Comité Public and Community Health de la Cámara de Representantes, 10 de febrero de 2026

Transcripción

343 turnos. Seleccione un tiempo para reproducir ese momento del video.

1. 0:11:02

   If I can now

2. 0:11:06

   get everybody in my committee to have a seat. Hello. Hello. Welcome.

3. 0:11:17

   Ooh, I think I've got something. That'll be fine. Okay. Um, all right. We now have a quorum. Okay. 10, so I'll call this meeting of the, uh, Committee on Public and Community Health, uh, that we are in s- um, session, we're meeting. So anyway, and first on, we have added, uh, um, an HR for, by Representative Will Wade. It was, uh, sort of a last minute thing. It got dropped off by mistake.

4. 0:11:48

   So, uh, Representative Wade, if you'll come, uh, present HR 713.

5. 0:12:00

   Thank you very much, Chair Lady. Appreciate it. And, um, colleagues, committee members, uh, I bring before you House Resolution 713, um, LC1123360. Um, this is a resolution that the objective is is to pro- promote awareness across the state of 988. And obviously, most of our constituents are very well-informed about what 911 is. However, because we now have a state that acknowledges the differences in medical emergencies versus somebody that might be in crisis that's not an exact emergency per se, we're trying to urge the healthcare providers that are already providing information regarding 911 to their patients when they're on hold or if they're calling in.

6. 0:12:49

   Oftentimes, I know as a parent, we schedule appointments for my children, um, and we'll be put on hold, and they'll say, "In case of an emergency, please call 911." We want to encourage, not as... This is not a mandate. This is an encouragement to also have language to provide, "In cases of mental health crisis, are you in a crisis? Do you need assistance? Do you need help? Please call 988." I worked with, um... This is not a governor's bill or resolution. The governor's office supports this. The First Lady has obviously been very, um, engaged in the promotion and the sharing of what 988 is, and I worked with Kevin Tanner, um, uh, as well on this.

7. 0:13:29

   They have done a great job of promoting it. This is just to help in continuation of that effort. Uh, my parents were both educators, and my dad especially would remind me that in, in order for something to be memorized and notated, you would actually have to have 14 points of connection before it became something that you could draw on and know. Um, I don't know if that's true. That was my dad. That's what he told me when I was a kid. I think it's because it took him 14 times to tell me something to remember what my dad said, including put your shoes up, wash your clothes, and don't be mean to your mom.

8. 0:14:01

   I only took that once. But regardless, 988 is important. Um, I'm not gonna read to the committee members the, the resolution is not very long, but it, it's in promotion of that effort. And so I would appreciate your consideration. If there are any questions, I'm happy to answer, but I think this can help us all in our districts to, to help those that are obviously in need to, to find a resource that is, we have invested in in the state.

9. 0:14:26

   Well, right off the bat, we have a question, Representative. It's from Representative Cannon.

10. 0:14:31

    Hey, thanks.

11. 0:14:32

    Hey.

12. 0:14:33

    Um, so is the department not able to do this at this time without this resolution? Were they-

13. 0:14:40

    No, this is-

14. 0:14:41

    ... open to it?

15. 0:14:42

    Th- they, uh, all of-

16. 0:14:43

    How does this change the-

17. 0:14:44

    All of the things are open to it, but I'll, I'll say this. I don't know that regulation or a law or a resolution is what created the healthcare industry having the common practice of saying, "If this is an emergency, call 911." It's just kind of what's occurred in the marketplace. I just think in some cases, especially in areas that are seeing many t- um... I've worked with my local 911 centers, and oftentimes the 911 centers are having to transfer or inform those constituents of 988 because in some cases it's not a true 911 emergency, it's a 988 would be the r- right resource.

18. 0:15:23

    That's not gonna stop. This is just about helping the public understand and at least be aware of those two distinctions. Does that make sense?

19. 0:15:32

    Yes. Do you know the appropriation that the department has used to publicize 988 so far since we did the rollout?

20. 0:15:42

    I, I don't have that, uh, figure, but this would be more, uh, in align with the private sector when you're calling and contacting them, like my children's doctor, their, uh, dentist office, those kinds of things. So this is not specific to one agency. This is specific to the overall ecosystem within, um, that space.

21. 0:16:04

    Okay.

22. 0:16:05

    Thank you.

23. 0:16:05

    Representative, are there other questions for Representative Wade? If there are no questions, uh, what is the will of the committee?

24. 0:16:15

    Make a motion to pass.

25. 0:16:16

    Second. Okay, we got a motion to pa- do pass. I got a second? Got a second. Okay. Now, any further discussion? Anybody wants to discuss it? I'm seeing in. Everyone in favor of the passage of House Resolution 713 say aye. Aye. Anyone opposed, no. Okay, the ayes have it. Thank you, Representative Wade.

26. 0:16:37

    Thank you very much, Madam Chair.

27. 0:16:38

    I will say that regardless of where you stand on sports betting, that one of my concerns about it, and I'll just put it out there, is the high incidence of suicides of young males that get addicted to sports betting. And, uh, I am very concerned about that and, uh, concerned that they can quickly get to the Help they need. And if I'm right, isn't there, if they call the 988 number, don't they talk to a live person at that time-

28. 0:17:14

    Yes

29. 0:17:14

    ... on the phone-

30. 0:17:15

    Yes, ma'am

31. 0:17:15

    ... that is trained?

32. 0:17:16

    Yes.

33. 0:17:17

    So-

34. 0:17:17

    They do

35. 0:17:17

    ... anything we can do to pass that number, uh, along to people.

36. 0:17:21

    Yeah. My only failure, Chair Lady, is that I did not have this House Resolution 988, so my apologies for that.

37. 0:17:27

    And, uh, um, so well, we'll, we'll forgive you on that one.

38. 0:17:31

    I know.

39. 0:17:31

    So.

40. 0:17:32

    I don't know who's filing what when, so anyway. Thank you.

41. 0:17:35

    Okay. Now, and so last time we left, uh, I, I think that, you know, with public health it's a learning, um, situation, uh, as well as passing bills. And so I've let each time, you know, when they're available, so people want to come and speak. And we have a special guest this time on a topic that should be important to all of us, and that's Alzheimer's and the latest research on it. Because if we didn't have hair color, there'd be a lot of gray hair, and there's already some gray for the men, but we had parents too that may be suffering from it.

42. 0:18:11

    So with that, I'm gonna turn it over. Sheila, are you gonna direct this? And, uh, whoever would like to present, they have promised they will be succinct, but we will be glad that we have had this information.

43. 0:18:26

    Do you want to pass those out later?

44. 0:18:28

    Yes.

45. 0:18:28

    Okay.

46. 0:18:32

    I think they're gonna, they're gonna sit up here, so we need to sit up here. We'll turn it on for him.

47. 0:18:40

    All right. Are you gonna introduce yourself or-

48. 0:18:42

    I am

49. 0:18:42

    ... you gonna introduce people or? Go ahead.

50. 0:18:44

    You know, if you give me a microphone-

51. 0:18:46

    No

52. 0:18:46

    ... that'd save trouble.

53. 0:18:47

    Succinct. We, we don't have to worry about y'all probably, but probably this one.

54. 0:18:53

    Good afternoon, Madam Chair, members of the committee. My name is Sheila Humberston with Stonebridge Consulting. I am just absolutely thrilled and honored to be with you guys today, especially with these just phenomenal people to my left. Um, I'm here with, um, representatives from Emory's Alzheimer's Disease Research Center. This is very personal to me. This is my mother's physician. Um, and when I tell you that he is my hero, I don't use that term lightly. For anyone in this room, probably most of the people behind me, I'm tough as nails and don't have a lot of soft spot to me, but when I tell you about how Dr.

55. 0:19:31

    Levy could give me the diagnosis of my mom's Alzheimer's in a way that had compassion and hope at a time where there really wasn't any hope, that's what drives this work, and that's how, the, that is why we built Georgia Memory Net, which is what you're gonna hear about today. So this is something that I'm really passionate about, and I am absolutely honored and thrilled to present to you Dr. Levy, who is the head of the Alzheimer's Disease Research Center, and Rebecca McIntosh, who is our just amazing champion and director for the Georgia Memory Net program.

56. 0:20:04

    Thank you very much. Hopefully none of you will ever suffer from Alzheimer's or have a family member that does, but I'm sure we all have constituents that suffer from it, and they need to know about this new network we have so that for early diagnosis and direction of treatment. So thank you very much. Go ahead.

57. 0:20:22

    Well, thank you so much, uh, Madam Chairwoman and members of the committee. It's a real pleasure to be here. Uh, this is something I'm passionate about. I'm gonna be quick so, and let Rebecca fill in some of the details. But, um, as, as, uh, you just heard, I've always had hope, and I've had hope for a good reason. Um, I've been doing this my entire career as a physician specializing in Alzheimer's disease, but also doing research. And, uh, we've been espousing hope, uh, but I'll show you today why we actually have real evidence and things are changing dramatically before our eyes.

58. 0:20:54

    And the, the short story is our state is the envy of the country because we have a network called the Georgia Memory Net that nobo- no other state has, that's anticipating the problem and dealing with it before other states. So, um, what you're looking at if you have the printed slides or, uh, is just the scary numbers, the, the, those of you fortunate not to know somebody with Alzheimer's disease, you're unusual. Um, as you can see, 42% chance for any, every one of us in this room to develop Alzheimer's disease during our lifetime.

59. 0:21:25

    Sorry, women, 48% for you too, for you guys. So, um, it affects everybody. It's clearly an age-related disease. You can see nearly 50% of people once they reach age 85 have Alzheimer's disease. And as we all know, the number of people 85 years of age and, is growing rapidly. It's exponential. And so we still have this massive burden of Alzheimer's disease and related dementias that are at our doorstep. Uh, the tsunami is here. Um, the little, uh, pie chart on the lower left, Alzheimer's disease is a complex disorder.

60. 0:21:58

    It's, we define it by presence of plaques and tangles, and the new treatments I'll tell you about remove them from the brain. Absolutely striking. Um, Alzheimer's disease often coexists with related disorders, and the first step for an unfortunate person or family is to get a, a detailed assessment to s- get a clear diagnosis so that appropriate treatment can be administered. And the Georgia Memory Net, uh, aspires to do that, training doctors and others around the state to how to make an accurate diagnosis, and that's been one of the many, I'd say, great successes of the program so far.

61. 0:22:33

    So the Georgia Memory Net was established, uh, I think it was in 2018, um, with all of your help and partnership. We were anticipating that we knew the costs already at that time, um, for the state for taking care of people and family, and a lot of it's borne by the state, by federal dollars, and mostly out of pocket for families. And we knew that, uh, treatments were coming down the road. Back in 2017 as a researcher, we saw this was happening, that we were gonna have the first disease-modifying therapies that could actually do something more than be hopeful, actually, uh, make an impact.

62. 0:23:06

    And so we set up the Georgia Memory Net with a couple of very simple goals. Um, what you're looking at is a trajectory. Dementia is a very gradually progressive process for most people. It's typically 10 to 12-year journey, and the very first time symptoms begin is a condition that we call mild cognitive impairment. Very rarely diagnosed in clinics. In fact, around this state and this country, 65% of people, um, have mild cognitive impairment when they go for an annual wellness visit.

63. 0:23:36

    Incredibly common. They're not getting diagnosed. Um, mild dementia is this early stage when people still really can do well. They're living at home. Sometimes they're even able to work and do things like that. And so quality of life for this disease re- all rests on early diagnosis and early intervention. Since we started the Georgia Memory Net, it's become abundantly clear that this disease process starts 20 to 30 years before those early symptoms of memory loss begin. So this is a life course disease, it's a chronic disease, and the future that I'm gonna tell you is coming down the pike that we have to be ready to deal with, is identifying people before they ever have symptoms.

64. 0:24:15

    There are 47 million people walking around today in this country who have Alzheimer's disease in their brain who don't know it, 'cause they're completely without symptoms. That's the stage where we need to arrest it, just like we arrest heart disease, atherosclerosis, and cancer before it grows and spreads and kills people. So the playbook is pretty simple, um, and it starts with early detection. We have dramatic advances. We have blood tests now to facilitate diagnosis, something we didn't have before. Um, and I'll show you, we have early interventions that actually are the first disease-modifying treatments for this disease.

65. 0:24:51

    We, um, health economists started projecting over 25 years ago that even a small s- step forward in slowing down disease progression would have a huge economic impact, and this was from a study in 1998, and you can just see that the numbers were dramatic. If we could slow down the disease six months, two years, five years for a long-course disease, um, and we thought that was realistic, it would have a real big impact on the num- preventing people from ever developing the disease. We view it as a success if you get hit by a bus and your memory's intact, or if you die of a heart attack or cancer with, uh, memory intact.

66. 0:25:29

    And, uh, we say that jokingly because we wanna make sure the golden years for people are, are excellent and they have great quality of life and their mind is intact and they can enjoy their family. So it was very clear the health, uh, economics was a major driver of the problem. Um, and these are the two medicines which we now have that are FDA approved. Um, there are two medicines. These are, uh, infusions. They're antibodies that remove the amyloid plaques, and they slow down the disease, um, about 30% over the course of the disease.

67. 0:26:00

    Some people debated whether that was a lot. Tell you as a doctor who takes care of people, if I can keep somebody independent for an extra year or two, that's a lot. It means a huge amount to individuals and their families. Um, and what's more important, that 30% slowing is what w- the outcome was after treating people for only one and a half years. The clinical trials that led to the approval are 18-month trials. What this graph shows is that that 30% is gonna grow if we continue treatment, and it's projected that it'll have a much bigger impact.

68. 0:26:31

    And so we're just at the beginning of launching these new treatments. We're getting our first patients in the real world onto therapies for over a year and a half, a- and, um, the impact is great. It also means that we have to diagnose early, and while we've had great successes for Georgia Memory Net, we're nowhere near where we need to be, here or anywhere in the country. We need to do even better because so many people escape these early diagnoses. And so if we s- if we miss somebody in the mild stage, they're not eligible for the treatments, and the disease is just gonna get, um, worse.

69. 0:27:07

    So these treatments were started about two years ago, and feel free to interrupt me if you, if there's something I say. I'm... Welcome any questions. Um, these treatments have been a huge challenge for health systems to begin to adopt. They rest on early diagnosis. We have to confirm people have Alzheimer's disease with spinal tests or these fancy PET images, and we need infusion centers. We have this whole ecosystem that doesn't exist. To set up treatment centers has not been trivial, and part of our goal with the Georgia Memory Net has been training people, getting people up and going so people can get treatment around the state.

70. 0:27:41

    Again, there's still a lot of room for improvement.

71. 0:27:43

    I have a question.

72. 0:27:44

    Yes, ma'am.

73. 0:27:45

    Yeah. One of the problems we have is with being an aging state. We have many counties that are dying practic- you know, and they're left with an... only, almost, an aging population that would certainly,

74. 0:28:00

    would, and they often, um, need something to keep afloat with their, uh, emergency care and their medical care. Is this the kind of thing that could be adapted and taught and used in rural areas, in rural hospitals safely to be a money maker? I mean, I take it that Medicaid pays for this, and-

75. 0:28:24

    They do

76. 0:28:24

    ... I, I, I mean-

77. 0:28:26

    Yeah, no-

78. 0:28:26

    Or does it have to be, uh, in the university setting, I guess, is what I'm asking.

79. 0:28:30

    No, it, it, it's a great question. It's, um... I think if a center, you know, can provide advanced cancer care, I think the center should be able to treat these people as well. So we can certainly train people. So that can be delivered around the state. And then one of the things that's really important, this is a rapidly changing environment. These first treatments are complex. E- Every year, they're gonna be getting better and better, safer and safer, and easier and easier to administer. So really setting up the network is really the most important thing to get diagnosis and people with, you know, access to these treatments.

80. 0:29:02

    So we've had, between us and Georgia Memory Net, as you'll hear, we've been, we've been able to be one of the- Leading states in the country in terms of getting their, our citizens access to these new treatments. Uh, between Emory and the Georgia Memory Net, we've treated about two-thirds of all the people in the state. Again, so I think the Georgia Ne- Memory Net really deserves a hu- huge amount of credit. And what I have here are these trajectories on this slide. Um, what we expect, what you're seeing is each line is a different person who's been treated with these medicines.

81. 0:29:33

    And what we know with Alzheimer's disease is they should all be going down. Um, they change. Everybody's memory gets worse every year. And what you see is over 55% of the people we were treating already are stable or improving, which is something I never in my lifetime thought I could say. Uh, it's pretty remarkable. Um, about 30% or so are doing what we would expect. They're having a, um, a, you know, a mild decline, and then some, as always, are having a worse course than others. So, um, really, really promising, and again, we expect these results to get better and better.

82. 0:30:06

    What's also is, um, really remarkable is how these medicines work. They're an intravenous infusion, which is make them, which makes them complicated to deliver. Um, people get them once a month or once every two weeks for, um, 18 months, but what it does over the time is it clears out essentially all detectable amyloid plaques in the brain. It's pretty remarkable. And those PET images, uh, you can look at your leisure. Yeah, and we can see basically everything removed over the course of treatment. And so the earlier we start, the better.

83. 0:30:38

    Thank you for your presentation. I know you still have more.

84. 0:30:39

    Yeah.

85. 0:30:40

    Quick question before we get too far is on the diagnosis piece. You had mentioned that there's a, a blood test now that we can do, which I, I assume is s- somewhat n- is that a newer-

86. 0:30:51

    It's-

87. 0:30:51

    ... diagnostic? 'Cause I remember back a, 5,000 years ago when I went to medical that it used to be thought of as either a diagnosis of exclusion or a postmortem-

88. 0:30:59

    Right

89. 0:30:59

    ... diagnosis to look at the pathology. What, what is the blood test?

90. 0:31:03

    It's a 12.

91. 0:31:04

    Oh, good.

92. 0:31:05

    Yeah, it's a great question. So it is a new, uh, blood test which is rapidly emerging. Uh, just this past fall, FDA approved it. Um, it's not 100% accurate, but it's great. It's pretty perfect for ruling people out. So if you imagine out in rural America, a doctor can get a blood test and can say, "Geez, it's negative. I don't have to worry about all the rest of this complicated stuff. I need to get people to Georgia Memory Net so they get services that the, that they need for other, you know, managing the disease, but not access to the treatment." Um, we still at Emory like to confirm, so if a blood test is positive, then we do advanced testing.

93. 0:31:39

    But now we can cut down by, uh, dramatically the numbers of people that need a PET scan or a spinal tap.

94. 0:31:44

    Well, what is the test you-

95. 0:31:45

    The test is, uh-

96. 0:31:45

    What is the test?

97. 0:31:46

    ... called the p-tau 217.

98. 0:31:48

    Mm-hmm.

99. 0:31:48

    And it's a surrogate-

100. 0:31:49

     Can you give us the-

101. 0:31:51

     Yep. It's, uh, P-T-A-U 2-1-7, and it's a simple blood test, and it me- it, it, if it's positive, it tells us that amyloid plaques are likely in the brain.

102. 0:32:03

     So I assume it's not commonly available in the world yet. It's a send-out lab to a-

103. 0:32:08

     It's a send-out, but it's really commonly available.

104. 0:32:10

     Got it.

105. 0:32:11

     It's ra- rapidly growing. Yeah.

106. 0:32:12

     And this, when you mentioned the CSF and PET scanning, that's just for the, for the study, right? To follow-

107. 0:32:17

     It's, it's not for-

108. 0:32:17

     ... the plaques, not for diagnosis

109. 0:32:18

     ... it's not really. Um, we have to be 100% per- certain a person has amyloid plaques-

110. 0:32:23

     Okay

111. 0:32:23

     ... 'cause there are a lot of masqueraders.

112. 0:32:25

     Mm-hmm.

113. 0:32:25

     And the blood test's not perfect enough. So we really have to confirm it, otherwise we would be putting people at high risk for these treatments. Yeah.

114. 0:32:32

     Great. Thank you.

115. 0:32:33

     Of course.

116. 0:32:34

     You're lighting up. I'm gonna take a couple more questions. Um, Representative O'Steen.

117. 0:32:39

     Thank you, Chair Cooper. At what point do you think that it, it would be prudent for us to, like, use this test i- in a, in an annual screening? Like, when somebody goes for their annual test, at what age would that be a great-

118. 0:32:53

     Thank you. 65. Uh, it could be-

119. 0:32:55

     65?

120. 0:32:56

     It could be earlier, but I think as a starter, if we get every person in the state an annual wellness visit that Medicare pays for at 65, we... As part of that screening assessment is asking if, if a person has memory loss. Many people don't know.

121. 0:33:10

     Mm-hmm.

122. 0:33:10

     But what we think is at that test everybody should get a few memory questions to see if there's objective evidence in that blood test, and that's coming. You know, I think that's a... If we could be there in the next couple years, it would be phenomenal. And the reason is because this treatment which removes 100% of the amyloid plaques is we think that if it's started before symptoms begin, it's likely to be even more effective. So there are 10 prevention trials underway right now. 10.

123. 0:33:37

     Wow.

124. 0:33:37

     10.

125. 0:33:38

     In the state?

126. 0:33:38

     In this country. Uh, several in this state, 10 in this country, and, um, they're testing these same two medicines that we now give people who are symptomatic, and this blood test we were just talking about is not supposed to be administered unless people have symptoms. So already it's a big part of the education because doctors are pr- are getting the test done when people shouldn't be getting it. It's inappropriate, and then they're thinking they should get treated. We've already had a handful of people, you know, coming in going, "What does this mean?" They're getting treated, and they shouldn't be.

127. 0:34:09

     Huh.

128. 0:34:09

     So these clinical trials are gonna st- read out in the next year and two, and this is... I feel like I'm back in 2017 talking to the group saying, "This is what's coming. We need to set up Georgia Memory Net for symptomatic people because what's coming in the next couple years is we have to start treating people preventatively i- in asymptomatic phase," and that's gonna be a major ecosystem shift-

129. 0:34:34

     I think

130. 0:34:34

     ... in practice of medicine. So really great news. So I'm gonna turn it over to Rebecca and give you more details.

131. 0:34:40

     I've got one more question.

132. 0:34:41

     Yeah.

133. 0:34:41

     Can you make it short, Representative Barnes?

134. 0:34:43

     Yes.

135. 0:34:45

     I'm a biomedical research scientist, so-

136. 0:34:47

     Thank you.

137. 0:34:49

     I was-

138. 0:34:49

     Sorry?

139. 0:34:50

     Any- um, can we contribute, attribute some of these findings to biomedical research scientists?

140. 0:34:57

     Thank you for that question.

141. 0:35:00

     No, I wanted to shout out my colleagues who are working hard for things like this. But, um, 20 to 30 years prior to the blood tests you can detect this? I mean, prior to it setting in

142. 0:35:13

     In research settings, we can detect sym- we can detect the presence of amyloid plaques 20 to 30 years in advance through PET scans or spinal taps.

143. 0:35:21

     But you recommend them getting a blood test at 65?

144. 0:35:24

     Um, in the future, not yet.

145. 0:35:25

     Mm.

146. 0:35:26

     So if people have memory, um, changes, then I recommend a blood test and get a value-

147. 0:35:30

     What about genetic, like in their genetics, do you recommend them getting a blood test?

148. 0:35:35

     Very similar. Um, I think people, if they have symptoms, they need to get a full evaluation in- including genetics as part of our evaluation to see if somebody's eligible. To your question about research, we would not, I would not be here today had, um, in 2012, we not had signed into law the National Alzheimer Plan Act.

149. 0:35:53

     Mm.

150. 0:35:53

     That was when our country started developing a strategic plan, and the strategic plan was a marked increase in funding for research, including our Alzheimer's center. We have the only Alzheimer's center in Georgia. We're one of the only ones in the Southeast. That budget has gone from $500 million to over $3 billion a year.

151. 0:36:11

     Mm.

152. 0:36:12

     And so that money is why we have this progress. It's a direct reflection of the research investment.

153. 0:36:18

     Well, I have a quick question, then we'll move on. What are the mild symptoms that you think when people exhibit, they should get tested?

154. 0:36:28

     Right. Um-

155. 0:36:30

     Just in general.

156. 0:36:31

     Um, really it's, it's memory loss, repetition, which is a little bit more than just searching for words. So if something, if pers- if it's something that's persisting, it's not maybe losing your keys once, but losing your car in the parking lot.

157. 0:36:45

     Oh.

158. 0:36:46

     I might have done that one or two times.

159. 0:36:48

     Regularly.

160. 0:36:48

     We'll say losing it regularly.

161. 0:36:53

     Cars in the parking lot- ... in my white car.

162. 0:36:56

     Yeah. I advoc- I advocate calling Ubers these days.

163. 0:36:59

     If I ever get a new car, I'm gonna get purple or something so I can find it. No, I don't really have trouble, but it is a problem with all the cars either gray or, you know, white, or in this heat of the summer. Okay, we're back to y'all.

164. 0:37:12

     The- the only thing I'd like to-

165. 0:37:13

     You have the floor

166. 0:37:14

     ... to interject really quickly is that the drugs are magnificent. Um, and obviously these folks can speak to it far more eloquently than I can, but they're not without significant risks. So that's the, that's the caveat, right? Is that there is a risk of brain bleeding, which is not great. Um, and so that's why, um, when Dr. Levy is talking about that it's, it's more of those specialized centers that are gonna be deploying these medications, at least until that pipeline, we get even safer and even better drugs out there. Right now, you have to monitor with PET scans to make sure you're looking for brain swelling and other, um, negative outcomes while you're pursuing the good outcomes.

167. 0:37:53

     Yep. Great. Thanks. Um, and thank you all again so much, uh, Chairman Cooper and members of the committee for having us. I'm not exaggerating at all when I reiterate that Georgia's really setting the tone for the nation here. Um, there's no other states that are this committed to building an infrastructure. To your, uh, question earlier, Chairwoman, about bringing this to rural people. So how do we take this science that our biomedical researchers and this federal funding and all the great things we're doing in the Alzheimer's Disease Research Center, how do we get this to the rest of Georgia?

168. 0:38:25

     Um, and how do we do this in a meaningful way, a thoughtful way with intention? And that's what Georgia Memory Net's all about, and I can tell y'all as somebody who's born and raised here, I'm very proud of this program and proud of our state. Um, the things we're doing in Alzheimer's space are really, really remarkable. Um, and hopefully this will advance. If not, it's gonna be a cognitive test for me of my memory. All right. Um, so, uh, like Dr. Levy was saying, you know, we've got these preventive therapies, and so 10, 15 years ago, our faculty researchers at the Alzheimer's Research Center had the, the foresight to know that these therapies were coming down the pipe from what they were seeing in their research, right?

169. 0:39:01

     And now here we are again, sort of GMN v2. Uh, before I get into... I'll, I'll take y'all back to sort of what we do as Georgia Memory Net, where we are, who we are. Um, but I just wanted to plant this seed or sort of replant it, that currently we are thinking about where are we gonna be three, five, 10 years in the future, and what does our infrastructure need to look like so that we can be sure folks have access, not just to the drugs that can slow progression, but potentially halt the disease from happening in the first place, right? And so we've got this wonderful network that I'll explain more about.

170. 0:39:34

     Um, I think probably all y'all are familiar with our, our state is aging. The aging population, um, is growing tremendously. You see some significant upticks in the 2010s, 2020, keeps on growing, and along with that is the prevalence of folks in our state who have Alzheimer's or a related dementia. So again, all of this is underscored by what's happening amongst our communities, um, across the state with aging and AD prevalence. The other piece, so obviously quality of life, preserving cognitive health, providing caregivers the support they need, all the things we wanna do also ties into economics, health economics, right?

171. 0:40:11

     The Medicaid cost to Georgia, we estimate by 2050, it'll be seven billion, um, a year, which is really remarkable, um, as that aging population increases. And then when you start looking at all costs, so that scale just shifted to the right, where you go from single digit billion to double digit billions, and you're talking about all cost medical, long-term care, formal care, and then Lord knows how much informal care, all those caregiver hours and time that's not billable that we estimate is being spent caring for folks. Um, so there's a real, um, sort of undercurrent too of like how do all of this care and quality and health economics play together.

172. 0:40:49

     So we knew from the beginning, so rewinding back to 2017, um, when we get this thing going, and, uh, before anybody in the DHS, Department of Human Services comms office comes after me for that old logo, this is a throwback slide. We don't use this anymore. Uh, but these were our original partners. We knew, um, that without the partnership of our al- uh, aging resource connection network, um, professional agencies, Alzheimer's Association, Rosalynn Carter Institute for Caregiving, were all key in getting this thing stood up, and not least of which the support, continuing support we've had- From DHS and Division of Aging Services.

173. 0:41:23

     Um, just really wonderful and committed leadership there, and I, I thank them. Um, so really the premise behind this also was, what do we need to do to get there, right? So engage with primary care providers statewide so that they understand risk factors, how to screen, be aware of this need. Um, and then of course, probably the most prominent feature of Georgia Memory Net is establishing the statewide network of memory assessment clinics. So we know that even neurologists across the state don't necessarily have the time and the tools to do all these assessments that you have to do to get the specific diagnosis.

174. 0:41:56

     So how can we build this infrastructure to support them, um, with this time, the tools, the education, the supports, and the infrastructure? Um, and then really what again is that underlying thing is, how do we bring the best practices and that research that we've translated into clinical care to the rest of Georgia through these memory net- networks? Um, and then importantly is coordination, direct coordination with community services. We have services educators embedded in each one of our memory assessment clinics that help bridge that gap, because honestly, eligible for drugs or no, at the end of the day, when you go home as a care partner or as a person living with dementia, you're gonna need some help and supports, so we wanna tend to that as well.

175. 0:42:36

     Um, and then to help keep this whole thing running and keep us honest with, um, you know, how we're doing and looking at disease prevalence and also ROI, we have a massive IT infrastructure in the background to help, um, keep this thing going. So where are we so far? You see that on that map, those circles, it might be really tiny if you're looking at a printout or even on a screen. The circles are a se- seven memory assessment clinics. These are seven non-Emory Healthcare healthcare agencies that we partner with, um, that are memory assessment clinics, and then the stars are partnerships that we have with local Department of Public Health offices to offer assisted telehealth.

176. 0:43:11

     So if you can't get all the way to a MAC, but you can get to your local public health office, you can do a telemedicine visit there. Since the beginning, we've seen just shy of 6,000 people. That five, uh, seven nine eight is a couple months old. We're a little closer to 6,000 people since we've started, and I can say the year over year is exponential. We're seeing more and more folks as the word gets out and we really hone this messaging. Importantly, over a quarter of our folks do live in rural counties, um, and importantly back to ensuring that we get folks early so that we can get them plugged into treatments, two-thirds of our folks that we're seeing res- are in early or early moderate stages with a, a little over a third of folks getting a mild cognitive impairment diagnosis, meaning we're doing what we set out to do, catching people early so that we can get them access to these treatments.

177. 0:43:59

     And like Dr. Lovey mentioned a little while ago, between the GMN network and Emory patients, we account for a little over 60% of all of the folks in Georgia who are currently on these drugs. Um, and we wanna see that grow, right? Um, and you know, importantly thinking again about how do we work with this infrastructure, what kind of resources w- might we need, and Sheila's probably been talking with y'all about some of our ideas, um, around this to prepare for prevention in the next few years. Um, so going back to some of that economic impact, a, a big thing, a big premise we have that's not really articulated on this slide, but you know, if you get folks diagnosed early, get them plugged into those community services and supports, say they're eligible for one of these drugs, you get them on drug, then you're gonna delay or even prevent things like skilled nursing or memory care.

178. 0:44:47

     You know, none of us wants to end up in a skilled nursing. None of us wants our loved ones to be in skilled nursing. So that's a big piece of it. The economic impact is really, really remarkable, um, if you can delay or even prevent those, and you can see some of these figures here. Um, I won't go into a ton of detail, but we will be around if y'all have questions for me. Uh, but suffice to say, GMN patients that are getting these services are coming in at a fraction of the cost, total cost, meaning not just Medicare, but out-of-pocket and private payer costs, and then Medicare, uh, GMN patients cost about half.

179. 0:45:20

     Um, we do know that GMN patients, at least with this little splice of data, um, are four times less likely to have inpatient stays, um, in the course of, of a year, which is really, really remarkable. Um, and again, talking about, all right, in the future, where do we need to go? So just kind of wrapping it up, our, our n- original goals, getting that access to the early, um, diagnosis, accurate diagnosis, and then moving into this space of, um, you know, how can we be prepared as a state, building from this in- infrastructure, so that folks can access these preventive therapies and never even, you know, be in that position of working with the disease in the first place.

180. 0:46:00

     Um, you know, Dr. Lovey-

181. 0:46:02

     Before

182. 0:46:02

     ... any questions.

183. 0:46:03

     I forget it.

184. 0:46:04

     Yeah.

185. 0:46:05

     You said you talked about, uh, reaching out and teaching our family practitioners. Okay, what about our medical schools? Our, are the medical schools, is Mercer letting you come? Is the Medical College of Georgia, uh, Emory? How are we doing on that?

186. 0:46:22

     Yeah, yeah. Um, pretty, pretty good. Um-

187. 0:46:25

     Okay

188. 0:46:25

     ... we, we could do better. We could, you know, we have to be pretty laser-focused on what we're currently legislated and funded to do. However, I will say that we have really good engagement, not only with Emory's residency programs, um, and medical school, but also up at Gainesville. Um, we work with Eng- uh, North Georgia, Northeast Georgia Physicians Group, NGPG, um, and they have residents rotating through. We do a lot of work with them up there. Um, and a lot of our memory assessment clinic sites actually have residents and trainees and med students rotating through-

189. 0:46:54

     Through

190. 0:46:54

     ... their memory assessment clinics as well. Yeah.

191. 0:46:56

     Yeah, and that's really good to hear-

192. 0:46:57

     Yeah, yeah

193. 0:46:57

     ... because they're, you know, our future, and I know we're-

194. 0:47:00

     Exactly

195. 0:47:00

     ... putting more and more of the doctors from our medical schools out into rural areas-

196. 0:47:04

     Yes, ma'am. Yeah

197. 0:47:05

     ... hoping they'll fall in love with that area-

198. 0:47:07

     Right, right

199. 0:47:07

     ... or at least somebody that lives there, and get married and go back.

200. 0:47:10

     Yeah.

201. 0:47:10

     So, uh, we're working on it. Representative Oliver.

202. 0:47:14

     Uh, Dr. Lovey is a hero to many people.

203. 0:47:16

     She loves-

204. 0:47:16

     She'd know f- uh, from the Emory community, we know, proud that you're here in Georgia. What is the state funding for Georgia Men- Memory Network right now?

205. 0:47:26

     So we currently have, um, 7.12 million a year. Um, gas holds onto 100 of that for central support, so we get s- just over seven.

206. 0:47:36

     And I'm guessing that the 6,000 people that have received treatment are part of your research database, or not? And how does this millions that we state fund pull down other federal research dollars?

207. 0:47:52

     Yes, ma'am.

208. 0:47:53

     Oh, um, yeah, we have a firewall. When we, when we worked together to start Georgia Memory Net, we said, "This is clinical, it's not research."

209. 0:48:00

     Okay.

210. 0:48:01

     So it's the 100% clinical care.

211. 0:48:04

     Okay.

212. 0:48:04

     Um, we've been a- we, we certainly wanna learn from it, and learn from the experience. And what we've been doing here puts us in a position to acquire federal funds to do independent research.

213. 0:48:14

     Mm-hmm.

214. 0:48:15

     So we just renewed the Alzheimer's Center through the NIH federal funding this year, and we highlighted our state, you know, and we got extraordinarily high, high marks, I think the highest in the country-

215. 0:48:25

     Mm-hmm

216. 0:48:25

     ... in part because of the innovation we've been able to do at this stage.

217. 0:48:29

     That's, that's very good to hear. Emory lost research money. All our rese- our institutions medical lost money in the last eight months, and so we're happy that we're gonna be a opportunity to build that back, and you're a part of that. Thank you.

218. 0:48:42

     Yep.

219. 0:48:43

     And I will say, if anybody doesn't know, these, uh, are recorded. Or they're going out live now. If anybody watches us, or if anybody wants to watch the discussion, they can go back and, and get it, which is nice. So hopefully, maybe it'll stimulate some people to listen and give encouragement to them. Representative Drenner. Another double PhD.

220. 0:49:04

     Oh, thank you.

221. 0:49:05

     We have really smart people in this committee. I serve with great people.

222. 0:49:10

     Thank you, Madam Chair. Just a, a quick question. Um, and thank you for your hard work. Uh, are these lifetime treatments once you're diagnosed and you-

223. 0:49:23

     It's, that's a wonderful question. It's, you said are they lifelong treatments, right?

224. 0:49:27

     Yes.

225. 0:49:27

     Um, the, there are two medicines, and in the, the newer one on the block is gonna be, recommended be g- given for about 18 months and then done. Or even a year for some people, we can check and done. So, um, we think the amyloid plaques are going to come back, but very slowly. And so, um, the other medicine, there's a maintenance dose. So instead of every two weeks, it goes to once a month. We, after a point, when people progress beyond mild stages of dementia and the quality of life is impaired, that's when the, it's appropriate to stop the treatments.

226. 0:50:04

     Right. I, I notice you did say something like, "And it really cuts down on people reaching the end of life." I would take it that meant that if you start doing this, you know, when you're 80 or something like that, it's a good possibility something will kill you before... I mean, just to put it bluntly-

227. 0:50:24

     Yes

228. 0:50:24

     ... some other-

229. 0:50:25

     That's right

230. 0:50:25

     ... heart disease or something will kill you before-

231. 0:50:28

     Right

232. 0:50:28

     ... you get to where the end stage. That is so terrible on families, the long goodbye often and all that goes on. And it's, and, and I will tell the faculty, I don't, uh, the committee, I, there are so much facts that come into my head, but somebody in the, um, assisted living memory care things said there hasn't been a new memory care unit built in several years, or nursing homes built. And if that's true, with the aging population, a- I mean, we're gonna really shortly, if we don't do something about this, be in a bed, into a, a problem with beds.

233. 0:51:07

     Yeah.

234. 0:51:07

     I, I, I mean, it's just if they reach that end st- stage or get to the point of it. Representative Au.

235. 0:51:15

     Thank you. Uh, one quick question about your resources and your funding with respect to outreach and screening. I feel like we might have worked together at a, a memory screening event in the community earlier this summer with Representative Marvin Lim.

236. 0:51:30

     Oh, yeah.

237. 0:51:30

     And this is part of what I wanna ask you about. Is that, that actually, you know, I was looking at this map of where you do the screenings, and obviously there's, there's a few. But they're pretty far apart, and people might not know about them, and, uh, how each clinic is resourced is different, right? So in terms of catching the maximum number of patients who could benefit, uh, this outreach that we did was at a senior center for, um, Asian Americans and immigrants in that community where we had translators. So obviously with a Mini-Mental status exam, which is the bluntest tool that we could use for that screening, we actually did catch, I think, two or three patients that day.

238. 0:52:02

     Um, but having the translator there was key, because I don't think that they could have completed the exam without a translator, and I don't know if that's available there. So in terms of outreach into specific pockets of the community and staffing them appropriately, is that part of your funding?

239. 0:52:15

     Yeah, it is. Um, what our, our model, um, really relies on, again, is, is getting that word out, doing the screenings, working with the primary care providers so that no matter where you are in the state, then that PCP can refer to the memory assessment clinic for the in-depth diagnosis. Um, the, the resources at each of those memory assessment clinics, it varies a bit as far as things like translation services. All of them have access to that. Um, and in our data architecture, the IT infrastructure, we have, um, they pre-populate care plans that are modifiable, and we actually have translated versions baked in.

240. 0:52:50

     So when a patient does come in, um, and it's, I think, five different languages or something, so they can even get their, their care plan in their, um, own language, which is, which is great. But I think to your point of having the staffing there, we're trying to do more with groups, like what we did with Representative Lim. Um, we're working with another group, uh, with Spanish-speaking communities, um, to get the word out with, with the DPH group, um, as well. And so trying to be more intentional about those types of things-

241. 0:53:17

     Mm-hmm

242. 0:53:17

     ... um, as, as part of it.

243. 0:53:19

     Two more questions and then we're gonna have to pause this, 'cause we have two more bills and people waiting. Uh, so if you'll be succinct. Sharper, Representative Sharper.

244. 0:53:27

     Uh, thank you so much.

245. 0:53:28

     She took a round two.

246. 0:53:29

     Thank you so much.

247. 0:53:30

     We can stick around too, so that anybody who wants to ask questions after the committee, we can do that.

248. 0:53:34

     Yeah. 'Cause I don't think this bill will take a long time.

249. 0:53:38

     All right. Okay, thank you. Uh, but, and I could probably get with you later on this, but, uh, you mentioned IV, you know, infusions, uh, things like that when you was talking about the medicines, but are there any IM or s- eventually subcu like you, you know, we know you're doing a monthly thing there, but can you just briefly say something, and I can talk to you later about that? But I just wanna know what type of routes.

250. 0:54:00

     No, it's a great question. The, the current ones are intravenous. Um, the same medicine is currently getting, um, inject- subcutaneous injection in a research setting, and I fully expect it'll be probably approved in the next year or two, which will really ease the burden of administration.

251. 0:54:15

     All right. Okay, thank you.

252. 0:54:16

     Chair, is there anything else?

253. 0:54:18

     O'Steen, you get the last one.

254. 0:54:19

     Okay. Thank you, Chair. This was great. I'm so glad you had them come. This is phenomenal to hear. Uh, really is phenomenal.

255. 0:54:26

     I think we'll probably be seeing them back-

256. 0:54:28

     Yeah

257. 0:54:29

     ... for support and more expansion, uh-

258. 0:54:31

     You read my mind

259. 0:54:32

     ... since they're getting good results and

260. 0:54:34

     Right.

261. 0:54:35

     Great.

262. 0:54:35

     I know you.

263. 0:54:36

     And in, and in speaking about that expansion, when you mentioned the, the infusion clinics, I'm a, a former oncology nurse and worked in an infusion center, so I'm wondering if that is something that we can eventually maybe move to? 'Cause a lot of these rural hospitals have infusion clinics-

264. 0:54:51

     Right, for cancer

265. 0:54:52

     ... right, for cancer, and so maybe it could be a combo kind of thing. Can somebody speak to that?

266. 0:54:58

     I think that's exactly right. I think that, uh, subcutaneous will help, but there are probably gonna still be infusions, and the newer generation of these medicines are gonna be safer, so giving them to rural hospitals that might have, not have all the fancy extra stuff- ... will be very, very efficient way to deliver the medicine.

267. 0:55:15

     Yes.

268. 0:55:17

     Mm-hmm.

269. 0:55:17

     And-

270. 0:55:17

     Yeah.

271. 0:55:18

     ... I thank you so much for coming. Thank you, Sheila, for-

272. 0:55:20

     Thank you

273. 0:55:21

     ... you know, having them come. Uh, I will have a question when it's over, if you're able to s-

274. 0:55:25

     I will be glad to stay. Thank you so much for having me

275. 0:55:27

     ... stick around.

276. 0:55:27

     Yeah. Thank you.

277. 0:55:27

     And I'm sure other people will. And can't thank you enough, and, uh, look forward, and I know a lot of people will still be here, uh, going down the road that hopefully will, after this, know why it's so important to help y'all with further expansions.

278. 0:55:41

     The only thing I wanted to just sort of close out was, um, in the budget, it is listed as the Georgia Alzheimer's Project because I named it poorly to begin with, um, but we do go by Georgia Memory Net in the field. But it, in the budget, it is, um, the Georgia Alzheimer's Project.

279. 0:55:55

     And you are in the budget this... I mean, you've, that's submitted again?

280. 0:55:57

     We're embedded in there, um-

281. 0:55:59

     Okay. Looks good so far

282. 0:56:00

     ... but if you see us again, if you see us again, that's when-

283. 0:56:03

     Oh, no, it's cut or something? Okay.

284. 0:56:04

     That's right.

285. 0:56:04

     Yeah, or down the road.

286. 0:56:05

     Thank you so much. I appreciate it.

287. 0:56:06

     Okay. Thank you so much.

288. 0:56:06

     And I'm gonna leave you with our Bruce Shores as well.

289. 0:56:09

     Okay. All right. Let's get, uh, Representative Donatucci, if you'll come present House Bill, uh, 1118.

290. 0:56:37

     You ready?

291. 0:56:39

     I'm ready.

292. 0:56:39

     Go ahead.

293. 0:56:40

     So the LC number is 461432S.

294. 0:56:45

     Okay. We got it.

295. 0:56:48

     Chair Lady Cooper and committee members, I'm here to present HB 118. This bill increases paid leave for birth mothers for six to nine weeks, from six to nine weeks for state employees, certain state employees. It creates a new category of leave for birth mothers, maternal birth leave. It must be used in the first three weeks immediately following the birth of a child for recuperation. State employees must be employed for a period of six months before using this leave.

296. 0:57:21

     There's no direct cost to the state because a full year of salary has already been funded, and employees would be paid from the maternal birth leave bucket before, um, bucket using their existing salary. And if you're familiar with this in t- in 2021, the three weeks was given to these employees, um, for maternity, paternity, and adoptive, and then in '24 it was expanded to six weeks.

297. 0:57:53

     All right. Questions for the presenter. Representative Reese.

298. 0:57:57

     Yes. Thank you, uh, Madam Chair. Representative, I love this bill.

299. 0:58:04

     Yeah. Thank you.

300. 0:58:04

     I think that it is so phenomenal in saying to the women that work for our state that we care about you and your mental health. My wife and I had a few complications after the birth of our daughter, and for her to have that additional time was just so critical to her full recovery. And as a man, I know it's difficult for us to understand what women go through when they give birth and the challenges that come after birth. And for this, I think this is the state sending an amazing message to so many women out there that we're gonna support you.

301. 0:58:35

     We want you to raise healthy families. We won't liberty the Georgians running around here on our playgrounds- ... and this is gonna help us get there. So I, I just had to tell you that. I could not wait to push that button. And at the appropriate time, Madam Chair, I would like to move this.

302. 0:58:51

     Is this any, any indication there might be another little Reese family member coming? Maybe down the future?

303. 0:58:58

     If you get me out of Atlanta, I might consider it.

304. 0:59:02

     Well, we're so short of physicians, it depends on how long if your wife has to be away from work.

305. 0:59:09

     Maybe.

306. 0:59:09

     Uh, so anyway, okay. Uh, who we got next? Representative Hilton.

307. 0:59:17

     There she is. Thank you so much to the author. I, I was shocked to learn, uh, just a, as a few years ago, how little, if none, we had. And so, um, I, I don't know if you'd like to kind of address who started this effort, but, uh, I think it's worth mentioning the speaker pro tem and, and her efforts to, to get this

308. 0:59:35

     Down the road. Yes, yes, definitely. The, the Pro Tem has been very proactive in this, in this bill.

309. 0:59:43

     Thank you. Yep. Okay, I don't see any other questions. Uh, what would the committee like? Uh- Madam Chair, so, yeah. Reese. Go ahead, Representative Reese. Madam Chair, as it relates to House Bill 1118 LC461432S, I move that we do pass. Okay, we got a due pass. Do we have a second? We have a second. Any further discussion? Pro Tem Johnson. What? Pro Tem Johnson. Oh, uh, we have a guest. Uh, we have Pro Tem in the room.

310. 1:00:13

     Where? Oh. I- On time. Now you under- Now, now everybody can understand when we had a very heated bill in here, and the lights were lower, and I sent somebody out 'cause we were at the fire marshal's level, and then somebody else came out, and I said, "No, no, no, we've already sent somebody. They can't come in." And when we got to the author's time to present the bill or go pass it, I asked where the senator was, and they told me I'd sent him out of the room.

311. 1:00:45

     Because I couldn't see him. So, S- Madam Pro Tem, I'm sorry. I didn't... Would you like to come say anything? No, I'd, I'd... I mean, if it's okay, I just wanted to speak in support of the bill. I think it's a good, good incremental progress, and will mean a lot to a lot of state employees. And we know that, um, leave is an important factor in retention and just, um... I think it's important for employees and certainly important for birth mothers to have some additional time.

312. 1:01:16

     Well, thank you for that. Uh, and I, if everything we... One of the major things we got on our desk today was from a group supporting young family members and babies and talking about that it's so important in life that they start out being loved and cared for, and one of the best ways to do that is to have a mother, a new mother at home so they can, if they're breastfeeding, get started. And if, and if not, even if they're not breastfeeding, so that they can love and hold on that baby and start bonding with them. That bonding element is so important.

313. 1:01:48

     Representative Hilton. Uh, Madam Chair, is it not true that about 30 seconds before the Pro Tem walked in, I credited- ... I credited her and her leadership on this issue. And had she been here, I would've gotten brownie points, but, um- ... yeah. It is true- Thank you ... as you speak. Thank you. Everybody in the favor of the passage to the substitute to House Bill 1118, say aye. Aye. Anyone opposed say no. Congratulations.

314. 1:02:19

     Thank you. The ayes have it, and the bill passes. Right. Okay, good. I mean, since I'm going, I'm moving. Thank you for coming to see us.

315. 1:02:30

     Okay, here we go. All right, so next and last, we have a bill sponsored by one of our members, Representative Taylor. Are you ready?

316. 1:02:41

     Oh, good.

317. 1:02:50

     Thank you, Madam Chair, members of the committee. I appreciate the opportunity today to bring you this i- important bill. It's, um, House Bill 1096. Um, just a little background on this bill. This legislation came as a result of the recommendations from the House Study Committee on evaluating funding for public health. One of the issues identified during the study committee was staff retention. This legislation seeks to assist in creating a, a s- sustainable career ladder that will help in improving employee retention in public health.

318. 1:03:25

     Exactly what does this legislation do? Local public health departments are staffed primarily by county board of health employees. In many circumstances, county board of health staff will progress through their career, and upon reaching the top ladder, they must choose to either forfeit their accrued leave and take a position at the state or the district, um, public office, or turn down further promotions, or actually leave public health, and we're seeing that happen. This legislation allows county board of health employees who move directly to state positions in the State Department of Public Health to retain accrued annual and sick leave.

319. 1:04:06

     The benefits are that it helps the Department of Public Health retain experienced public health professionals who often leave public service or turn down promotions after reaching that top of their career ladder at the county level. It prevents loss of institutional knowledge. It will reduce the need to train new staff unfamiliar with Georgia's public health system. Other considerations are that it applies only to a narrow group of employees. These are members of the state retirement system who transition directly to state employment through the Department of Public Health with no break in service, explicitly prohibits counties from paying out accrued leave at transfer.

320. 1:04:48

     It prevents double benefits or windfalls. It limits, uh, fiscal impact. It affects only occasional transfers. It's not a large number of employees that this would affect. It authorizes the State Personnel Board to adopt the rules and to ensure consistent implementation across the state. Uh, there is a substitute language, so you have... I'm working off of LC600282S, and we really just wanted to clarify. It's line 17 and 18, um, and it says, "And shall retain seniority for purposes of graduated leave accrual." This language just justifies and clarifies that the staff will retain their seniority for the purposes of graduated, uh, leave accrual.

321. 1:05:32

     This was always the intention. Um, we just wanted it to be clear so there wouldn't be any questions about it, and it took away any ambiguity

322. 1:05:41

     So I'm, I'm thinking this is something, as we traveled the state this past summer and fall, this is one of the things we heard over and over again. And, um, it was a very informative study committee, and this is the first piece that we feel like we can actually help the department. They've asked for this, and it will help them. I'll be happy to answer any questions.

323. 1:06:01

     Representative O'Steen.

324. 1:06:02

     Thank you, Chair. I enjoyed this committee, learning a lot about our state. Remind me, Chair, isn't, isn't it true that our county health em- health department employees are... They participate in state health benefit plans, right?

325. 1:06:19

     Uh, their county... Yes, they do, but their county, um, it's a combination. It's a very unusual circumstances. They actually are employed by their county. How- however, they do have some state benefits. So-

326. 1:06:31

     So-

327. 1:06:31

     It's an unusual circumstance of how it works. Um, we found out many things as we studied public health and how it functions. We actually found out if you've seen one public health office, you've seen one public health office. But this is something that was consistent everywhere as we went.

328. 1:06:48

     Right.

329. 1:06:48

     Thank you.

330. 1:06:48

     So follow-up is that these, these, um, employees are kind of caught in a system that we maybe unintentionally created, and they were not able to move up without foregoing all of their benefits.

331. 1:07:03

     That's correct.

332. 1:07:03

     Correct.

333. 1:07:04

     And I think this came to the surface, frankly, with COVID and other emergencies that we have had where we needed their knowledge at the state level.

334. 1:07:14

     Representative Cheokas. Madam Chair, at the appropriate time. Okay. Uh, seeing no other questions, this is the appropriate time.

335. 1:07:28

     Madam Chair, I

336. 1:07:33

     move that the 1096, LC602608, excuse me, LC60... Let me put my glasses on. Right. 0282S. That's the one. You got it. Thank you. You're, you're welcome. I try. Ah. Anyway. Glad- Uh, I move to pass. Would you like to see the doctor when we get through this? I might need to. Save a place for us. I'm teasing him. So, um, now I've embarrassed myself. Okay. You would like to- Move to pass ... move to pass of the substitute to House Bill 1096.

337. 1:08:06

     Do I have a second?

338. 1:08:07

     Second.

339. 1:08:07

     I've got a second. Is there any further discussion? Seeing no further discussion, everybody in favor of the passage of the substitute to House Bill 1096, say aye.

340. 1:08:19

     Aye.

341. 1:08:19

     Aye. Anyone opposed, no. Ah, the ayes have it. Thank you-

342. 1:08:22

     Thank you, Madam Chair and committee

343. 1:08:24

     ... for bringing it to us. And with that, we are adjourned. Chu-