Comité Health and Human Services del Senado, 23 de febrero de 2026

Transcripción

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

1. 0:04:59

   Senate, uh, HHS, and, uh, we're happy to be here on this, uh, in-between day, this committee work day. So with that, we're running a little bit late because of the previous committee that was, uh, took just a little bit long, and we've had some substitutions, and I think everybody has that. Let's start it off. If, uh, Chairman Goodman, if you don't mind, open us up in prayer.

2. 0:05:25

   Be, be an honor to, Mr. Chairman. Y'all pray with me, please. Dear Heavenly Father, we just thank you for today, Lord. We thank you for loving us. We thank you for the gift of salvation. We thank you for the awesome opportunity to come here together, Lord, and, and work on the people's business. And as we go about it, Lord, we just ask that you grant us wisdom and discernment so that we may, may make the best decisions on behalf of the 11 million Georgians that we represent, Lord. And, uh, we just, we thank you so much for your many blessings that you best- bestow upon us each and every day, Lord. And, and with, with things going on around the world geopolitically, Lord, we just ask that you please, uh, have your hand in those situations, Lord.

3. 0:06:02

   And we just, uh, we thank you for all of our doctors and nurses and everyone in our healthcare industry, Lord, that, that, uh, keep us healthy. In Jesus's name we pray, amen.

4. 0:06:12

   Amen.

5. 0:06:13

   Amen.

6. 0:06:14

   Amen. Thank you. Uh, so I'm, I am, we're gonna change the schedule around a little bit. We're doing, uh, Senate Resolution 567. We're gonna do that last. Uh, and I'll let Senator Hodges and Senator Kirkpatrick decide who wants to go first. He is-

7. 0:06:32

   Do both of yours together?

8. 0:06:33

   No.

9. 0:06:34

   Okay.

10. 0:06:34

    Uh, so we're gonna do Senator Kirkpatrick, vice-chair of Health and chair of Children's and Families. She's doing SB 535. Um, we're making some changes in community service boards. And let me make sure we're all correct on the substitute. Uh, LC 33-9879 S.

11. 0:06:59

    That's it.

12. 0:07:00

    Okay. And-

13. 0:07:02

    And I, I brought a friend along. Uh, most of you probably know-

14. 0:07:06

    Former house member Kevin Tanner, now DBHDD. How long have you been there? Little over three years, Mr. Chairman. Oh, wow. That's great. Thank you. Good for you and good for us. And, uh, the floor is yours.

15. 0:07:18

    Thank you so much. Um, this is an agency bill for DBHDD. And, uh, I think everybody on the committee already knows this, but our CSBs are our safety net, um, mental health providers around the state. There's 22 of them. And, um, when I got here in 2017, because I came in in a special election, I didn't know what I was supposed to do. So I went and met with all the agency heads, and one of the things that became apparent right away was the inconsistency in the CSBs around the state, and how they operated and how effective they were or not.

16. 0:07:58

    And so, this bill is an effort to, um, really put a more consistent framework in place for how the CSBs operate around the state to give some additional oversight from DBHDD and, um, to just help them function more effectively. So, um, I'm gonna just briefly tell you what the sections do, and then Commissioner Tanner will be happy to answer any questions that I don't know the answers to.

17. 0:08:33

    So on section one, this basically just changes some definitions about the definition of community service board and service area. Section two is also definitions about mental health and developmental disabilities and addictive diseases. And then section three changes the structure of the, um, provisions about governing board membership, executive director, eligibility, appointments, and term limits.

18. 0:09:06

    And it establishes bylaws requirements effective July 1st of this year. Section four revises, uh, the same code section to specify the roles and responsibilities of the executive director, who will be appointed by the commissioner starting July 1st, 2026. And then section five allows the community service boards to reconstitute or convert their structure into nonprofits, units of county government, or components of hospital authorities with certain conditions.

19. 0:09:44

    Section six outlines procedures for the cessation of operations by a com- community service board. Section seven defines venue for legal actions against community service boards as the county where the principal office is located. And section eight authorizes community service boards to operate meetings by teleconference under certain conditions. So basically, this is more oversight from DBHDD, consistency in the bylaws, and the, um, sort of how the board and the CEOs operate.

20. 0:10:23

    Questions?

21. 0:10:24

    So with that, I'm gonna stop and take any questions.

22. 0:10:26

    Yeah. Questions from the committee? No questions on...

23. 0:10:30

    I do.

24. 0:10:30

    Okay. Uh, you are on one.

25. 0:10:37

    Thank you, Mr. Chairman. Um, Madam Chair, can you walk me through on 37 through 42? We're striking through community service board and community service board area. What, what exactly are we doing there?

26. 0:10:55

    I'm gonna phone my friend here.

27. 0:11:01

    Just confirming, you said line 37, starting at line 37-

28. 0:11:04

    I think what we did was-

29. 0:11:04

    ... and forward to-

30. 0:11:05

    ... we moved that up to section one

31. 0:11:06

    ... I guess ... Oh, yeah, I'm looking at that now.

32. 0:11:07

    Yeah.

33. 0:11:08

    Okay.

34. 0:11:08

    Sorry.

35. 0:11:08

    Senator Brass, I think we moved it-

36. 0:11:09

    See-

37. 0:11:09

    ... up to section one.

38. 0:11:10

    That's correct.

39. 0:11:12

    Okay.

40. 0:11:12

    The line is-

41. 0:11:13

    But we're not changing the definitions-

42. 0:11:14

    ... 24

43. 0:11:14

    ... we're just relocating them?

44. 0:11:16

    That- that's correct, in that section.

45. 0:11:17

    Okay. All right, 'cause I was looking after and didn't see anything.

46. 0:11:19

    Yeah.

47. 0:11:19

    So it was before. Okay.

48. 0:11:21

    Good.

49. 0:11:21

    I'm good. Thank you.

50. 0:11:21

    Thank you. Any other questions from the committee?

51. 0:11:28

    All right. And, and I'll be happy to entertain a motion.

52. 0:11:33

    I'll move redo pass.

53. 0:11:34

    Okay. Redo passing sev- LC33-9879S. Can I have a second? Second, Senator Goodman. All those in favor, raise your hand. Oh, looks like it is unanimous. And, uh, thank you, Commissioner.

54. 0:11:54

    Yes, sir.

55. 0:11:55

    Didn't, didn't have to say much at all- ... but we appreciate that.

56. 0:11:57

    I, I knew when I was sitting next to this lady, I would.

57. 0:11:59

    Oh, yeah.

58. 0:12:00

    Thank you.

59. 0:12:00

    All right. So that brings up, uh, uh, Senator Hodges. I think so you were second, but I tell you what, that was a quick second. All righty. The floor is yours.

60. 0:12:15

    You want that one, but-

61. 0:12:17

    So we are Senate Bill 500, Senator Hodges. Uh, this, we've actually seen this.

62. 0:12:25

    Yes.

63. 0:12:25

    And, um-

64. 0:12:29

    And Mr. Besean is here with you.

65. 0:12:33

    He is.

66. 0:12:33

    We hope he does as good a job as Commissioner Tanner.

67. 0:12:38

    Good to see you again, Mr. Chair.

68. 0:12:39

    All righty.

69. 0:12:40

    As, as quick a job as the commissioner. Um, you're right. Um, you're right, Mr. Chairman. Thank you. You have seen this bill before, this SB 500. We passed it in the Senate last year, 49 to one as, uh, Senate Bill 131. It went to the House, and the House gutted it and put something in it to, uh, set up a, um, review board for parity spending, which we did not look at the last day. So we decided to just start over with this.

70. 0:13:12

    Um, it is a- it's an agency bill, uh, SB 500. By the way, LC is 520964. Uh, it is for the Georgia Board of Healthcare Workforce. This is Chet Besean, who's the executive director. Um, this bill, uh, as we did last year, this bill helps in our mission to make sure that Georgia has the appropriate number of healthcare providers, uh, wherever in the state that they're needed. Um, the bill enhances, um, a database, an existing database of healthcare providers across the state by adding nine licensing agencies to five existing to get a total of 14 licensing agencies that will report, uh, data on their licensees to the board so the board can accurately collect, analyze data to, uh, measure the state's adequacy of its healthcare professionals.

71. 0:14:07

    Uh, bill does a couple of things. It, uh, allows the board to enter into agreements with those licensing entities to create, um, house, and provide, uh, information for the governor, the general assembly, state agencies, and the public regarding our healthcare workforce. The board allow- the, the bill allows the board to seek federal or other, uh, funding sources to do this. The bill, um, allows the board to create and maintain a dashboard on their website to provide information on the workforce to the public.

72. 0:14:43

    And then the bill establishes a minimum data set, um, survey to be utilized to collect data, um, on, um, healthcare providers, uh, not to include any personal information, just, um, uh, other information. And then the bill, uh, includes to that data set the type of insurance accepted by the provider and whether or not they accept Medicare and Medicaid. Basically, all this information collected will be used by the, um, healthcare workforce board to, um, for planning and managing our workfor- uh, healthcare workforce and for information purposes for the public.

73. 0:15:25

    Thank you. Uh, just to be clear, no names or personal information.

74. 0:15:29

    No names, no personal information.

75. 0:15:30

    So this is-

76. 0:15:31

    That is correct

77. 0:15:31

    ... we're going for numbers here. Um-

78. 0:15:34

    Yep.

79. 0:15:34

    I don't know, do we get ages too? Probably do get ages, don't we?

80. 0:15:37

    You get ages.

81. 0:15:37

    Ages.

82. 0:15:38

    Yeah.

83. 0:15:38

    'Cause, 'cause if a phys- if, uh-

84. 0:15:40

    But without names

85. 0:15:40

    ... all the dentists in the state of Georgia are 80 years old, then we know-

86. 0:15:44

    That's right

87. 0:15:44

    ... we got a problem. Gotcha.

88. 0:15:45

    Mm-hmm.

89. 0:15:45

    All right. Uh, questions from the committee? Um, number five.

90. 0:15:55

    Where does this state that you're keeping up with they're 80 years old? I mean, where-

91. 0:16:03

    Oh

92. 0:16:03

    ... I'm looking at line 30 through 38.

93. 0:16:06

    Sorry.

94. 0:16:06

    I mean, I'm, where-

95. 0:16:08

    These are-

96. 0:16:08

    How are you getting the ... Where's the gut of this bill?

97. 0:16:12

    The ... Senator, that's a good question. The, um, these are the changes to existing legislation. There was a sub prepared which included the existing legislation. Didn't change the bill, but it included. And I've got a ... But I didn't get it back in time to get it in to your staff. I've got it here. It's got the existing, uh, legislation in it. Um, you wanna know what-

98. 0:16:40

    I can follow up with you. I'm not gonna get into-

99. 0:16:43

    Okay. I mean, I've got-

100. 0:16:43

     ... the weeds on it, but I am interested in that.

101. 0:16:45

     Okay. All right. B- but I've got that here, so.

102. 0:16:48

     Any other questions?

103. 0:16:50

     So are we working on a different-

104. 0:16:52

     No, we're on the original bill, is what we're on.

105. 0:16:54

     We're on the original bill.

106. 0:16:55

     Which is LC52-0964.

107. 0:16:58

     That's right.

108. 0:17:00

     Um, if not, I'd be happy to entertain a motion.

109. 0:17:07

     Senator Goodman.

110. 0:17:08

     Um, Mr. Chairman, if I, if, uh, if our two doctors on this committee who are experts in their field are good with this bill, then I'd like to make a motion do pass.

111. 0:17:16

     All righty. So we have a motion do pass LC52-0964. Do I have a second?

112. 0:17:22

     Second.

113. 0:17:22

     Second. And do we, uh, all those and any further discussion? All those in favor, raise your hand. All right. Looks like we're all 100% unanimous. Thank you.

114. 0:17:36

     Thank you, Mr. Chairman.

115. 0:17:37

     Well, this is going much more smoothly than I thought, so.

116. 0:17:41

     He was, he was shorter than Commissioner Ginn.

117. 0:17:45

     All righty. I- I'm afraid to ... So, uh, I don't ... Oh, I see Senator Still. Senator Still, we, we could go ahead and do a resolution now if you need a couple minutes.

118. 0:17:58

     Please. Thank you.

119. 0:17:59

     All right. Well, we ... He asked us to go ahead and do the resolution. I hope, uh, Chairman Kirkpatrick's okay with moving that up, the, to the SR 567.

120. 0:18:11

     Do you want to do that now?

121. 0:18:12

     Yeah. Let's go ahead and do that now. And, uh, I think we have a couple people that want to testify, and, uh, just out of courtesy to everyone-

122. 0:18:23

     I'm gonna do that from here. Does that-

123. 0:18:24

     Anywhere you would like. Absolutely.

124. 0:18:26

     Room seven.

125. 0:18:27

     Yeah.

126. 0:18:29

     Thank you, Mr. Chair. This is a resolution, and it has to do with an unusual medical disorder called Prader-Willi syndrome, and it creates a Prader-Willi Syndrome Awareness Day, which, um, is fully intended to raise awareness of the disease. One thing that we've seen recently in rules is that we need to change this to a day at the Capitol rather than a state day, so we'll need an amendment for that part.

127. 0:19:00

     But with that, um, I will let the people who are impacted by this disease speak to it and educate you all. Um, Lisa?

128. 0:19:11

     Yes, ma'am. If I may, some handouts?

129. 0:19:13

     Certainly.

130. 0:19:14

     Yeah, we can bring it up here.

131. 0:19:14

     Yeah. Just, um, Paris, would you mind grabbing that, please? Or we'll distribute it. We'll, we'll get it distributed.

132. 0:19:20

     Don't grab it. We'll, we'll hand it out.

133. 0:19:21

     We'll hand it out.

134. 0:19:21

     And then if you'd go to the podium mic right there.

135. 0:19:24

     Hand it.

136. 0:19:26

     And introduce yourself, please.

137. 0:19:28

     Yes. Thank you for the opportunity to speak before you all today. My name is Lisa Matuszak, and I'm the mother of a young adult with Prader-Willi syndrome. I'm also the president of the Georgia Association for Prader-Willi Syndrome and a researcher for the Foundation for Prader-Willi Research. These roles have provided me with an in-depth understanding of the devastating and life-threatening challenges pos- posed by this condition, particularly the relentless food-seeking behaviors that define it. Every moment of a person's life with PWS revolves around food security and the need to prevent catastrophic outcomes.

138. 0:20:01

     Many of you may not be familiar with Prader-Willi syndrome, or also called PWS. It is a rare brain-based genetic disorder due to missing genetic information at birth. As you may recall from biology, genes direct growth, development, and health, and in PWS, the missing genetic material disrupts brain function, particularly the hypothalamus, leading to a predictable and lifelong pattern of medical and behavioral challenges. PWS is both a neurodevelopmental disorder and a medically fragile condition that requires coordinated care from infancy through adulthood.

139. 0:20:32

     In infancy, failure to thrive, low muscle tone, and feeding difficulty, feeding difficulties are prevalent, often requiring tubes in the nose or surgically placed in the abdomen to receive nutrition. However, this changes as the, as the child ages, and the hallmark feature of hyperphagia emerges. Hyperphagia is an unrelenting and life-threatening drive to eat. The biological compulsion results in individuals feeling as though they are starving, no matter how much they've eaten. Strict supervision, locking up of refrigerators, food pantries, and monitoring with cameras because of this insatiable hunger is critical to prevent harm or even death.

140. 0:21:05

     For individuals with PWS, food, which is a basic human necessity, becomes the greatest threat to their lives. Individuals with PWS also face a myriad of medical issues, ranging from scoliosis, psychiatric and behavioral challenges, diabetes, obesity, hypertension, sleep apnea, thyroid issues, skin picking, and many, many more. PWS is a lifelong condition with evolving complex medical needs, and outcomes depend heavily on consistent access to specialized coordinated care across disciplines, including endocrinology, behavioral health, nutrition, sleep medicine, and social services.

141. 0:21:39

     When care is fragmented or unavail- unavailable, there are higher rates of emergency interventions, hospitalizations, and institutional placements. I'd like to share a little bit about my own personal experiences with caring for someone with PWS. Like every person with PWS, my son's lived experience is unique. He is a person who graduated from high school with honors. He earned a Hope Scholarship and attends college, but not in the way that you might imagine. He does this remotely from the safety our, of our home, where every bit of food is under lock and camera.

142. 0:22:11

     It is unsafe for my adult son to have a cellphone, as he requires, uh, an, excuse me, to have a cellphone, and he requires a computer with parental controls. And he is not afforded the freedom to visit unapproved websites, make purchases, or send messages, because those are opportunities that invite danger in a world where food can be ordered online and delivered to your home. We know the danger of this firsthand when hundreds of dollars of food arrived at our door purchased online with a stolen credit card. Intellectually, he knows this is wrong.

143. 0:22:42

     Emotionally, he knows he shouldn't do it, but biologically, he is driven beyond his control, and he cannot stop. Academic success and intellectual abilities will never override these hardwired biological signals which place him in constant jeopardy. As parents, we are exhausted from the intensity of caregiving and advocating. For almost 20 years, we have remained hypervigilant around food. We avoid family gatherings and social outings because food isn't secure. School was never safe. We live in isolation with no respite.

144. 0:23:13

     My son has limited social opportunities, and that is only with direct parental oversight. We have struggled to maintain Medicaid coverage, facing policy termination multiple times, most recently due to clerical errors, resulting in a loss of critical care and access to medications. PWS families are in desperate need of services in Georgia to ensure the best quality of life, but the system is flawed. Due to the unique and complex nature of PWS under the typical eligibility guidelines for disability services and waivers in Georgia, a person with PWS may not qualify.

145. 0:23:44

     Safety around food is of utmost priority regardless of IQ, which is often a strict guideline for de- defining a disability. My son is a prime example of a person who on paper appears to have the cognitive capacity to earn an income and care for himself, yet if left unsupervised, he will eat foods to which he is allergic and die from anaphylactic shock. The hunger drive will always take control, and he will never be safe without supports. Meaningful change for our PWS families would involve qualifying for services based on a diagnosis of PWS.

146. 0:24:16

     Some examples of other change that would be impactful are allowing providers and group homes to secure and lock food in kitchens for safety, providing access to, um, to respite so our son can go into the community, and ensuring families don't lose access to critical services like Katie Beckett Waivers when mistakes occur, have a defined system in place to resolve those issues. In the span of a day where the scant few hours of sleep we get is often our only respite, the time it takes-

147. 0:24:42

     Ms. Matuszak

148. 0:24:42

     ... for a special needs parent to advocate-

149. 0:24:44

     We don't-

150. 0:24:44

     ... for bas- basic services-

151. 0:24:46

     Ms. Matuszak, we, we, we, hey, right here.

152. 0:24:49

     Oh, yes, sir.

153. 0:24:49

     Hey, we wrapping this up?

154. 0:24:51

     Yes, sir.

155. 0:24:51

     Okay, great. Um, because we have someone else who wants to speak, and we have another bill to do.

156. 0:24:56

     Yes, sir.

157. 0:24:56

     Okay.

158. 0:24:57

     Overall, I just want to give you an overview of the syndrome and understand how difficult it is for our families and convey to you the importance of some supports that we could benefit from as individuals and families living with PWS.

159. 0:25:10

     We certainly concur with that, and we appreciate that.

160. 0:25:12

     Thank you.

161. 0:25:13

     Thank you so much. Um, Kelly Gilgan.

162. 0:25:18

     She's not here today. My son Cooper is speaking, and then I am as well. Is it okay if... He's gonna have trouble with the podium

163. 0:25:24

     Sure.

164. 0:25:24

     But we're-

165. 0:25:25

     Or he was gonna speak.

166. 0:25:26

     Yes.

167. 0:25:27

     So why don't we come down here because I, I don't think we have anything to elevate him, and we'd rather have him right there in front of that mic right there. Or do you want to sit by him, or are you okay?

168. 0:25:35

     I can. I've got a little bit to say after.

169. 0:25:37

     Okay. All right. Just, uh, tell us who you are, big man.

170. 0:25:42

     Hi. My name is Cooper. I'm eight years old, and my brother has Prader-Willi.

171. 0:25:52

     I'm gonna be telling you guys about, like, what it's like.

172. 0:25:58

     Like, one thing I like about him is that he's always happy no matter what. Like, if I said, "Okay, Juju, it's time to take a bath," he's like, "Yay." If I say, "Okay, Juju, it's time to take a shower," which most k- most kids actually don't like, he would say, "Yay." Like, basically anything he wants, anything that we do, he's happy about it. One thing that is hard is that he only listens to certain songs, like Blippi, which is actually driving me crazy all the time, and he only plays with certain toys, which isn't as bad.

173. 0:26:37

     My hope for him is that he can overcome the disadvantages of having Prader-Willi. I hope Juju gets all the services he needs, me- services, medications, and support that he needs.

174. 0:26:52

     Cooper, we really appreciate that. Thank you so much for coming down here in support of your brother. Uh, I know he appreciates that, and, and I know everybody here on the committee does, too. Does anybody have any questions for, for Cooper? We do not. But, uh, so you stay right there, and we're gonna recognize your-

175. 0:27:10

     Mom

176. 0:27:10

     ... mom. Okay. Um, all right. You have the floor.

177. 0:27:14

     Um, so my name's Jessica McCabe, and I have a six-year-old, Julius, with-

178. 0:27:17

     Might need to get a little bit more closer to that. That'd be great. There we go.

179. 0:27:20

     My name is Jessica McCabe, and my sweet six-year-old son, Julius, has Prader-Willi. I'm here to speak about early intervention and the need for Katie Beckett services. Um, Katie Beckett services are crucial for young children diagnosed with Prader-Willi. We're specifically requesting that Prader-Willi is an automatic qualifier for Katie Beckett because insurance coverage allows our children to receive early intervention therapy and medication services in the first year, which alter the trajectory of our kids' future. We know that early intervention, um, in the first year of life takes advantage of the brain's high plasticity period to build neural connections.

180. 0:27:54

     It improves language, motor, and cognitive skills. During Julius's first year of life, along with most other children who have Prader-Willi, in fact, almost universally, he had eight medical specialists, five therapy services a week, and underwent three surgeries. He had an NG tube for nutrition and oxygen supplementation. We estimate that his medication or his medical costs without insurance would have been in the millions. Despite his expensive medical needs, extensive medical needs, and my knowledge of the medical system as a physician, he was denied for Katie Beckett twice.

181. 0:28:25

     Um, we actually had to hire a pri- private advocate for $1,500 and put the money up front so that we could get it approved. There are many families who do not have this option, and given the fact that this syndrome presents with severe medical issues in the first year, uh, we feel the diagnosis should be enough to automatically qualify and help our families out. I can confidently say that early intervention i- is going to change Julius's future, and our hope is to improve the lives of the next generation of children who, um, are impacted by this syndrome.

182. 0:28:56

     Thank you so much. We appreciate that. Any questions? Um...

183. 0:29:02

     I, I, I thought I heard the previous speaker say that they had had, uh, Medicaid, but I see on the handout that Georgia's not a Medicaid expansion state, which means some adults are not covered-

184. 0:29:15

     Right

185. 0:29:15

     ... with this complex condition. I mean, so you can qualify, it's just that not everyone qualifies.

186. 0:29:21

     Um, it's, it's-

187. 0:29:21

     Or how does that work to get qualification?

188. 0:29:23

     It's very difficult

189. 0:29:24

     ... if it's not an expanded, if we're not Medicaid expanded?

190. 0:29:28

     Um, it's very difficult to get Medicaid services. It, it despite... I mean, a lot of families, you, in order to qualify for Katie Beckett, you have to have documented five therapy services a week. If you have parents who are both trying to work-

191. 0:29:40

     Oh

192. 0:29:40

     ... five therapies a week.

193. 0:29:42

     Oh, okay.

194. 0:29:43

     In addition to extensive medical needs, in addition to a Babies Can't Wait evaluation that diagnoses them as moderate to severe in all categories. Because my son was taking a little bit of, um, bottle milk, not, not much, most of it was NG tube fed, he was, um, listed as mild in the, uh, um, the domain of oral motor, um, abnormalities. And so for that reason, he was denied, even though we know that the, the syndrome in, in the first year is very severe and most of our children are failure to thrive and require extensive medical, um, med- medical services to even make it through the first year.

195. 0:30:18

     Thank you. Any other questions? Senator Lawrence?

196. 0:30:22

     Uh, tha- thank you, Mr. Chair. Just, just quickly, did I understand you to say you're a physician?

197. 0:30:26

     I am.

198. 0:30:27

     And what, and what's your, uh, area of practice?

199. 0:30:30

     I'm a physiatrist. It's physical medicine and rehabilitation.

200. 0:30:33

     Uh-huh. Thank you.

201. 0:30:35

     Mm-hmm.

202. 0:30:36

     Thank you. All right. That's all we had signed up. Uh-

203. 0:30:40

     We actually, we have one more. We actually have somebody with Prader-Willi here to speak.

204. 0:30:44

     Okay. All right.

205. 0:30:45

     You ready? Okay.

206. 0:31:02

     Thank you for being here.

207. 0:31:04

     Tha- and thank you, both senators, Chairs. Good mo- good afternoon, senators. I am Shawn Andrea Cooper, and I have Prader-Willi syndrome. When I was first diagnosed with PWS at the age 12, life expectancy was in the early 20s. I am 52 years old and have a comp medical waiver. I live in an apartment in Roswell, Georgia with two roommates, and we have support staff through our provider and community.

208. 0:31:44

     I am on the National Prader-Willi Syndrome, PWS, Adult Advocacy Board. We would like people in the city where we are living, there are some chall- there, there are some challenges

209. 0:32:05

     and some good things also. I have

210. 0:32:11

     challenges with ins- insulin resistance, bone density, and a new medication from Solino is to help persons with PWS control the hunger. Thank you, Solino. I have good doctors at Emory, Centers, and University of Florida, and I am now on a 900-calorie diet, d- day diet prescribed by support, prescribed by...

211. 0:32:49

     Oh, where is it? Where is she at?

212. 0:32:54

     By international PWS specialist, Dr. Jennifer Mellow. I have good support staff, parents, and family members who love me so much. They give me healthy meals, and I have eyes on me at all times, especially when I'm in the kitchen area. Over the time, my weight dropped from 189 to 112 pounds.

213. 0:33:24

     Living with PWS is hard, but with good support staff, we can overcome our challenges, and we can live.

214. 0:33:36

     Some people with PWS do not have the Katie Beckett or Medicaid waiver. So if we can please unlock the Medicaid waiver, that would, that would help them out to thrive and live. We need that. Thank you for the, this opportunity, giving me this opportunity.

215. 0:33:57

     Thank you so much. Any questions at all? Thank you. We really appreciate you being here. Um, so now I'm looking for a motion for, uh-

216. 0:34:07

     Make a motion to pass

217. 0:34:08

     ... make a motion to pass.

218. 0:34:10

     Second.

219. 0:34:10

     Second it. S-

220. 0:34:11

     We need an amendment then

221. 0:34:12

     ... and we have an amendment, uh, and, uh, s- uh, uh, Chairman Hostetler.

222. 0:34:19

     If I heard, um, Chairman Kirkpatrick right, after day on line one, she wanted to put at the Capitol and take out state in that same line.

223. 0:34:30

     And then on the next page, I think is the same thing.

224. 0:34:33

     Right.

225. 0:34:33

     I think it's line 27.

226. 0:34:34

     27. At the end, say at the Capitol, and take out state on line 27.

227. 0:34:39

     Okay. And our legislative counsel is nodding her head 'cause she actually did the amendment, so, uh, any questions on that? So I got a motion, have a second, uh, and any discussion further? Excuse me. Um, so all those in favor-

228. 0:35:03

     Of the amendment

229. 0:35:03

     ... of the amendment, uh, raise your hand. Okay. Um, everybody's raised their hand, so that's unanimous. And then a motion of do pass as amended. Um, that is already... No, we're going... Senator Orock.

230. 0:35:21

     We already have that.

231. 0:35:21

     We've got that. We've got that. We-

232. 0:35:23

     But it wasn't as amended though.

233. 0:35:24

     Yeah.

234. 0:35:25

     So the, so that's-

235. 0:35:26

     We can't devote

236. 0:35:27

     ... so, so moved. Seconded. Discussion. Any discussion?

237. 0:35:34

     All right. We're ready to vote. Ready to vote. All those in favor, raise your hand. All right, again, that's unanimous. Great. Appreciate that. Thank you so much. It passes.

238. 0:35:44

     Thank you.

239. 0:35:49

     Okay. All righty, so we are on the last bill, and that is, um- 439 ... 439, Senator Still. We've had a hearing on this already. We sent them off, and I reviewed the changes, um,

240. 0:36:09

     uh, last week, and we have the changes here. We've already had testimony, and what we'll do is, um, Senator Still, if you would present the, uh, present the bill. Just give us a little quick overview, and then if we can go on the changes, and then if we have any questions, or, uh, we'll see if we need to have any testimony, uh, from that standpoint. Okay? Thank you. Yes, sir.

241. 0:36:32

     Witness two. Hey, everybody. We are back. Uh, Senate Bill 439, we are working off a committee sub LC443482S.

242. 0:36:47

     What I believe was a well-intentioned bill, um, got a little hair on it along the way, and, uh, took us on a bit of a, an odyssey of learning more about the referral process, uh, to assisted living, independent living, uh, Alzheimer unit, any sort of private pay, uh, personal care home. And what we came to realize is that the, the folks on the facility side largely rely on referral agencies who are marketing companies, and then they promote their services to the public who might be looking for a place to, to send a loved one.

243. 0:37:33

     And the issue became, as we heard in testimony, that some of the facilities may get the same referral multiple times, or that someone may have just fallen off their radar and then ends up signing up to stay in that facility. And then many months or even years down the road, that initial referral agency is trying to get a fee for said placement. This is all a contract, and as the chairman and I have discussed, this is one of those rare industries where the state has to regulate it, even though it's self-pay, it's, it's a conscious decision to sign up with a referral agency, and then everyone has to figure out what are they agreeing to, for how long are the terms.

244. 0:38:22

     And so this bill has to use Georgia law to determine what private industries have to decide is best for their relationship between who's doing the marketing, who's making the referral, for how long is that referral active, to how many places can they make the referral. And then on the facility side, if that loved one, the referred, uh, per- referred person, uh, what do they owe to the, uh, referral agency for said purpose?

245. 0:38:52

     And so the two major hangups that we had based on the testimony that we had was on the length of time of the referral and the notification. So the folks from the Senior Living Association wanted to reduce it from 36 months from the time of first contact to placement. They wanted to reduce that to 12. This bill reduces it to 24. The other question came up about notification.

246. 0:39:23

     They wanted the person being referred to know that a fee was being paid for said placement. So, um, rather than it just being between referral agency and facility, they wanna make sure that the patient or that the r- the family of the patient is aware that they're being referred in. And so this amended bill before you speaks to that. Um, much of the language is the same, but until you jump to line 58, where it says, "The referral agency shall obtain from a prospective resident or his or her authorized representative a documented written, electronic, or verbal acknowledgement," and then it has to be retained by the referral agency.

247. 0:40:11

     It doesn't create a contractual relationship between the agency and the resident, just between the assisted living community or the personal care home.

248. 0:40:22

     Then on the last page, page four of the bill, starting on line 76, changed it from 36 months down to 24 months, but it's really split as a 12 and 12. So it's saying after the initial 12 months, if they haven't relocated, then they have to resubmit another referral for that same initial one. So it's a, it's a 12 plus 12, not a straight 24. The folks on the referral agency side would prefer it to just be a straight 24.

249. 0:40:52

     The folks on the assisted living side prefer the 12/12. Um, and those were the two major issues that were not al- allowing us to move forward last time I presented this bill. Uh, this is the final version, um, that we've come up with. Uh, there is still some consternation, uh, among some folks on the referral agency side, uh, with this, because it doesn't address 100% of their concerns, but it certainly has, um, created, uh, a degree of compromise far less than what our original version of the bill had.

250. 0:41:31

     And as I'm seeing this substitute for the first time today, as you are seeing this, this is our dear friends in legislative council working frantically to try to meet everyone's questions and concerns, but this is the latest version that we have to work on, and happy to answer any questions.

251. 0:41:49

     Let me just give a little background here too for us fresh. Remember, remember skilled nursing facilities, uh, those are, do receive government funds, and that is subject to anti-kickback, and that is entirely illegal. Remember, it's the Stark, uh, Pete Stark, California Democrat, uh, during a Democratic administration, says you can't do kickbacks to skilled nursing facilities. They did not cover assisted living. I would wonder what would happen now if Pete Stark were still there. I suspect he'd probably do it.

252. 0:42:21

     Uh, I went over personally with the, um, the five points that they were concerned about and made sure they were all in there. I think the, uh, the assisted living facility would be happy with 12. They were happy with, what was it, 36?

253. 0:42:41

     36.

254. 0:42:41

     36. So I think this is pretty good compromise from that standpoint. Um, and I did go through all five of those issues with them. All five of those things are in here-

255. 0:42:53

     Mm-hmm

256. 0:42:53

     ... and except there was a little compromise there with the 12 plus 12 versus 36 versus 12. I will tell you, the industry that has come down from New York and does the franchises, they don't want anything. But I don't think it's fair to the family or the patient to not know that they're doing a referral, and they may or may not have a contract with that one in there. So I, all of that is not entirely clear in this acknowledgement, but it does give a little bit of acknowledgement.

257. 0:43:24

     So I'll open it up for questions.

258. 0:43:27

     We got a-

259. 0:43:27

     Hufstetler

260. 0:43:28

     ... technical question here, I guess.

261. 0:43:30

     Sure.

262. 0:43:30

     I'm looking at line 66, and it says, "Referral agencies may charge or collect a fee from assisted living community or personal care home only after the resident relocates." And then when I go to the next page, E, it says, "Referral agency shall not charge or collect a fee from assisted living or personal care home." And I guess it's all these conditions passed is, is what you're saying, right? They have to meet the conditions.

263. 0:43:53

     They, those are the conditions. That's right.

264. 0:43:54

     Okay. So I just wanted to make sure-

265. 0:43:57

     Right

266. 0:43:57

     ... I'm following that.

267. 0:43:58

     Okay. Um-

268. 0:43:59

     One question.

269. 0:44:00

     Senator Hodges.

270. 0:44:00

     Um, if the assisted living facility is-

271. 0:44:05

     Do- do you want to get that mic a little bit closer-

272. 0:44:06

     Sorry

273. 0:44:06

     ... if you don't mind?

274. 0:44:07

     Excuse me. If... Thank you, Mr. Chairman. If the assisted living facility is using a marketing, um, entity, a marketing company to help bring, um, residents, uh, into the facility,

275. 0:44:23

     and they're paying a fee for it, does the liability for the fee go away after two years? In other words, if the home doesn't pay the fee, if, if I've referred somebody to them and, and, and they just don't pay me for two years, do they... Is, is that it? It j- Does their liability end at two years?

276. 0:44:44

     I, I, I'll, I'll speak-

277. 0:44:46

     Do I have... I don't have a cause of action, so what's the, what's the answer there?

278. 0:44:49

     They, they, there's a written contract between the referral agency and the facilities. They, they enter into a business relationship. So if they've agreed to make payment within that 24-month period, and, and, and they've made the referral, they've moved in within that 24 months, but they don't pay, then they're gonna end up in court.

279. 0:45:08

     So the marketing company does have a cause of action?

280. 0:45:11

     Yeah.

281. 0:45:11

     It w-

282. 0:45:11

     But that's between their contract with them.

283. 0:45:13

     Like in a private contract.

284. 0:45:13

     We're not gonna legislate that.

285. 0:45:14

     Yeah, I just noticed in there no cause of action, but that's the-

286. 0:45:17

     That'll be their contract

287. 0:45:18

     ... residents. Okay.

288. 0:45:19

     That's right.

289. 0:45:19

     I gotcha. All right. Thank you.

290. 0:45:20

     Senator, Senator Goodman.

291. 0:45:22

     Thank you, Mr. Chairman. I just have a quick question. I have a friend that's in, in the, uh, assisted living business, and he, he told me that, uh, he's, has had a case in the past where for the same patient, he's paid three different placement fees. Now, if you think about it in like the real estate industry, you know, that's... My mom was in the real estate industry for a long time. They call it co-broking, where it is split versus... J- I'm just curious, is there anything in your legislation to adjust that, where, um, where the people aren't, uh-

292. 0:45:55

     Right

293. 0:45:55

     ... one of these folks aren't paying three people for the same person, basically?

294. 0:45:59

     Lines 58 through 60 do attempt to address that. So if there's a prospective resident,

295. 0:46:08

     then the, uh, line 61, so jumping from 58 to 61, the referral agency obtains from a prospective resident, their authorized represent, either a documented, a written electronic, or a verbal acknowledgement of receipt, and it'll be retained by the referral agency. So it's kind of the, whoever the first one in was who made that, they track that. So in the case of your friend, if three, if, if Mrs. Goodman was referred by three different...

296. 0:46:39

     If you contacted on behalf of your mom three different agencies, the first one to contact the personal care home, there would be a, a recorded receipt of that first referral. So any subsequent attempts to make that referral would just be, they'd be notified, say, "We're, we're already under con- We've already received the referral by this company."

297. 0:46:59

     I gotcha.

298. 0:47:00

     Okay. Any other questions? S- Senator Merritt, 12.

299. 0:47:03

     Thank you, Mr. Chairman. So I have a couple of issues with this bill. Um, the one, it was still never answered for us how many customers at the end are being harmed by what's happening. We st- I have not seen an overwhelming, I don't have any verification that the customer's being harmed. That's my first question. But on the other side, I do think that these referral agencies, and I think we took out, why were, why did we take out the DCH, um, web portal checkoff?

300. 0:47:37

     Like, they had to go to DCH to kind of refer. Because where I'm getting to, I do think these referral agencies should be held accountable for who they're referring to, meaning they should be checking, um, whatever senior home it is and make sure they're legit, make sure they have a license, and make sure they have good service, and I think that is something these referral agents should be checking-

301. 0:47:59

     Yes.

302. 0:47:59

     And we should require that.

303. 0:48:01

     Yes, ma'am.

304. 0:48:01

     So I don't know if that's in the bill. Did we take it out? I think we took it out. That part I don't like that we took out.

305. 0:48:08

     I think, I think what we took out was the-

306. 0:48:10

     I don't-

307. 0:48:11

     ... responsibility of the-

308. 0:48:13

     Negotiation

309. 0:48:13

     ... um, did you say-

310. 0:48:16

     I think it was the DCH web portal. Like, the referral agencies-

311. 0:48:19

     Right

312. 0:48:19

     ... would have to go on there to refer, to go look to see-

313. 0:48:22

     Seth, did you answer that?

314. 0:48:23

     Yeah.

315. 0:48:24

     Seth?

316. 0:48:24

     Yeah.

317. 0:48:26

     'Cause I think, Seth, you actually brought that to my attention.

318. 0:48:29

     Yeah.

319. 0:48:29

     So why did we take that out?

320. 0:48:30

     All right.

321. 0:48:30

     Yes.

322. 0:48:31

     Identify yourself and who, who you represent.

323. 0:48:33

     Sure. I'm Seth Daniels. I'm with the Georgia Senior Living Association. We represent assisted living, personal care homes, and independent living. Uh, Senator, you are correct. In the original LC version of the bill, we had that. Um, in the course of negotiation, that was one of the things that was asked from the other side to be taken out, uh, at least some parties on the other side. There are multiple people. Um, I would, uh, to that point, I'd, I'd point out to, uh, the members of the committee, in your packets, I believe, is a copy of the letter from the National Placement Referral Alliance that lays out the five or six points that Chairman Watson referenced.

324. 0:49:10

     And you'll see on the last page, that was one of the things. Um, we agreed to take that out if it would get us to a deal. Um, the senator still said there's still some, uh, some opposition to the bill just because of the underlying they don't wanna do it.

325. 0:49:26

     Yeah. Yeah, I don't think this is a perfect bill. Uh, but we're gonna continue to move it along and, uh, change it if we need to in the future. Any other questions? Senator, Chairman, uh, Brass.

326. 0:49:42

     Yeah, thank you, Mr. Chairman. Chairman, I'm gonna kind of refer to, you had brought up the Stark Law, the anti-kickback. So based on what I'm reading, uh, the only part of the bill that's addressing anti-kickback is lines 45 through 48. Am I correct on that? Is there any other part of this bill dealing with anti-kickback?

327. 0:50:07

     Well, there's-

328. 0:50:09

     Is there something I'm missing?

329. 0:50:11

     There's, there's no, it, it's not illegal to give this kickback.

330. 0:50:15

     Mm-hmm.

331. 0:50:16

     We're not making it illegal to get the kickback.

332. 0:50:19

     Well, I don't cons- well, first off, I don't consider a, a reference of-

333. 0:50:22

     Oh, all right

334. 0:50:23

     ... a referral-

335. 0:50:23

     Reference fee or broker's fee

336. 0:50:25

     ... of kickback, but-

337. 0:50:25

     Reference fee or broker's fee. It's not illegal

338. 0:50:26

     ... but I, I would think it would be a, a little bit of a conflict if you're referring to something you own, if, if you're selling yourself as a referral company and then... So I get-

339. 0:50:38

     Right

340. 0:50:39

     ... I understand lines 45 through 48.

341. 0:50:41

     Okay.

342. 0:50:43

     I guess my first question is, well, actually, I guess this would be my second question, is why were... All right, Stark Law was a, was a federal law. Am I correct? All right. And do we know why they left off assisted living communities?

343. 0:51:01

     Because that's a cash business.

344. 0:51:03

     Private pay versus federal dollars.

345. 0:51:05

     Okay.

346. 0:51:06

     This is strictly for private.

347. 0:51:09

     Okay. So we're... Okay. Um, so, uh, well, outside of anti-kickback, the rest of the bill, we're s- we're really just dealing with the contract itself. Is that accurate?

348. 0:51:25

     Ef- effectively, right. It's just saying that the referral agency can't collect a fee from the patient. They're only collecting it from the facility to which they're being placed.

349. 0:51:36

     Well, they're doing that now.

350. 0:51:37

     And, and this is acknowledgement, basically.

351. 0:51:39

     Yeah.

352. 0:51:39

     It, it, just buyer beware, consumer beware acknowledgement.

353. 0:51:46

     Okay.

354. 0:51:47

     Not a contract.

355. 0:51:48

     Okay.

356. 0:51:48

     All right, any other questions?

357. 0:51:49

     Yeah, you're not help-

358. 0:51:50

     I had real quick on the fee.

359. 0:51:51

     All right, let's get Senator Mangham, and then we'll come back to you.

360. 0:51:54

     It's my fault.

361. 0:51:55

     Thank you for bringing this bill, Senator. At what point does the, the, the user of this service, the resident, get to know that there is such an arrangement? When? When? And then, and, and can that make a difference in their, do they have a real choice?

362. 0:52:16

     So there's always a choice. You pull up the line on that. So while he's looking at the exact line number, I'll, I'll answer the question. The choice is personal care homes can choose not to use referral agencies. They could hire their own marketing person. They could go find their own patients. They could, they could absolutely go do that entirely on their own. There is a cost associated with that, and, and that's a business decision that they have to make.

363. 0:52:46

     That's what created rise to these referral agencies that, um, they're, some of them are very, very large, you know, national companies that, that do these referrals. So they have these huge marketing machines that collect data. They, they mine that information, they get the patient's information, and then they refer it out to the facilities with whom they have a contractual relationship, and typically charge about one month's rent stay at that facility.

364. 0:53:19

     And in the, the major assisted livings in the metro Atlanta area, that could be anywhere from 6 to 10,000 a month. So that's their fee, is usually one month.

365. 0:53:30

     So it is upfront.

366. 0:53:32

     Correct.

367. 0:53:32

     They're acknowledging that.

368. 0:53:33

     Yeah.

369. 0:53:33

     I think that was his question.

370. 0:53:34

     Right.

371. 0:53:34

     What was the line?

372. 0:53:35

     So the resident knows-

373. 0:53:36

     Then later, then the-

374. 0:53:37

     ... as they move in, they know that that fee is being paid.

375. 0:53:40

     Line 40.

376. 0:53:41

     Line 40.

377. 0:53:41

     Thank you.

378. 0:53:42

     Thank you.

379. 0:53:44

     Okay. Any other- Senator Merritt, you still, uh, ac- actually, you had a question. I'm gonna come back to you.

380. 0:53:49

     Still makes me angry.

381. 0:53:50

     Senator Hodges. I mean, uh, Hatchett.

382. 0:53:52

     Number 10.

383. 0:53:53

     10. Thank you.

384. 0:53:54

     Thank you, Mr. Chairman. Two questions. The DCH language, you said that was the other side. Who is the other side exactly?

385. 0:54:04

     The referral agencies didn't want the responsibility of having to continually cross-check with-

386. 0:54:09

     Well, they're, they're not all on board-

387. 0:54:11

     Not all. Some

388. 0:54:11

     ... with everything. They're, some are in agreement, some are not in agreement.

389. 0:54:14

     Well, no, I'm just trying to get the parties here. So it's the refer-

390. 0:54:16

     Oh, sure

391. 0:54:16

     ... referral agencies and the-

392. 0:54:18

     It makes it fancy.

393. 0:54:19

     Yeah, the referral agency.

394. 0:54:21

     Okay Um, and then the other side would be the assisted living facilities? Those are the two parties at the table?

395. 0:54:29

     Yes.

396. 0:54:29

     They're, they're contracting, yes.

397. 0:54:31

     Okay. The DCH stuff, the only concern I have is if a referral agency knows of bad actors in the industry, but they may give the best referral fees. Is there any mechanism in this bill that they would have to disclose knowledge that they have about a certain facility that may not be safe, suitable, anything like that? Would that... My que- The DCH language that was in there, would that have protected potential residents?

398. 0:54:59

     Would-

399. 0:54:59

     And was that taken out?

400. 0:55:00

     Well, correct me if I'm wrong, but I mean, DCH does, uh, inspect these facilities-

401. 0:55:05

     Yes

402. 0:55:05

     ... and, uh, that is on their website.

403. 0:55:07

     It is.

404. 0:55:08

     Yeah. That's, that's not changed.

405. 0:55:10

     That can still be done. It's just not in the bill.

406. 0:55:12

     And I would presume that the referral agency would be doing that themselves.

407. 0:55:15

     But they don't have to in this bill.

408. 0:55:18

     Contractually-

409. 0:55:19

     No

410. 0:55:19

     ... they can do that on their own.

411. 0:55:21

     But are they required to?

412. 0:55:23

     Okay.

413. 0:55:24

     All right.

414. 0:55:24

     I, I'm not gonna-

415. 0:55:26

     Okay

416. 0:55:26

     ... slow it down, but okay, the second part is the attorney general, uh, this bill doesn't have a lot of teeth. Uh, public enforcement by the attorney general, what does that look like?

417. 0:55:38

     That's all the chairman. He's got, uh-

418. 0:55:42

     I-

419. 0:55:42

     ... and we're gonna lose members. I mean, that's, uh, he's, he's got finance-

420. 0:55:45

     Yeah

421. 0:55:45

     ... at 3:00. He's chair of finance.

422. 0:55:47

     This would, uh-

423. 0:55:48

     We still got three minutes.

424. 0:55:50

     Got three minutes?

425. 0:55:50

     He left early. Where is he going?

426. 0:55:51

     He, he's got one minute according to mine, but go ahead.

427. 0:55:54

     Uh, this would go under the Consumer Protection Bureau within the Attorney General's office that enforces the Fair Business Practice Act.

428. 0:56:00

     And Senator Merritt.

429. 0:56:01

     Yeah. I just wanted to clarify the disclosure part. Did we change, is it like a signature now, or is it a checkbox? What do we do?

430. 0:56:07

     That, that is-

431. 0:56:07

     Make the most of it, yeah

432. 0:56:07

     ... one of the changes that we made. It's not a, a, the first version of the bill, uh, that we heard two weeks ago said signed and dated. This version, uh, now just says an acknowledgement. It can be written, electronic, or verbal.

433. 0:56:21

     Okay.

434. 0:56:21

     That's on, that's on line 59.

435. 0:56:22

     Got it. And just back to your point about, this is a industry fight to me. You have the smaller companies don't wanna pay the referral companies. Got it. Or the smaller senior living places, whatever, don't wanna, those that don't wanna go with the referral agencies, and they're scared that, or their issue is going with a referral agency or not going with a refer- a refer- referral agency gives the upper hand to those that choose to do so. And yes, maybe they, maybe it's a marketing thing that the smaller ones that don't wanna go with a referral agency, maybe they need to market more, or maybe, I don't know.

436. 0:56:57

     That is something that's a whole nother issue, so I'm not disagreeing with that. But this is a complicated situation. We have two sides here that feel very strongly about what they think. But, um, yeah. That's all I wanna say, and I just wanted to get clear about-

437. 0:57:12

     I meant not a question. All right

438. 0:57:13

     ... the disclosure. Not really a question.

439. 0:57:14

     Any other questions? Senator Orrock, are you, uh, making a motion? No. Absolutely not. Okay.

440. 0:57:22

     Uh, thank you, Mr. Chair. Uh, I, I, I'm questioning what does this language mean in the real world about, um-

441. 0:57:32

     Make a motion

442. 0:57:32

     ... the, um, requiring, th- this thing about re- requiring a, a, um, now I've lost the language, but it says that, uh, requiring a documented... W- w- where is that thing?

443. 0:57:48

     58.

444. 0:57:50

     Yeah, 58. What is a, a, a documented, written, electronic, or verbal acknowledgement? What is a docu- how do you document a vertal, verbal acknowledgement? What does that-

445. 0:58:02

     Just write it down like in a medical chart.

446. 0:58:04

     Yeah. That's what I was gonna say.

447. 0:58:04

     Yeah. It's the same, same I do every day, Senator. All right.

448. 0:58:08

     Well, I, I'm sorry.

449. 0:58:08

     In, in a chart. I, I, I do that every day, verbal acknowledgement. Nurses do that all the time. Yeah.

450. 0:58:12

     Uh-huh.

451. 0:58:13

     Verbal order per so-and-so. Yeah.

452. 0:58:15

     Uh-huh.

453. 0:58:15

     All right.

454. 0:58:15

     Just send that draft. I just, uh, thank you, Mr. Chairman. I just have a quick question. Um, these folks that are paying this referral fee, is there any guarantee that that patient is gonna stay there for any length of time, or is- No ... there's not? They could leave after a month. Okay.

455. 0:58:32

     All right. S- Senator Hodges.

456. 0:58:35

     Um, Mr. Chairman, I'd like to make a motion.

457. 0:58:42

     3482S, I have a second. Second Senator Goodman. Uh, any further discussion? All those in favor raise your hand.

458. 0:58:55

     One, two, three, four, five, six, seven, eight. All those against? Eight to one. Uh, motion passes, and, um, I think that's it for today. And

459. 0:59:12

     all right, well, so this is our last meeting, uh, for the year for s- taking up Senate bills. So we will, stay tuned from that perspective. You said this is the last meeting? Last HHS for Senate, but we're going to continue to meet after-

460. 0:59:30

     Maybe.

461. 0:59:30

     After. Maybe, maybe not. We'll see. Thank you.

462. 0:59:52

     And the-