SB411: SB411 Professions and Businesses; dry needling to be performed by certain licensed professionals; provide

LC 46 1567S The House Committee on Rules offers the following substitute to SB 411: A BILL TO BE ENTITLED AN ACT To amend Code Section 31-8-9.1 of the Official Code of Georgia Annotated, relating to tax1 credit for cont ributions to certain rural hospital organization s and hospital eligibility and2 requirements, so as to revise the definition of "rural hospital organization"; to amend Title 313 of the Official Code of Georgia Annotated, relating to health, so as to provide for the4 certification of community health workers; to provide for defin itions; to provide for the5 establishment of the Georgia Community Health Worker Certification Committee; to provide6 for membership, powers, and duties of the committee; to provide for committee abolishment7 and transfer of powers and duties to the Department of Public H ealth; to provide for8 administrative support; to provide for rules and regulations; t o provide for standards; to9 provide for the approval of training programs; to provide for a pplication procedures; to10 provide for requirements; to provide for related matters; to pr ovide for an effective date11 conditioned on appropriations; to repeal conflicting laws; and for other purposes.12 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:13 - 1 - LC 46 1567S SECTION 1.14 Code Section 31-8-9.1 of the Official Code of Georgia Annotated, relating to tax credit for15 contributions to certain rural hospital organizations and hospital eligibility and requirements,16 is amended by revising paragraph (3) of subsection (a) as follows:17 "(3) 'Rural hospital organization' means an acute care hospital or rural freestanding18 emergency department licensed by the department pursuant to Article 1 of Chapter 7 of19 this title that:20 (A) Has its primary campus Provides inpatient hospital services at a facility located in21 a rural county or is a critical access hospital;22 (B) Participates in both Medicaid and medicare Medicare and accepts both Medicaid23 and medicare Medicare patients;24 (C) Provides health care services to indigent patients;25 (D) Is licensed by the department to provide maternal and newborn services or has Has26 at least 10 5 percent of its annual net revenue categorized as indigent care, charity care,27 or bad debt;28 (E) Annually files IRS Form 990, Return of Organization Exempt From Income Tax,29 with the department, or for any hospital not required to file I RS Form 990, the30 department will provide a form that collects the same information to be submitted to the31 department on an annual basis;32 (F) Is operated by a county or municipal authority pursuant to Article 4 of Chapter 733 of this title or is designated as a tax-exempt organization under Section 501(c)(3) of the34 Internal Revenue Code; and35 (G) Is current with all audits and reports required by law; and36 (H) Has a three-year average patient margin, as a percent of e xpense, less than one37 standard deviation above the state-wide three-year average of organizations defined in38 subparagraphs (A) through (G) of this paragraph, as calculated by the department. As39 used in this subparagraph, the term 'patient margin' means gross patient revenues less40 - 2 - LC 46 1567S contractual adjustments, bad debt, indigent and charity care, other uncompensated care,41 and total expenses."42 SECTION 2.43 Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising44 Chapter 31, which is reserved, as follows:45 "CHAPTER 3146 31-31-1.47 As used in this chapter, the term:48 (1) 'Certified community health worker' means an individual to whom the committee has49 issued a certificate to serve as a certified community health worker based on standards50 and requirements approved by the department.51 (2) 'Commissioner' means the commissioner of public health.52 (3) 'Committee' means the Georgia Community Health Worker Certification Committee53 established by Code Section 31-31-2.54 (4) 'Community health worker' means a frontline public health worker who is a trusted55 member of a community or has a demonstrated knowledge of a comm unity and56 individuals served and:57 (A) Provides culturally appropriate health education, informat ion, and outreach in58 community based settings such as homes, schools, clinics, shelt ers, local businesses,59 and community centers;60 (B) Bridges or culturally mediates between individuals, communities, and health and61 human services, including actively building individual and community capacity;62 (C) Assures that community members access the services they need;63 - 3 - LC 46 1567S (D) Provides direct services, such as informal counseling, soc ial support, care64 coordination, and health screenings;65 (E) Advocates for individual and community needs with an empha sis on healthcare66 needs; and67 (F) Provides any additional services that may emerge in the de velopment of68 community health worker practice.69 (5) 'Core competencies' means the knowledge and skills a certi fied community health70 worker is expected to demonstrate in order to carry out the mis sion and goals of the71 profession. Such term includes, but is not limited to, communication skills; interpersonal72 and relationship-building skills; service coordination and navi gation skills;73 capacity-building skills; patient advocacy skills; education an d facilitation skills;74 individual and community assessment skills; community outreach and engagement skills;75 evaluation and research skills; and knowledge base.76 (6) 'Department' means the Department of Public Health.77 (7) 'Training program' means an education and training program that meets the78 curriculum and training required for a community health worker to be eligible for79 certification and that has been approved by the department base d on standards and80 requirements recommended by the committee. Reserved.81 31-31-2.82 (a) There is established the Georgia Community Health Worker Certification Committee.83 The commissioner shall appoint the 11 voting members of the committee as follows:84 (1) One licensed physician with a specialization in primary care or family medicine;85 (2) One licensed physician with a specialization in maternal and child health;86 (3) One licensed physician with a specialization in geriatrics;87 (4) One licensed social worker;88 - 4 - LC 46 1567S (5) Three representatives of community health worker employers , one of whom shall89 represent hospitals, one of whom shall represent a federally qualified health center, and90 one of whom shall represent a community based organization;91 (6) One person with experien ce and training in public health p olicy, with special92 consideration given to an active member of the Georgia Communit y Health Worker93 Advocacy Coalition;94 (7) Two practicing community health workers, provided that such persons are eligible95 for certification as community health workers in this state and shall obtain such96 certification within a time frame specified in bylaws adopted by the committee; and97 (8) One active member of the Georgia Community Health Worker Advisory Board.98 (b) The commissioner shall appoint two department representatives to serve as nonvoting99 members of the committee.100 (c) Any voting member of the committee shall serve a two-year term, and no such member101 shall serve on the committee for more than two consecutive full t e r m s . A m e m b e r102 appointed for less than a full term may serve two consecutive f ull terms, and a former103 member shall be eligible again for appointment after a lapse of one or more years.104 (d) If there is a vacancy on the committee, such position shall be filled in the same manner105 as the original appointment. Members of the committee may be removed from office by106 the commissioner under the same conditions for removal from off ice of members of107 professional licensing boards provided in Code Section 43-1-17.108 (e) Members shall serve without compensation, but they may be reimbursed by the109 department, subject to fund availability, in the same manner as state officials and110 employees for travel and other expenses actually incurred by th em in carrying out their111 duties as members of the committee.112 (f) The committee shall be abolished June 30, 2030, and the po wers and duties of the113 committee shall transfer to the department upon such abolishment.114 - 5 - LC 46 1567S 31-31-3.115 (a) The committee shall meet at least quarterly and may meet at such other times at the call116 of the chairperson or by a majority of the members as necessary to transact its business.117 Such meetings may be conducted in person, by telephone, by virt ual means, or any118 combination thereof.119 (b) The committee shall elect a chairperson, vice chairperson, and secretary from among120 its membership. Such officers shall serve for terms of two years.121 (c) A majority of the members of the committee shall constitute a quorum and shall have122 the authority to act upon any matter properly brought before th e committee. The123 committee shall follow all policies and procedures of Chapter 1 4 of Title 50, relating to124 open and public meetings.125 (d) The committee shall have the following powers and duties:126 (1) To make recommendations to the department on the standards and requirements for127 approval of training programs and a means for programs providing education and training128 to community health workers prior to July 1, 2027, to become ap proved training129 programs;130 (2) To make recommendations to the department on the standards and requirements for131 the certification of community health workers and a means for individuals employed or132 engaged as community health workers prior to July 1, 2027, to b ecome certified133 community health workers;134 (3) To make recommendations to the department on the standards and a means to assess135 the mastery of core competencies necessary for an individual to become a certified136 community health worker;137 (4) To provide for an expedited means for a community health worker duly certified in138 another jurisdiction to become a certified community health worker in this state;139 (5) To make recommendations to the department on the establishment of tiered levels of140 practice for certified community health workers and requirement s for each established141 - 6 - LC 46 1567S level, including a level that qualifies a certified community h ealth worker to act as an142 educator or trainer in an approved training program;143 (6) To establish a process for the receipt, review, approval, and denial of applications for144 certification;145 (7) To establish a process for the receipt and review of complaints related to the practice146 of certified community health workers;147 (8) To establish disciplinary procedures and actions, includin g revocation or denial of148 a certificate issued, or a combination of the foregoing; and149 (9) To perform such other functions and duties in order to protect public health, safety,150 and welfare as may be required to carry out this chapter.151 (e) The department shall provide reasonably necessary administ rative support for152 committee activities.153 (f) The department shall be authorized to promulgate rules and regulations necessary to154 implement the provisions of this article, including recommendations from the committee.155 31-31-4.156 (a) All training programs in this state shall satisfy the requ irements established by the157 department. No entity shall hold itself out as providing training and education for certified158 community health workers in this state unless its training program has been approved by159 the committee.160 (b) The department shall post on its website the requirements and the application form for161 a training program to become approved and for the renewal of su ch approvals. Such162 requirements shall include 45 hours of core competency training, of which 16 hours shall163 include training on specific health topics.164 (c) An applicant for an approved training program shall submit an application to the165 committee demonstrating satisfaction of the requirements for a training program and pay166 a fee set by the department; provided, however, that, if an applicant provided education and167 - 7 - LC 46 1567S training to community health workers prior to July 1, 2027, such applicant shall submit an168 application to the committee demonstrating satisfaction of requirements for such program,169 pay a fee set by the department, and provide a list of students who successfully completed170 such program at any time from January 1, 2016, to July 1, 2027.171 (d) An application is not com plete until the committee has rec eived all the required172 materials. The committee shall notify the applicant within 15 calendar days after receipt173 of an application whether such application is complete or incom plete and identify any174 materials that are needed to complete such application. When the applicant fails to provide175 the required documentation within 120 calendar days of notification, the committee may176 administratively close such application or deny the application . An applicant whose177 application is administratively closed or denied may reapply and submit a new application178 and a new application fee.179 (e) The approvals of training programs under this Code section shall be valid for up to two180 years and shall expire biennially unless renewed. Suspension and revocation of approvals181 shall be subject to the administrative procedures contained in Chapter 13 of Title 50, the182 'Georgia Administrative Procedure Act.'183 31-31-5.184 (a) The title 'certified community health worker' shall only b e used by individuals who185 have met the requirements and qualifications for certification as a community health186 worker as established by the committee and have been duly certified by the committee. An187 individual certified as a community health worker shall identif y himself or herself as a188 certified community health worker during any patient interactions and shall not utilize any189 other titles that such individual is not certified or licensed to use.190 (b) The department shall post on its website the requirements and the application form for191 a community health worker to become certified and for the renewals of such certificates.192 - 8 - LC 46 1567S (c) An applicant for a certified community health worker shall submit an application to the193 committee demonstrating satisfaction of the requirements for a certified community health194 worker and pay a fee set by the department. A certified community health worker shall:195 (1) Be 18 years of age or older;196 (2) Possess a high school diploma or its recognized equivalent;197 (3) Not be ineligible for certification on grounds established by the committee;198 (4) Provide professional references, one of which shall be a current or former supervisor,199 with direct knowledge of the applicant's work and ability in th e core competencies for200 community health workers;201 (5)(A) Have received satisfactory results from criminal backgr ound checks. The202 committee is authorized to conduct and receive criminal background checks, including,203 but not limited to, by the submission of fingerprints or other identifying information to204 the Federal Bureau of Investigation through the Georgia Crime Information Center. In205 order to determine an applicant's suitability for certification as a community health206 worker, the committee shall require the applicant to furnish the committee with a full207 set of fingerprints or other identifying information as may be necessary to enable208 criminal background checks to be conducted.209 (B) The committee shall submit the fingerprints or other ident ifying information210 furnished by an applicant to the Georgia Crime Information Cent er. The G e o r g i a211 Crime Information Center is authorized to submit such fingerprints or information to212 the Federal Bureau of Investigation for a national criminal bac kground check. The213 Georgia Crime Information Center shall notify the committee in writing of its findings,214 including, but not limited to, the inability to identify a criminal record. Any findings215 received by the committee shall be used for the exclusive purpo se of carrying out its216 responsibilities under this Code section, shall not be public r ecords, shall be217 confidential, and shall not be disclosed to any other person or agency, except to any218 person or agency which otherwise has a legal right to inspect such data. Any records219 - 9 - LC 46 1567S obtained in furtherance of this Code section shall be maintaine d by the committee220 pursuant to laws regarding such records and the rules and regul ations of the Federal221 Bureau of Investigation and the Georgia Crime Information Center as applicable.222 (C) By applying for a license under this article, an applicant consents to the223 performance of criminal background checks as provided for in th is paragraph. The224 applicant shall be responsible for any fees associated with the performance of such225 background checks;226 (6) Submit proof of successful completion of an approved training program and 2,000227 hours of employment as a community health worker within ten yea rs of the date of228 application; and229 (7) Satisfy any other requirements established by rules and regulations promulgated by230 the department.231 (d) An applicant may satisfy the requirement provided in paragraph (6) of subsection (c)232 of this Code section if such applicant submits an application p rior to July 1, 2028, and233 proof of:234 (1) Successful completion of an education and training program for community health235 workers completed between July 1, 2016, and July 1, 2027, and 2 ,000 hours of236 employment as a community health worker within ten years of the date of application as237 established by the committee; or238 (2) At least 4,000 hours of employment as a community health worker within ten years239 of the date of application and an attestation from an employer that such applicant240 performed duties that included core competencies and is competent to perform activities241 as a certified community health worker as established by the committee.242 (e) An application for a certified community health worker is not complete until the243 committee has received all the required materials. The committee shall notify the applicant244 within 15 calendar days after receipt of an application whether such application is complete245 or incomplete and identify any materials that are needed to com plete such application.246 - 10 - LC 46 1567S When the applicant fails to provide the required documentation within 120 calendar days247 of notification, the committee may administratively close such application or deny the248 application. An applicant whose application is administrativel y closed or denied may249 reapply and submit a new application and a new application fee.250 (f) Certificates issued pursuant to this Code section shall be valid for up to two years and251 shall expire biennially unless renewed. Suspension and revocation of certificates shall be252 subject to the administrative procedures contained in Chapter 13 of Title 50, the 'Georgia253 Administrative Procedure Act.'"254 SECTION 3.255 (a) Except as provided in subsection (b) of this section, this Act shall become effective on256 July 1, 2026.257 (b)(1) Section 2 of this Act shall become effective only if fu nds are specifically258 appropriated for the purposes of this Act in an appropriations Act enacted by the General259 Assembly.260 (2) If funds are so appropriated, then this Act shall become effective on the later of:261 (A) The date on which such appropriations Act becomes effective; or262 (B) The beginning date of the fiscal year for which such appropriations are made.263 SECTION 4.264 All laws and parts of laws in conflict with this Act are repealed.265 - 11 -