Gold Dome Report - Legislative Day 33 - March 2024

The Georgia General Assembly gaveled back in on Monday, and the rapping in the House had a different but eerily familiar tone. In honor of the 100th anniversary of the late Speaker Tom Murphy’s birth, Speaker Jon Burns dusted off a gavel and sound block belonging to the longest-serving Speaker of the House in Georgia history. Speaker Murphy passed away in 2007, but his legend remains prominent under the Gold Dome. We presume Speaker Burns returned the gavel undamaged, otherwise, vengeance may be had.

The House and Senate took up several bills on the floor today before turning to a full day of committee work. Read about all the action in this #GoldDomeReport.

In this Report:

• Floor Notes
• Committee Reports
• What’s Next

Floor Notes

The House took up the following measures on Legislative Day 33:

• SB 50 - Education; local boards of education which operate a school with grades nine through 12 may provide instruction in lifeguarding and aquatic safety; provide — PASSED 163-1
• SB 335 - "Safeguarding Adopted Children from Sexual Violence Act"; enact — PASSED 164-0
• SB 348 - Notification of Suspicious or Unusual Deaths; individual had not been seen by a physician prior to death; revise the period — PASSED 163-1
• SB 370 - Human Trafficking Hotline Information; certain establishments to post human trafficking hotline information; require — PASSED 164-1
• SB 389 - Georgia National Guard; adjutant general to be the official sponsor of the state sponsored life insurance program; provide — POSTPONED
• SB 421 - Obstruction of Public Administration; offense of transmitting a false public alarm; enhance penalties - PASSED 162-2
• SB 436 - Farm Use Vehicles; define a term — PASSED 165-0

The Senate took up the following measures on Legislative Day 33:

• HB 299 - Georgia Code; add appropriate references to United States Space Force; provisions — PASSED 48-0
• HB 385 - Retirement and pensions; add appropriate references to United States Space Force — PASSED 45-1
• HB 563 - Fair Employment Practices Act of 1978; hearing before an administrative law judge; provide — PASSED 46-0
• HB 1181 - Income tax; limit carry-forward periods of certain income tax credits — PASSED 45-2

Committee Reports

Senate Regulated Industries Committee

Chairman Bill Cowsert (R-Athens) and members of the Senate Regulated Industries Committee met this morning to take up one bill, HB 1399, the legislation authored by Representative Butch Parrish (R-Swainsboro) which addresses Georgia’s Certificate of Need (“CON”) laws in Chapter 6 of Title 31. This morning’s meeting was the presentation of the Senate Substitute to the language that passed the House. Chairman Cowsert explained that the legislation contained 14 sections, but only 12 were “substantive” and of those, 5 received changes from the Senate.

The CON program began in 1979 in response to a federal law mandate, which was to measure, determine, and define capital expenditures to help control healthcare costs and guarantee access to services. In 2006, the efficacy of the program was assessed, and it was found that CON was a failure and the federal government no longer required states to have such a program. In 2008, Georgia began its push to “dismantle” CON, and since that time, several bills have been introduced and studies conducted. This activity culminated in 2023, according to Chairman Cowsert, with studies conducted by the House and Senate. The Senate had a more aggressive approach and recommended fully dismantling the program as it had no information that showed that CON made healthcare more affordable or provided citizens increased access. The Senate has focused on rural healthcare (which he indicated that proponents of CON in rural areas had indicated that the program was those facilities' guardian angel). There was discussion that changes should not be done in one large swoop. 

Senator David Lucas (D-Macon) expressed his passionate belief that Medicaid expansion should be implemented. Senator Lucas argued that Georgia has $1.2 billion in federal funds targeted for its use, and the State could spend $580 million to obtain these federal funds. He argued further about the work requirement component (such as in the Arkansas plan) and noted that there were ways to address it. He questioned how long it would take for Georgia to do something, noting that the states of North Carolina and Mississippi have expanded while Georgia continues to “study” the effort. Further, Senator Lucas noted that uncompensated care is not always reported, and he mentioned the Governor’s Pathways program that has had poor enrollment (while the state has perhaps 700,000 without coverage). Chairman Cowsert remarked that the Pathways program had setbacks, and now there was litigation; he indicated that the legislature needed to be open-minded about expansion.

Chairman Cowsert acknowledged that the issue of CON is complex, but a change was needed to increase access and address rural healthcare needs. In particular, he mentioned the need for perinatal services, mental health, and addressing maternal and infant mortality. Chairman Cowsert mentioned the Senate’s concern about maternal healthcare desserts as well as the impacts the closure of Atlanta Medical Center has had on healthcare. This legislation addresses expenditures, exemptions (there are 34 in the proposed law), and an expedited appeal. There are changes contained in the bill addressing joint-venture ambulatory surgery centers. There is also a new exemption to allow Morehouse School of Medicine to have an exemption for a short-stay facility as a teaching facility to fill a void caused by the closure of Atlanta Medical Center. The changes in the Substitute fall within these categories:

• Ambulatory surgery centers
• Freestanding imaging centers
• New facilities in rural areas
• Enforcement of CONs
• Transfers of beds and services
• Psychiatric and substance use disorders

Jacqueline Harn, with Americans for Prosperity, testified that her group supported the legislation but wanted a full repeal. She noted the state of Florida has 21 birthing centers; Georgia has 2 such centers. Further, she mentioned that there were zero deaths in the state, and only 1 percent of cases were transferred to hospitals. She asked for an amendment to allow more of the birthing centers, noting the testimony by Katie Chubb, who wanted to build a birthing center in Augusta and who had testified at the various meetings over the summer and fall about her struggles to get a CON for a birthing center because of the lack of obtaining a transfer agreement.

Jamie Cavanagh, an attorney with the Institute for Justice, noted that the Department of Community Health found there was a need for more birthing centers. CON, she argued, prevented competition and stifled advances. Further, she noted that the economic literature that the Institute for Justice had studied found that CON laws lead to negative or neutral results. Chairman Cowsert asked Cavanaugh for a copy of the Institute’s report.

Anna Adams, with the Georgia Hospital Association, raised hospital concerns with the new language, particularly around ambulatory surgery centers and cardiac caths; multi-specialty allowances; free-standing imaging and the requirement of a CON before an equipment expenditure exemption occurred; enforcement concerns; transfers of patients, particularly with birthing and Cath Lab patients. She noted to the Committee that CON was an entry point, not a barrier. Senator Ed Harbison (D-Columbus) noted that cath lab safety concerns were a concern and what procedures should only be done in a hospital. Hospitals provide more staff and support for those cases. Senator Matt Brass (R-Newnan) asked about transferability and why hospitals might not accept patients; Adams countered that some of that might be due to acuity of patients. He also asked about cherry-picking of patients; that does occur. He also mentioned Medicaid expansion and whether that might soften the blow for horizontal growth. Adams noted that GHA wants individuals to have insurance, but even now, signing up for Medicaid has proven to be difficult (noting the redetermination process). Adams also mentioned that patient populations in communities and facilities vary, and in some, there are more Medicare-eligible individuals versus Medicaid-eligible persons. Senator Lucas noted that if Medicaid was expanded, facilities and providers would receive something versus nothing. Adams noted that addressing charges by hospitals were required to be the same regardless of the payor; indigent care is reported for individuals who are below 125% of the federal poverty level; and uncompensated care could be things like Medicaid shortfall or individuals’ high insurance deductibles.

Monty Veazey, with the Alliance of Community Hospitals, remarked that the proposal was a major public policy change. He argued that his facilities would like Medicaid expansion before entertaining CON reform. Veazey noted that the states of Texas, Arizona, and Colorado had no CON laws; Georgia, however, with CON, had less expensive care. He mentioned the Cleverly study. Senator Brass asked about joint ventures and why hospitals could not do those in rural areas; Veazey explained that some of that had to do with access to capital. Veazey remarked that keeping rural hospitals open depended on many factors: age of the population; unemployment; employed individuals' insurance (many with high deductibles); etc. He acknowledged that the proposed bill contained language to bolster the Rural Hospital Tax Credit program, which the Alliance supports. He further noted that his facilities support the language addressing rural hospitals' ability to reopen (this is known as the Cuthbert issue). Committee members asked about data on procedure outcomes, and Veazey mentioned that data was requested but not fully reported.

Kathy Butler Polvino, an attorney with Health Law Strategists, noted that the legislation’s language did not meet the described intent for imaging and ASCs. There have been free-standing cardiac cath labs in Georgia; many closed due to lack of volume. Further, she noted the CPORT requirements to be met to assure quality of care, which concerns Alliance members. Further, she mentioned that time matters — that would be the case for heart cases as well as birthing center issues.

Brian Allen, with the Libertarian Party, indicated he wanted a full repeal of the laws as CON had no place in a free society.

Travis Lindley, a lobbyist representing several physician practice organizations as well as the Georgia Society of Ambulatory Surgery Centers, wholeheartedly supported the legislation. He indicated that it had been 16 years since the state had looked at CON. Further, he noted that all ASC’s operating rooms are sterile; transfer agreements are part of licensure (noting that bad things happen); the state requires an annual report on March 15; and joint ventures have been permitted since 2008. Further, Lindley noted that the last multi-specialty ambulatory surgery center that received a CON was for a facility in Athens in 2012 (one application is presently pending for a facility in Braselton).

The Committee adopted two amendments to the proposal: 1) to provide an exemption for birthing centers and 2) to change the composition of the Comprehensive Health Care Coverage Commission, adding two individuals from the Minority Party. The legislation received a DO PASS recommendation as amended and is expected on the Senate Floor on Thursday. The initiative will need to be worked out in a Conference Committee, more than likely if cleared by the Senate.

House Education Committee

The House Education Committee, chaired by Representative Chris Erwin (R-Homer), met on Monday to consider the following measures:

• SB 169, authored by Senator Chuck Payne (R-Dalton), amends Title 20 to provide for limits on the extension of hearing dates for student discipline tribunals. It also provides appropriate grade-level instructional materials to any student in in-school suspension.

Senator Payne presented the bill to the Committee, which recommended the bill DO PASS and be sent to the Rules Committee.

• SB 395, authored by Senator Clint Dixon (R-Gwinnett), amends Title 20 to allow visitors and employees to carry opioid antagonists in schools and would exempt anyone who administers it in good faith from civil liability. The bill also requires schools to keep a supply of opioid antagonists on hand for administration.

Senator Dixon presented the bill to the Committee, which recommended the bill DO PASS and be sent to the Rules Committee.

• SB 440, authored by Senator Matt Brass (R-Newnan), amends Title 20 to establish the Accelerated Career Diploma Program. The bill also establishes and provides for the ACE Grants pilot program. This measure builds on the progress of SB 86 (2023 Session). This measure seeks to consolidate the high-demand career lists with certain instructional courses, specifically math, to better align with Pathway programs. The sunset is also extended to 2027.

Senator Brass presented the bill to the Committee, which recommended the bill DO PASS and be sent to the Rules Committee.

House Health Committee

The House Health Committee, chaired by Representative Lee Hawkins (R-Gainesville), was called to order Monday to discuss the following:

• HR 1231, authored by Representative Mark Newton (R-Augusta), creates the House Study Committee on Maternal, Prenatal, and Pediatric Care Access and Funding. An amendment was made to include trauma. No action was taken on this measure.

• SB 455, authored by Senator Brian Strickland (R-McDonough), amends Code Section 49-4-148. The measure seeks to clean up for federal compliance. The measure prevents third-party payers from denying payment for health care items or services solely based on the payer not previously authorizing it and requires third-party payers to respond to the department within 60 days. An amendment passed that included changes to pharmacy benefit managers' reimbursements to independent pharmacies for the state health benefit plan. The measure received a DO PASS recommendation.
• SB 505, authored by Senator Blake Tillery (R-Vidalia), amends Title 31 to increase transparency in hospitals. The measure builds on a previously passed measure that required hospitals to share financial documents on their website. This measure instructs the Department of Community Health to create templates for hospitals to use for these filings. The measure also includes an amendment that requires a five percent community benefit floor. A new amendment added reporting requirements for for-profit hospitals and removed the community benefit language. Tim Kibbler from the Georgia Alliance of Community Hospitals and Anna Adams from the Georgia Hospital Association expressed support for the underlying measure and the amendment. Josh Belifante, HCA, expressed concern for the measure. Senator Tillery was not favorable to the amendment striking the community benefit language. The measure received a DO PASS recommendation as amended.
• SB 515, authored by Senator Bo Hatchett (R-Cornelia), amends Title 31 to create an ambulance two-year pilot program. Specifically, the measure seeks to provide four extra ambulances in Regions 2 and 8. This is in an effort to reduce and improve coordination within each region. Representative Dexter Sharper (D-Valdosta) asked who would staff these ambulances and who has oversight. A procurement process would be created for the regions with the expectation that the current first responders apply. An amendment changes date requirements to ensure the measure is not repealed before funds are appropriated. The measure received a DO PASS recommendation as amended. The measure will be carried by Representative Devan Seabaugh (R-Marietta).

House Public Health Committee

Chairman Sharon Cooper (R-Marietta) and the Public Health Committee took up the following measures:

• SB 456, authored by Senator Brian Strickland (R-McDonough), is the Central Caregiver Registry amendments at O.C.G.A. 31-7-380 et seq. (adding disabled persons to the registry). The registry was originally implemented in 2018. Joe Hood, the Chief Operating Officer with the Department of Community Health, explained this allows individuals to look at persons to check caregivers’ backgrounds when hiring. They will give fingerprints, which run through GCIC and FBI as well as the Sex Offender Registry etc. to allow individuals to know if persons are compliant - there is no wrapback function - just a “yes” or “no” on the person. The person who is trying to be hired consents to being fingerprinted. It is not a prerequisite for licensure. Impaired versus incapacitated requested to be used by Representative Karen Bennett (D-Stone Mountain); Hood indicated that the wording was to be consistent with disabled definitions and asked not to place it in jeopardy. Representative Mary Margaret Oliver (D-Decatur) indicated that disability has more definitions and “impaired” may not be as precise. Hood indicated that the definition is being mimicked from other places in Code. The initiative received a DO PASS recommendation.
• SB 480, authored by Senator Mike Hodges (R-Brunswick), adds a new Code section at O.C.G.A. 49-10-7. Chet Bhasin spoke on behalf of the Georgia Board of Healthcare Workforce, which administers residency payments, operating grants to Morehouse and Mercer, and administers loans to physicians. Senator Hodges was not present. This legislation would allow service-cancelable loans to individuals in the behavioral health profession and has $850,000 in the base budget for that purpose. LC 33 9611 was reviewed. Representative Darlene Taylor (R-Thomasville) indicated the funds are in the Budget and moved for the bill to “do pass.” Representative Oliver asked about the student loan forgiveness program, which was implemented in HB 1013 in 2022. Why is a bill needed? It is separate funds per Bhasin. Representative Oliver asked if this would be an expansion; it will allow the Georgia Board of Healthcare Workforce would be permitted to do this - this is much different than the $10 million that has been previously appropriated. Representative Shelly Hutchinson (D-Snellville) thanked Bhasin for the legislation and said forgiving loans would be helpful. The legislation received a DO PASS recommendation.

The Department of Behavioral Health and Developmental Disabilities provided the Committee with a report on the Intellectual and Developmental Disabilities Workgroup. Ron Wakefield, with DBHDD, provided a Report to the Committee on this workgroup, which convened in September 2023 - with three areas of focus: IDD planning List for NOW/COMP waivers; community hospitals and emergency rooms (many folks get “stuck” in those ERs); and IDD provider workforce. IDD Workgroup has looked at these areas and partnered with the University of Georgia to help develop recommendations. The workgroup had a cross-section of members - including the Council on Developmental Disabilities, families, case management folks/support coordination, legislators, etc.

The planning list has challenges for folks who need services now as well as those who need help in the future. More than 7,000 are on this list. One recommendation was to hire a national consultant with experience working with other states. DBHDD has the funding to look for a consultant to start at the grassroots level to develop a plan on how the Department moves forward with the planning list. By the 2025 session, DBHDD hopes to have more information to provide information on what to do with waivers moving forward. 

In Community Hospital and ERs, approximately 30 individuals are “stuck” in ERs daily. Mostly, this is due to a lack of providers. They want to maximize dollars - three community options are recommended (pending DCH Board and CMS approval). This will be contracted out. Short-term, there will be 8 beds in the Augusta area so that if an individual is in an ER, that person can move to these homes to be stabilized. They are in the process of building a center in Macon, using two types of providers to work with folds with IDD. They can stay in the Macon facility for 90 days before returning to their community.

IDD Provider Workforce is composed of direct support professionals who are the backbone of the profession and work one-on-one with these individuals. The pay, however, is only $10.63 per hour as well as low benefits; the turnover rate, thus, is high. A pilot project is in the works, starting February 2024-February 2025; already, DSPs are completing their work (with a $5,000 bonus at the end of training). No other state has done this.

IDD Rate Study is also underway — $79 million in the budget will help build back up the provider network. The salary will move to $16.70 per hour, with benefits built into it for the DSP folks. 

Representative Mary Margaret Oliver (D-Decatur) inquired about IEP services as an entitlement — 30% of folks who are currently on this list could get services — thus, the planning list would be around 4,500 individuals, according to Representative Oliver. The salary for the workers was increased last year, but the Governor disregarded the salary increase for those employees. Wakefield acknowledged the disregard of that funding; he indicated that, ultimately, CMS needs to approve the increase. Representative Oliver stated that this is the same thing the General Assembly did a year ago.

Representative Clay Pirkle (R-Ashburn) inquired about those who are under 21 and would qualify for another program. He asked about the distinction of COMP needs, which have higher needs. He asked if folks moving to Georgia from another location somehow bump into individuals waiting for services. He wants more efficiency in the distribution of resources.

Representative Scott Hilton (R-Peachtree Corners) indicated that, as a parent of a child with disabilities, Georgia had studied the issue to death. A Senate bill creates a Commission on the issues.

Unfortunately, IDD Services is not the bright spot in Georgia, per Darcy Robb. Other states in the Southeast Region fund services more compared to Georgia. There is a small amount of new waivers annually; the rate study is on the right track, but it is a huge problem. There were many things that the workforce did not discuss: transportation; employment; management; housing; and technology. Senator Sally Harrell (D-Atlanta) spoke to SB 198, establishing the Georgians with Intellectual and Developmental Disabilities Commission, which would be in place for five years and include expertise for all competing interests. It is not duplicative of the workgroup, which is a good start.

Senate Health and Human Services Committee

Chairman Ben Watson (R-Savannah) and the Senate Health and Human Services Committee took up the following measures:

• HB 1072, authored by Representative Sharon Cooper (R-Marietta), is the legislation amending Chapter 8 of Title 31 for changes needed by goodpill.org, an organization which distributes medications at low costs to needy Georgians. Since its inception, the entity has provided 800,000 plus prescriptions at a cost savings of $64 million. This legislation defines “disposition” of drugs as well as terms “eligible drug” and “expiration” of a drug. Additionally, pharmacy tech ratios allowed by this organization have been amended, and it also encourages reverse drug distribution. The legislation received a DO PASS recommendation. Senator Matt Brass (R-Newnan) will carry the bill forward.
• HB 1326, authored by Representative Ron Stephens (R-Savannah), is the annual dangerous drug update in Chapter 13 of Title 16, following the FDA updates. Section 10 adds that naloxone is allowed over-the-counter and can be placed in vending machines. The legislation received a DO PASS recommendation. Chairman Watson will carry the legislation in the Senate.

Senate Finance Committee

On Monday, the Senate Finance Committee, chaired by Senator Chuck Hufstetler (R-Rome), was called to order to discuss the following:

• HB 581, authored by Representative Shaw Blackmon (R-Bonaire), amends Title 48 to revise deadlines, selection criteria, and required content for the annual analysis. The measure requires the Department of Audits and Accounts to conduct ten economic analyses annually. No action was taken on the measure.
• HB 814, authored by Representative Beth Camp (R-Concord), amends Title 48 relating to qualified investment property. This measure would create a tax credit to offset taxes levied on rural broadband facilities and infrastructure, which would only apply to rural counties and grantees of the American Rescue Plan or the Broadband Equity Access and Deployment Program. The measure received a DO PASS recommendation.
• HB 971, authored by Representative Mark Newton (R-Augusta), amends Title 48 to create a tax credit for those purchasing a storage device for guns or participating in a training course. The credit will be $300 and be on a first come, first serve basis. Senator Blake Tillery (R-Vidalia) asked how DOR could ensure no double dipping if a list is not kept. Chairman Hufstetler said DOR would be able to reply later. No action was taken on the measure.
• HB 1019, authored by Representative Matt Reeves (R-Duluth), amends Title 48 to increase the homestead exemption from $2,000 to $4,000. LC 44 2531 is aimed at improving homeownership statewide. Committee members expressed concern since the Senate measure on this subject passed and was not moving in the House. No action was taken on this measure.
• HB 1069, authored by Representative Chas Cannon (R-Moultrie), amends Title 48 relating to timber sale. The measure seeks to allow the Forestry Commission the ability to request timber harvest data (harvest and compensation) without requiring a subpoena or court order. This is a Department requested bill. The measure received a DO PASS recommendation.
• HB 1115, authored by Representative Noel Williams (R-Cordele), amends Title 48 regarding HOST and SPLOST. This measure shares the local sales tax with those wanting to participate to offset the property tax. Basically, local sales tax is limited to 2%, but there are limitations. No rate higher than 9%, or 10% if they have a MOST, is allowed. The bill includes local gov procedures. The county can come together for an IGA. If a local delegation agrees, it will become a referendum. This tax would sunset after five years. This is a flexible penny option tax. Macon-Bibb did this last year.

Dante Handel (ACCG) and Ryan Bowersox (GMA) explained that the 3% cap does not include E-SPLOST, T-SPLOST, or MOST. The measure allows counties and cities to come together for a local act for 1% property tax relief. Senator Greg Dolezal (R-Cumming) asked for an example that this would help. This is envisioned to be countywide. He then asked if Forsyth County did this and collected $100,000 and how this would work. The county would take this and create a millage rate to roll back the prior year. Senator Tillery asked about LOST and why LOST should not be increased to 2%. This is only for five years. LOST is required to be rolled back against the millage rate, as this is, too. Senator Bill Cowsert (R-Athens) asked if local sales taxes could be waived. There is no local mechanism to waive taxes. House Ways and Means Chairman Shaw Blackmon (R-Bonaire) explained you are choosing sales tax versus property tax. No action was taken regarding the measure.

What’s Next

The General Assembly is in adjournment on Tuesday, March 12 for a Committee Workday and will reconvene for Legislative Day 34 on Wednesday, March 13 at 10 a.m.

The House Rules Committee has not set a Rules Calendar for Legislative Day 34.

The Senate Rules Committee has not set a Rules Calendar for Legislative Day 34.