Gold Dome Report - February 2019 #15

Legislative work began early and continues on as today’s #GoldDomeReport hits your inbox. As the sun was rising this morning, members of the House Appropriations Committee met in their Subcommittees to discuss recommendations for their version of the FY 2020 Budget. Action proceeded on the House and Senate floors, with the Senate taking up five health measures and the House considered, among other proposition, one really big one relating to elections and balloting in Georgia. And legislators continue to meet in committees across the Capitol and Legislative Office Building as the sun sets over Georgia. Check out the progress thus far on Legislative Day 22 in today’s Report, and stay tuned tomorrow for more details.

In this Report:

• Senate Passes Five Health Measures
• House Approves Voting Machine Legislation
• House Appropriations Subcommittees Consider FY 2020 Budget
• Committee Updates
• New Legislation
• Rules Calendars for Legislative Day 22

Senate Passes Five Health Measures

Legislative Day 22 was Health Day in the Senate, which took up five health-related measures, including:

• SB 18, authored by Senator Kay Kirkpatrick (R-Marietta), amends Title 33 to provide that a direct primary care agreement between a physician and individual patient is not insurance for purposes of regulation under the state’s insurance laws. The bill also sets forth requirements for such agreements and provides conditions under which a physician can decline to enter or discontinue a direct primary care agreement. The Senate approved the bill by a 55-0 vote, and the legislation moves to the House.
• SB 106, authored by Sen. Blake Tillery (R-Vidalia), is Governor Deal’s “Patients First Act.” The bill amends Title 33 to allow the Governor to apply to the federal government for a Section 1332 waiver from the Patient Protection and Affordable Care Act. It would also amend Title 45 to allow the Department of Community Health to apply for a Section 1115 Medicaid waiver that “may include an increase in the income threshold up to a maximum of 100 percent of the federal poverty level.” State law expressly prohibits the State from seeking the waivers without statutory authority from the General Assembly, and the “Patients First Act” would grant broad authority to the Governor and DCH to craft the waiver applications. The Senate approved the bill by a 32-20 vote along party lines, and the legislation moves to the House.
• SB 115, authored by Sen. Renee Unterman (R-Buford), amends Title 43 to authorize the Composite Medical Board to issue telemedicine licenses to physicians that are licensed in other states but not Georgia. The bill provides for a list of eligibility requirements for qualifying physicians along with reporting requirements and grounds for license revocation. The Senate approved the bill by a 54-0 vote, and the legislation moves to the House.
• SB 118, authored by Sen. Renee Unterman (R-Buford), amends Title 33 to modernize the Georgia Telemedicine Act including language addressing insurers and their responsibilities and limitations in coverage for telemedicine services. Notably, the bill prevents insurers from refusing to cover a telehealth service when the in-person service is not available for a patient, nor can insurers require its insureds to use telemedicine services in lieu of in-person services. The Senate approved the bill by a 50-0 vote, and the legislation moves to the House.
• HB 62, authored by Rep. Sharon Cooper (R-Marietta), is “Margie’s Law.” The bill amends Title 31 to require that a healthcare facility conducting mammograms notify women with dense breast tissue that such tissue may make it difficult to detect cancer through a mammogram and that such women should discuss with their physician whether supplemental tests are warranted. The Senate approved the bill by a 55-0 vote, and the bill moves on to the Governor’s desk for signature.

House Approves Voting Machine Legislation

Although the House Rules Committee limited floor debate to one hour on HB 316, which authorizes the Secretary of State to conduct an RFP process for new voting machines and outlines certain specifications for which he must abide, members on both sides on the aisle spoke at length about the issue, invoking both stories and scientific minutia to prove their points. Rep. Barry Fleming (R-Harlem) pointed out that the minority party’s sticking point arose from the lack of exclusion for barcode centric paper ballots in the RFP process outlined in the bill, which he attests would unduly limit the RFP process to a single vender. Speakers from the minority party explained that this objection is due to the inability of a voter to read a barcode and verify their vote. In the end, the bill passed 101-72.

House Appropriations Subcommittees Consider FY 2020 Budget

Beginning at 7AM this morning, subcommittees of the House Appropriations Committee began meeting to discuss their recommendations for the FY 2020 Budget. Although copies of the budget documents are not yet publicly available, discussions in the subcommittee meetings revealed a number of the changes from Governor Kemp’s budget proposal that we will see in full tomorrow when the Appropriations Committee takes up the entire spending bill:

• Education: The House’s FY 2020 Budget will extend $2,775 raises to certified teachers and other certified professionals (including school counselors, social workers, and psychologists), increase extended day funding for Career, Technical, and Agricultural educators, provide funding for high school industry certification in construction, increase Non-QBE Formula Grants to recognize utilization growth, and funds for personal hygiene products for low-income students in residential treatment facilities.
• Community Health: The House’s FY 2020 Budget will increase funds for the Champions for Children program; add 140 medical student capitation slots for PCOM Georgia and South Georgia; add funding for a rural surgery initiative and child and adolescent psychiatry slots at Augusta University; add funding for a Maternal Mortality Center of Excellence at Morehouse; and provide funds in nursing homes for personal needs allowances, background checks, and direct care rate enhancement.
• Human Resources: The House’s FY 2020 Budget will provide funds to add capacity for the Court Appointed Special Advocate program; increase the personal needs allowance for nursing home residents; continue reducing the Meals on Wheels waiting list; and increase the relative foster care per diem rate.
• Public Health: The House’s FY 2020 Budget will provide funds to increase maternal mental health screening and treatment for rural and underserved areas; expand a nurse peer assistance program for recovering nurses; establish two satellite perinatal support sites in Jenkins and Wilcox counties; and increase newborn screening to include four additional disorders.

Committee Updates

House Retirement Committee

Rep. Sam Watson (R-Moultrie) took over the chairman’s duties as Chairman Tommy Benton (R-Jefferson) presented two bills. HB 196 was passed by the committee previously but recommitted by the House Rules Committee for a change. That change would strike language exempting certain public retirement system trustees from the requirement to undergo training in fiduciary responsibility. The bill received a recommendation DO PASS. HB 109 would amend Title 47 to amend the Teachers Retirement System of Georgia. This bill modifies conditions for individuals who became members on or after July 1, 2019. Included in the bill are provisions regarding calculations for average earnable compensation, adjustments to the contribution deductions, new definitions for normal retirement age, and new guidelines for retirement allowances for those that became members on or after July 1, 2019. Chairman Benton explained a change in the current version of the bill reduces the ceiling of contribution deductions from 10% to 8.5%. Vincent Fort from the Georgia Federation of Teachers spoke to the committee. He explained that while the Federation appreciates the reduction in the contribution rate, he is still worried the bill as a whole would endanger teacher recruitment and retention. The received a recommendation DO PASS.

Senate Regulated Industries and Utilities

This Committee took up several bills in a late afternoon meeting:

• SB 100 - Sen. PK Martin, IV (R-Lawrenceville) presented this initiative which has previously passed the Senate.  The bill permits funds collected for individuals to receive hearing assistance on their land line telephones and this also would allow that fee to help individuals with hearing impairment assistance with their wireless phones.  This legislation received a DO PASS recommendation and moves to Rules.
• SB 146 - Sen. Frank Ginn (R-Danielsville) presented this legislation which permits tastings to be done in package stores.  The bill is a compromise and it does retain the three tier system.  It will allow 52 tastings annually with no more than four bottles open at any one time.  It caps distilled spirits at 1.5 ounces; malt beverages are 8 ounces; and wine at 5 ounces. This would potentially impact 1,200 package stores.  The local governing authority would be notified of these tastings but Department of Revenue would develop rules and regulations deemed necessary for implementation.  Staff of these stores would be allowed to answer questions about products.  The Committee asked about liability insurance; that would be dependent on the package store.  The substitute bill received a DO PASS recommendation.
• SB 153 - Sen. Tyler Harper (R-Ocilla) presented this legislation to address “trauma scene clean up” and a regulation process of this industry.  Georgia has 29 such entities which perform this work.  The regulation will have no board like other professions.  It will be under the GBI and require a license fee, bond requirement and an insurance requirement.  These entities must also undergo criminal background checks.  There are a few exceptions - so that individuals may continue to do their own clean up so that they are not required to pay for such clean up.  It also exempts auto accidents.  An amendment was made so as to eliminate the word “location” on line 105 and insert the words “trauma scene” in its place.  The amendment was adopted; the legislation cleared with a DO PASS recommendation as a committee substitute.
• SB 74 - Sen. Matt Brass (R-Newnan) presented his version of certificate of need revisions to the Committee.  A new Substitute (LC 33 7828S) was before the Committee.  No action was taken today; it will likely be voted upon on Thursday. Chairman Cowsert asked that any new Substitute be made available by close of business on Wednesday.  This legislation is about 90 percent complete per Sen. Brass.  The new Substitute LC 33 7828S does the following:
  
  
  • Leaves CON in place
  • Puts back into play the Health Strategies Council - 15 members with five appointments each by House, Senate and Governor
  • Raises capital expenditure amounts
    
    
    • building/construction at $10 million
    • Equipment at $3 million
  • Addresses the CON objection/appeal process and requires that an objecting facility be within the same planning area and have like services
  • Mental health is included in CON (Sens. Burke, Watson and Brass agreed about this)
  • Cancer Treatment Centers of America
    
    
    • Removes the 65 percent requirement for patients to come from out of state
    • Removes the 50 bed cap
    • Requires that such hospital stay type specific (e.g. cancer)
  • Does not address the issue of Legacy Sports
  • Addresses multi-specialty ambulatory surgery centers and allows a single specialty if
    
    
    • Entity has been in existence for five years
    • Has 50 physicians
  • Long term care is still regulated by CON
  • Medical use rights are banned (no buying of CONs)
  • Addresses transparency for facilities (follows Sen. Burke’s language) with requirements for federal 990 forms
  • Eliminates the FOIA language
  • Retains that imaging centers will be required to have a CON
  • Leaves cardiology under CON process and not exempted
  • Leaves freestanding emergency departments under CON

Issues outstanding on the legislation are around indigent care percentages - now around 7.85-8 percent (new language does not include what was proposed in the House of Medicare times 1.5 percent).  It does still allow for a discount for the for-profit facilities which pay taxes.  The author is still working on appeal language.  Sen. Ben Watson, MD (R-Savannah) indicated that the spirit of negotiation has been earnest.  Many articulated support and appreciation of Chairman Cowsert and his handling of the bill and process.     

Chairman Cowsert indicated that SB 122 will have another meeting tomorrow.

The Blue Cross president spoke to support CON reforms.  Blue Cross is the largest insurer in the State.  Family of four pays $30,000 includes premiums and other costs..  Rural healthcare is higher with more than half of income going to healthcare.  Blue Cross serves 3 million in commercial market and 2.6 million work for a self-insured entity.  He indicated  that the amount of innovation in healthcare is fascinating and pace is incredible.  There were some questions about Blue Cross’s bottom line and its profit margin - he indicated it would depend on whether it was a large group market product.  Blue Cross insures 54 million nationally.  $6-$8 per premium per person was reported as the profit made annually in Georgia.          

Senate Health and Human Services - Finance Subcommittee

Sen. Chuck Hufstetler (R-Rome) and his Subcommittee held a hearing on Sen. Lindsey Tippins (R-Marietta) bill addressing requirements for backup generators for nursing home and assisted living facilities.  The Department of Community Health expressed some concerns and is to work with the author to come up with new language for SB 113.  

New Legislation

The following legislation of interest was introduced in the House today:

• HB 451, by Rep. Houston Gaines (R-Athens), addresses the procedures, conditions and limitations relating to tax credits for rehabilitation of historic structures in Chapter 7 of Title 48.  There is process for preapproval of additional tax credits for current recipients of tax credits. This bill was referred to the House Ways and Means Committee.
• HB 452, by Rep. Steven Sainz (R-Woodbine), addresses Chapter 11 of Title 19 relating to the enforcement of duty of support.  It allows the Department of Revenue to access the Bank Match Registry housed by the Department of Human Services so that it can assist in identifying information for delinquent taxpayers and information on individuals under child support orders. This bill was referred to the House Judiciary Committee.
• HB 459, by Rep. Ginny Ehrhart (R-Powder Springs), relates to school bus drivers in Chapter 2 of Title 20 and proposes to provide for a driver’s license verification system for such drivers.  It would require that local boards of education participate which employs such individuals.  The local systems would be required to submit to the Department of Public Safety the driver’s full name and license number and update such list at least twice within each calendar year. If a school bus driver has his or her privileges suspended, revoked or cancelled, then the local board of education is to suspend or revoke the authorization given to such person to drive a school bus and inform such driver of the reason for the suspension or revocation. This bill was referred to the House Public Safety and Homeland Security Committee.
• HB 464, by Rep. Martin Momtahan (R-Dallas), seeks to require in O.C.G.A. 20-2-589(b) that local boards of education have a public comment period during every meeting which would be included on the agenda.  Further, it does not require that the local board of education require notice by an individual prior to the date of a meeting as a condition of addressing the local board during that comment period. This bill was referred to the House Education Committee.
• HB 472, by Rep. Bert Reeves (R-Marietta), revises the Juvenile Code in Chapter 11 of Title 15.  It seeks to add that the Department of Juvenile Justice staff who are acting as juvenile court intake officers may not make determinations concerning alleged dependent children.  The bill also adds that each juvenile court intake officer exercising authority to remove a child is to successfully complete each year eight hours of appropriate training relevant to the performance of such determinations, including but not limited to training concerning contrary to the welfare determinations, reasonable efforts to prevent removal of a child and diligent search requirements, reasonable alternatives to foster care, and DFCS policies and procedures related to the removal of a child and placement of such child in foster care. It also contains new definitions for “fictive kin” and “temporary alternatives to foster care.”  The initiatives also addressing removal of children from home and protective custody  and what the court must consider prior to authorizing the removal of a child from his or her home and whether reasonable alternatives to the removal of the child and placement of the child in foster care and the court may order temporary alternatives to foster care in lieu of removing the child and placing the child in protective custody or continuing the child in protective custody. Further, it outlines when temporary alternatives to foster care may be ordered by the court ex parte prior to a preliminary hearing or following a preliminary hearing.
• HB 476, by Rep. Valencia Stovall (D-Forest Park), seeks to address compulsory attendance for students in elementary and secondary education adding a new Code Section at O.C.G.A. 20-2-692.3, providing that child entertainer students (a child under 18 years of age who is employed as an actor or performer in motion pictures or theatrical productions, in radio or television productions, or in any other performance, concert, or entertainment in the making of phonographic records or as an advertising or photographic model) is to be counted as present by the school and not counted as absent, either excused or unexcused for any day,  portion of a day or days missed from school as long as the child’s parent or guardian provides a receipt of paperwork form provided by the Department of Labor from the entertainment employer. This bill was referred to the House Education Committee.
• HB 477, by Rep. Ron Stephens (R-Savannah), addresses O.C.G.A. 31-45-3, exempting pools located in condominium complexes from being required to obtain a permit for operation.
• HB 478, by Rep. Mandi Ballinger (R-Canton), seeks to amend Georgia’s laws relating to the central child abuse registry in Chapter 5 of Title 49.  The legislation provides for notice of abuse allegations in substantiated cases resulting from investigation by an abuse investigator (which has to have been found by a preponderance of the evidence that such alleged child abuser committed an act of child abuse).  It also seeks to provide for the reporting of abuse cases to the DFACS’ office. This bill was referred to the House Juvenile Justice Committee.
• HB 479, by Rep. Heath Clark (R-Warner Robbins), addresses greater protections for individuals who have suffered from childhood sexual abuse which if enacted would be known as the “Hidden Predator Act of 2019.”  It extends the statute of limitations for the  bringing of such actions so as to allow a plaintiff who is between the age of 23 and 38 years of age may bring a civil action for recovery of damages suffered as a result of childhood sexual abuse committed on or after July 1, 2019. This bill was referred to the House Judiciary Committee.
• HB 481, by Rep. Ed Setzler (R-Acworth), addresses Titles 1, 16, 19 and 31 and proposes to provide that all natural persons at any state of development, including an unborn child at any stage of development who is carried in the womb, shall be included in state population based determinations.  It also proposes to revise current law on when an abortion may be performed and make changes to the Woman’s Right to Know Act to provide for advising women seeking an abortion of the presence of a human heartbeat.  It states that no abortion is authorized or shall be performed if the unborn child has been determined to have a human heartbeat or except when, in reasonable medical judgment, the abortion is necessary to avert the death of the pregnant woman or avert serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman or preserve the life of an unborn child.The legislation if passed and signed into law is to be known as “Living Infants Fairness and Equality (“LIFE”) Act.” This bill was referred to the House Health and Human Services Committee.
• HR 329, by Rep. William Boddie (D-East Point), proposes to create a House Study Committee on Homeowners’ Associations, Condominium Owners’ Associations and Property Owners In Community Associations.  Such study would be conducted by five members of the House of Representatives and the Committee would stand abolished on December 1, 2019. This resolution was referred to the House Special Rules Committee.
• HR 367, by Rep. Ken Pullin (R-Zebulon), is an urging resolution that encourages Georgia’s school districts to have an emergency medical technician present during all full-contact sporting events. This resolution was referred to the House Education Committee.

The following legislation of interest was introduced in the Senate today:

• SB 178, by Sen. P.K. Martin, IV (R-Lawrenceville), provides for statements of account under the “Georgia Condominium Act” and the “Georgia Property Owners’ Association Act” in Title 44 and when such are to be obtained by a mortgage lender.  It outlines who is authorized to complete such statement of account and the information which is to be contained regarding the lot for which the request has been made.  The legislation does propose a statutory form for such purpose. This bill was referred to the Senate Special Judiciary Committee.
• SB 182, by Sen. William Ligon, Jr. (R-Brunswick), seeks to provide for mariculture development in Chapter 4 of Title 27.  This would regulate shellfish production on the Georgia coast.  Rep. Jones has a House bill on this same subject.  This issue was brought to the attention of the House Rural Development Council. This bill was referred to the Senate Natural Resources and Environment Committee.
• SB 183, by Sen. Chuck Hufstetler (R-Rome), seeks to provide that each person who files or is required to file a Form 1099-K with the Internal Revenue Services shall also file electronically a copy of such form with the state’s Revenue Commissioner on or before the federal deadline. Such forms are required to be filed by settlement payment entities. This bill was referred to the Senate Finance Committee.
• SB 184, by Sen. Greg Kirk (R-Americus), provides that covered services under the State Health Benefit Plan and which are furnished by a federally qualified health center are to be reimbursed at no less than the then applicable Medicare maximum allowable reimbursement rate paid to federally qualified health centers. This bill was referred to the Senate Health and Human Services Committee.
• SB 185, by Sen. Elena Parent (D-Atlanta), provides for a qualified Medicare beneficiary program in O.C.G.A. 49-4-23 which is to be designed to provide financial assistance to low-income Medicare beneficiaries to fill the gaps in Medicare coverage to pay Medicare premiums, deductibles, and coinsurance for Medicare covered services or to purchase Medicare supplemental insurance coverage.  It outlines eligibility: must be a citizen or legal resident of the United States and Georgia; must be enrolled in Medicare Part A or eligible to enroll in Medicare Part A; does not exceed the asset limits a identified by the Department; and have a limited income as defined by the Department. This bill was referred to the Senate Health and Human Services Committee.
• SB 187, by Sen. Elena Parent (D-Atlanta), proposes to address disclosure and dissemination of criminal records to private persons and businesses resulting in responsibility and liability of the Georgia Crime Information Center and provision of certain information to the FBI in conjunction with the National Instant Criminal Background Check System in Chapter 3 of Title 35.  It provides for a judicial procedure by allowing an individual to petition the court in which such hospital proceedings occurred for relief and for the purging of a person’s involuntary hospitalization information received by the center for the purpose of the National Instant Criminal Background Check System.  It outlines the evidence which the court is to consider. This bill was referred to the Senate Judiciary Committee.
• SB 188, by Sen. Larry Walker, III (R-Perry), addresses reinsurance of risks in O.C.G.A. 33-7-14 and provides for the incorporation of the National Association of Insurance Commissioners reinsurance model law into th Georgia Insurance Code.  It outlines that credit shall be allowed when the reinsurance is ceded to an assuming insurer which meets certain conditions (including determining if the insurer has its head office or domiciled and licensed in a jurisdiction that has been recognized as a reciprocal jurisdiction by the Commissioner of Insurance and assuming that the insurer has and maintains on an ongoing basis minimum capital and surplus, or its equivalent, etc.). This bill was referred to the Senate Insurance Committee.
• SB 189, by Sen. Bill Cowsert (R-Athens), relates to health records in Title 31. The bill expands the persons allowed to request copies of a patient’s medical records from a provider to include a party to a civil lawsuit requesting records pursuant to subsection (c) of Code Section 9-11-34. The bill also mandates that records be delivered electronically unless physical copies are specifically requested. The bill outlines fines for failure to deliver requested records and sets a flat fee of $26.50. This bill was referred to the Senate Health and Human Services Committee.

Rules Calendars for Legislative Day 23

The House is expected to consider the following measures on Wednesday for Legislative Day 23:

• HB 187 -- Community Health, Department of; pilot program to provide coverage for the treatment and management of obesity and related conditions; provide (H&HS-Dempsey-13th)
• HB 213 -- Georgia Hemp Farming Act; enact (Substitute)(A&CA-Corbett-174th)
• HB 310 -- Insurance, Department of; must submit an autism coverage report to General Assembly; move annual due date to June 15 (Ins-Morris-156th)
• HB 332 -- Local government; advertisement of certain bid or proposal opportunities; change provisions (GAff-McCall-33rd)
• HR 214 -- House Rural Development Council; reauthorize (ED&T-Watson-172nd)

The Senate is expected to consider the following measures on Wednesday for Legislative Day 23:

• SB 15 -- "Keeping Georgia's Schools Safe Act" (Substitute) (PUB SAF-56th)
• SB 20 -- Counties and Municipal Corporations; establishment of banking improvement zones; areas underserved; provide (B&FI-33rd)
• SB 65 -- Alternative Ad Valorem Tax on Motor Vehicles; transfer of a title between legal entities owned by the same person; not constitute a taxable event; provide (Substitute) (FIN-7th)
• SB 71 -- Hospital Authority; sale or lease of a hospital; provisions; revise (Substitute) (H&HS-1st)
• SB 91 -- Nonpublic Postsecondary Educational Institutions; exemption for dental schools meeting certain criteria; provide (Substitute) (H ED-52nd)