2016 GA Legislative Preview
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The document summarizes Georgians for a Healthy Future's policy priorities and advocacy opportunities for the 2016 Georgia legislative session. GHF's top priorities include closing Georgia's coverage gap by expanding Medicaid, setting and enforcing network adequacy standards for health plans, and ending surprise out-of-network medical bills. The document outlines the Georgia legislative process and opportunities for public advocacy, such as testifying at committee hearings or contacting legislators.
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2016 GA Legislative Preview
- 1. A Look Ahead at Health Care Policy in the 2016 Georgia Legislative Session Laura Colbert, MPH, CHES Meredith Gonsahn, MPH January 21, 2015
- 2. Georgians for a Healthy Future
- 3. Webinar objectives • At the end of the presentation, attendees should be able to: – State one of GHF’s legislative policy priorities – List a health care advocacy opportunity during the upcoming session – Find Georgia-specific resources about health care policy and advocacy
- 4. Georgia’s health care policy environment • Republican Governor • Republican Senate and House • ~30 health, insurance professionals • Evolving ACA sentiment • Struggling rural hospital system • Poor state health outcomes • America’s Health Rankings=40
- 6. Close Georgia’s coverage gap • 300,000 uninsured Georgians • 37% white, 36% black, 22% Hispanic • 60% ages 18 to 39 • Working in construction & trucking, food service, grocery stores, retail, education & child care
- 7. Economy •$8 billion per year in new economic activity •$220 million per year in new tax revenue When Georgia closes its coverage gap Everyone benefits People •Affordable health care access for 300,000 Georgians •Financial, health peace of mind Health Care Industry •$3 billion in federal money annually •Reduce uncompensated care costs for all hospitals •Help struggling rural hospitals Workforce •56,000 new jobs created
- 8. Georgia can map its own route to coverage. Georgia is in the Driver’s Seat! COVERAGE Georgia can hit the brakes at any time.
- 9. Set and enforce network adequacy standards for all health plans in Georgia • Insured consumers don’t always get what they pay for • What is an adequate network? • Ultimate power to set standards lies with Georgia Background GHF’s Role • Actively engaged in state policy development • Support the adoption of the NAIC 2016 Model Act with GA-specific modifications including quantitative standards • GA Department of Insurance enforcement
- 10. End surprise out-of-network bills • Surprise bills are just that! • Little to no protections exist for consumers • Georgia legislators are actively engaged in the issue Background GHF’s Role • Partnering with Georgia Watch to support legislation that holds consumers harmless
- 11. Ensure provider directory accuracy and usability • Provider directories are an important tool • Often, directories are inaccurate and hard-to- use • Current standards fall short of ensuring accuracy Background GHF’s Role • Actively engaged in state policy development • Support legislation that sets basic standards for provider directory accuracy and usability.
- 12. Remove unnecessary restrictions on consumer education and assistance • HB 943 (2014)—Health Care Freedom Act • Prohibits GA from setting up state-run health care exchange • Prohibits any state entity from participating in federal navigator program • Prohibits state entities from using resources to influence public opinion in support of Medicaid expansion Background GHF’s Role • GHF’s Getting Georgia Covered report • ID’ed confusion about HB 943 as a barrier to enrollment • GHF supports lifting this restriction .
- 13. Ensure access to quality health care services Medicaid and PeachCare • Medicaid: Children, very low- income parents & older adults, and people with disabilities • PeachCare: low- to middle- income children (up to 247% FPL) • Enrollment: -1.975 million Georgians (majority children) -12.7% between July 2013 & July 2015 Background GHF’s Role • Support and highlight policies that: • Facilitate continuous coverage and enrollment • Preserve and expand access to care • Improve health outcomes • Maintenance of the enhanced primary care provider reimbursement rate .
- 14. Prevent youth substance use disorders through utilizing SBIRT in Medicaid • Youth substance use disorders can be reduced through prevention • Screening, Brief Intervention, and Referral to Treatment (SBIRT) • “Turning on” Medicaid codes will promote greater use of SBIRT Background GHF’s Role • Somebody Finally Asked Me Campaign • Supports the activation of Medicaid codes for reimbursement of SBIRT services for youth.
- 15. Increase Georgia’s tobacco tax • Current tax= $0.37 • National average= $1.54 • For every penny increase in tax, state revenue increases by $5 million • Every 10% retail price of a pack of cigarettes = corresponding ~4% in cigarette consumption • among youth= 7% Background GHF’s Role • Suggested tax increase of $1.23 Resulting annual revenue increase of ~$600 million • Partnership formed with American Heart Association, American Lung Association, American Cancer Society, March of Dimes, others
- 17. Expected health care legislation • FY 2017 budget • Medicaid payment parity • Increased health coverage costs for non-certified school workers • HB 768—ABLE legislation • HB 722—medical marijuana production • HB 700—”Medical necessity” definition • Medical lien reform bill • Provider directories • Surprise out-of-network medical bills
- 20. Legislator sees need for new law or changes in existing law and decides to introduce bill 1. Legislator goes to Office of Legislative Counsel 2. Legislator files bill 3. Bill is formally introduced during period of first readings 4. Bill is assigned to a standing committee 5. In House only, 2nd reading on next legislative day (but bill is in committee) In Senate, 2nd reading comes after bill is reported favorably from committee
- 21. 6. Bill considered by committee. Author and other legislators may testify. If controversial, public hearings may be held. 7. Bill is reported favorably by committee and returned to Clerk or Secretary. 8. Clerk or Secretary prepares a General Calendar of Bills favorably reported from committee. 9. The Rules Committee of each house meets and from bills on General Calendar prepares a Rules Calendar for the next day’s floor consideration. 10.Presiding officer calls up bills from the Rules Calendar for floor consideration. 11.Once presiding officer calls bill up from Rules Calendar, Clerk or Secretary reads bill’s title (third reading). Bill is now ready for floor debate, amendments, and voting.
- 22. 12. After debate, main question is called and members vote. If bill is approved by a majority of total membership of that house, it is sent to the other house. 13. If second house passes bill, it is returned to house where bill was introduced. If changes are accepted…. If first house rejects changes and second house insists, a conference committee may be appointed. If committee report is accepted by both houses…. 14. Bill is enrolled and sent to Governor (if requested). Otherwise, all enrolled bills sent to Governor following adjournment sine die. 15. Governor may sign bill or do nothing, and bill becomes law. Governor may veto bill, which requires two-thirds of members of each house to override. 16. Act becomes effective the following July 1, unless a different effective date is provided in act.
- 23. Advocacy opportunities within the legislative process 1. Ideas for new law or changes to existing law 2. Committee hearings and votes – Provide testimony – Submit comments 3. Floor debates and votes – Contact your legislators
- 24. Contact your legislators In person Appointment at their office Get coffee with small group “On the ropes” (during legislative session) Phone Email To find out who your legislators are Healthyfuturega.org → “Get Involved” tab → Contact Your Legislator
- 25. How to talk to your legislators Tell them who you are, where you live, and why you are contacting them The “ask”—what do you want your legislator to do? Why is this issue important to you?
- 26. Share your story at healthyfuturega.org, “Get Involved” section Invite us to present in your community Sign the petition at Coverga.org Join a coalition Advocacy opportunities
- 27. Advocacy Resources • Georgians for a Healthy Future— healthyfuturega.org – Georgia Health Action Network – Consumer Health Advocates Guide – FB & Twitter: @healthyfuturega – Events— healthyfuturega.org/events • Getting What You Pay For policy forum • Feb 2, 8 am, Georgia Freight Depot • Georgia Health News— georgiahealthnews.com • Georgia General Assembly— legis.ga.gov • Families USA— familiesusa.org
- 28. References • Medicaid – www.medicaid.gov/medicaid-chip-program-information/by- state/georgia.html – dch.georgia.gov/sites/dch.georgia.gov/files/2015AnnualReport- 1.pdf – www.medicaid.gov/medicaid-chip-program-information/program- information/downloads/july-2015-enrollment-report.pdf
- 29. Thank you! Laura Colbert Director of Outreach & Partnerships lcolbert@healthyfuturega.org Meredith Gonsahn Health Policy Analyst mgonsahn@healthyfuturega.org 100 Edgewood Avenue, Suite 1015 Atlanta, GA 30303 Phone: 404-567-5016 Fax: 404-935-9885 info@healthyfuturega.org healthyfuturega.org FOLLOW & SHARE
Editor's Notes
- Mission & Vision: Our mission is to build and mobilize a unified voice, vision, and leadership to achieve a healthy future for all Georgians. Our vision is of a day in which all Georgians have access to the quality, affordable health care they need to live healthy lives and contribute to the health of their communities. Each year, we develop public policy priorities to move Georgia closer to this vision. Our three-pronged approach includes: 1) outreach, education & engagement with consumers and communities; 2) building and mobilizing coalitions; and 3) public policy advocacy. Outreach, Education & Engagement with Consumers & Communities: We organize community forums and workshops across Georgia to foster substantive local dialogue about health issues. We convene local leaders, medical providers, stakeholders, and consumers to discuss the most important health care issues facing them in their communities. Coalition Building: Leadership, Coordination, & Strategic Direction: We provide leadership, coordination, and strategic direction for a wide range of individual patient and consumer advocate organizations with missions to impact health care policy on behalf of their constituents. Engagement with Policymakers & Public Policy Advocacy: We serve as an important resource and source of information for policymakers who make decisions that impact the lives of Georgia health care consumers, and we use our strong and effective voice to advocate for public policy change that brings us closer to our vision of a day in which all Georgians have access to quality, affordable health care.
- Georgia can map a route to close the coverage gap in a way that works best for our state. Medicaid provides significant flexibility to states in the design of each state’s program. Georgia can create a program that works best for its budget, its health care system, and Georgians. Georgia can hit the brakes at any time. If the federal government ever fails to pay its share of the costs, Georgia can discontinue the expansion at no cost.
- Part One: The Georgia Health Care Freedom Act Section One of Part One of the Act prohibits the “state [or] any department, agency, bureau, authority, office, or other unit of the state [or] any political subdivision” from using “moneys, human resources or assets to advocate or intended to influence the citizens” in supporting or expanding the ACA.54 The Act specifically does not prohibit any state “officer or employee” from “advocating or attempting to influence public policy” as performing official duties, acting on personal time, or “providing bona fide educational instruction about the federal [ACA] in institutions of higher learning or otherwise.”55 The Act also specifies that it should not be construed as forbidding participation in Medicaid programs.56 Section One of the Act also prohibits the State or its subdivisions from establishing or changing any program, rule, policy, guideline, or plan, or from accepting federal money for the purposes of establishing a state run exchange.57 Finally, the section prohibits the State or its subdivisions—including the University of Georgia—from continuing its Navigator program once the grants that were in effect expire.
- Ensure access to quality health care services for Medicaid and PeachCare beneficiaries. The Medicaid and PeachCare for Kids programs provide health insurance for many of our state’s most vulnerable citizens, including low-income children, some low-income parents, and people with disabilities. Enrollment in these programs is growing as uninsured families explore health insurance options and find that their children meet the eligibility criteria. This presents an opportunity to bring down our state’s uninsured rate and improve access to care. Georgians for a Healthy Future will support policies that facilitate continuous coverage and enrollment, preserve and expand access to care, and improve health outcomes. Specifically, in 2015 Georgians for a Healthy Future will advocate for maintenance of the enhanced primary care provider reimbursement rate that was temporarily funded through federal dollars. Sustaining this enhanced reimbursement rate is necessary to ensure adequate provider networks.
- Increase the tobacco tax. Georgia has one of the lowest tobacco taxes in the country at just 37 cents per pack, which makes tobacco much more accessible to youth in Georgia than it is in other states. Increasing the tobacco tax to the national average will reduce youth smoking, addiction, and the burden of chronic disease in our state. Increasing Georgia’s tobacco tax will also bring much-needed revenue to our state which can be invested in health care coverage, access, and prevention.
- ABLE legislation HB 768 (Hawkins-27th) "Georgia Achieving a Better Life Experience (ABLE) Act" - Allows contribution of funds to tax-exempt accounts to pay for the qualified expenses of individuals with significant disabilities with onset before age 26, meet the conditions of disability as defined by SS, SSDI, or are certified under pending IRS rules. Income earned by the accounts and withdrawals for qualified disability expenses would not be taxable. Individuals may only have one ABLE account, and total annual contributions may not exceed $14,000. Aggregate contributions to an ABLE account would be subject to the State 529 account limit of $235,000. Withdrawals for non-qualified expenses would be subject to tax and a 10% penalty. Upon the beneficiary’s death, a claim for the remaining account assets may be used to reimburse Medicaid for payments made from the date the account was created. STATUS: House Hopper. The Senate Republican Caucus included the ABLE Act in its top priorities for the 2016 session. The Medical Association of Georgia has also adopted a Resolution supporting enactment of ABLE legislation. Disability advocates groups support this too. HB 722—medical marijuana production Similar to Minnesota’s system of marijuana cultivation & regulation Peake wants the state to issue up to six licenses for medical cannabis cultivators in Georgia. His bill also would open medical cannabis use to many more Georgians. People who have any one of 17 diagnoses -- including post-traumatic stress disorder, intractable pain, HIV and AIDS -- would be eligible for Georgia-made cannabis liquids or pills. The bill also aims to put more of the decisions about medical marijuana in the hands of the Georgia Department of Public Health, with its staff of medical professionals, rather than leaving medical questions to the state Legislature. The department would have the power to add diagnoses to the cannabis-eligible list and authorize different forms of medicine besides liquids and pills. Read more here: http://www.macon.com/news/local/politics-government/article53291655.html#storylink=cpy HB 700—PT, OT, Speech Therapy Associations, Voices for GA’s Children Sponsored by Bubber Epps (Dry Branch) -Bill is for kids who need PT/OT/Speech/Behavioral therapies on an on-going basis for habilitative or rehabilitative services -Applies to Medicaid Early Periodic Screening, Diagnostic, and Treatment (EPSDT) Program and Children’s Intervention Services (CIS) Program under DCH -Requires the Department of Community Health (DCH) and the care management organizations with which it contracts to enroll and maintain in their networks a sufficient number of pediatric providers of therapy services who are actively filing claims for therapy services to meet the needs of recipients in the federal in all areas of this state. -It clarifies the definition of Medically Necessity and states that Prescribed medically necessary services cannot be denied—Approval of services will be for 6 month. Current short approval times are hindering health of kids with chronic conditions who may not show much improvement. In that same vein, it requires CMOs to cover services that may not improve or cure a child’s condition, but does keep it from getting worse -Duplication of services—if similar services provided in community and at school, often CMOs deny coverage of one b/c providers are working with kids on same/similar therapy (ex: fine motor skills). Requires CMOs to cover all prescribed therapies, even if they are similar or duplicative. It also clarifies the information to be provided to the Medicaid recipient and DCH when services are denied. Status: House Health and Human Services Committee For more information: Tom Bauer If it were to pass, very good! Medical lien reform bill—Georgia Watch Beth Beskins—to be filed soon Brought to light thru recent GA state Supreme Court case: Kight v. MCG Health Hospitals can place a medical lien on the settlement (court case) after an injury accident (car, etc.) in anticipation of a settlement or payout. Often this is done before the hospital has even found out if the patient has health insurance. Sell medical lien to debt collector. Result that patient can be hounded by debt collectors for a debt that they may not even owe. This does damage to the victim/patient’s credit and financial life. GA Watch working with legislators to pass reforms that better protect consumers in situations like this. First, have to find out if patient have insurance. Must bill insurance. Only take out the lien on settlement, but may not pursue collection of that debt.
- Legislator sees need for new law or changes in existing law and decides to introduce bill Legislator goes to Office of Legislative Counsel. There, attorney advises legislator on legal issues and drafts bill. Legislator files bill with Clerk of the House or Secretary of the Senate. On legislative day after filing, bill is formally introduced. In chamber, bill is read during period of first readings. Immediately after first reading, presiding officer assigns bill to a standing committee In House only, on next legislative day, Clerk reads bills title (second reading) in chamber, although actually bill is now in committee. In Senate, second reading comes after bill is reported favorably from committee