State waiver proposal coming soon; hospital transparency rules unveiled

State officials are expected to have at least one health care waiver proposal ready for an agency board to consider in early November.

The waiver development is a central part of Gov. Brian Kemp’s strategy to improve Georgia health care. The state has a high uninsured rate, and its health rankings on various measures lag behind most other states.


The federal government can waive certain health system regulations in response to a state proposal, and a Georgia law enacted earlier this year authorized that such proposals be made. The state has hired Deloitte to help devise its waiver proposals.

As outlined by the new law, the two central waiver categories involve possibly adding members to the state’s Medicaid program, under a so-called 1115 waiver, and identifying possible changes to the health insurance exchange rules in Georgia, under a 1332 waiver.

Blake Fulenwider, chief health policy officer at the Georgia Department of Community Health, told GHN on Thursday that the group is working on both waiver proposals. He did not identify which of the two is more likely be presented Nov. 4.

Fulenwider spoke after a meeting of the agency’s board. At that meeting, members voted for initial adoption of the state’s regulations for implementing a new hospital transparency law.

Nonprofit hospitals across the state have posted financial data on their websites as required by the transparency law, which took effect Oct. 1. The implementation rules, written by staffers under the governor, were unveiled this week.

A big effect on Medicaid

The legislation authorizing the waiver requests, pushed hard by Kemp, passed the General Assembly earlier this year. It outlines a possible Medicaid change of including people up to 100 percent of the federal poverty level. That’s in contrast to the standard Medicaid expansion level of up to 138 percent of poverty.

Georgia is one of 14 states that have not expanded Medicaid under the Affordable Care Act. Democrats here have argued that a standard expansion, at 138 percent, would cover more people at a lower cost than the Kemp plan envisions. But the Kemp administration has ruled out a full Medicaid expansion. Republicans who control the state government have rejected expansion for years as too costly.

One state that Georgia officials have tracked closely is Utah.

Through a 1115 waiver, Utah increased Medicaid coverage to adults up to 100 percent of the poverty level, and introduced requirements for work and “community engagement’’ by people to get those benefits. (A federal court has struck down Medicaid work requirements in Arkansas and Kentucky.)

Utah received a traditional federal matching rate of 70 percent for those additional Medicaid members, but then sought a 90 percent match – up to now, reserved to states that fully expand Medicaid.

But federal health officials rejected Utah’s attempt to get the 90 percent match.

The 1332 waiver, meanwhile, could include a plan for a reinsurance program to stabilize premiums in the state’s insurance exchange.

Wisconsin, one of seven states to get reinsurance approvals, projected that average premiums will be 11 percent lower this year after a waiver OK.

Other individual insurance waiver ideas include adding health savings accounts, creating a different subsidy structure for help with premiums, and expanding the availability of catastrophic insurance plans.

Bill Custer, a health insurance expert at Georgia State University, said Thursday that the Utah proposal on a partial Medicaid expansion “was pretty close to what Georgia proposes.’’

But he added that under the 1332 waiver, a state theoretically could come up with a broad revamp of its health system, as long as the new system covered the same number of people and the state didn’t request a higher amount of federal funding.

“It’s a wide-open waiver,’’ Custer said.

Georgia could combine the two waiver ideas under the 1332 category, he said, by proposing to add people to Medicaid in conjunction with a major overhaul of health care. That move could let the state possibly get a different ruling than Utah on a federal match, he said.

More openness for hospitals

The draft regulations for the hospital financial disclosure law include definitions of terms and other provisions, with a goal to “give health care consumers the tools to make an informed decision in selecting a hospital.’’

The law will pertain to about 160 nonprofit hospitals, said Rachel King of Community Health.

The new law requires reporting of executive compensation and the financial holdings of hospitals, among other information.

The regulations also state that hospitals should post a link to its transparency information ‘’in a prominent location on the main page of its website.’’

Some hospital systems have links to this financial data that are positioned in smaller print in the lower regions of their websites, including Piedmont Healthcare, Emory Healthcare and Northside Hospital.

“The intent of these rules is to standardize the location and phrasing so the lay consumer knows where to find the information,’’ said Ryan Loke, chief health care policy adviser to Gov. Kemp.

When asked about this positioning regulation, Ethan James of the Georgia Hospital Association said hospitals wouldn’t object to putting the information in a prominent place on their websites.

An initial look at hospital websites shows some have not listed separately the salaries and fringe benefits of the top 10 highest-paid administrative positions in the hospital, as outlined under House Bill 321.

The transparency law also requires nonprofit hospitals to report data such as:

** Audited financial information, including charity care provided, on the hospital’s website

Hospital Outpatient Entrance Sign

** Financial information about a hospital’s affiliates and subsidiaries

** All property holdings of the hospital, including the location and size, purchase price and current use

** Ownership or interest the nonprofit hospital has in any joint venture, partnership, subsidiary, holding company or captive insurance company, and related financial information

** Any bonded indebtedness, outstanding loans or bond defaults

Failure to comply could halt state health care funding to a hospital, a potentially devastating penalty.