Comité Health de la Cámara de Representantes, 18 de febrero de 2026

Transcripción

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1. 0:06:24

   Well, good afternoon. I know we're a few minutes late, but, uh, we're gonna go ahead and get started here. We're gonna start with, uh, let me see. How about Chair Lady Taylor? Uh, HP 1192.

2. 0:06:40

   Mr. Chairman.

3. 0:06:41

   What?

4. 0:06:42

   If I may, uh, I have a quick question.

5. 0:06:44

   I don't think so. No. We're not doing that Medicaid thing again. You're out of order, now and later.

6. 0:06:54

   We got more Democrats here than Republicans that move to expand Medicaid.

7. 0:06:58

   Go ahead, Chair Lady. Thank you.

8. 0:07:02

   Thank you, Mr. Chairman. Um, I bring you today House Bill 1192. I'm working off of LC52-0972. Uh, this bill came about, um... I chair the Appropriations for Healthcare, and our committee felt like we needed to have a, a little more oversight on how funding was done and getting more reporting. So what this bill actually does, it affects the Department of Human Services and the Department of Community Health. Um, and it talks about any of those that have state or federal funds, whether it be for administrative costs or matching federal funds.

9. 0:07:35

   Uh, we felt like they needed to be a- appropriated, allocated by us. We need to know how they're being spent, and we actually are gonna ask them to give us a report every, um, year so we know how the funds are being allocated. And they must be used for the purposes that they've been assigned. That's basically what it does. It also makes the commissioner, uh, I guess you would say he's the named chief administrative officer, and he will be, or she would be, uh, responsible for seeing that these things are done and the oversight on them. It's a very simple bill. We felt like there needed to be more oversight.

10. 0:08:06

    Now, you are the chair lady of the Subcommittee on Health Appropriations, aren't you?

11. 0:08:10

    Yes, I am, sir.

12. 0:08:11

    You know what of, what you speak?

13. 0:08:13

    Yes.

14. 0:08:13

    Yes. I thought so.

15. 0:08:14

    Thank you.

16. 0:08:15

    Representative Kelley.

17. 0:08:17

    Thank you. Thank you, Mr. Chairman. Chair Lady Taylor, thank you for, uh, bringing legislation. I think any time that, that we as a state can be accountable to our taxpayers for how we're spending their money is great. Uh, do we do this with any other, uh, agencies or commissioners? And did we think about doing that for all agencies, not just DHS?

18. 0:08:42

    Um, I'm not sure what others are requiring. I know there is general accounting and auditing being done. But because of the size and growth of our health agencies and human services, we felt like the growth has been so high, it, the dollar has grown so much, that this needed attention now. Be happy to consider the others, but since this did touch my appropriations committee, we felt like we needed to move on this.

19. 0:09:05

    I kinda just wanna make it apply to everybody.

20. 0:09:08

    Yes.

21. 0:09:09

    Thank you. Representative Mitchell.

22. 0:09:11

    Yeah. Uh, uh, Chair Lady Taylor, thank you so very much. I agree. Uh, I just was curious. Is, is there an incident that brought us to this point? I, I had assumed that some of this was being done already. W- why was it necessary to bring the bill forward?

23. 0:09:25

    Okay. I, I will tell you, the department does do some, um, auditing and, you know, the Office of Budget. Everybody has a little look-see. But you can audit, and then you can audit more deeply, and that's what we are looking for to make sure how the funds are spent. Again, when we allocate funds for a certain area, we wanna make sure that it's actually being done that way.

24. 0:09:44

    Mm-hmm.

25. 0:09:44

    So.

26. 0:09:45

    But no specific incident?

27. 0:09:47

    Um, I guess in the press we've seen where they've had problems in other states. This, um, we wanna make sure we don't have anything like that happen in the state of Georgia.

28. 0:09:56

    Thank you, Mr. Chairman.

29. 0:09:57

    Thank you.

30. 0:10:02

    Thank you, Mr. Chair. Um, my question is pretty simple. It's, um, are we asking the Department of Human Services to do this audit, or are we asking the Department of Audits, like, the people who are already doing audits in our state to do-

31. 0:10:20

    The department is to actually oversee it. He's responsible for having it done. It could be, um, we've actually, there's other legislation out there where they cannot, uh, use their own insight for it. But this is gonna be their responsibility to see that it is done. Right now, the state does do some. We want additional, and it has to be overseen by the department.

32. 0:10:41

    Um, so I guess a, a, a follow-up to that. So, um, we're not require, are, are we, or are we not requiring them to use, like, a third party to do this audit, or can they use the department that already does budget audits and-

33. 0:10:57

    It, it will be an oversight by them. There will be some instances where they can do simple audits within, within theirs. But they will have outside audits also. It will be both.

34. 0:11:07

    Okay. Thank you.

35. 0:11:08

    Mm-hmm.

36. 0:11:09

    Representative Barton.

37. 0:11:11

    Mr. Chairman. Oh. Thank you, Mr. Chairman. Um, uh, Chair Lady, uh, as a member of-

38. 0:11:18

    Sorry

39. 0:11:18

    ... of Health Appropriations with you, just wanna emphasize a couple of things. First of all, um, it's not only very important that we make sure that, uh, that we don't forget how important it is we use these funds correctly, but our concern is also very much about seeing that those populations that we're interested in ensuring get the care they need are getting that care. And, uh, it's, isn't it also true that we are very interested in making sure the department has the resources to do these audits as well? Because that's very important that we give them the resources when we ask them to do things like that.

40. 0:11:53

    That, that is very correct. And as we're working on the budget this year, we are seeing where they do need help. They need more staffing, and we wanna make sure we get a full picture, and we are not getting that now. So we think this will help us get that full picture.

41. 0:12:08

    I see no, no other questions. Do we have a sign-up sheet? Hold on just a second.

42. 0:12:24

    Oh, really? I know.

43. 0:12:29

    Uh, Representative Newton, do you have a question? Sure. Oh, okay. I have a question. So who we got?

44. 0:12:39

    Me.

45. 0:12:40

    Oh, Schofield.

46. 0:12:42

    Uh, thank you, Madam Chair. I really do think this is a timely bill and really needs to be done. Just a question on line 55. Uh, are there two ... Are the funds being ... They shouldn't be commingled. Were they being ... Are there separate accounts?

47. 0:12:55

    We wanna make sure that they are.

48. 0:12:56

    Okay.

49. 0:12:56

    Because I don't want one big pot of money, and you cannot follow it as easily. So if it is something designated. I'll use example like when we have, um, the tobacco fund. That was separate. We wanna know that it's spent there. It's much easier to trace it and track it that way.

50. 0:13:10

    Yeah, I agree.

51. 0:13:10

    So that's what we're talking about. When you have something that's allocated for a certain area, a certain type of service-

52. 0:13:16

    Mm-hmm

53. 0:13:16

    ... that that's where it goes, and we can follow it.

54. 0:13:18

    Thank you.

55. 0:13:19

    Thank you.

56. 0:13:20

    Follow it?

57. 0:13:20

    We can pass it.

58. 0:13:23

    Okay. That's good.

59. 0:13:26

    Thanks.

60. 0:13:26

    Mr. Chair? Mr. Chair?

61. 0:13:27

    Yes, ma'am.

62. 0:13:28

    Is there a way, I don't know if there's someone from the department already here. I'm just very curious if we already separate federal funds versus state funds in separate accounts in this department. I, I just genuinely wanna know.

63. 0:13:44

    And you just what?

64. 0:13:45

    I gen- genuinely wanna know if there's someone from the department that could answer that.

65. 0:13:50

    Do we want to hear from the department?

66. 0:13:56

    Okay. So-

67. 0:13:58

    Who's right here?

68. 0:14:00

    ...

69. 0:14:00

    Yeah, you, yeah, speak to the mic please.

70. 0:14:02

    It's right here.

71. 0:14:04

    Emily Yonah from the Department of DCH.

72. 0:14:08

    Thank you. Hey, uh, Emily Yonah, Chief of Staff at the Department of Community Health. Hopefully I don't fall. But actually, I have Cody Whitwalk, who is our Chief Financial Officer. He can speak to that.

73. 0:14:19

    Uh, the, the short of it is, yes, ma'am. We have separate accounts, both from a, the sense of Georgia Fund One, which is Treasury, so you don't have those federal dollars commingled in your bank accounts. And then also from a budgetary perspective, you have separate, what they're called, fund sources. Um, so you have identifiers from a budgeting standpoint that has separate budgeting standards for state, federal, specific ALNs, CFJAs, which is tied to what that federal grant is.

74. 0:14:49

    Thank you.

75. 0:14:49

    You good? Okay. Th- thank y'all very much.

76. 0:14:53

    Thank you.

77. 0:14:53

    I see no other questions. Do I hear a motion?

78. 0:14:56

    Motion to pass.

79. 0:14:57

    Do I hear a second? Second. All those in favor say aye.

80. 0:15:02

    Aye.

81. 0:15:02

    All those nay. Congratulations.

82. 0:15:04

    Thank you.

83. 0:15:05

    You have a due pass on House Bill 1192, LC 520972.

84. 0:15:12

    Thank you very much.

85. 0:15:12

    Thank you.

86. 0:15:13

    Thank you, Cody.

87. 0:15:13

    Okay. All right. Next up, House Bill 810.

88. 0:15:21

    R- Representative Jaspers.

89. 0:15:26

    There we go. Thank you, Mr. Chairman. Thank you, Committee, uh, for letting us revisit House Bill 810. Uh, we made a few changes after it became, uh, evident, uh, the day after our committee meeting-

90. 0:15:38

    Excuse me. L- let's make sure we got the s- the same-

91. 0:15:41

    Oh, yes, sure

92. 0:15:41

    ... LC of 461454S.

93. 0:15:44

    Yes, sir.

94. 0:15:45

    Thank you. Go ahead.

95. 0:15:46

    And, uh, with saying that, I wanna make sure we, uh, again thank Vance, our legislative council, and you, Chairman, for working so quickly for, to help me get this through. You know, um, Representative Douglas made a comment the other day about this bill is helping the little man, and that's where this substitute addresses. It addresses rural pharmacies in the low population, low ... A lot of miles between pharmacies, to make sure that the contracts that they have with PBMs right now are protected.

96. 0:16:20

    And that's essentially what it does. It does two. And the other two things, it changes the effective date. If you look over on line 55. And it simplifies that sentence from the original bill, kind of gets them on track. And then, and then in line 22 through 24, we define rural areas, and it's also defined in code, so that's easy to transfer. And we use this definition in line 48 through 53 to protect the reimbursement plans that they have in s- place now. That's what the substitute does, and, uh, appreciate your s- consideration on this.

97. 0:16:57

    Thank you for the clarity of this, uh, substitute. Appreciate that.

98. 0:17:00

    Yes, sir.

99. 0:17:01

    Do I have any que- I see some questions. Representative Schofield.

100. 0:17:05

     Thank you, Mr. Chair. So my, my question is, I mean, I have lost pharmacies in my district and area. I live in an rural area. So are they not also-

101. 0:17:14

     No, you're-

102. 0:17:14

     ... should they not be protected?

103. 0:17:15

     If I ... I'm not exactly sure where you live, but you do live in a area greater than 35,000.

104. 0:17:20

     But I've lost, we've lost, we have lost four or five independent-

105. 0:17:23

     Oh, I'm sorry. I jumped ahead. Yeah, this will help you. I mean, the f-

106. 0:17:27

     But it says rural. It says nothing in-

107. 0:17:28

     Well-

108. 0:17:28

     ... other than it's look like it's just targeting rural

109. 0:17:30

     ... it, it does not. It targets all pharmacies. If you'll look in the, um, in section where it goes through B, on lines 25 down through there, that's where we talked about last week, where it talked about all pharmacies-

110. 0:17:45

     Okay

111. 0:17:45

     ... in Georgia.

112. 0:17:47

     Where? Let me just-

113. 0:17:48

     We- the, the substitute-

114. 0:17:49

     See, I'm still, I'm still-

115. 0:17:50

     The substitute-

116. 0:17:50

     Why do we define rural then? Why is that-

117. 0:17:52

     Because if, like I said, we became evident after this bill passed committee that this bill that we as passed would harm those pharmacies that were in a rural area, less than 35,000, so many miles between them, you know, the density. So we wanted to make sure we did not harm them, and that's why we created the substitute to correct that.

118. 0:18:15

     Okay. Thank you. Thank you.

119. 0:18:16

     Yes, ma'am.

120. 0:18:19

     Seeing no other questions, do I hear a motion?

121. 0:18:21

     So moved.

122. 0:18:22

     I hear a second. Second. All those in favor say aye. All those opposed say nay. Congratulations.

123. 0:18:29

     Thank you, Mr. Chairman.

124. 0:18:29

     We have a due pass on House Bill 810, LC46-1454S.

125. 0:18:36

     Thank you. Thank you, Chairman.

126. 0:18:38

     Thank you. Good presentation. Okay, how about up next, Representative Clark, 951.

127. 0:18:51

     Mr. Chairman. Thank you, Chairman and, uh, colleagues. I have, uh, House Bill 951, LC52-0886. And I had, uh, presented the bill in the, uh, I think two weeks ago.

128. 0:19:03

     Right.

129. 0:19:03

     We're waiting for the physical note.

130. 0:19:05

     Right.

131. 0:19:05

     'Cause last year we had the state, the state healthcare plan and the, uh, Board of Regents, but we took it out 'cause we needed a physical note, and we got one. It was 55 million, uh, but now it's 1.4, which is where we thought it should be. But anyway, so we had to go back, get a new physical note.

132. 0:19:20

     Right.

133. 0:19:21

     Um, so now I'm just bringing the bill to hopefully get voted on and-

134. 0:19:24

     Right

135. 0:19:24

     ... th- this would just bring parity across the board.

136. 0:19:26

     Right.

137. 0:19:27

     'Cause right now the commercial, uh, commercial healthcare plan, we passed that last year, and now it brings the state healthcare plan and the Board of Regents, um, to, to allow them to use the, um-

138. 0:19:37

     Right

139. 0:19:37

     ... prosthesis and-

140. 0:19:39

     Yeah

141. 0:19:39

     ... yeah, orthosis.

142. 0:19:41

     Thank you. I see no questions. I think everybody understands this bill, and I held it up without the fiscal note. We have that now. Oh, do you have a question?

143. 0:19:49

     Real quick.

144. 0:19:50

     Uh, Representative-

145. 0:19:51

     Chairman Newton.

146. 0:19:52

     Thank you, sir.

147. 0:19:53

     Um, on, um, lines 18 through 20, is, is... Th- that's a new change, or, or did it just get moved somewhere?

148. 0:20:01

     Can you speak into the mic a little bit more?

149. 0:20:03

     On lines-

150. 0:20:04

     Sure

151. 0:20:04

     ... 18 through 20 where we, uh, eliminated the, the, the exclusion, we eliminated the exclusion for Medicaid through DCH. Is there, um... I- is... Do we want the, we want this to include

152. 0:20:23

     Medicaid now? Am I read, am I reading that right? Since we're eliminating the current code language that says, starting on line 18, um, basically Medicaid CMOs. Maybe DCH can speak to it. I don't know. Are we trying to exclude Medicaid, or are we just taking out the exclusion to Medicaid and including them?

153. 0:20:45

     Yeah, um, if Rachel Oyer could answer that, that'd be awesome.

154. 0:20:48

     Yeah. Thank you.

155. 0:20:50

     Yeah, go ahead.

156. 0:20:54

     Hold on. Brandy. Brandy, would you like to speak to it from DCH?

157. 0:20:57

     We got three.

158. 0:20:57

     Why don't we have DCH speak to it?

159. 0:20:59

     Yeah.

160. 0:20:59

     I think that'd-

161. 0:21:00

     Tag team

162. 0:21:00

     ... work a little bit better.

163. 0:21:01

     Kim, you're next.

164. 0:21:04

     Brandy Silva at DCH. Yeah.

165. 0:21:07

     Uh, good afternoon. Brandy Silva, director of government relations with Department of Community Health. Uh, I was just reviewing the fiscal note and it, uh... We do only have that cost estimate at, uh, applying to SHBP. So since this is a Title 33-

166. 0:21:21

     Okay

167. 0:21:21

     ... bill, I'm guessing that, uh, it's the way that that is defined in that code section. But I can certainly go back and double-check that. But we interpreted it as applying to SHBP.

168. 0:21:32

     So it, it does not apply to Medicaid or CMOs as-

169. 0:21:36

     That is not included on the fiscal note that was put together. So I would assume that that, that... Uh, I, I'd need to verify this, but I believe that that means we interpret it as only applying to SHBP.

170. 0:21:53

     Okay. Thank you, Mr. Chair.

171. 0:21:55

     I guess my, my question, since we took out the language that it doesn't apply to Medicaid-

172. 0:21:59

     That's right

173. 0:21:59

     ... um-

174. 0:22:00

     Not state health benefit

175. 0:22:02

     ... thank you.

176. 0:22:02

     Well-

177. 0:22:02

     You, you gotta

178. 0:22:03

     ... and typically in Title 33 bills, they would, they are explicitly written in if it is intended to ri- apply to Medicaid or the CMOs.

179. 0:22:12

     Thank you. Thank you.

180. 0:22:14

     Okay.

181. 0:22:14

     That's good.

182. 0:22:16

     You have any comments, Representative Clark?

183. 0:22:18

     No.

184. 0:22:18

     You all good?

185. 0:22:19

     I'm good.

186. 0:22:19

     Okay. I see no e- I see no other questions. Do I hear a motion?

187. 0:22:24

     Move to pass.

188. 0:22:25

     Do I hear a second?

189. 0:22:26

     Second.

190. 0:22:27

     All those in favor say aye.

191. 0:22:29

     Aye.

192. 0:22:29

     All those in disagreement. Okay. Congratulations. You have a due pass on House Bill 951, LC52-0886. Okay. Next up, let's, um, let's do Representative Camp, Chairman Camp, 1002.

193. 0:22:55

     Oh, bring us.

194. 0:22:58

     Thank you, Mr. Chairman.

195. 0:23:02

     Thank you for hearing this bill today. Thank you, Mr. Chairman, and thank you for hearing this bill today. Thank you, Committee. Um, I'm gonna take a page out of Chairman Taylor's book. Um, the reason I brought this bill, um, House Bill 10002, LC33-9857, is because as Chair of Judiciary Juvenile, I, we had a very long meeting on December the 18th to just discuss some of the challenges that DFCS is facing. And one of the challenges that arose is unfortunately managed care sometimes is an obstacle for children in DFCS custody in the foster care system.

196. 0:23:41

     I was really surprised at the rates of trauma and behavioral challenges that children have who are often in custody. Um, oftentimes they have a number of issues from lack of previous medical care to chronic medical conditions to developmental delays and again, to behavioral challenges, um, that they change frequently schools, locations where they are, and they need the most simple, direct, and reliable access to care. Um, unfortunately, there are delays sometimes under managed care.

197. 0:24:14

     Um, services require approval before they can begin. Foster parents and caseworkers have to navigate appeals, and children have to wait for therapy and evaluations or treatment. Um, moving children back to fee-for-service Medicaid would reduce administrative barriers, allow providers to deliver care without insurer gatekeeping, restore clear state oversight through, um, DFCS and Medicaid, and it should be for faster, it should be faster access and fewer delays. Um, and House Bill, uh- 10-002.

198. 0:24:47

     It's just a couple pages long. Um, and I think the biggest provision, um, is on line 23. "Upon expiration or renewal of contract, or earlier if authorized under terms of the contract, the department shall transfer all medical assistance coverage for foster children from care management organizations to fee-for-service Medicaid programs." Um, we do have, um, the commissioner here if there are questions the committee has regarding this, and I'm happy to answer any questions the committee may have.

199. 0:25:15

     Okay. Do you have a question? You have a question, Representative Clark?

200. 0:25:20

     Yes. Um, thank you, Mr. Chair, and, uh, thank you for the bill. I know we, uh, talked about this before. I'm curious about, uh, line 29. Why is there a sunset? Is there a reason why it's-

201. 0:25:32

     Well, this could... Well, because it, we would not have managed care any longer, so there'd be a sunset on the prohibition for managed care in the future. That's my understanding. Um, legislative council actually wrote this bill for us. Good to see you.

202. 0:25:47

     Uh,

203. 0:25:48

     Would you, can you clarify that for us?

204. 0:25:49

     Would you, I think what you, well, what she said is accurate. There'd be no need to leave it in if this goes through.

205. 0:25:54

     Because it would strangle, uh, further addit- sh- additional legislatures in the future from making choices if they decide to go back to managed care. Is that correct?

206. 0:26:02

     We can't bind, yeah, can't bind future legislatures.

207. 0:26:06

     Thank you. Does that answer that for you?

208. 0:26:09

     That actually made me question more what's going on. Um, yeah.

209. 0:26:16

     Okay. Representative, I don't know what... Gisler.

210. 0:26:19

     Down here. Yeah. Thank you, Chairman. Thank you, Chairman. Um, I have a question, so, um, 'cause we have a lot of different managed care plans.

211. 0:26:27

     Mm-hmm.

212. 0:26:27

     Um, when was this sp- sp- specific population of foster children placed under managed care initially?

213. 0:26:36

     And that's probably gonna be the commissioner. I have heard two different numbers.

214. 0:26:39

     Is there someone that can speak to that here?

215. 0:26:41

     Could I bring Commissioner Brose up? Mr. Chairman, would that be okay?

216. 0:26:45

     Yes.

217. 0:26:45

     All right.

218. 0:26:46

     Absolutely.

219. 0:26:46

     Thank you.

220. 0:26:47

     Because it, it likely was at one time fee-for-service before, I suspect.

221. 0:26:51

     It was.

222. 0:26:51

     I'm just curious.

223. 0:26:52

     It was fee-for-service.

224. 0:26:52

     So, and it was moved to managed care when, is the question. Thank you. Thank you, Commissioner.

225. 0:26:58

     You're welcome.

226. 0:27:03

     I've been listening to you, I promise.

227. 0:27:07

     That was great.

228. 0:27:08

     I believe, I believe it was 2014, is my understanding, that we moved from fee-for-service to managed care for foster care, for children who have been adopted, um, out of state custody, and then a s- a smaller group of children that have, like, DJJ involvement. That's, that's who's covered by the current managed care contract.

229. 0:27:28

     And that's administered out of DCH.

230. 0:27:30

     It-

231. 0:27:31

     Correct

232. 0:27:31

     ... DCH holds the contract-

233. 0:27:33

     Right

234. 0:27:33

     ... with Amerigroup. That's the-

235. 0:27:34

     Right

236. 0:27:34

     ... the entity that runs it. Yes.

237. 0:27:37

     Right.

238. 0:27:37

     Thank you.

239. 0:27:38

     Any other questions?

240. 0:27:42

     I think you got off a- awful easy, didn't you?

241. 0:27:44

     Yeah, I almost got one more.

242. 0:27:45

     Gisler. Representative Gisler.

243. 0:27:48

     Yeah. Um, uh, this is a great bill. I, I do appreciate what you're trying to do. Um, but fee-for-service, i- if I understand correctly, runs the risk of being more expensive. Is there a fiscal note on this? Any kinda estimate on how much more it would cost?

244. 0:28:02

     Um, I know the chairman has requested a fiscal note on this, and typically, fee-for... And the commissioner can speak more on this than me, but I just wanted to say that fee-for-service is reimbursement directly from the federal government to the providers for providing the service. Um, so there's not a middleman involved in this. I... Is there... I don't know for a fact there's any cost savings to having, uh, a managed care. Is there?

245. 0:28:29

     Well,

246. 0:28:32

     uh-

247. 0:28:32

     I mean, I think the, the fiscal note that was previously prepared, we may have a copy of it handy. Um, and yeah, I think that we do. So we can grab that. Um, that fiscal note-

248. 0:28:44

     Was like in the $9 million range difference. Something like-

249. 0:28:47

     I don't wanna speak out of turn since there's gonna be a definitive source, but, but this fiscal note too was prepared where there was a higher foster care population, so keep that in mind. Um, and, um, you know, it might be that, that DCH is better prepared to speak to, like, actual cost savings, but, um...

250. 0:29:12

     So it's based on the, um, fiscal note that Chairman Hill, Chairman Jack Hill had prepared in 2020. Um, the additional cost for fee-for-service Medicaid for this population was a little under $9 million. Um, I did talk about at that prior, um, budget hearing that we are, DFCS is, paying for what is clearly healthcare-related costs that on paper should be covered by Medicaid, but because we do often struggle to get access to providers or certain services for children, we will pay for it outright.

251. 0:29:55

     Um, we created a special team within the agency of Medicaid-trained attorneys so that we can pursue appeals, and we've been pretty successful getting some cash back. Um, but, you know, there are costs that are still being incurred even with what we thought could be cost savings with the new plan.

252. 0:30:15

     Chair Lady, I'd like to ask you a question myself.

253. 0:30:18

     Mm-hmm.

254. 0:30:18

     Do you think this would increase access to care for these foster care children?

255. 0:30:23

     I, I do wholeheartedly believe it would increase access to care.

256. 0:30:26

     Yeah.

257. 0:30:27

     And based on the fact that Chairman Hill had this bill prepared in 2020, um, pretty close to my bill-

258. 0:30:34

     Yeah

259. 0:30:34

     ... I, I believe that he shared that same consensus. So, um, I wish he was here to ask, and I'd love to hear his thoughts on this. But, uh, uh, the kids in foster care, we have to treat them like they're the, they're our children, um, because they are in state custody. So we're responsible as a state to make sure they have everything that they need. They did not ask to be in foster care, and of course, they did not ask to have the complex problems many-

260. 0:30:57

     Right

261. 0:30:57

     ... of them do have. So I, I do feel that a, a direct payment to the provider for the services that are, uh-

262. 0:31:05

     In a court order that were recommended by DFCS that are completely within line of their diagnosis and their needs should be fee for service in this case rather than having to go through a middleman.

263. 0:31:18

     Commissioner Brody, do you agree? I do. Thank you. Okay, got some more questions. Representative Clark.

264. 0:31:26

     Thank you, Mr. Chair. Um, so I'm still very confused about the sun setting, um, and I'm just kind of curious what happens January 1st, 2029? Can we now all of a sudden go back to managed care if we want to? Um, and that's my first question. And the second question is just as we contemplate this, um, how are we going to ensure that this already very vulnerable population does not see a disruption in their care? Because we have heard in this committee many, many times that there are lots of, uh, providers that don't take Medicaid.

265. 0:32:00

     And, and, and I just wanna make sure that we're not putting them in a situation where it's even harder for them to get care.

266. 0:32:07

     That's a very good question. Um, based on the information that I have, um, Amerigroup is providing the care, but it is Medicaid still. Um, so it's the providers that are providing services, and stop me if I'm wrong, but the providers that are providing the services now are Medicaid providers.

267. 0:32:26

     Okay.

268. 0:32:27

     So there should not be a disruption in service.

269. 0:32:31

     Hopefully you'll see an increase-

270. 0:32:33

     Yeah

271. 0:32:34

     ... in, in, uh, being able to access the, uh, healthcare. Uh, Representative Douglas.

272. 0:32:39

     Thank you, Mr. Chair. Madam Chair, I just have a quick friendly question. Has that population, it increased or de- decreased since the start of the new program?

273. 0:32:51

     It's decreased since this fiscal note was prepared.

274. 0:32:54

     Okay. The population of people?

275. 0:32:56

     The population-

276. 0:32:56

     Of children.

277. 0:32:57

     Children, yes.

278. 0:32:57

     Um, yes, it's, it's a smaller population-

279. 0:33:00

     Okay. Does that cover-

280. 0:33:01

     ... for foster children

281. 0:33:02

     ... does that cover everything that we have as far as the children is concerned?

282. 0:33:07

     Uh-

283. 0:33:07

     We're not leaving any children out?

284. 0:33:08

     No.

285. 0:33:09

     That's what I'm asking.

286. 0:33:09

     No, this, and, and this is very narrow. Um, this is just children who are currently in foster care.

287. 0:33:16

     Yeah.

288. 0:33:16

     This is not children in other populations that would be impacted.

289. 0:33:20

     Okay, great. Great job.

290. 0:33:25

     Okay. Well. I have- Well, who do we got now? I have ... going, uh, a- after him. Who do we... Uh, Petrea.

291. 0:33:41

     Sir.

292. 0:33:41

     Representative Petrea.

293. 0:33:42

     Sorry, Chairman, one more thing. I just wanna point something out that I think we all need to recognize, and I'm not really trying to make a point, but just we need to recognize this. So we're talking about moving away from managed care with a very vulnerable population. We are currently in the process of moving aged, blind, and disabled and other vulnerable populations into managed care that are right now under fee for service. I just think we as a committee need to recognize that. That's, it's interesting to me, and I know we've, you know, we've talked about it before, but at any rate, so it- it- it's-

294. 0:34:17

     I-

295. 0:34:17

     ... it's a conversation we need to have.

296. 0:34:19

     Yes, sir. And if I could answer, just make a comment back.

297. 0:34:22

     Yes, please. Yes, ma'am.

298. 0:34:22

     Um, you know, most of the population you just described are gonna be pretty stationary. They're probably not more transient. Um, if you're a child in foster care, you could be moved pretty rapidly to anywhere in the state-

299. 0:34:33

     That's a good point

300. 0:34:33

     ... and have to start back over. So having to get approvals for a new doctor in a new area can be cumbersome. Um, and certainly if, uh, you know, if a person is gonna be more stationary, wraparound services, um, having more holistic approach might be better. But if you're moving from one area to another area to another area, it'd be almost, it'd be really challenging to get approvals to do all the things that are necessary in a timely manner.

301. 0:35:03

     Representative Davis.

302. 0:35:05

     Thank you, Chairman. Um, once we do this, are we gonna monitor or, or analyze if this improved the overall service to the foster children? I mean, uh, do we have a record of how it was beforehand that motivated us to take this action?

303. 0:35:26

     So I mean, I hate to put DCH on the spot that, you know, they're the contract holder. Um, for the information that I have access to, I, I generally look at, um, whether the CNO is meeting CMS thresholds for getting our kids the doctor within the timeframe that they're required to get them.

304. 0:35:45

     Mm-hmm.

305. 0:35:46

     And, um, for federal fiscal year 2024, they fell short of that threshold. Um, now, you know, I understand that there can be all sorts of reasons for that, um, and I don't expect per- perfection from anybody. Um, but, um, that is sort of a basic, that is a, a basic requirement to something the state will be held to in terms of liability, regardless of whether it's contracted out or not. So it is a very, um, it's a consistent threshold to look at when you're looking at CMO performance across states, and that's why I look at it.

306. 0:36:23

     Representative Schofield.

307. 0:36:25

     Uh, thank you, Mr. Chair. Just curious, um, why is Americorp the only vendor that we're using in the state, and is there opportunities for others?

308. 0:36:35

     I think that at the time, and I wasn't here, well, I think I was a committee aide for this committee here at that time when this happened. Um, but, um, I think the, the, the rationale was that it would be, they wanted to see if you had, um, one entity in charge instead of having multiple so that you could better track data.

309. 0:36:57

     Yeah.

310. 0:36:57

     And you had a more centralized, uh, form of care. I think that was the rationale.

311. 0:37:02

     But thank you.

312. 0:37:02

     Yes.

313. 0:37:03

     Thank you.

314. 0:37:04

     And again, I think when you have a more stationary population, um, there, there might be opportunities for a more managed care system. Representative Stinson. Yes, sir. Thank you, Mr. Chairman. Um, and I apologize for being late to this question 'cause I was in another committee meeting, so this question may have been asked already. Uh, just as Representative Douglas stated, friendly question. Um, I understand what you're trying to accomplish, Chair Lady, with this particular piece of legislation. But earlier, after our earlier meeting today, um, it was mentioned about foster care providers, there's some issues with foster care providers.

315. 0:37:42

     Would, would those issues somehow impact this legislation and what Chair Lady Camp is trying to accomplish with this bill? Not directly. Okay. But it, but it is still, it is still related, and, and this is probably the, an oversimplified explanation, but it, I think it gets to your point. We pay for a lot of healthcare, um, costs and healthcare related costs that Medicaid should cover on paper. Um, and so many of our contracted providers- Mm-hmm ...

316. 0:38:14

     um, provide those. And part of the reason why we've had to establish a specific unit for delivered services is to make sure that we don't have gaps, and that can mean, and does in fact mean, that we are, the state is in some circumstances double paying for healthcare for foster youth, right? Mm-hmm. So that is certainly a consideration for the legislation. Okay. I'm gonna say this.

317. 0:38:44

     W- we've had a number of committee meetings outside of this committee about foster children, and one of the things that we heard over and over again is the mobility of these children and the parents, changing of parents and guardians, and then reestablishing new docs and all the things they have to go through. If you're a Medicaid doc, you're signed up. So if this stays in, in the CMO world, they can only go to those Medicaid docs. If it goes to fee for service, they can go to a doc that takes Medicaid and one that doesn't.

318. 0:39:18

     So it increases the access for these kids. Mm-hmm. And it's gonna really help when they're moving around to, to be able to get healthcare, good quality healthcare. Which is important. Thank you. Good question. Thank you. Representative Kelley. Thank you, Mr. Chairman. Uh, Chair Lady Camp, I noticed the second signer of your bill, bill is Chairman Hatchett. I'm assuming before he signed it, y'all had a conversation about the potential impact to the budget, and he feels confident in our ability to provide this care for our state's most vulnerable population.

319. 0:39:50

     He is the si- signer of my bill. It's very astute of you to notice that. And, um, we had long, detailed conversations regarding this. Um, he is a supporter of the bill. Thank you. Thank you. Okay. We, I see no, uh, no other questions from the committee, but we do have two people signed up to speak to the bill. Roland, and I'm sorry, I cannot read your last name, so- Boehm, like Nick. I'm sorry? Boehm. Okay. Like Nick. How about coming up to the mic and speaking to the mic?

320. 0:40:22

     You may want to stay.

321. 0:40:27

     No, maybe so. Let's see. Turn and tranface y'all.

322. 0:40:36

     Members of the committee, thank you. My name is Roland Boehm, and I'm here to support HB 1002 because Georgia's foster youth are trapped in a system that looks like care coordination on paper, uh, and functions like rationing in pra- in, in practice. Start with the simplest question. What does Georgia buy when it pays Amerigroup to coordinate care for children in state custody? If the answer is timely, medically necessary treatment, the outcomes don't match the invoices.

323. 0:41:10

     This is not a small problem. The American Academy of Pediatrics' Healthy Foster Care America initiative calls mental and behavioral health the greatest unmet health need for children and teens in foster care. An April 6, 2023 AJC article describes an 11-year-old who entered foster care in crisis. She had just been released from psychiatric hospital. When she got to her new foster home, she tried to jump out of a window.

324. 0:41:41

     Amerigroup denied authorization for residential treatment, approving it only months later, after the child attempted both drowning and electrocution. By then, the artor- article reports no facility would accept her. Now, ask what happens after a crisis discharge. Do children get the follow-up care clinician's order? That would be a hard question to answer, say, a year or so ago. But fortunately, the good folks at Children's have been looking at this m- issue, in that they have implemented an electronic health records-based system that is able to track what happens after those children leave.

325. 0:42:24

     When they leave, they get a discharge report. That discharge report says, "You need to get X, Y, and Z care." An example might be X care is you need to get 90 days of dialectical behavior therapy treatment, right? So then what CHOA did is not just sort of see what was recommended. They had care coordinators follow up with parents and find out if they got the care that they were supposed to get. And in 60% of the sit- in, in 60% of the cases, they did not get the care.

326. 0:42:55

     Now, there are some who argue, well, that's because we don't have enough providers. Well, Children's took an epidemiological sample of those same s- uh, those same children, and they took on the responsibility of finding whether they could get care, and to pay for that care if necessary. And when they took over that responsibility, they were able to secure care for over 96% of the children.

327. 0:43:21

     96, where the people who were paid to do it could do it only about 40%. This isn't workforce scarcity. CHOA didn't go out of state to try and find new providers. They found the providers right here in the state of Georgia. So how do we figure out what do we do? I heard one of the kind members of this, uh, committee talk about accountability, and I think that's what Chair Camp, uh, is, is talking about here.

328. 0:43:51

     Where is the accountability? Because this is not the first time this has happened, right? This has happened several times since they've come in as the MCO. So and who pays for delay? Uh, I think one of the other members said, uh, and you as well, Chair Camp, uh, Georgia pays, and Georgia pays twice. First, Georgia pays because it pays its share of the capitation amount that goes to the MCO, in this case, Merit Group. So Georgia pays about 35% of that.

329. 0:44:22

     Then when they deny care, delay care, find reasons not to provide care, Georgia has to play, pay through DFCS and DHS, and there Georgia pays 100%. So why is it that we're not getting the care that we're supposed to have? And I will say Commissioner Brose, uh, maybe didn't realize how accurate she was at the time, but there was a letter in August of, uh, 2022 that she sent to then commissioner, DCH Commissioner, um, Kayley Nagel.

330. 0:44:53

     And one of the lines was saying, "You're not using the definition of medically necessary care that's found in the state or federal law." And that was absolutely true because as of July 1st, 2022, the definition of medically necessary care was what many of you who were here voted unanimously for in the parity act. It's a clear, definitive definition. It doesn't allow a lot of wiggle room.

331. 0:45:24

     It's not narrow. It's broad. And all you have to do is to look in Amerigroup's provider manuals or Amerigroup's member's handbook, and you'll see the definition that they use is different and narrower than the definition that this body passed in 2022 when all of y'all voted in favor of HB 1013. So strongly support the bill, accountability, but more importantly, we need to get the care to these children, right?

332. 0:45:58

     And if we can get care to the children, but at the same time saving taxpayers money, hard to argue against that. So thank you for the opportunity to speak.

333. 0:46:07

     Thank you, sir. I appreciate it. There's a question. Representative Clark, do you have a question?

334. 0:46:11

     It's not for the, this, it's a general question when we get after that. It's just, um, um-

335. 0:46:16

     Go ahead. Go ahead

336. 0:46:17

     ... just I, I know we mentioned, um, earlier about fiscal notes. Is there a fiscal note for this particular bill?

337. 0:46:26

     Um, do you have a fiscal note? We have not seen one in, I don't believe, have we?

338. 0:46:31

     No, the fiscal note that we are working off of is from 2020.

339. 0:46:36

     Okay.

340. 0:46:37

     We do not have an updated fiscal note-

341. 0:46:39

     Okay

342. 0:46:39

     ... even though it was requested.

343. 0:46:40

     Given that, um, the commissioner mentioned that there's been a lot of changes, the number of people in care and all of that, is there any way to expedite, um, a fiscal note so we can just kinda get an idea of what this costs?

344. 0:46:52

     Um, I think DCH is gonna speak to that.

345. 0:46:55

     Okay.

346. 0:46:55

     We've had conversations, so if you can hold that, I think we'll get to that.

347. 0:46:59

     Thank you.

348. 0:46:59

     Thank you, sir.

349. 0:47:00

     Yes, sir.

350. 0:47:01

     Um, I saw that Brandi left, but, uh, you got someone else to speak? Okay.

351. 0:47:22

     Thank you.

352. 0:47:22

     Okay, thank you.

353. 0:47:23

     Yeah. Good afternoon, everybody. Again, my name is Emily Yonna, and I'm the chief of staff here at the Department of Community Health. And I have Lynette Rhodes, who's our chief health policy officer, who really is the expert behind all of Medicaid. She's served the state for a long time, so I'm gonna let her speak. And, and but really, I just wanted to start out with DCH's position here is not to advocate for the bill or to, you know, kill the bill. That is not our position. We are strictly here to just educate on current and then what, you know, this would mean to the state, just to be clear. I know there was a question on a fiscal note. We have responded.

354. 0:47:53

     I mean, part of the process is it goes to DOAA. So we have some rough numbers which we could share, but until that comes out, they're not official. They have received, mi- to my understanding, all the data, so that is imminent to come out. So, um, like I said, just here to educate the committee, and we can answer any questions on current day, you know, the shift, anything like that, and, and what this could potentially mean. Again, not in favor or, you know, against the bill. I wanna be very clear on that. It is literally just for education, so I'll let Neget- Lynette go.

355. 0:48:22

     Hi. Good afternoon. My name is Lynette Rhodes. Again, I'm the chief health policy officer with the Department of Community Health. Uh, thank you for the opportunity to present. Um, so as Ms. Yonna stated, I'm just gonna provide some hopefully, hopefully some helpful clarifications, um, that will help to guide your decision. So I'm gonna try to take this in a, as much as a, a logical order, uh, as I can, based upon the comments and the questions that have been raised. I'm gonna start with, uh, provider enrollment.

356. 0:48:54

     In the Medicaid program, uh, all providers must be enrolled. They must have a provider enrollment ID so that we can track what services they're providing, where they're providing the services, who they're providing them to, and reimbursement. This is also part of fraud, waste, and abuse. Um, so I do wanna just correct one thing that may have, uh, been mentioned earlier. In the Medicaid space, whether you are in managed care or you are in fee-for-service, you can only be seen by a Medicaid provider There are some exceptions to that.

357. 0:49:32

     For example, if someone is traveling out of state, let's say they take a vacation and they're in Florida, and they get sick in the state of Florida, and they need assistance. Um, and they have to see a Florida practitioner. That practitioner, if they're not within the fifty-mile radius, may likely not be enrolled. And so yes, that member can receive services from that provider. But if that provider wants to be reimbursed, then they will have to enroll as a Medicaid provider in order to receive their reimbursement.

358. 0:50:06

     That is the national standard. You must be an enrolled Medicaid provider. So I did wanna want to clear that up from a starting point. Second, federal regulations allow every state Medicaid agency to put in place policies, procedures, and requirements around utilization, medical necessity, what benefits they provide, and who they provide them to. So in the Medicaid program, whether you are in managed care or whether you are in fee-for-service, the standard is medical necessity.

359. 0:50:46

     It doesn't matter which side of which delivery system you're receiving healthcare for. That's pretty standard even in a commercial plan. You have to meet some type of standard in order to receive the services. So for the foster care population as well as every other Medicaid population, in order for them to receive any type of service, whether that's, I'm just gonna name occupational therapy, speech therapy, um, PT, autism services, surgery, whatever the case may be, you have to meet that medical necessity standard.

360. 0:51:27

     And if that standard is not met, then the member will not be able to receive those particular services. So that's gonna be the same whether you're in managed care or whether you're in fee-for-service. And the reason that point is important is because for many of our services, there are prior authorization requirements, which means before those services can be rendered, there has to be an approved prior authorization.

361. 0:52:00

     So I do wanna give some clarity around this because I think that there is a misunderstanding that when this population moves to fee-for-service, which is a different delivery system, that those prior authorization requirements go away. They do not. Prior authorization is required in the managed care delivery system, and prior authorizations are required in fee-for-service.

362. 0:52:32

     They, they just are. So in terms of, you know, this thinking that, "Well, when we get to fee-for-service, we won't have to deal with this particular requirement," unfortunately, it is a requirement. And this all ties back to utilization review and ensuring that the services that are received are medically necessary, and that from a program integrity perspective, that we are preventing fraud, waste, and abuse.

363. 0:53:06

     I also wanna address the appeals. I think there was a comment made about appeals. So appeals are required if you're in managed care. Appeals are required in fee-for-service. Any time there is a suspension, reduction, or termination of services, a member gets due process rights, due process of law. It's the same in either delivery system. It, it does not go away.

364. 0:53:36

     In terms of access to services, I do want to just take a moment to explain some of the fundamental differences between managed care and fee-for-service that, that I think are important. In the managed care setting, settings, member act- members actually get more services than they get in fee-for-service. The managed care entities have the ability to go above and beyond what you get in traditional Medicaid.

365. 0:54:07

     So the things like care coordination, care management, value-added benefits, those things will go away when they move to the fee-for-service side of the house. So just wanted to make sure that everyone, uh, is aware of that particular fact.

366. 0:54:27

     There is a fiscal note, uh, as Ms. Jona stated. I don't know if you all have seen that. I know that that has been developed.

367. 0:54:36

     Uh, and then I think that there were some discussions about not meeting thresholds for federal fiscal year twenty-twenty four. I think Commissioner Brose mentioned that. So just to make sure that everyone is aware, um, for federal-- The standard relates to, uh, early and periodic screening and diagnostic testing. The standard is eighty percent. For federal fiscal year, they were at seventy-eight percent. For federal fiscal year, they exceeded it and were at eighty-two percent.

368. 0:55:08

     That report is being finalized and developed right now. So they did in fact improve in that particular area.

369. 0:55:18

     So I think those are the main points, um, that we wanted to just clarify for the committee for your consideration, and I will pause for any questions that you may have.

370. 0:55:31

     Representative Kelley. Representative Kelley.

371. 0:55:33

     Thank you, Mr. Chairman. Thank you for being here with us. Thank you for the work you do over at, uh, DCH. When you talk about the population, how many children d- are we currently serving under this managed care arrangement?

372. 0:55:45

     So under Georgia Families 360, as of January the 31st, there were 29 thou- a little over 29,000 members in that plan all together. Um, and then when you break that out, I think the foster care population was, uh, actually the smallest. I think somewhere around a little over 2,000. I'll have to go back and check, check those numbers.

373. 0:56:15

     Okay. And do you have... If one follow-up, Mr. Chairman. Um, do you know about on average what we're paying per month per child?

374. 0:56:26

     For foster care, it is a little over $900. I actually have that written down. I think it's $949 and some change. It is, um, a flat fee for foster care members per member per month.

375. 0:56:43

     And, and just to be clear on that, I think, you know, we do a rate certification every year, so that is, you know, that's this year, just to be clear on that.

376. 0:56:51

     Mm-hmm.

377. 0:56:51

     We have to do an annual rate certification with all of the managed care entities, and so I just want to be clear, that is the rate as of this year.

378. 0:56:57

     Right.

379. 0:56:58

     Thank you.

380. 0:57:01

     Okay.

381. 0:57:01

     What was the-

382. 0:57:02

     S- I'm sorry.

383. 0:57:02

     You can use time. Yes, sir.

384. 0:57:05

     Uh, it's 900, I think, $49 and some change. I'll give you the exact amount. Per month.

385. 0:57:09

     Okay.

386. 0:57:09

     Per member per month.

387. 0:57:10

     Yep.

388. 0:57:10

     Right.

389. 0:57:11

     About 2 million a month.

390. 0:57:12

     That's a, that was one of the questions I had, was because isn't that almost double what we pay for non-foster care? So there's already a recognition in the fee for service schedule that these are gonna be more-

391. 0:57:24

     Yes

392. 0:57:24

     ... likely more, uh, costly, and that's part of the bid process, I assume.

393. 0:57:28

     That's correct. The Georgia Families 360 capitation rate is at the high end of the range, and that's because of the complex needs of those members.

394. 0:57:37

     Right.

395. 0:57:37

     So you're, you're correct.

396. 0:57:39

     Well, earlier, the... And, and I appreciate the gentleman who spoke, Mr. Bane, Bames.

397. 0:57:43

     Yes, sir.

398. 0:57:43

     Um, a- and those numbers were very impactful about the, the challenge. One question I've had, though, is, is, um, you can be, uh, like a doctor can participate in Medicaid.

399. 0:57:54

     Mm-hmm.

400. 0:57:54

     But that doesn't mean you get in-network with all the different care management organizations. They may not have a need for your specialty-

401. 0:58:00

     That's right

402. 0:58:00

     ... in an area. They, they may offer a rate that... But you c- so you could be a Medicaid fee for service provider, but not be eligible to get a referral in-network with Amerigroup, correct?

403. 0:58:12

     That's correct.

404. 0:58:12

     S-

405. 0:58:12

     They, they select their own network. Yes, sir.

406. 0:58:15

     So naturally when, if somebody went and ignored the network, you could either go out and find doctors who had not been chosen by Amerigroup or had, had, had, or turned down the rate that Amerigroup offered, and maybe they would take Medicaid. But it is possible that some of those, if CHOA went out, which is very bold and, and innovative, is to just say, "We'll take care of the bill one way or another," they could have had access to providers who didn't participate in fee for service or, or Amerigroup, I believe. And therefore, w- we may need a companion bill, kind of what, uh, Representative Kelley mentioned w- uh, that, that recognizes that the rate we're offering, whether it's through managed care or through Medicaid, just is not a, a, a sustainable rate for our mental health providers.

407. 0:58:58

     So I'd love to have a little more data to find out at some point, were these, were they able to find providers to get to 96%, was that because they went out of the Medicaid network and offered rates that Medicaid just can't offer or doesn't?

408. 0:59:12

     Right.

409. 0:59:12

     That's something we might could work on.

410. 0:59:14

     Yes.

411. 0:59:14

     But anyway, so that is a possibility. Okay.

412. 0:59:18

     Yeah, no, the... That is a overarching, um, area of concern that that's been in place at least for the 20 years that I've been with the department, is are the rates sufficient enough, um, to, um, incentivize and encourage providers to participate in Medicaid.

413. 0:59:39

     Or what's called a Medicaid network.

414. 0:59:40

     Right.

415. 0:59:40

     Which, which is the timeliness. Well, thank you for working on it.

416. 0:59:42

     Right.

417. 0:59:42

     I hope this is a step in the right direction. I support it.

418. 0:59:46

     Yes.

419. 0:59:46

     Representative Davis.

420. 0:59:48

     Thank you, Chairman. Um, when you were talking about Georgia Families 360-

421. 0:59:53

     Yes, ma'am

422. 0:59:54

     ... um, and you was giving the percentages, that was for the rating for Georgia Families 360, or for Amerigroup? What, what was the percentages for?

423. 1:00:07

     Right. So the, the topic of discussion here is just the foster care population, and they are enrolled in, with Amerigroup, and the name of the program is Georgia Families 360. So those numbers that I gave, like the 29,400 total, that's just for all of the members that are enrolled in that particular program with that care management organization.

424. 1:00:30

     Well, you were talking about utilization reviews. Am I correct?

425. 1:00:34

     Yes. Yes, ma'am.

426. 1:00:34

     And when you were saying, like, it's up to 80-some percent-

427. 1:00:38

     Oh, yeah

428. 1:00:38

     ... is that what you meant about the... W- what, what was-

429. 1:00:42

     Right

430. 1:00:42

     ... describing the percentages?

431. 1:00:44

     So the 80% standard applies to this particular program, and what it's doing is it's capturing whether or not those members are receiving their screening tests, so vision, hearing, um, you know, physical exams, whether or not those are occurring annually or based upon the periodicity schedule, uh, as they should be based upon their age. So that's what that 80% is tracking to. Uh, and Commissioner Brose mentioned that for federal fiscal year 2024, they fell below that 80%.

432. 1:01:18

     And so the percentage that I shared with you was, that's correct, they were at 78%, but for the following fiscal year, they've actually exceeded that 80% and are at roughly about 82%.

433. 1:01:32

     Yeah.

434. 1:01:32

     And one more question to follow up. I, while I was sitting here, I-

435. 1:01:38

     Google Family, Georgia Families 360.

436. 1:01:42

     Yes.

437. 1:01:43

     And I notice that you have an ombudsman?

438. 1:01:46

     Yes.

439. 1:01:47

     So if there are complaints or problems, you... Is that in-house or that's separate?

440. 1:01:54

     That's through the Georgia Families 360 program. So that assists members to be able to, uh, get their inquiries and problems addressed through the ombudsman, so it's specific to that program.

441. 1:02:07

     Thank you.

442. 1:02:09

     Representative Kell- uh, Representative Kelley.

443. 1:02:13

     Sorry.

444. 1:02:15

     There it goes.

445. 1:02:16

     Thank you for that full-throated recognition, Mr. Chair.

446. 1:02:19

     Sorry. I'm wearing out.

447. 1:02:22

     I keep thinking of questions, uh, as w- as we keep going through this.

448. 1:02:26

     Yes, sir.

449. 1:02:26

     And so I appreciate you indulging me for, for one more.

450. 1:02:29

     Yeah.

451. 1:02:30

     And I, I think I know because I- I've heard, but can you speak to the rate of denials f- you know, the, for under a CMO versus, um, a fee-

452. 1:02:45

     That's okay

453. 1:02:45

     ... for service? Is it higher under managed care as compared to fee for service?

454. 1:02:52

     Um, I don't have the exact percentages in terms of, you know, how they, whether one is happening more on one side than the other. What I can tell you is that both have denials.

455. 1:03:05

     Yes.

456. 1:03:05

     Uh, I've been at the agency long enough. They both have denials. Now, the percentages, that's something that we would have to go and look into, but it happens on both sides of the house. Um, depending, you know, it doesn't matter which delivery system you're in. So when, if this population moves from managed care to fee for service, those utilization reviews, those prior authorization requests will be reviewed just by a different entity.

457. 1:03:33

     Right.

458. 1:03:33

     Yeah.

459. 1:03:34

     And I want to just say something to you really quickly, is that, you know, I know we keep referencing the 84% that Amerigroup is, is at, and they've achieved-

460. 1:03:41

     Yeah

461. 1:03:41

     ... gone above the 80%. You know, e- we at DCH want them to be at 100%, to be clear.

462. 1:03:46

     Right.

463. 1:03:46

     That doesn't mean it's, you know, that's not, doesn't mean we're, "Okay, check it off." I just want to be clear on that. And we are making changes and, you know, I just want to be clear on that, to get that up.

464. 1:03:55

     Right.

465. 1:03:55

     There have been a lot of changes y'all probably know that we can't even talk about, and changes in this space that could potentially equal better outcomes later. And so I just wanted to be clear on that, that we're not defending the 84%. It's just, it has improved, but we can as a department, we're making changes to contracts and that sort of thing to try to con- continue to increase that number.

466. 1:04:14

     Thank you.

467. 1:04:15

     Representative Gisler.

468. 1:04:16

     Yeah.

469. 1:04:17

     Yeah. Thank you, Mr. Chairman. Um, if I could just play back what I think I heard.

470. 1:04:22

     Yeah.

471. 1:04:22

     So under the fee for service program, there are still pre-authorizations.

472. 1:04:26

     Yes, sir.

473. 1:04:27

     And, and providers still have to be enrolled in Medicaid.

474. 1:04:31

     Yes, sir.

475. 1:04:31

     Um, the aim of this bill is to get these children, you know, easier access to medical care. If these still remain under fee for service, where is that coming from? Like, how's it gonna be easier?

476. 1:04:47

     I'm happy to answer that.

477. 1:04:52

     Well, there should be less hurdles. Um, and, and I say that, and no disrespect at all to the wonderful work DCH does, um, but in the fee for service Medicaid provider reimbursement rates cannot be changed by the state in managed care, but they can be under fee for service. So right now all of our providers are getting a set rate.

478. 1:05:13

     Mm.

479. 1:05:13

     So that's part of. Um, and Amerigroup, um, you know, I understand, and I'm not hitting on Amerigroup, but, um, this is a managed care issue. They're talking about wraparound services, of course, that are provided. They're only... Uh, the state could provide wraparound services. Um, and my understanding is there's 9,000 children roughly in foster care, not two. Um, and when you look at those numbers, um, I did quick math, um, because I've got a calculator. I saw Trey Kelley doing it in his head, which is very impressive.

480. 1:05:43

     Um, but, um, roughly we're spending $8.5 million a month on managed care, which is $102 million a year just on having someone manage the care. The state, I, I mean, I would like to assert the state probably could provide a lot of services for $102 million to that small population. Um, and the numbers, which is very admirable, I'm so glad you're above 80%, but s- part of that population that you're talking about are also in juvenile justice and not in out of care service.

481. 1:06:15

     They're in their homes.

482. 1:06:16

     Mm-hmm.

483. 1:06:16

     So it's quite possible that the, the children who are currently in foster care may be skewing those numbers, um, as they're moving around the state from home to home getting all the services, especially the screenings. Um, I'm not, this is not a silver bullet. I wish it was. My hope is that children who need care will be able to get it faster, um, and, and have it in a more streamlined position. Um, unfortunately, I don't have a crystal ball to tell you that's exactly what's going to happen.

484. 1:06:49

     And I do appreciate DCH. I know they have some numbers as well. I have not seen the numbers because you're waiting for the audits. But 100, it's one, 102 million 492 a year we're paying Amerigroup to manage just foster kid pop- pop- population. Not the other, just kids who are in foster care.

485. 1:07:09

     If I had one quick follow-up.

486. 1:07:11

     Go ahead.

487. 1:07:11

     Um, so I appreciate Chairman, uh, Newton pointing out that, um, you know, some enrolled providers may not be under the CMO, so it sounds like that might offer more options out there. Um, just for my own education, if we go to the fee for service program, who does that pre-authorization request go to?

488. 1:07:30

     Uh, they will go to our vendor, Alliance Health Solutions.

489. 1:07:33

     Okay. Okay, thank you.

490. 1:07:37

     Now, I want to ask you a question. Maybe I misunderstood.

491. 1:07:39

     Yeah.

492. 1:07:39

     Did you ask- Does this expand the availability for the patient?

493. 1:07:45

     Yes.

494. 1:07:46

     Yeah. So if it's a Medicaid provider and that patient is only a med- is a Medicaid patient, they can only go or be compensated going to that Medicaid provider.

495. 1:07:58

     Mm.

496. 1:07:58

     If it's a fee for service, they can go to that Medicaid provider or a non-Medicaid provider. Medicaid providers take fee for service patients too.

497. 1:08:08

     Okay.

498. 1:08:09

     You don't have to be a total Medicaid provider.

499. 1:08:12

     That, that's not what you said.

500. 1:08:12

     Right. Yeah. So I'm-

501. 1:08:13

     So-

502. 1:08:14

     ... I'm, I'm shaking my head. Sorry. Yeah.

503. 1:08:17

     So we, we have dentists out there that are doing both, but when you have a dentist that's not a Medicaid and the patient can see them, all of a sudden you got an extra provider, so you got greater access.

504. 1:08:29

     You, sure, but, but-

505. 1:08:30

     Yeah, but-

506. 1:08:30

     You're shaking your head no.

507. 1:08:31

     Yeah. So you, you, when ... You have to be an enrolled Medicaid provider.

508. 1:08:40

     For fee for service?

509. 1:08:41

     For, for fee for service. Yes.

510. 1:08:45

     Okay.

511. 1:08:45

     Really for both, unless it's, like, an emergency situation. Um, and even then, in order to be reimbursed, you've got to be enrolled in order to, to receive your payment. So I-

512. 1:08:57

     All right. Well, then-

513. 1:08:58

     ... I think there's some confusion there.

514. 1:08:59

     Then-

515. 1:08:59

     I stand corrected

516. 1:09:00

     But, but you-

517. 1:09:00

     Yeah.

518. 1:09:00

     I, I thought they could access anybody they wanted to as fee for service. They have to ha- access a assigned fee for service?

519. 1:09:08

     Yes, sir.

520. 1:09:09

     Okay.

521. 1:09:09

     Isn't it true that providers do end up making more per visit than, than what's currently allowed under Amerigroup's model?

522. 1:09:17

     Oh, no ma'am. Most providers are paid more through managed care than they are in fee for service.

523. 1:09:23

     How are they paid more?

524. 1:09:24

     Because the CMOs have the ability to negotiate rates, whereas we simply set a fee schedule that is approved by CMS. And this-

525. 1:09:33

     Is the fee schedule is higher than ... You're telling me the sche- the fee schedule for providers is higher than Medicaid would pay if it was a direct fee for service?

526. 1:09:42

     Yes. In many instances, not all, in some cases they're the same, but in many instances, the managed care entities actually pay higher rates than fee for service, and that's because, again, they negotiate those rates or they have the ability to negotiate them with the providers.

527. 1:10:02

     Because I've had a number of providers in a number of different fields say otherwise. So that's interesting conflict.

528. 1:10:09

     I hear that from providers also. I've, I've had dentists leave Medicaid because the rates were so low and they could do better with fee for service. But anyway, we won't get into a debate about that right now. Okay. Um, I've got a blinking light. Is that Douglas? O- okay, boy.

529. 1:10:32

     I've got, I've got I, I, appreciate, uh, what my friend and the Chair Camp is trying to do. Just curious though, uh, Amerigroup is no longer have the contractual relationship. I was wondering w- with the recent, uh, procurement, uh, how will this bill, uh, affect, uh, uh, what's going on? How this bill impact your agency?

530. 1:10:54

     Sure. Um, so I think as a starting point, um, it is important to note that Amerigroup is still under contract with the state. Um, that contract has not ended. We have, um, issued a procurement. We've res- received responsive bids, uh, but we are in the protest phase. So until that is resolved, uh, we don't know who the, who the new suppliers will be. That has to be resolved. Um, but to answer your question in terms of what impact it would have on the procurement, if you remove the foster care population from that program, it could, and I emphasize the word could, have a financial impact on that particular managed care entity.

531. 1:11:41

     Um, so in other words, they submitted their bid, um, under the assumption that all three popul- they would serve all three populations, that being foster care, uh, Department of Juvenile Justice members, and adoption assistance. So this bill in essence pulls the foster care population out. So then the question becomes for whomever that new managed care will, plan will be, is it financially viable to con- to move forward with this particular program, right?

532. 1:12:16

     Are you gonna bring in enough income to be able to offset your administrative expenses, debts, et cetera?

533. 1:12:23

     Mr. Chair, if I may follow up. I- is there any way for us to know that at this time?

534. 1:12:27

     No.

535. 1:12:29

     Okay. I'd li- like to ask a question of Emily Oona. Why am I hearing from dentists who were treating, uh, ABD patients fee for service saying they could no longer treat their ABD fee for service patients when they went on the Medicaid roll? They were, told me they were not Medicaid dentists and could not treat them.

536. 1:12:51

     It, and, um, I know that you know this clearly, that I know this, this has been going on for a long time. It, they were actually getting reimbursed through a waiver, through a, through a different, not Medicaid, just to be clear. So I think what we're talking about-

537. 1:13:02

     Right

538. 1:13:02

     ... is the NOW/COMP waiver-

539. 1:13:04

     Right

540. 1:13:04

     ... which, you know, at that point they are no longer getting it through Medicaid.

541. 1:13:07

     Right.

542. 1:13:07

     And so that is how those dentists were getting paid and not being Medicaid providers.

543. 1:13:10

     Right.

544. 1:13:11

     We know there's challenges with that now that they've added adult dental, but that is the reality there of how-

545. 1:13:15

     Right. Okay

546. 1:13:15

     ... some of those dentists get, get coverage without being a Medicaid provider.

547. 1:13:19

     So we're getting really deep into all this.

548. 1:13:21

     Yeah.

549. 1:13:21

     Probably deeper than most people here- ... wanna get. I think w- keeping our eye on the ball, what is gonna be the best for these children, these foster children, and how will they access care at a more, in larger numbers and in a timely fashion? And so we're hearing fee for service. We've had testimony fee for service. Are there any more que- questions? Do I hear a motion?

550. 1:13:49

     Move to pass.

551. 1:13:50

     Second. All those in favor say aye.

552. 1:13:54

     Aye.

553. 1:13:54

     All those against say nay.

554. 1:13:56

     Nay.

555. 1:13:58

     You want to raise your hands to nays? I think we just had two. One? Okay. Thank you. Congratulations. You- you did get a due pass on 1002 LC339857. Thank you. Thank you. And thank DCH for sitting here. Emily. Thank y'all.

556. 1:14:17

     Thank you.

557. 1:14:18

     I appreciate it.

558. 1:14:20

     Yep.

559. 1:14:20

     Okay, next bill up, H bill- HB1211. Representative Kelley. If you want to do it from there, you can.

560. 1:14:29

     I've got that.

561. 1:14:30

     It's fine.

562. 1:14:30

     But I don't want to break it.

563. 1:14:33

     It's fine.

564. 1:14:36

     He's all- He's all right there.

565. 1:14:39

     Okay. Do y'all have, uh... Which side do you want to be on here? Do you want to stop colon cancer or...?

566. 1:14:49

     Thank you, Mr. Chairman. Uh, bringing before you today House Bill 1211. I'm working off of LC520992. Uh, this bill, uh, would simply recognize, uh, two other well-known, um, trusted groups as it relates to cancer, uh, care, as well as, uh, recognizing coverage determinations through our CMS, uh, system at the federal level.

567. 1:15:23

     And basically will say that, uh, our health plans will cover, uh, any kind of colorectal cancer screening, examination, or laboratory test, uh, if it's recognized by any of those, uh, organizations. So it'll include the American Cancer Society, uh, in consultation with the American College of Gastroenterology and the American College of Radiation- Radiology, excuse me, and then we're adding the National Comprehensive Cancer Network, the United States Preventive Task Force, and as well as our Federal Centers for Medicare and Medicaid.

568. 1:16:00

     Essentially, this is gonna allow for coverage for blood, uh, screenings for colorectal cancer. Uh, and the goal of this is to, uh, increase compliance, uh, and have more people screened, um, because a blood screening is less invasive from some of the other screening methods. And it will... The goal would ultimately be to detect, uh, colorectal cancer risk earlier so that those can get treated and hopefully lead to people, um, getting the treatment they need to cure themselves of that horrible disease.

569. 1:16:37

     That's what it does, Mr. Chairman.

570. 1:16:39

     Thank you. I see no questions. Okay. Don- Oh.

571. 1:16:45

     Sorry.

572. 1:16:45

     Ers, you want to go ahead. Is that Petrea? Representative Petrea? I can't... Oh.

573. 1:16:51

     No.

574. 1:16:51

     Chris, okay. I'm sorry.

575. 1:16:52

     I'm full of questions today, Mr. Chairman. I'm sorry.

576. 1:16:55

     No, that's fine.

577. 1:16:55

     Uh, w- what happens in the event that two of these organizations provide different guidelines?

578. 1:17:00

     It allows for any of the one... If- if any of them recognize it as a option, uh, then it will allow. It doesn't require all to be united.

579. 1:17:09

     Mm-hmm.

580. 1:17:09

     It just says if any of... Recognizes all of these are trusted sources. This hasn't been updated in 18 years.

581. 1:17:16

     Okay.

582. 1:17:16

     And so we're just modernizing and saying that they have the expertise as well. So if any of them recognize this blood screening, then it would be covered.

583. 1:17:25

     Okay. Thank you.

584. 1:17:26

     Thank you for the question.

585. 1:17:29

     Any further questions? Seeing none, do I hear a motion? Motion to be passed. Do I hear a second? All those in favor say aye.

586. 1:17:36

     Aye.

587. 1:17:37

     All those opposed? Congratulations. House Bill 1211, LC520992 is a due pass.

588. 1:17:45

     Thank you, Mr. Chairman. I would owe to my second sponsor.

589. 1:17:51

     Okay, up next, uh, let's hear HR592, Representative Newton. Or Chairman Newton.

590. 1:18:10

     Thank you, Mr. Chairman, members of the committee. I do bring House Resolution 592. It's LC339817. Uh, this is looking at something that many of us have heard about, especially those of us not far from the border. I've heard recently from physicians, both in the Augusta area, something... When there was a management change at one of our health systems, a doctor who's non-compete required him to leave the state and go over to Aiken, South Carolina to work, um, because of the- the non-competes. And just recently, uh, I think a Gainesville area, North Georgia physician is now working in North Carolina.

591. 1:18:44

     Um, the non-competes are something that had been in the news when the FTC banned them in ni- in 2024, not just for physicians, but in general. Obviously, that was seen as overly broad and was struck down by a federal court. Doesn't change the fact that there is a question out there. 12 states have elected to ban non-compete clauses in healthcare, recognizing that the physician-patient relationship i- is different than a normal business relationship, and it, and, and the value of that kind of takes precedence over what might be otherwise appropriate business, uh, contractual agreements.

592. 1:19:16

     This resolution simply, uh, establishes a house study committee, uh, to look at that, to look at that over the year in the same way we look at many of these things, rather than kind of come through with maybe too harsh. Of the other 38 states, many of them have restrictions, some as little as, like limiting it to more tha- no more than a year or 10 miles. Many of the ones in Atlanta, I mean, I've heard of a, of a residency program that the residents that we had tried to attract to Georgia, that they have a 35-mile radius in an Atlanta area hospital system that you can't work in after you finish residency there.

593. 1:19:48

     Um, and so it's a kind of a... It brings up these interesting things to where we're going. What is the right balance between that? I mean, basically, I guess you work for that system or you move, some often out of state if you wanted a city the size of Atlanta. So I just thought it was worthy of us to look at this, to say, what, what is a best practice? What can work? Ha- we got to recognize the fact we do have different areas, and the needs in Atlanta may be different. But the needs of the patient are pretty clear. Um, one large piece of this also is our insurers are now becoming a larger and larger employer of physicians.

594. 1:20:22

     They're Uh, they, they sometimes partner with the hospitals. They, they often own physician practices. I know I did see that private equity has gone in the last 10 years from 800 in 2012 practices that were owned by private equity entities to now in 2021, 5800. Um, there's a quest- um, United Healthcare itself is one of the insurers. They have an Optum physician group that now reportedly has about 90,000 physicians either contracted or employed across the United States, including a number in Georgia, in Atlanta, Floyd County, Forsyth, Bartow, Savannah, many of our, many areas of our state.

595. 1:20:59

     So you have insurers employing and then sometimes putting non-competes. We have training that we are trying to expand in Georgia that apparently some of those are putting non-competes on those graduates we try to attract to Georgia for their residencies, um, and, and we have private equity doing the same thing. Certainly, health systems and physician practices sometimes spend a lot of money and effort recruiting an appropriate spine specialist or pediatric specialist in a certain hematology maybe or something. So this is not to... The reason it needs a little more study than just a ban, I th- I believe, is because there are appropriate places for this that recognize the significant expense and effort that goes into evaluating the needs of your population and then going out and recruiting those specialties in the numbers that are needed, whether it's mental health like we just finished discussing, you know, urology, hematology, oncology, pediatric specialties.

596. 1:21:52

     So we want to recognize that there is an appropriate place for people to, to expect entic- entities to, um, expend a lot of time, effort, and money, um, both recruiting, moving here, then introducing them to the, the community and to patients. We want to make sure we respect that, but at the same time respect that if you or your child has gotten to be in with one of these pediatric oncologists, you'd like to know that they could stay with them even if there was a management change at the, um, at, at, at whatever the employers, uh...

597. 1:22:23

     So that's the, that's the bill. It's a, it's, uh, straightforward.

598. 1:22:26

     Thank you. You do have a question?

599. 1:22:27

     Yes, sir.

600. 1:22:28

     Representative Clark.

601. 1:22:30

     I promise this is a friendly question.

602. 1:22:31

     Thank you.

603. 1:22:32

     On line 56, it says that this will be abolished on December-

604. 1:22:36

     We do need a motion

605. 1:22:38

     ... 2025.

606. 1:22:38

     I do. Thank you. And you-

607. 1:22:39

     Um, and so I would like to offer a friendly amendment-

608. 1:22:41

     A friendly amendment

609. 1:22:42

     ... to-

610. 1:22:42

     There will be a time for that, I believe, right, Chairman? Ab- about to, to... Obviously, this bill did not make it through last year, um, and so the, the language from last year will need some, uh, adjustment of one digit, I hope. Um, but thank you.

611. 1:22:56

     Good catch. You get an A+ for the day. Way to go. Uh-

612. 1:23:03

     Mr. Chair.

613. 1:23:04

     Rep Qu-

614. 1:23:04

     I have the same question.

615. 1:23:05

     Oh, okay.

616. 1:23:06

     About the year fif- line 56, 20-

617. 1:23:08

     You both get an A for the day

618. 1:23:10

     ... 25.

619. 1:23:10

     Motion to pass when you get the amendment.

620. 1:23:13

     It was, it was a test.

621. 1:23:14

     Do I hear a motion-

622. 1:23:14

     We got two As

623. 1:23:15

     ... same question.

624. 1:23:16

     Oh, okay. Go ahead.

625. 1:23:18

     Thank you.

626. 1:23:19

     She's

627. 1:23:19

     Since you are making a friendly amendment... Uh, thank you, Mr. Chair. Um, I'd like to look at, uh, line 23 and ask could we a- include lupus in that?

628. 1:23:29

     And ask what? I'm sorry.

629. 1:23:31

     Could we include lupus?

630. 1:23:33

     Lupus?

631. 1:23:34

     Include...

632. 1:23:35

     Lupus. The cost used to medication to treat-

633. 1:23:38

     You're talking about bifurcating the study committee.

634. 1:23:40

     Yeah.

635. 1:23:40

     That'd be a little tough.

636. 1:23:41

     Huh? Oh, I'm sorry.

637. 1:23:43

     Wrong bill.

638. 1:23:44

     Sorry. Sorry.

639. 1:23:44

     You're on the wrong bill.

640. 1:23:45

     I'm on the wrong bill. No, that's f-

641. 1:23:47

     You get a B for the day.

642. 1:23:48

     I do?

643. 1:23:48

     It's okay.

644. 1:23:48

     I, I just told him I-

645. 1:23:49

     You're always A. You're always an A.

646. 1:23:52

     What did I just do?

647. 1:23:53

     What-

648. 1:23:53

     I got a... I did get-

649. 1:23:54

     Is Clark messing you up?

650. 1:23:55

     Yes.

651. 1:23:55

     Yeah.

652. 1:23:56

     She threw me off. That's my, my-

653. 1:23:58

     Okay. Uh, do I hear a motion?

654. 1:24:01

     Do pass.

655. 1:24:02

     Uh, okay. Uh, before we c- take the vote, uh, would you like to offer amendment?

656. 1:24:08

     I'd like-

657. 1:24:08

     Yes, I would like to offer-

658. 1:24:10

     Go ahead

659. 1:24:10

     ... an amendment.

660. 1:24:11

     Please do.

661. 1:24:12

     Um, uh, amendment to strike 2025 from line 56 and change it to 2026.

662. 1:24:19

     Sounds like a good one. Do I hear a motion? Second. Second. Motion. All those in favor of the amendment, say, "I."

663. 1:24:25

     I.

664. 1:24:25

     All those... Now we're back to the main motion. All those in favor of the bill, say, "I."

665. 1:24:30

     I.

666. 1:24:30

     Congratulations. House Resolution 592.

667. 1:24:33

     That's what I said.

668. 1:24:34

     Oh.

669. 1:24:34

     I looked and I was like, "Great."

670. 1:24:36

     Oh, that's-

671. 1:24:36

     As amended. Excuse me.

672. 1:24:37

     Great.

673. 1:24:38

     As amended. Thank you, sir.

674. 1:24:41

     Is there any opposition? Hearing none.

675. 1:24:45

     See, I'm not-

676. 1:24:45

     Congratulations

677. 1:24:46

     ... I'm not crazy.

678. 1:24:47

     You got HR 592-

679. 1:24:49

     But she was on the same page

680. 1:24:50

     ... LC 3398 17.

681. 1:24:52

     So that's like, "Oh, good."

682. 1:24:56

     Okay. Now on... And I apologize to Representative Stevens. I should've done you 'cause these guys were gonna stay and let you go, and I apologize.

683. 1:25:07

     I agree.

684. 1:25:07

     I agree. I always think y'all when I see you here. Okay, we got Representative Stevens with HR 948, study committee.

685. 1:25:18

     Thank you, Mr. Chairman, members of committee. Um, for the past three years you've seen some of the, um, fallout, if you will, from, um, the lack of transparency with pharmacy benefit managers, um, specifically, um, related to vertical integration where the, uh, PBM may own or be owned by the insurance company above them, where they sell the policies. The PBM that directs the transaction and even the mail-order house all the way down, so it's a vertical integration. And I think Blake Tillery had a, uh, Senator Tillery had a bill, um, regarding bla- uh, vertical integration.

686. 1:25:54

     But we truly need to, uh, eliminate some of the smoke and mirrors. Uh, we've seen generational pharmacies go out of business, uh, in places where the only healthcare they had at all was their local drug store, uh, that may have been there for many, many years. So all this bill seeks to do is a study committee on the PBMs itself. Um, and HR 948 will have a total of five members. One, the chairman of the House Appropriations Committee will be one, the chairman of this health committee will be two, and three other members as appointed by the Speaker of the House for no more than five days or 如果它 drags on and more is needed.

687. 1:26:41

     Um, this probably could be one of the more beneficial study committees that we have. Uh, as you know, there is, um, very little transparency. Um, a- and just... I'll just hit one thing here. It'll include things like leveraging the, uh, vertical integration, steering patients to pharmacy benefit manager affiliated pharmacies, their own pharmacies, making up the cost of medications on the pharmacy benefit manager-owned pharmacies, manipulating pharmacy reimbursement rates.

688. 1:27:12

     You saw that last year and year before last through state merit as pharmacies went out of business from December 31st to January 1, whenever things went to the penny on some pharmacy types, like independents across the board. Unfair practices and harm to patients, retail pharmacies, payers, and employers, and for God's sakes, let's not forget the taxpayer. Um, these are some of the things I believe we ought to look at. I want to thank Representative Kelly for last year and, and, uh, taking the bill that probably saved more independent pharmacies and communities, um, regarding state merit than we can even name.

689. 1:27:54

     Um, uh, but I would ask for your favorable consideration. And again, since we put this in at the end of last year on the last page, um-

690. 1:28:03

     You mean my name

691. 1:28:04

     ... sorry. B plus, uh, that we amend, um, the date to 2026. And Mr. Chairman, that is my presentation.

692. 1:28:14

     Thank you. Did that take care of your question? You got one.

693. 1:28:16

     Well, I do want to ask, uh-

694. 1:28:18

     Okay, go ahead. Go for it

695. 1:28:19

     ... line 23, can we add lupus in there, please? Since you have to make a change.

696. 1:28:28

     Uh, let me say this. When, when we do study committees, we try not to bifurcate them. And since we only have up to five days, this is gonna be a hot one. I- I don't think this would be a good idea.

697. 1:28:39

     Okay.

698. 1:28:39

     I understand, though, and we need to address your issue as, uh, uh, uh, an issue one day.

699. 1:28:45

     Mr. Chairman, if I can, your issue is so big that I would like to see that one as a study committee on its own, and I would love to serve on it.

700. 1:28:52

     Okay. Thank you.

701. 1:28:54

     That's a hint.

702. 1:28:56

     Yep. You hear that, Council?

703. 1:28:59

     Okay. All right. So do I hear a motion? Move to pass. Okay. We ha- have an amendment, line 83. Oh, do I have a second? Second. Okay. Um, on line, we have an amendment on line 83, change 25 to 26. D- do I hear a motion? So moved. Do I hear a second?

704. 1:29:23

     Second.

705. 1:29:24

     All those in favor say, "Aye."

706. 1:29:27

     Aye.

707. 1:29:27

     All those nay. Did you get that? Back to the main bill. All those in favor say, as amended, say, "Aye."

708. 1:29:36

     Aye.

709. 1:29:36

     All those against say, "Nay."

710. 1:29:38

     Nay.

711. 1:29:38

     Congratulations, your bill's passed.

712. 1:29:41

     Thank you, Committee. Thank you, Mr. Chairman.

713. 1:29:43

     That is 948, HR 948, LC 620212.

714. 1:29:52

     You know, I'm just...

715. 1:30:06

     We need somebody strong

716. 1:30:10

     in

717. 1:30:15

     this team.