These charges, which have rocked many consumers, can come from ER doctors, anesthesiologists and radiologists, among others.
Unterman’s bill, which passed the Senate unanimously, relied on a percentage of charges from a national database as the tool to resolve billing situations disputed by patients. Smith pushed alternate legislation that would have set up a new formula for out-of-network reimbursement for emergency services, but did not have a similar set-up for scheduled patient care by other hospital-based physicians, such as anesthesiologists. That version was opposed by physician groups.
Unterman said Thursday that with the failure to get any legislation passed on the issue, patients will continue to be subject to “predatory surprise billing.’’ Smith told GHN that he would have a study committee on the issue later this year, with an eye toward legislation in a future session.
Beth Stephens of Georgia Watch said Thursday that the consumer advocacy group “is very disappointed that we didn’t pass something that was a robust consumer protection bill.” She said she looks forward to continuing the discussion in the study committee.
The lead testing bill also passed the Senate overwhelmingly, but failed to gain a vote in the House.
“My fundamental approach is that parents need to know what their children are ingesting,’’ Sen. Vincent Fort (D-Atlanta), the bill’s sponsor, told GHN on Thursday.
“There are children who are drinking leaded water,’’ said Fort, who added that he was “very disappointed’’ that the Legislature failed “to protect the most vulnerable citizens.”
Some metro Atlanta school systems have begun testing their water for lead, and have found some areas that have levels of contamination above the EPA limit. There is no safe lead level for children, the CDC says. (Here’s a GHN article on the lead issue.)
Georgia lawmakers Thursday voted to expand access to medical cannabis by adding six new diagnoses, including autism and AIDS, to the list of qualifying conditions.
The Senate voted 45-6 to agree with the House and send the bill to the governor’s desk.
The optometry bill, which passed Thursday, was fiercely opposed by ophthalmologists, who are physicians specializing in the eye. Currently, they are the only people authorized to administer such injections in Georgia, and they saw the proposal as a potential safety problem.
Optometrists — who examine the eye, test vision and prescribe corrective treatment but are not physicians — argued that the legislation would increase patients’ access to these eye services. Supporters of the measure said optometrists doing the injections would be appropriately trained and monitored.
CON laws remain as before
The hospital industry was among the winners early in the session when the Legislature swiftly approved the renewal of the “provider fee,’’ a funding mechanism that draws an extra $600 million in federal funding for the state’s Medicaid program.
And the industry successfully fought off challenges to the state’s certificate-of-need (CON) regulatory apparatus for health care facilities. These efforts included a high-profile attempt by Cancer Treatment Centers of America to accept more patients from Georgia and expand the capacity of its hospital in Newnan. The CTCA facility in Newnan is a regional hospital (for the Southeast), and current state law limits the percentage of patients it can treat from Georgia.
Other proposed CON revisions stalled out as well, including one by a group of doctors seeking to loosen restrictions on operating a multispecialty outpatient surgery center.
The passage of the dental hygienist legislation came a year after the sudden collapse of similar legislation in the 2016 General Assembly session.
Suzanne Newkirk of the Georgia Dental Hygienists Association said her organization “is very pleased to see the passage of HB 154. The legislation will make a difference in the lives of thousands of Georgians who have little to no access to preventive dental care now.’’
Proposals addressing Georgia’s opioid epidemic included codifying Gov. Nathan Deal’s executive order allowing the sale of naloxone, an antidote for drug overdoses, without a prescription, and closer tracking of the prescribing of opioid medications.
Another bill that passed Thursday would put more state oversight on the opioid treatment centers that have proliferated in the state, especially in its northwestern region. The centers offer medical-assisted treatment and counseling to help treat patients with addictions to heroin and other opioids.
“We’re overwhelmed with them,’’ said Sen. Jeff Mullis (R-Chickamauga). Georgia, he added, “has an easy permit process” for such treatment centers, and many of the patients they treat are coming from neighboring states where the rules are tighter.
The lawmaker who created Georgia’s new tax credit program for rural hospitals successfully sought to boost the incentives for donors. State Rep. Geoff Duncan, a Cumming Republican, introduced a House bill that would raise the tax credit from 70 percent to 90 percent for individuals and corporations who donate money to rural hospitals.
“This is one of the most optimistic initiatives for rural hospitals that we’ve seen,’’ said Jimmy Lewis, CEO of HomeTown Health, an organization of rural hospitals in the state. “It opens the door for community participation and donor participation.”
Children’s health advocates praised funding in the budget and legislation to help kids, including a bill that requires insurers cover hearing aids for children, and the dental hygienist legislation.
The budget provided $2.5 million in state funds for behavioral health treatment of children up through age 5 in Medicaid. And more than $20 million was approved for autism treatments for children in Medicaid.
“Overall, I would say it has been a good session for children where health is concerned,’’ said Polly McKinney of Voices for Georgia’s Children. “It is great to see the General Assembly prioritize things like money for autism, dental care, young children’s behavioral health and primary care providers. Plus there has been some helpful legislation passed which kids have needed for a while, like the children’s hearing aid bill, the dental hygienist bill and an array of bills attempting to address the opioid epidemic, which ultimately results in thousands of children being taken into state custody as a result of neglect by addicted caregivers.’’
The state budget includes $38 million for higher payment rates for primary care physicians and ob/gyns serving Medicaid patients. And the budget, with $6.5 million, aims to resolve the problem of a pay differential among physicians who treat Medicaid patients. The “attestation’’ issue that creates the disparity has frustrated many Georgia physicians. (Here’s a GHN article on attestation.)
Senior groups praised funding in the budget to raise the pay for nurse inspectors of nursing homes; and money for more “waiver’’ slots for older people to continue to live in their communities.
The Georgia Council on Aging also noted that Gov. Deal added $750,000 in funding for senior meal programs and $250,000 for a rate increase for meals providers, and added $766,000 for additional Adult Protective Service workers who investigate the abuse of the elderly and disabled.