State Legislative News

Georgia Moving Forward on Health Insurance Exchanges

An advisory panel appointed by Gov. Nathan Deal has recommended that the state move forward to create health insurance exchanges aimed at providing Georgians with a wider range of affordable coverage options.

The Georgia Academy supports this position, so that Georgians can shape how insurance will be offered to our patients in the future. The panel is currently working on legislation to authorize the exchanges in the 2012 session of the Georgia General Assembly. For more information, visit http://healthcarereform.georgia.gov.

October 31st, 2011

Report 9 & State Legislative Wrap Up - May 23, 2011

The Georgia legislative session has concluded the first of its two year session. However, Governor Deal will recall the Legislature on August 15th to deal with redistricting. It is not expected that any other issues will be addressed during the special session.

I. GAFP Legislative Priorities

Oppose Physician Cuts for Medicaid - Ongoing

The Governor signed his 2012 budget that will begin July 1, 2011. There is a .5 percent cut to physicians who accept Medicaid patients. The GAFP, along with other physician groups, worked vigorously during the session and was able to reduce cuts significantly. Last summer, former Governor Perdue was considering recommending a 12-14 percent cut. Governor Deal proposed a 1 percent cut and the State House restored half of that cut. GAFP leadership is continuing to work with senior staff at the Governor's office to discus reversing the cut in the amended budget for 2012 as well as seeking for an increase in the 2013 budget.

Expand Patient Centered Medical Home - Ongoing

No current legislation is pending on implementing the medical home. However, Governor Deal has indicated an interest in the PCMH as he looks at new models of care for State Health Benefit Plan (state employees) and Medicaid Managed Care.

Support Prescription Drug Monitoring Act/Narcotic Drug Registry - Success!

The GAFP endorsed and supported Senate Bill 36, the Prescription Monitoring Act that was passed and signed into law on May 13th and will be effective on July 1, 2011.

Scope of Practice Review - Success!

The GAFP supported House Bill 303 that gave both physician assistants and nurse practitioners authority to sign certain health certificates under a physician's delegated authority. This bill was signed into law on May 11th.

No other scope of practice initiatives were successful for the 2011 session.

Support Implementation of the Affordable Care Act - Ongoing

The GAFP continues to support both public and private initiatives to support implementation of the Affordable Care Act in Georgia. GAFP supported the bill that would have created a Health Exchange Initiative (House Bill 476). Although this bill failed, the Governor will create a Health Exchange through his executive authority and the GAFP will ask to be a part of that initiative.

Board Secretary Wayne Hoffman, MD is also on the Insurance Commissioner's Steering Committee for Medical Providers that will be asked to review potential regulations that will need to be created to support the ACA.

The GAFP Board of Directors has approved the following tenets as it relates to entities that are created to assist with ACA implementation:

Commission will convene key state agencies, officials, policymakers, stakeholders, and consumers to develop a comprehensive plan and timetable to implement the ACA in Georgia and make recommendations to state agencies.
Commission will include appropriate primary care physician representation to include at least one family physician.
Commission will hold regular meetings open to the public that include a process for public comment.
Commission will act as a liaison between Georgia and the federal government on health reform issues.

II. Other GAFP Legislative Actions

The GAFP Board of Directors also made the following actions on the legislation below:

Oppose House Bill 278 - Disallow Medical Removal of Hydration/Nutrition

Background: The GAFP opposes House Bill 278 that would disallow medical removal of hydration or nutrition unless the patient has prior written health care directives. The GAFP has opposed this type of language during the last legislative session as it relates to mandating Physician Orders for Life Sustaining Treatment Forms. Multiple end-of-life illnesses would be exacerbated with forced feeding and nutrition. There is also concern about legislating appropriating medical activities.

Oppose Senate Bill 210 - Physician Liability for Counseling Women on Abortion

Background: Senate Bill 210 is entitled, Torts; provide for liability for violations of laws relating to abortion; definitions; wrongful death of an unborn child. See attached current version of the bill and a staff review of the bill. GAFP past policy on bills related to abortion are to oppose any abortion bill if it criminalizes medical procedures that are legal and is a standard of care taught in medical school. There is a concern that this would dramatically increase malpractice insurance for any physician who councils women related to pregnancy and could affect our current tort reform law. The ability for any person or group to file a lawsuit for homicide related to abortion could have long term effects and damages on any physician or facility that performs the procedure.

III. Other Health Care Legislation that Passed and was Signed into Law

Special Advisory Commission on Mandated Health Insurance Benefits

SB 17 by Sen. Tim Golden (R-Valdosta) creates the Special Advisory Commission on Mandated Health Insurance Benefits to advise the Governor and the General Assembly of the social and financial impact of current and proposed mandated health insurance benefits. The commission shall be composed of 16 members and 3 ex-officio members as prescribed by section 1(a) of the bill. The commission is required to complete evaluations of existing mandates no later than December 12, 2012. The Commission will provide assessments of all newly proposed mandates going forward from effective date. This bill was signed into law on May 11th and will be effective on July 1, 2011. One family physician is required, by law, to be a part of this commission.

Offering Insurance Across State Lines

Mandating Fingerprinting for Nurse Licensure

HB 99 by Rep. Valerie Clark (R-Lawrenceville) mandates fingerprint background checks on all nurses before they are licensed. Governor Deal signed this bill into law on May 11th and it will be effective on July 1, 2011.

Prompt Pay Extended to Self-funded Health Plans

HB 167 by Rep. Steve Davis (R- McDonough) provides extended the state's prompt-pay law to cover insurers administering self-funded health plans; reduces the number of individuals necessary to form a group to provide a group insurance policy with respect to associations, labor unions, and multiple employers in the same industry. Includes employees with income reported on an IRS 1099 to the number of people allowed to participate in a multiple employer welfare arrangement. This bill, heavily supported by the Medical Association of Georgia, was signed into law by the Governor on May 12th and will be effective on July 1, 2011.

Establishment of a Department of Public Health

Report 8 - April 11, 2011

The General Assembly was in recess last week; however budget conferees met throughout the week to discuss final provisions to the FY 2012 budget. Meanwhile, House and Senate leaders continued to work on the omnibus tax reform legislation. A new version of the tax reform legislation is expected to be announced when lawmakers return on Monday, April 11.

Lawmakers will reconvene this week, Monday, April 11 for day 38, Tuesday, April 12 for day 39 and then stand adjourned on Wednesday, April 13. The legislature is scheduled to adjourn sine die on Thursday, April 14. In the final days of the 2011 legislative session the legislature is expected to address the following issues:

Tax Reform

FY 2012 Budget

Sunday Sales

Immigration Reform

Governor Deal has already announced the need for a special session to be dedicated solely to redistricting. That session is expected to begin in late August or early September.

GAFP Leadership Weighs in on Proposed Budget Cuts

Board Chair, Dr. Leonard Reeves, was quoted in an article (and radio news program) from Georgia Public Radio:

Doctors Worry About Medicaid Reimbursement Reduction

By Jeanne Bonner - Georgia Public Radio

Some Georgia doctors are girding themselves for another reduction in the Medicaid reimbursement rate. Lawmakers proposed the cut as part of the 2012 budget. Doctors worry it may further drive down their numbers from rural areas.

The proposal would cut doctor reimbursement rates with patients on the government-run healthcare program by a half of a percent. The reduction would come on top of other cuts in the past 10 years. Medicaid serves low-income children, senior citizens and people with disabilities.

The Georgia Academy of Family Physicians says, many doctors might stop accepting Medicaid, reduce staff, delay hiring or close their practices as a result. Dr. Leonard Reeves, the academy's chair, says this is especially so in rural areas, where doctors see higher numbers of Medicaid patients.

"Family physicians, primary care physicians, who are so rooted in their communities will more than likely stay there," Reeves said. "But new physicians will not go there, and you're just going to see the shortage in the rural areas get worse."

Separately in the budget, lawmakers plan to borrow $100 million from Medicaid to fund other items. Tim Sweeney, a healthcare analyst with the Georgia Budget and Policy Institute, said that may weaken the program's viability in the future. He said, paired with the half a percent reduction, the development is just one more blow to Medicaid.

"The importance of the half a percent cut can't be seen in a vacuum," Sweeney said. "It's not that we're going from 100 percent of their costs to 99.5 percent of their costs. It's really sort of the culmination of years and years of not being able to increase provider reimbursement rates."

Some lawmakers say they know they can't continue raising Medicaid. They will have to pass the budget next week when the legislative session ends.

Twelve Month Eligibility for Medicaid Children - In Jeopardy

As we move into the final days of the legislative session, an important change to the Medicaid program is in jeopardy of remaining in the state budget. Members of the Georgia House of Representatives have included funds to move from a 6-month to a 12-month certification process for kids enrolled in Medicaid, and the State Senate has also expressed support for this change.

A move to 12-month certification would result in continuity of coverage and improved access to health care while reducing the administrative burden and helping Georgia qualify for federal bonus dollars. However, there is concern that now this important policy change is in question.

Recent Action was taken on the Following Bills:

House Bill 214 would move the Division of Public Health out of the Department of Community Health and establish a new, independent agency, the Department of Public Health, implementing the recommendation of the Public Health Commission. The new stand-alone agency would operate on the same budget as the Division of Public Health and provide Georgians a nimbler and more efficient public health agency with a clear focus on prevention and population-level health. The bill was passed by the House and the Senate and now moves to the Governor for his signature.

House Bill 476 (pulled from the calendar on Crossover Day) would have established the Georgia Health Exchange Authority, the governance body for Georgia's health insurance exchange. Under the Affordable Care Act, Georgia recently received a $1 million grant from the Department of Health and Human Services to begin planning for a health insurance exchange. HB 476 also would have created an Advisory Committee to make policy recommendations to the exchange governing board and the Governor by November 15, 2011 for next steps. The bill was pulled under pressure from tea party activists just prior to Crossover Day and is no longer viable this Session. Governor Deal has indicated he will move forward with an Advisory Committee.

Senate Bill 17 would establish a Special Advisory Commission on Mandated Health Insurance Benefits to study the social and financial impact of current and proposed health insurance benefit mandates and providers. The bill has passed the Senate and the House and now heads to the Governor for his signature.

Senate Bill 63 would enact a Georgia Medical Assistance Fraud Prevention Program utilizing smart card technology to verify identification of Medicaid recipients, first directing the Department of Community Health to develop and implement a pilot program. Implementing the bill could present barriers to accessing care, and the methodology proposed has not been proven to be a successful method to target fraud within the Medicaid system. Further, there has been some controversy over a vendor that has been lobbying for the bill. SB 63 has passed the Senate and is now in the House Health and Human Services Committee.

Report 7 - April 1, 2011

The Legislature is scheduled to be in recess next week (April 4-8) and then finish their 40 days by working April 11, 12, and 14). *Schedule subject to change. Governor Deal has already announced the need for a special session to be dedicated solely to redistricting. That session is expected to begin in late August or early September.

State Revenue

State revenues for the first eight months of this fiscal year are running

9.2 percent ($853 million) ahead of the FY 2010 revenue collections. More than $226 million of the growth is accounted for by a decrease in the number of refunds distributed. Discounting fewer refunds distributed, actual revenue growth is 4.6 percent. The FY 2010 revenue estimate is based on 4 percent revenue growth. It appears likely that FY 2010 will result in a surplus of between $300 and $400 million. Surplus funds will be used to begin to replenish the Revenue Shortfall Reserve.

Georgia Academy to Oppose Senate Bill 210 The Legislative Committee recommended to the Executive Committee to oppose Senate Bill 210 entitled, "Torts; provide for liability for violations of laws relating to abortion; definitions; wrongful death of an unborn child.

The current version of SB 210 can be found online here: http://www.legis.ga.gov/legislation/en-US/displaybill.aspx?BillType=SB&billNum=210

GAFP past policy on bills related to abortion are to oppose any bill if it criminalizes medical procedures that are legal and is a standard of care taught in medical school.

Discussion about the bill centered around three main themes:

1. The bill is poorly worded and vague;

2. There is a concern that this would dramatically increase malpractice insurance for any physician who councils women related to pregnancy and could effect the current tort reform law; and; 3. The ability for any person or group to file a lawsuit for homicide related to abortion could have long term effects and damages on any physician or facility that performs the procedure or other medical terminations.

State Budget

The Georgia Senate adopted their version of the FY 2012 state budget this week by a vote of 47-4. The House disagreed to the Senate amendments and both chambers appointed a committee of conference. The House and Senate budget conferees are the following: House Speaker Pro Tempore Jan Jones (R-Alpharetta), House Majority Leader Larry O'Neal (R-Bonaire), House Appropriations Chairman Terry England (R-Auburn), Senate Appropriations Chairman Jack Hill (R-Reidsville), Senate Natural Resources Chairman Ross Tolleson and Rene Unterman, Senate Health & Human Services Chair.

The Senate version of HB 78:

• The Senate agreed to the House restoration of .5 percent of the proposed 1 percent reduction for physician Medicaid reimbursements. The total fiscal impact of one percent proposal is $2.4 million in state funds and a total of $4.8 million;

• The Senate agreed to the House recommendation of the budget. The budget includes a controversial proposal to offset a $250 million shortfall in the state health insurance plan by imposing a 20 percent increase of health premiums for state employees and teachers.

Recent Action Was Taken on the Following Bills:

SB 17 by Sen. Tim Golden (R-Valdosta) creates the Special Advisory Commission on Mandated Health Insurance Benefits to advise the Governor and the General Assembly of the social and financial impact of current and proposed mandated health insurance benefits. The commission is required complete evaluations no later than December 12, 2012. The Senate Insurance & Labor Committee unanimously adopted SB 17 by committee substitute on Thursday, February 10, 2011. The bill passed the Senate 32-16 on February 24th and was assigned to the House Insurance Committee. SB 17 was passed by the House on March 30.

SB 36 by Sen. Buddy Carter (R- Savannah) provides for the establishment of a program to monitor the prescribing and dispensing of Schedule II, III, IV, and V controlled substances and provides for the establishment of an Electronic Database Review Advisory Committee. The Senate HHS Health Care Delivery Subcommittee voted to adopt the bill on Wednesday, February 9, 2011. The Senate HHS Committee favorably reported the bill on February 17, 2011. The bill passed the full Senate 49-6 on February 23rd and was referred to the House Judiciary Non-Civil Committee for review. SB 36 was passed in the House on March 31 by a vote of 117-45. GAFP supports this bill.

SB 93 by Sen. Buddy Carter (R- Savannah) changes certain provisions relating to Schedule I, III, IV, and V controlled substances. The Senate adopted this bill on March 16 by a vote of 51-0. The House Committee favorably reported this bill on March 28.

SB 135 by Sen. David Shafer (R- Duluth) provides that no person other than a doctor of chiropractic may render chiropractic services. This bill passed out of the Senate on March 14 by a vote of 51-2. Georgia Osteopathic Medical Association is insuring that this bill will not affect the practice of a physician with a osteopathic medical degree.

HB 47 by Rep. Matt Ramsey (R-Peachtree City) authorizes insurers to offer individual accident and sickness insurance policies in Georgia that have been approved for issuance in other states. HB 47 differs from last year's version of the bill by allowing Georgia domiciled insurers to offer all products approved for sale in the state. HB 47 also differs from last year's bill with the inclusion of NAIC compliance standards. The House Insurance Health & Life Subcommittee favorably reported the bill to full committee on Tuesday, February 15, 2011. The full House Insurance Committee favorably reported the bill on February 24, 2011. The House overwhelmingly voted 111-47 to pass the measure. The bill was sent to the Senate Committee on Insurance and Labor on March 11.

HB 99 by Rep. Valerie Clark (R-Lawrenceville) mandates fingerprint background checks on all nurses before they are licensed. The full House passed the bill 156-9 on February 17, 2011 and the bill was adopted in the Senate on March 29 by a vote of 52-0.

HB 167 by Rep. Steve Davis (R- McDonough) provides extended the state's prompt-pay law to cover insurers administering self-funded health plans; reduces the number of individuals necessary to form a group to provide a group insurance policy with respect to associations, labor unions, and multiple employers in the same industry. Includes employees with income reported on an IRS 1099 to the number of people allowed to participate in a multiple employer welfare arrangement. The House adopted this bill on March 14 by a vote of 162-9. The Senate Judiciary Committee adopted HB 167 on March 30.

HB 214 by Rep. Mickey Channell (R- Greensboro) establishes the Department of Public Health. It provides for a Board Appointments and a Commissioner. The Department of Public Health will combine the previous functions of the Division of Public Health and the Office of Health Improvement of the Department of Community Health. This bill was referred to the House Committee on Health and Human Services. The committee favorably reported the bill on February 24, 2011. The House passed the bill on March 3rd, and it was referred to the Senate Committee on Health and Human Services. The Senate adopted HB 214 on March 31 by a vote of 46-7.

HB 275 by Rep. Mike Cheokas (R- Americus) - defines what a caregiver is and allow as a caregiver to be the recipient of a do not resuscitate order. This bill standardizes the form used for a do not resuscitate order and allows the procedure to take place in care and nursing homes. The House adopted this bill on March 14. The bill was sent to the Senate Committee on Health & Human Services. The Senate adopted HB 275 by a vote of 47-0 on March 28.

HB 303 by Rep. Sharon Cooper (R-Marietta) allows the board of Community Health to regulate Physicians assistants and broadens their scope of practice. This bill was adopted by the Senate Committee on Health & Human Services on March 31.

HB 343 by Rep. Amy Carter (R- Valdosta) provides for crisis stabilization units for the purpose of providing psychiatric stabilization or detoxification services. The full House adopted this bill on March 14 by a vote of 150-5. The Senate Committee on Health and Human Services adopted this bill on March 31.

Report 6 � March 21, 2011

The Legislature is scheduled to work three days this week � March 21-23. *Schedule subject to change.

Grassroots Needed to Alert State Senators on Looming Medicaid Cuts

GAFP leaders have asked the membership to contact their State Senator and request that they restore the cut in Medicaid payment to physicians in the State FY 2012 budget. You can link directly to the letter from here:http://capitol.aafp.org/aafp/state/main/?state=GA&view=myofficials

Medical students have also been asked to call Senate leadership and request that the cut be restored to insure that upon graduation they will be able to stay in Georgia and treat Medicaid patients. We appreciate all of your efforts on behalf of the Georgia Academy and our patients.

Bump It Up a Buck to Launches Petition Drive

Voters throughout Georgia who support a $1 bump in the per pack tax on cigarettes have been asked to show state leaders how they feel thanks to a 48-hour, online petition drive. We urge you to show your support and sign the petition!

Accessible via www.facebook.com/BumpItUpaBuck or www.BumpItUpaBuck.org, the petition will help leaders understand that the people of Georgia think it is wrong for the state to have a tax rate so low that each year it leads to 11,400 kids in the state starting to smoke and 10,500 people suffering premature, smoking-caused deaths.

Experts say a $1 bump will generate an estimated $350 million per year in revenue at a time when the state is spending $537 million of its Medicaid budget on health care for people suffering from smoking-caused illnesses. Smoking causes Georgia's employers to experience $3.29 billion in productivity losses annually.

GAFP Takes Stand on Several Bills of Interest

Last week, the Legislative Committee recommended that the Executive Committee take action on several bills of interest to the GAFP.

The GAFP will support legislation to create a Commission for Transparency and Efficiency in Implementing the Affordable Care Act (ACA) framed by the following principles:

Commission will convene key state agencies, officials, policymakers, stakeholders, and consumers to develop a comprehensive plan and timetable to implement the ACA in Georgia and make recommendations to state agencies.
Commission will include appropriate primary care physician representation to include at least one family physician.
Commission will hold regular meetings open to the public that include a process for public comment.
Commission will act as a liaison between Georgia and the federal government on health reform issues.

One of the legislative priorities approved by the GAFP Board of Directorsis to:
Remain a willing partner to serve as a state leader in the implementation of the Affordable Care Act in Georgia whether it is through regulation or legislation.

The GAFP Congress of Delegates approved the following resolution:
The GAFP will collaborate with professional and community partners to advocate for the establishment of a Georgia Health Reform Implementation Task Force.

Rationale for a State Commission to support implementation of the Affordable Care Act:

To reform our health system in the way that works best for Georgia within a federal framework that allows considerable flexibility.
To ensure a transparent process and a systematic mechanism for public, consumer, and stakeholder input (*including primary care physicians).
To allow Georgia to adopt a cohesive, strategic approach to implementing federal health reform.
To facilitate information sharing between Georgia policymakers, agency officials, and stakeholders.
To systematically address cross-cutting issues that fall under the purview of multiple state agencies.
To assure a smooth transition to the new health care environment for Georgia consumers, providers, industry stakeholders, and state and local government.
To maximize federal funding opportunities available through the ACA to make structural improvements to our health care delivery system, expand our health care workforce, and transform communities through prevention and public health.

The GAFP will oppose House Bill 278 that would disallow medical removal of hydration or nutrition unless the patient has prior written health care directives.
Background: The GAFP has opposed this type of language during the last legislative session as it relates to mandating Physician Orders for Life Sustaining Treatment Forms. Multiple end-of-life illnesses would be exacerbated with forced feeding and nutrition. There is also concern about legislating appropriating medical activities.

Report 5 � March 16, 2011

The General Assembly convened this week and is meeting March 14 (Day 29) and March 16 (Day 30). Note that Day 30 is the traditional "Cross Over" day where legislative rules require all bills to have been passed by one of the legislative body and "crossed over" to the other body to be considered for final consideration for the 2011 legislative session. Next week's legislative schedule (subject to change) would have the legislature working on March 21 (Day 31), March 22 (Day 32), and March 23 (Day 33). Georgia General Assembly can meet up to 40 legislative days annually.

Tobacco Tax Coalition Seeks GAFP Members to Attend Press Conference

To continue to keep pressure on the state legislature and encourage them to increase the tobacco tax, the Tobacco Tax Coalition is planning a press conference at the Capitol on Wednesday, March 23 at 10:00 am.

They are requesting as many physicians and medical students to attend as possible and to wear your lab coats. The Coalition will be presenting a petition from Georgia citizens asking the legislature to increase the tobacco tax. Wednesday, March 23 coincides with National Kick Butts Day.

If you are available to attend the press conference that will last an hour, please email Fay Brown at fbrown@gafp.org. She will have the Coalition media consultant contact you regarding logistics and potential media interviews.

House Passes FY' 12 State Budget � Restores Half of Medicaid Cut

On Friday, March 11th, the House of Representatives adopted the $18.25 million FY 2012 budget by a vote of 132-33. The House proposed significant changes to Governor Deal's original budget proposal including the following:

1. Restores funding for the cut that would have eliminated optional benefit coverage for adult vision, dental, and podiatry services.

2. Reduces the 1 percent provider cut, including physicians, which already excluded hospitals and community based services, to a .5 percent cut.

3. Increases savings generated by national drug company settlements and also associated with the Accountable Care Act changes to pharmacy rebate policy.

4. Reflects $7.8 million in state funds savings associated with a Medicaid fraud settlement announced in February 2011.

5. Funds an additional 33 slots in the Independent Care Waiver Program which reduces the current waiting list by 20 percent. Note � no new slots have been added to the program since FY 2009.

6. Effective January 1, 2012 transitions Medicaid eligibility from 6 month reviews to 12 month reviews while still requiring clients to report changes in their status outside of the review time. The estimated total funds cost is $26.6 million.

The House version of the budget also includes a controversial proposal to offset a $250 million shortfall in the state health insurance plan by imposing a 20 percent increase of health premiums for state employees and teachers.

GAFP Supports House Bill 476 to Establish a Health Exchange Authority

The GAFP Executive Committee approved a recommendation by the Legislative Committee to support House Bill 476. House Bill 476 will establish the Georgia Health Exchange Authority to enact rules and regulations to facilitate the implementation of qualified health plans in the individual market in Georgia and to provide for the establishment of the Small Business Health Options Program Exchange for qualified health plans for the small business market.

This bill will allow the Governor to have a mechanism to begin organizing Georgia for the implementation of federal health reform. The Exchange does allow for citizen appointments and the GAFP will work to have family physician representation.

Health Care Bills � Of Interest

SB 17 by Sen. Tim Golden (R-Valdosta) creates the Special Advisory Commission on Mandated Health Insurance Benefits to advise the Governor and the General Assembly of the social and financial impact of current and proposed mandated health insurance benefits. The commission is required complete evaluations no later than December 12, 2012. The Senate Insurance & Labor Committee unanimously adopted SB 17 by committee substitute on Thursday, February 10, 2011. The bill passed the Senate 32-16 on February 24th and was assigned to the House Insurance Committee. The bill was adopted on March 1.

SB 36 by Sen. Buddy Carter (R- Savannah) provides for the establishment of a program to monitor the prescribing and dispensing of Schedule II, III, IV, and V controlled substances and provides for the establishment of an Electronic Database Review Advisory Committee. The Senate HHS Health Care Delivery Subcommittee voted to adopt the bill on Wednesday, February 9, 2011. The Senate HHS Committee favorably reported the bill on February 17, 2011. The bill passed the full Senate 49-6 on February 23rd and was referred to the House Judiciary Non-Civil Committee for review.

SB 81 by Sen. Buddy Carter (R- Savannah) provides for mental and physical examinations of licensees or applicants for the practice of pharmacy and for applicants for registration as pharmacy technicians. The Senate passed this bill on March 10.

HB 47 by Rep. Matt Ramsey (R-Peachtree City) authorizes insurers to offer individual accident and sickness insurance policies in Georgia that have been approved for issuance in other states. HB 47 differs from last year's version of the bill by allowing Georgia domiciled insurers to offer all products approved for sale in the state. HB 47 also differs from last year's bill with the inclusion of NAIC compliance standards. The House Insurance Health & Life Subcommittee favorably reported the bill to full committee on Tuesday, February 15, 2011. The full House Insurance Committee favorably reported the bill on February 24, 2011. The House overwhelmingly voted 111-47 to pass the measure.

HB 167 by Rep. Steve Davis (R- McDonough) provides extended the state's prompt-pay law to cover insurers administering self-funded health plans; reduces the number of individuals necessary to form a group to provide a group insurance policy with respect to associations, labor unions, and multiple employers in the same industry. Includes employees with income reported on an IRS 1099 to the number of people allowed to participate in a multiple employer welfare arrangement. On Monday, March 14, HB 167, passed the House of Representatives by a vote of 162 to 9 and moves on to the Senate for consideration.

HB 214 by Rep. Mickey Channell (R- Greensboro) establishes the Department of Public Health. It provides for Board Appointments and a Commissioner. The Department of Public Health will combine the previous functions of the Division of Public Health and the Office of Health Improvement of the Department of Community Health. This bill was referred to the House Committee on Health and Human Services. The committee favorably reported the bill on February 24, 2011. The House passed the bill on March 3rd, and it was referred to the Senate Committee on Health and Human Services.

March 16, 2011

Report 4 - March 8, 2011

The General Assembly convened this week meeting all five business days. They are currently scheduled to meet on Monday, March 14th (29th legislative day) and Wednesday, March 16th (30th legislative day). Note that Day 30 is the traditional “Cross Over” day where legislative rules require all bills to have been passed by one of the legislative body and “crossed over” to the other body to be considered for final consideration for the 2011 legislative session.

*Subject to change.

Increasing Tobacco Tax Will Increase Revenue and the Health Status of Georgians

Last week, the GAFP membership was asked to contact their state legislators by email, fax, or letter requesting that they support increasing the tobacco tax during the 2011 legislative session.

The letter said in part:

Conspicuously absent from the budget conversation however, is one of the largest drains on our budget: Tobacco. At just thirty-seven cents per pack, Georgia has the 48th lowest cigarette tax in the country, which nets the state about $200 million per year. Yet Georgian taxpayers spend nearly $500 million per year treating tobacco-related disease through the state Medicaid program alone; A $300 million per year loss. I call that a Medicaid tax. But even more important than the financial costs are the human costs. Everyday, I see the devastating toll that tobacco-related disease takes on families. I am a family physician.

Raising Georgia’s tobacco tax by $1.00 per pack would yield more than $400 million per year in new revenue—and still leave us below the national average. And are doctors and medical providers less important than a cheap pack of cigarettes?

My prescription for legislators, increase the tobacco tax by at least $1.00.

To date, over 75 GAFP members have written to 150 legislators asking for their assistance in increasing the tobacco tax. If you would like to send a similar letter, you can find it on the AAFP/GAFP speak out page:

http://capitol.aafp.org/aafp/state/main/?state=GA&view=myofficials

Budget – Moving Out of the House This Week

GAFP Legislative Committee Chairman Rick Wherry, MD testified on behalf of the GAFP on February 28th asking the Subcommittee on Health Care Appropriations to restore the cut to physicians rates in Medicaid, add a state tax credit for primary care physicians who precept Georgia medical students, and to restore the cut to the family medicine capitation rate for residents.

A portion of his testimony is below:

Please help me – by restoring the cut – so that I can continue to make the case to my colleagues that brighter days are ahead and for them to continue to take Medicaid patients – both children and adults who qualify for Medicaid benefits.

As you know, when there aren’t adequate physicians to care for the Medicaid population – they end up in the Emergency Room. The recent growth in the use of emergency departments is costly, undesirable, and unnecessary. This trend is partly due to a growing proportion of people who lack a usual source of care. This group is increasingly likely to rely on Emergency Rooms for their health care needs compared with those who have a usual source of care. This isn’t good medicine, good business, or good policy.

Health Care Bills – Of Interest

SB 6 by Sen. Judson Hill (R-Marietta) creates the Georgia Individual High Risk Reinsurance Pool. One quarter of one percent of the Georgia premium tax is designated to fund the high risk pool.

SB 20 by Sen. Judson Hill (R-Marietta) prohibits any department or agency from implementing any provision of federal health care reform legislation unless the department or agency provides a certain report to the General Assembly and the General Assembly authorizes such implementation by statute.

SB 29 by Sen. Judson Hill (R- Marietta) to opt out of funding certain abortions through certain qualified health plans. This bill was referred to the Senate Committee on Insurance and Labor.

SB 63 by Sen. John Albers (R- Atlanta) provides for the adoption of a medical assistance fraud prevention program, outlines how the Department of Community Health will administer the program and provides for a pilot program with the participation of the Department of Human Services. This bill was referred to the Senate Committee on Health and Human Services.

SB 67 by Sen. Buddy Carter (R-Savannah) prohibits the use of the title "nurse" unless licensed as a registered professional nurse or a licensed practical nurse. This bill was referred to the Senate Committee on Health and Human Services.

B 93 by Sen. Buddy Carter (R- Savannah) changes certain provisions relating to Schedule I, III, IV, and V controlled substances. This bill was referred to the House Committee on Health and Human Services.

SB 135 by Sen. David Shafer (R- Duluth) provides that no person other than a doctor of chiropractic may render chiropractic services. This bill was referred to the Senate Committee on Health and Human Services.

SB 149 by Sen. William Ligon (R- St. Simons) provides for the filing of a proposed complaint of a medical malpractice claim against a medical assistance provider and amends Article 2 of Chapter 9 of Title 9 of the O.C.G.A., relating to medical malpractice arbitration, so as to include actions for medical malpractice in the definition of a medical malpractice claim for which arbitration is authorized. It also amends Chapter 9 of Title 33 of the O.C.G.A., relating to regulation of rates, underwriting rules, and related organizations, so as to require that medical malpractice insurers provide a reduction in premium for medical malpractice policies under certain circumstances. This bill was referred to the Senate Committee on Judiciary.

SR 140 by Sen. Greg Goggans (R-Douglas) proposes an amendment to the Constitution so as to annually dedicate from license tag fees collected $10.00 per each vehicle registered in this state for the purpose of funding trauma care. This bill was referred to the Senate Committee on Finance.

SR 153 by Sen. Barry Loudermilk (R- Cartersville) seeks to amend the constitution in order to change the definition of a “person” in order to make abortions illegal. This resolution was referred to the Senate Committee on Rules.

HB 47 by Rep. Matt Ramsey (R-Peachtree City) authorizes insurers to offer individual accident and sickness insurance policies in Georgia that have been approved for issuance in other states. HB 47 differs from last year’s version of the bill by allowing Georgia domiciled insurers to offer all products approved for sale in the state. HB 47 also differs from last year’s bill with the inclusion of NAIC compliance standards. The House Insurance Health & Life Subcommittee favorably reported the bill to full committee on Tuesday, February 15, 2011. The full House Insurance Committee favorably reported the bill on February 24, 2011. It now awaits action by the House Rules Committee. The Georgia Chamber of Commerce is on record in support of the measure.

HB 99 by Rep. Valerie Clark (R-Lawrenceville) mandates fingerprint background checks on all nurses before they are licensed. This bill was referred to the House Committee on Health and Human Services. The HHS committee favorably reported the bill on February 3, 2011. The full House passed the bill 156-9 on February 17, 2011.

HB 121 by Rep. Doug McKillip (R- Athens) – no contract for healthcare policy or disability income policy that contains a provision allowing the health carrier or insurer to interpret the provisions on the contract shall be upheld if it is inconsistent with the laws of the state. This bill was referred to the Committee on Insurance.

HB 132 by Rep. Ben Watson, (R-Savannah) the “Medical Food Equity Act,” will mandate that all insurance companies licensed in the state provide coverage and reimbursement for the medical foods used to treat inborn errors of metabolism. This Bill was referred to the House Committee on Insurance.

HB 145 by Rep Matt Hatchett (R-Dublin) includes the practice of dry needling to the definition of physical therapy. This bill was referred to the House Committee on Health and Human Services. The committee favorably reported the bill on February 10, 2011. The full House passed the bill 164-1 on February 17, 2011.

HB 167 by Rep. Steve Davis (R- McDonough) provides extended the state's prompt-pay law to cover insurers administering self-funded health plans; reduces the number of individuals necessary to form a group to provide a group insurance policy with respect to associations, labor unions, and multiple employers in the same industry. Includes employees with income reported on an IRS 1099 to the number of people allowed to participate in a multiple employer welfare arrangement. The House Insurance Health & Life Subcommittee favorably reported the bill to full committee on Thursday, February 17, 2011. The Medical Association of Georgia testified in support of the bill. The America’s Health Insurance Plans (AHIP) and the Georgia Chamber of Commerce testified in opposition to the bill.

HB 182 by Rep. Pedro Marin (D- Norcross) – mandates insurance coverage for infertility. This bill was referred to the House Committee on Insurance.

HB 184 by Rep. Tom Weldon (R- Ringgold) - provides for the establishment of a program to monitor the prescribing and dispensing of Schedule II, III, IV, and V controlled substances and establishes the Electronic Database Review Advisory Committee to oversee the program. This bill was referred to the House Committee on Judiciary (Non-Civil). The GAFP supports this bill.

HB 229 by Rep. Sharon Cooper (R- Marietta) provides any appeals for Medicaid reimbursement, the decision of the administrative law judge shall be the final administrative decision of the commissioner of The Department of Community Health. This bill was referred to the House Committee on Judiciary.

HB 249 by Rep. Barbara Sims (R- Augusta) provides for information on pertussis disease by hospitals to parents of newborn infants. This bill was referred to the House Committee on Health and Human Services.

HB 263 by Rep. Ron Stephens (R- Savannah) provides training requirements and scope of practice for surgical technologist. This bill was referred to the House Committee on Health and Human Services. 10

HR 252 by Rep. Rusty Kidd (I – Milledgeville) creates the House Study Committee on Adult Mental Health and Disability Facilities. This bill was referred to the House Committee on Health and Human Services.

HB 275 by Rep. Mike Cheokas (R- Americus) – defines what a caregiver is and allow as a caregiver to be the recipient of a do not resuscitate order. This bill standardizes the form used for a do not resuscitate order and allows the procedure to take place in care and nursing homes. This bill was referred to the House Committee on Health and Human Services.

HB 278 by Rep. Tim Bearden (R-Villa Rica) Established a form for patients to prescribe to an advance directive also it provides that under no circumstances shall an attending physician deprive a person receiving health care of nourishment or hydration unless the attending physician determines that such deprivation is necessary for medical treatment. This bill was referred to the House Committee on Human Relations and Aging.

HB 317 by Rep. Ron Stephens (R- Savannah) to extend an exemption for a limited period of time regarding sales to certain nonprofit volunteer health clinics. This bill was referred to the House Committee on Ways and Means.

HB 361 by Rep. Pat Gardner (D-Atlanta) provides that every retail pharmacist shall include the normal retail price or the wholesale acquisition price of an outpatient prescription drug on the receipt for that prescription drug.

Report 3 � February 17, 2011

The General Assembly reconvened on Tuesday, February 15, 2011 and worked through Thursday, February 17th, the 16th legislative day (out of 40).� *The schedule for next week is for the legislature to be in session Tuesday, February 22 through Thursday, February 24th (legislative day 19).� *Subject to change.

Largest Turn Out of Physicians for Day at the Capitol
Over 115 physicians and medical students attended the Day at the Capitol last Thursday, February 10th.�� Joining the GAFP were internists, pediatricians, and ob-gyns that all have common legislative priorities.� We were joined by the Community Health Commissioner David Cook and the Insurance Commissioner Ralph Hudgens.� All of the attendees spent over two hours at the Capitol speaking to their legislators about the budget, tort reform, and other public health issues.� The one-pager that our members gave to legislators included the following comments about the lack of funding for physicians who take Medicaid:

1.�� The rate of Georgia medical school graduates entering:
- Family medicine declined from 20% in 1999 to 4% in 2009
- Pediatrics remained the same at 13% (while the state population increased 18.3%)

2.� Physicians will close offices and stop seeing Medicaid patients if rates are decreased.
�- Over 600 physicians responded to a Jan. 2010 survey indicating:
- 84% of respondents currently see Medicaid patients
- 36% said they would stop seeing Medicaid patients
- 37% said they would reduce # of Medicaid patients seen
- 12% of Pediatricians said they would close their offices entirely

3.� Low physician rates may actually increase cost by limiting access and diverting members to more expensive sites for care, such as emergency rooms.
- One study found that the highest physician reimbursement states had only � the overall cost when compared to the lowest physician reimbursement states.
- Another study affirmed that reduced physician fees resulted in increased use of the ER.
- Most recent evidence supports the assertion that sound physician rates can support lower overall cost; 18 states had higher than average physician rates and lower than average overall cost, while only 7 states both lower than average physician rates and costs.7

4.� Private practice physician offices are significant economic engines in the state.
- Created more than 180,000 jobs
- Provide over $10 billion in personal income
- Create nearly $20 billion in total economic activity
- Generate nearly $2.7 billion in state a local government revenues

GAFP Supports RX Monitoring Act/Narcotics Registry
The Legislative Committee recommended to the Executive Committee support of Senate Bill 36 (and the companion House Bill 184).� The Executive Committee approved this recommendation and the GAFP now stands in support of this legislation.

Background:� One of the GAFP legislative priorities for the 2011 session is as follows:
Support Adoption of Prescription Drug Monitoring Act
Review and work with sponsoring legislators to enact a program that will outlaw and prevent doctor-shopping for drug seekers and pill-mill clinics.�

In discussing Senate Bill 36 and House Bill 184 the Legislative Committee agreed that this bill would support our legislative priority if implemented correctly.� Staff will continue to work with the bill sponsors; Senator Buddy Carter and State Representative Tom Weldon on some of the nuances of the legislation if passed in regards to filing the information in paper format and how this legislation will work with hospice agencies.

Currently, Senate Bill 36 has been approved "due pass" in a subcommittee of the Senate Health and Human Services Committee and now awaits review and approval by the full committee.� House Bill 184 currently resides in the House Non-Civil Judiciary Committee.

Healthcare Legislation � Of Interest
SB 6 by Sen. Judson Hill (R-Marietta) creates the Georgia Individual High Risk Reinsurance Pool. One quarter of one percent of the Georgia premium tax is designated to fund the high risk pool.

SR 24 by Sen. Judson Hill (R-Marietta) is the constitutional amendment required to earmark a percent of the premium tax to fund the high risk pool. A two-thirds majority vote is required in both chambers to send the amendment to the voters to be ratified in the next general election.

SB 17 by Sen. Tim Golden (R-Valdosta) creates the Special Advisory Commission on Mandated Health Insurance Benefits to advise the Governor and the General Assembly of the social and financial impact of current and proposed mandated health insurance benefits. The commission is required to complete evaluations no later than December 12, 2012. The Senate Insurance & Labor Committee unanimously adopted SB 17 by committee substitute on Thursday, February 10, 2011.

SB 29 by Sen. Judson Hill (R- Marietta) to opt out of funding certain abortions through certain qualified health plans. This bill was referred to the Senate Committee on Insurance and Labor.

February 18, 2011

Report 2 � February 7, 2011

The General Assembly reconvenes Monday, February 7, 2011 for the 11th legislative day. The following schedule has been set and yet is subject to change:

Monday, February 7 - legislative day 11
Tuesday, February 8 - adjourned
Wednesday, February 9 - legislative day 12
Thursday, February 10 - legislative day 13
Tuesday, February 15 - legislative day 14
Wednesday, February 16 - legislative day 15
Thursday, February 17 - legislative day 16
Tuesday, February 22 legislative day 17
Wednesday, February 23 legislative day 18
Thursday, February 24 legislative day 19

State Budget
The House and Senate Appropriations Subcommittees held hearings with most state agencies under the jurisdiction of their respective subcommittees. The AFY 2011 budget will be reported out of House subcommittees on Monday, February 7th and Tuesday, February 8th. The Appropriations Committee is schedule to adopt the Subcommittee recommendations on February 9th and may be on the Floor of the House for a vote the week of February 14th.

The Senate should take up the AFY 2011 budget once passed the House although they are already having hearings in preparation of the forthcoming legislation. Not many changes from the Governors recommendations are expected in the AFY 2011 budget. The FY 2012 will follow the same process in both chambers.� Note � there are no cuts to physician payments in the FY 2011 budget.

Healthcare Legislation � Of Interest

SB 6 by Sen. Judson Hill (R-Marietta) creates the Georgia Individual High Risk Reinsurance Pool. One quarter of one percent of the Georgia premium tax is designated to fund the high risk pool.

SB 29 by Sen. Judson Hill (R- Marietta) to opt out of funding certain abortions through certain qualified health plans. This bill was referred to the Senate Committee on Insurance and Labor.

HB 121 by Rep. Doug McKillip (R- Athens) � no contract for healthcare policy or disability income policy that contains a provision allowing the health carrier or insurer to interpret the provisions on the contract shall be upheld if it is inconsistent with the laws of the state. This bill was referred to the Committee on Insurance.

HB 132 by Rep. Ben Watson, MD (R-Savannah) the "Medical Food Equity Act," will mandate that all insurance companies licensed in the state provide coverage and reimbursement for the medical foods used to treat inborn errors of metabolism. This Bill was referred to the House Committee on Insurance.

HB 145 by Rep Matt Hatchett (R-Dublin) includes the practice of dry needling to the definition of physical therapy. This bill was referred to the House Committee on Health and Human Services.

HB 187 by Rep. Mickey Channell (R- Greensboro) provides for a single administrator and procurement of services for dental services for Medicaid recipients and PeachCare for Kids participants. This bill has not been assigned to Committee.

February 8, 2011

Report 1 � January 24, 2011

The First Session of the 151st Georgia General Assembly convened Monday, January 10, 2011 for a 40-day legislative session. Due to the icy conditions in Atlanta, the legislature met on Monday and Wednesday, January 12 for mostly pro forma days. The legislature then recessed last week to hold joint House and Senate Appropriations Committee meetings on the proposed FY11 supplemental appropriations act and the FY12 budget. The legislature will reconvene on Monday, January 24th for as yet undetermined amount of days.

GAFP Legislative Priorities for 2011

The Executive Committee of the GAFP approved the Legislative Committee's requested legislative priorities for the 2011 session. The priorities include the following:

A. Protect Medicaid Budget for physician cuts
This will include supporting an increase in the tobacco tax and supporting budget language for the practices that have NCQA recognition for the Patient Centered Medical Home. It will also include protecting looming cuts for family medicine capitation rates.

B. Patient Centered Medical Home
Seek sponsorship of legislation to increase payments to primary care physicians' practices who have achieved NCQA recognition for the Patient Centered Medical Home for both Medicaid (CMO and Fee for Service) and State Health Benefit Plan.

C. Support Adoption of Prescription Drug Monitoring Act
Review and work with sponsoring legislators to enact a program that will outlaw and prevent doctor-shopping for drug seekers and pill-mill clinics.

D. Scope of Practice Review
Stand vigilant and ready to review and work with other medical providers who are interested in legislating expansion of their scope of practice. Insure safety of patients and have a proven need of expansion with appropriate physician supervision.

E. Affordable Care Act
Remain a willing partner to serve as a state leader in the implementation of the Affordable Care Act in Georgia whether it is through regulation or legislation.

Governor Deal Reveals Recommendations for 2011 and FY2012 Budget

Governor Nathan Deal gave his State of the State address on January 12th and released his budget recommendations to the General Assembly. He has recommended no cuts to Medicaid rates for physicians in the current budget and a one percent cut for the FY2012 budget. This reflects a reduction of $2.4 million in state funds.

The Governor also recommended a reduction in capitation rates for family medicine residency rates. Staff is working with the Georgia Board for Physician Workforce to clarify the amount of this recommended cut.

For the 2012 budget that begins on July 1, 2012 lawmakers must cut between $1.2 billion and $2 billion from the state budget. In order to balance the budget Governor Deal is asking agencies to take on average a 7 percent cut from their 2011 budget.

The complete FY 2012 budget can be found here

Department of Community Health Budget

Public health spending and Medicaid eligibility were major topics as newly appointed Commissioner David Cook of Department of Community Health, gave his budget presentation Thursday to state legislators.

Commissioner Cook told the joint House-Senate Appropriations panel that Medicaid needs a new eligibility system prior to the expansion of that program under federal health care reform. He cited a proposal for a state bond issue to fund a system that would improve those eligibility procedures.

Cook acknowledged problems in the state's public health system and legislative commission has recommended that public health become a stand-alone agency for greater transparency and visibility. Gov. Nathan Deal's budget plans significant reductions in public health funding.

The Department of Community Health is also looking into the issue of millions of dollars that managed care companies owe to public health for vaccines.

A link to The Department of Community Health budget presentation is found here

January 24, 2011

Day at the Capitol- Record Turn Out

Even under the threat of a snow storm the Day at the Capitol had a record turnout on February 10th!� GAFP members were joined by colleagues from across the state and other physicians from Georgia OB/GYN Society; Georgia Chapter, American Academy of Pediatrics; Georgia Osteopathic Medical Association; and the Georgia Chapter, American College of Physicians.

The day was highlighted by presentations from Alan Essig, Executive Director, Georgia Budget & Policy Institute; Ralph Hudgens, Department of Insurance Commissioner; and David Cook, Department of Community Health Commissioner.� In addition, the attendees spent over two hours at the Capitol speaking to their legislators about the budget, tort reform, and other public health issues.

Thank you to GAFP's industry partners for their support of the 2011 Day at the Capitol:

United Healthcare
Blue Cross Blue Shield of Georgia
MAG Mutual Insurance Co.
Pediatrix
PhyTest
Peach State
PHRMA

A special thank you to the GAFP members who took the time out of their busy schedules to attend.

Temitope Afon	Faiqa Mahmud, MD
Teresa Beck, MD	Caroline Oczachowski, MD
Mike Busman, MD	Bidemi Olaniyi-Leyimu, MD
Michael Callander	Simrat Parmar, MD
Michael Chambers, MD	Ramon Parrish, MD
Samuel Church, MD	Christa Pepitone, MD
Michelle Cooke	Adriana Pratt, MD
Amy Cooper	Harsha Ravindranatha, MD
Lucas Davis, MD	Thad Riley, MD
Abhay Deshmukh, MD	Katina Robertson, MD
Niyomi DeSilva, MD	Nicole Rodriguez, MD
Gurinder Doad, MD	Mitzi Rubin, MD
Vahide Dougan-Bag, MD	Susan Schayes, MD
Bilqees Fatima, MD	M. Alex Schiaffino, MD
Feben Girma, MD	Shalina Shaik, MD
Kevin Graham, MD	George Shannon, MD
Wayne Hoffman, MD	Altof Tadkod, MD
Warren Hutchings, MD	Priya Vasudevan, MD
Mihaela Ille, MD	Nga Vu, MD
Ann Marie Lam, MD	Michael Walsh, MD
Paul LeBlanc, MD	Amy Walthour
Bruce LeClair, MD	Jeffrey Westerfield, MD
James Lemley, MD	Rick Wherry, MD
Debra Levin, MD