Comité Rural Development de la Cámara de Representantes, 16 de septiembre de 2026

Transcripción

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1. 0:22:46

   If you want to take a seat, we'll get started here in just a minute. If everybody wants to take a seat, we'll get started here in just a minute. Good morning everyone, and, uh, welcome to beautiful Blue Ridge,

2. 0:23:06

   Georgia. We're gonna call this meeting of the House Rural Development Committee to order. I'm gonna start by recognizing and thanking a few people. Um, house media services. We cannot have these meetings without house media services.

3. 0:23:33

   Good morning everyone, and welcome to beautiful Blue Ridge, Georgia. We're gonna call this meeting of the House Rural Development Committee to order.

4. 0:23:46

   I'm gonna start by recognizing and thanking a few people.

5. 0:25:20

   Lauren says we're ready to try it again. Well, let me just go ahead and thank Lauren Harsh, Jayda, and Rachel that are back there from House Media Services. Ben Massey's our photographer right here. Um, thank you for always being here with us. Deborah Jackson is the best committee assistant a chairman could have and, and a good friend.

6. 0:25:47

   And of course, we, we could do nothing without our senior policy analyst, Leo Chancy here, who we're so fortunate to have with us. There's, um, practically nobody that I know that has such a, a knowledge of rural issues for the state as Leo. So very happy and honored to have him with us today and always. Before we get started, we're gonna, uh, as we typically do, start with, um, a prayer.

7. 0:26:22

   Oh, but I did forget a very important person that I wanted to acknowledge, and that is Representative Will Wade. Our colleague, not for much longer, but got the bright idea that he needed to change jobs. And, uh, we do wish you the best of luck here. Um, so sorry that you have, uh, made the unfortunate decision that you have. But the people of this, this, uh, senate district would be very fortunate to have you represent them, and I thank you for being here with us today, sir.

8. 0:26:59

   Well, well, yes. Thank you for that. We need that, and we will, we will, um, appreciate you being there to help us out with that. Thank you, Will. Okay. I- I'm going to acknowledge Representative Johnny Chastain, who is a good friend, um, a person who is selfless in giving to others in his community. He has been so kind to organize this meeting of the committee here in Blue Ridge. I've asked him to open us up with a word of prayer.

9. 0:27:31

   And then, uh, Representative Chastain is going to then say a few words if he likes, but also introduce some, um, local, uh, dignitaries that are gonna say a few words. And if you all wanna speak from this podium whenever, whenever, uh, you're recognized, that, that's where we're gonna go for our speakers today. Representative Chastain.

10. 0:27:56

    Let's pray. Woo, it's a little hot.

11. 0:28:01

    Dear Lord, we thank you, Father, for this day that you've given us. We always wanna acknowledge that and never take it for granted because we, we, um, we never know, uh, what circumstances we may wake up to. So we wanna just thank you for this beautiful day that you've given us. Thank you for this, uh, this time. We just pray that you, uh, lead, guide, and direct us in every, uh, thing that we do this morning, um, for the great state of Georgia. Thank you for all the folks that are here. Thank you for all the speakers. Uh, thank you for all the hands that have w- that have went in together to put this, uh, meeting together this morning.

12. 0:28:34

    Uh, we thank you, we love you, and we praise you, and we ask you to be with us in this service. In Jesus' name we pray, amen.

13. 0:28:42

    Okay. Well, thank you. I'm super excited. I don't know if you can tell or not, but wow. W- welcome to Blue Ridge. Um, I, uh, really thank the chair lady for allowing us to, to do this. I know we coulda had this meeting anywhere all over the state of Georgia and, and we have. We've had them in, in South Georgia and Middle Georgia. But we're so thankful that we're here, uh, Chair Lady Hagan, for the, the meeting here, uh, this morning in Blue Ridge. Super excited too about just the sneak peek of, uh, the presentations, uh, this morning because, wow, uh, it lines up so much, like with our district, uh, uh, here in North Georgia, the things that we're gonna be talking about this morning.

14. 0:29:22

    Uh, from healthcare to the, to the railroad. Uh, and it's gonna be a great presentation, so thank everyone for coming, uh, today. Thank all the members that are here, uh, from all over, all over the state. So I hope, uh, hope you have a good time while you're here. All right. I wanna just, uh, I wanna introduce two or three folks really quick that's gonna s- uh, say a few words, welcome people to the community, maybe say a few remarks about the community. Uh, really appreciate North Georgia College- And for allowing us to have, uh, the meeting here this morning.

15. 0:29:56

    Um, Jordan, I don't know if Jordan's in the room, but Jordan's, uh, has been a huge help, uh, all the way through with the logistics and getting things together. Thank you for that, Jordan. Christie Gribble, who's here with us this morning as well. Uh, thank you, guys, for the help. But I'd like to call on the, uh, Provost, Dr. Chadrin Gill, and she's gonna give us a few remarks, uh, this morning from North Georgia College.

16. 0:30:44

    Thank you. We're honored to host the House Rural Development Committee here in Ralston Hall, and we're grateful for your commitment to the communities that make rural Georgia such a vital part of our state. This campus stands as a powerful example of what can be accomplished when leaders invest in the future of rural regions. It is especially fitting today that we gather in Ralston Hall. Speaker David Ralston's vision, his leadership, and his unwavering commitment to North Georgia were instrumental in securing the support and resources that made this campus and this building possible.

17. 0:31:27

    His belief that students in this region deserved greater access to higher education continues to shape lives and strengthen communities across the mountains of North Georgia. In this very building, we train nurses and we train teachers for this community. We prepare entrepreneurs, and we provide an access point for students to get a start in their educational journey in pursuit of their purpose for their lives. So as you conduct your important work here today, I hope you will see this campus as a testament to the transformative impact that thoughtful public investment can have on rural communities.

18. 0:32:09

    We're grateful for your service and your leadership and your dedication to strengthening rural Georgia. And for all the members of the community who are here and who will be making presentations, we thank you also for your involvement, your commitment, and your partnership with the University of North Georgia. So I thank you all for being here today, and you are always welcome at our Blue Ridge campus. We wish you a productive and successful meeting. Thank you.

19. 0:32:46

    Now we're not on mute. Thank you so much for that presentation. And again, thank you so much for allowing us to use the facility this morning. It's great. Beautiful, beautiful place. Okay, I'm gonna call on Christie Gribble to come up. Christie is our chamber president here in Fannin County. I know we all love to brag on our chambers. Our chamber here in the seventh district, uh, in Fannin County is just absolutely rocking and rolling. Thank you, Christie, for the leadership. Also, uh, Christie, the chamber, and Jordan for the North Georgia College is sponsoring lunch today. I want to get that in because you're gonna ... Th- this is coming from the, the rum cake lady who's ...

20. 0:33:20

    You're gonna have a great lunch. I think Representative O'Steen knows about the rum cake lady, so sponsoring lunch today. Yeah.

21. 0:33:28

    Good morning. Um, it's an honor to be with you, uh, this morning. I can't think of a better way to start the day. Um, we are beyond blessed to have this facility. It is incredibly beautiful. And now we are able to host some conferences, and we've got one of our first big conferences for tourism here in December, so it's really exciting. Um, so Christie Gribble. I am born and raised here. Um, I'm a daughter of educators. Um, my dad was school superintendent for 10 years, retired.

22. 0:34:01

    And when I graduated college, or when I graduated high school, I said, "See you later. I'm not coming back." So I left for about 12 years, and, um, what did me in was living in Atlanta. And I'm sorry for anybody that is currently living in Atlanta, but, um, I started coming back up to the mountains on the weekends, and found it really hard to go back into the city. And so I ended up, um, moving back home, um, around 2015, and I started working in economic development.

23. 0:34:35

    I think it was the best decision I ever made, although I do love the city. Um, I am so honored to serve our community in the capacity of being the, um, chamber president. We do tourism work, too, so actually that's the biggest part of what we do. So tourism is our biggest economic driver in this community. And we all, all of our community leaders love what our downtown offers. We've got the most unique Blue Ridge Scenic Railway.

24. 0:35:05

    I'm so, so blessed to have that. Um, amazing restaurants. Um, many of you ate at Harvest on Main last night, which was one of the first that opened years ago, and, um, helped set the stage for incredible food in this community. Um, and then of course we have unique shops, which I hope some of you might have time to shop at later. Um, but what is so great about our leadership, um, you'll hear from Commissioner Hensley and Mayor Andy Rhodes, Johnny Chastain, is we appreciate what makes this community special.

25. 0:35:38

    So living in a peaceful home on the top of a mountain or being able to go to the river and fish, we are doing everything we can to help preserve what makes the community special. So we recognize, um, how important it is to continue developing, um, and improving this community through i- infrastructure, et cetera, but what can we do to help preserve, um, what makes it special? So we've got an incredible group, and, um, I know you're gonna hear from a couple others here in a minute.

26. 0:36:09

    So thank you again.

27. 0:36:15

    Thank you, Christy. Appreciate that. Okay, Mayor. Mayor Rhodes, come on up. We've got, we have a new mayor in Blue Ridge, Andy Rhodes, doing a fabulous job, and we appreciate him being here with us this morning and saying a few words.

28. 0:36:30

    Uh, thank you, Johnny. Um, like Johnny said, I'm Andy Rhodes, uh, mayor of Blue Ridge. Um, I've just been the mayor for about nine months, so honestly you guys probably know more about my job than I do at this point. Um, but I'm proud to say we've hit the ground running. We've accomplished a lot in a short amount of time. Uh, we're already back in compliance with the state with our financial situation, with our audits. Uh, we have, uh, an extension for our '25 audit, and hopefully that'll be wrapped up in the next couple of months. Um, we're gonna be in a pretty solid financial state moving forward for 2027.

29. 0:37:04

    Uh, we, we, with that we have a lot of projects on the horizon. We're, uh, number one, we're about to put our downtown restroom project up for bid. Um, that's gonna allow access for, for folks to, to use the restroom with ADA compliance from East Main Street, also track side at the depot, uh, the historic depot. Um, we also are working with the WIP program through an application to do a water sewer infrastructure study. Um, we're working with EPD for our asset management plan, of course, to help our capital improvement plan moving forward for the coming years.

30. 0:37:38

    Uh, we're looking to update a couple of our pump stations, uh, add some generators to our system. So we've got a lot going on in the city, and of course I'm biased, but I think Blue Ridge is one of the most beautiful places on earth. And so I'm proud to be the mayor. I'm proud to have you guys here in our community, uh, to discuss the issues that are, that are facing our state. So thank you for being here, and thank you for your dedication, and welcome to Blue Ridge.

31. 0:38:03

    I didn't know it was... I knew I'd be done.

32. 0:38:06

    Great job, Andy. Thank you for being here. I think I saw our commissioner, Jamie. Jamie back there? Come on up, Jamie. We're so glad to have our, uh, commissioner, uh, chairman with us here this morning, Mr. Jamie Hensley. I think Jamie's in his second-

33. 0:38:22

    Sixth

34. 0:38:22

    ... term?

35. 0:38:23

    Yeah, I'm sixth year, but second term in office.

36. 0:38:24

    Yes. And doing a great job for Fannin County, and, uh, we just appreciate. I heard my buzzer go off and I thought, "You're gonna s- you're gonna sneak out on me," 'cause he is very active-

37. 0:38:32

    I was gonna

38. 0:38:33

    ... in our EMS world here. But we're glad you're here, Jamie, so it's all yours. Thank you.

39. 0:38:38

    Well, um, I do appreciate you having us here this morning. Uh, my name is Jamie Hensley. I'm chairman of the board of commissioners here in Fannin County. Um, it's an honor and a privilege to serve in this position. It truly is. And that's, that's something we should never forget. We are servants, and let's nev- never forget that one way or another, okay? Um, you know, for us, you know, there, there are issues here in the county. Uh, everybody has issues, um, especially living in a rural community. Um, I know we, we've talked a little bit about infrastructure and things like that, but, uh, we do need to, to improve on that.

40. 0:39:12

    Um, but we are kinda challenged in where we lived as well about getting that infrastructure to different locations and things like that. Uh, one thing Fannin County did, um, was we, we purchased a water plant. We had a, a great opportunity. Um, everything just kinda happened in one day and, and we were, uh, able to make things happen. So we're, we're very thankful for that. But our hope is to be able to, to, to get water where it's needed. Um, some of our wells, you know, they have iron and sulfur and things like that in, so we're, we're trying to expand that system, and also trying to help our, our neighbors in McCaysville and Blue Ridge in the event that there are shortages there as well.

41. 0:39:49

    So, um, we, we feel like we have made progress our, our first year. Um, I like to say it like this, but we, we kinda, we kinda bit the bullet and, and, uh, struggled a little bit, but we were able to get our county out of debt. So we're very thankful for that. Um, and in the meantime, um, you know, Christy, uh, hit on tourism, and that's huge for us. That is our industry, basically. Um, so to be able to provide services to that, we're, we're a little over 26,000 on paper is what we have.

42. 0:40:22

    But we service twice that just about at any given time. So, um, for us to be able to provide the services that are needed, not only for our local citizens, but for tourism i- is huge for us. And, and for that, we've, we've been able to build two new fire stations. Um, you know, we built a new library, uh, to hopefully have some of those, uh, conferences as well. Um, and it's fitting that we're in this building because David Ralston had so much to do with that. And, uh, he helped me so much, um, trying to make those decisions, trying to make the best decisions moving forward.

43. 0:40:57

    So, um, you know, we also talk about affordable housing, things like that, and, and I, I kinda joke, it's affordable for who, you know? But, uh, I, I know I, what I can afford, and it's not what our medium price is. But, um, but nonetheless, we're, we're trying to get with, uh, uh, the GICH program, um, Georgia Initiative for Community Housing. We're trying to get a grant from there to try to move forward with that aspect as well. Um, you know, healthcare is another issue for us. Um, you know, our, our, I think we share the same issue, uh, across the state with rural hospitals struggling.

44. 0:41:35

    And, um, you know, for us, you know, we either have to go to one of the neighboring counties, Gilmer or Union. Um, so it's, it's very important for us to look what the solutions are there, try to, try to move forward in a positive manner as well. Um, but it is, it's a, it's a fun job. I've never been in politics in my life and, and quite honest with you, I'm not sure I like politics, but I love my job. It's the best job I've ever had in my life, is, is to be able to serve this community.

45. 0:42:06

    And, uh, we have a great relationship with our, our, uh, neighboring cities, you know, with, uh, with our municipalities within the county, and that's something else. You know, Christy talked about strong leadership. I don't know if I'm strong leadership- But I can get past any ego that's ever out there to try to make what's best for us moving forward. And that's what it takes. It, it's about a putting me to the side, putting somebody else to the side. What's better for our communities? And that's what we strive to do every day, and I'm very thankful to be able to work with the mayors in this county.

46. 0:42:36

    So appreciate having y'all. Uh, it- it's, you know, thanks for coming to the mountains. Um, it's God's country. It truly is. Like Christie, um, I couldn't wait to get out of this place when I graduated, but it didn't take me 12 years, it took me four. I went to Chicago. Yeah, go figure that. That was a holy cow kinda moment. But, uh, I woke up one morning, it's like, "I've got to go home." And that's what I did. Our, our family represents eight generations here in Fayette County. My grandkids are eight generations here in Fayette County.

47. 0:43:08

    It's home. And, and I couldn't wait to get back down I-65 to 24 to, you know, come down the old coway. I was like, "Phew, thank goodness." So but thank you guys, uh, for being here today, and thanks for allowing us to have a moment to speak to you.

48. 0:43:28

    Thank you, Jamie. We really appreciate that. And one other thank you, I saw, uh, Rhonda Chatham sitting back there. Rhonda got up early and brought us fresh apple pies from the orchard this morning, so thank you, Rhonda, for being here, bringing those.

49. 0:43:41

    You represented Chastain, and I would add, uh, R&A Orchards, if as you're heading south, you may wanna stop by there. Um, that's Rhonda's family place. And she said the store is open today. So I wanted to put a plug in for my, for my good friends. Um, and also, as Christie, as you mentioned, uh, dinner last night, I did wanna make sure that I mention that we had a wonderful dinner last night at, uh, Harvest on Main, and Sparrow & Burns, the Georgia Railroad Association, and, um, Ameripro.

50. 0:44:19

    We'll be hearing from two of those today, but they were kind enough to treat us to dinner last night and, and it was a wonderful setting and, and great food, so we thank y'all for that. I do wanna point out that, uh, Commissioner Dean Burke is here. He's gonna be speaking later, but I didn't want anybody to think that I wasn't acknowledging you. Thank you for being here with us this morning. Yeah. Did you-- Is it true that you came up from Macon this morning? Came up from Atlanta. Yeah.

51. 0:44:49

    Thank you for being here. We do look forward to hearing from you here in a little while. All right, everyone. Well, let's move on. Um, I'm gonna recognize Beth Ehrhart with the Lions Lighthouse Foundation. Beth, if you wanna go ahead and work your way over to the podium. And while she's doing that, I wanna remind the committee that we originally attempted to hear from the Lions Lighthouse Foundation when we had our meeting in June in Vidalia, but we had a hard stop, and unfortunately, we had to cut them short.

52. 0:45:20

    But they do some important work in the state, particularly in rural areas, and I wanted to invite them to come back to do their presentation so that we could, we could hear it. And thank you for being so flexible with us, Beth.

53. 0:45:35

    Oh, thank you for having me again. Uh, really appreciate that. We are so excited to be here to meet with the committee, to share with people about the work that we're doing, and to have the opportunity to really, um, hopefully meld the work that we're doing together, which I think is important. Um, I don't have anything on my-- There we go. Okay. All right. So we're all about transforming vision care for Georgians in need, who need it most.

54. 0:46:06

    We do serve people that are at two hundred percent of poverty or below, uh, to make sure that those who don't have access to care get it. So what we have seen is that we try to fill the gaps, particularly obviously in vision care with our screening system that we have for families and providers. Uh, the need is urgent. Uh, Georgia Lions Lighthouse, we recommend that the State of Georgia would require mandatory screenings for children pre-K through elementary and even into twelfth grade schools on an annual basis.

55. 0:46:46

    Primarily because what's happening is children are spending a lot more time on screens, especially-- They were on the screens a lot. And now, at this point, it's changed the shape of their eyes. And so many of the children are becoming more and more myopic. When we first started working in this program, uh, years ago, before the pandemic, on a national average, you would see about twenty percent of the children that were screened would be referred for further care.

56. 0:47:16

    And at this point, what we are seeing across the nation is thirty percent, and we have seen schools that are even up to fifty percent of the children are referred. And it's purely because they're spending a lot more time inside and not getting that long distance vision. So we definitely feel that's important. We also are seach-- seeking access for rural Georgians that are ages ten and up who need access to vision care. There are fifty-two counties in this state that do not have vision care providers.

57. 0:47:48

    And in that, um, it really makes it difficult for the low income people that are at two hundred percent of poverty to get vision care. We see people who have said to us that there are times where they have not had any exam ever in their life, or it's been five years or, you know, a period of time, and they have suffered. Uh, we have seen people share glasses with their children. Their prescriptions are not the same.

58. 0:48:19

    But there's access issues. So we feel that it's very important to, to, uh, work towards our teleoptometry program, which we'll talk about a little bit more in a minute, uh, to have that ability to get into more of the clinics. We do come here, uh, to Blue Ridge. We are a part of the Federally Qualified Health Center that we provide the vision care here on a consistent basis. If you'd love to, we have a list of different locations that we are at around the state. Lillian, who's with me today, she has the lists, and we can share those with you afterwards if you'd like.

59. 0:48:55

    We also are seeking access for funding, uh, whether it would be a grant or something from the state's budget that would help us to cover some of our costs, especially for the fact that now we have, for the first time ever, we were established in 1949. For the first time ever, we have hired an optometrist to be on staff with us, which is great, but you can only go so far with one. Now we have two. We just brought on a second one, but you can only go so far with two people.

60. 0:49:27

    Uh, we have celebrated over seventy-five years of service. We've been around since 1949. We were founded by Lions Clubs. Um, a man named Tom Bingham, who was a part of the Atlanta Lions Club, uh, was blinded in a hunting accident as a young man, and he decided that Georgians needed to have access to care. And so them, the Atlanta Lions Club, Moultrie, and Albany Lions Clubs each put in a thousand dollars to get us started.

61. 0:49:59

    One of the things that we started with, which is still our cornerstone program, was a surgery program. We provided a surgery for a four-year-old named Max. We didn't do the surgery ourselves. We coordinate with ophthalmologists around the state to be able to do our surgery program. But as, as for Max, none of the patients that we serve with surgery pay for anything. Those costs are completely donated. And, uh, w-with him in his family, he was not the only one that had congenital cataracts.

62. 0:50:30

    There were three others, and so we assisted them also with that surgery. But together, we continue to set the standard for service, equal access to vision care for Georgians in need. It's definitely a passion of mine to make sure that in those fifty-two counties where there's very little eye care, if any available, that we're getting to those. We're at about forty-eight right now, so I'm excited about that, but we have ways to go. Our, um-- Again, we partner with a statewide network of Lions optometrists and ophthalmologists that help us to provide vision screenings, eye exams, eyeglasses, and surgeries to Georgians.

63. 0:51:11

    Last year, we served nearly seventy thousand patients, um, and I believe we served more this year. We haven't had a chance to put together those numbers yet. We just finished our fiscal year at the end of June. We bring improved sight to Georgians who need it most. Our de-definitely our goal is to provide access and affordability. So what we do is we go into communities with variety of different ways, mostly at this point with teleoptometry, to provide those-- the care to those that don't have access to it any other way to help serve them with unmet needs.

64. 0:51:48

    We serve Georgians that are at two hundred percent of poverty or below. What we can say is that seventy-three percent of the services patients that we serve are either in suburban or rural areas.

65. 0:52:03

    Accessibility and affordability is important, so in 1996, we started our mobile clinics. It was kind of like a big semi-truck with a trailer. I would love to see a picture of the inside. I've never seen that. But, uh, they would provide the services there. You had to hire a CDL licensed person to drive that trailer around. It relied upon optometrists to be there to provide those services. In 2011, we opened our vision clinic that we have in Chamblee, and we recently upgraded that with state-of-the-art equipment.

66. 0:52:35

    In 2022, we started our statewide teleoptometry program, which we'll talk about a little bit more. That was been a game changer. In early '23, we started working in the schools, and particularly we focus on Title I schools or schools that are at free or re-- sixty percent or higher free or reduced lunches. And our eyeglasses are currently produced in our own optical lab in Chamblee. We also have an eyeglass recycling center. Those glasses go across the world, um, on mission trips, and we process them in our Chamblee office to prepare them for that mission.

67. 0:53:14

    We-- Transforming vision care for children in Georgia. Our mobile school clinic is providing clear vision and opportunity one child at a time. We started in '23 with the Atlanta Public Schools at the request of a funder. We've had partnerships with the Lions Clubs who come in and do the vision screenings for us. This current year, we had in the Atlanta metro area thirteen thousand vision screenings, and we provided exams and glasses for all the students that were identified as needing further care.

68. 0:53:47

    Today, we're in Fulton, Gwinnett, DeKalb, Clayton, and Chatham school districts. And thanks to Lions completing those screenings across the state, we're working to expand to cover rural areas of the county as well, such as Union and Camden Counties. We're hoping to cover more. We make referrals for surgery as needed for-- with our partner ophthalmologists for children that are identified as needing further care. Since we've been doing this, I'm only aware of one child that we found that needed cataract surgery, but we do help coordinate that for them again.

69. 0:54:20

    And again, we have our optometrists. We're so excited to have them. So, um, I just want to show you a little video about our mobile school clinic. We're gonna see if I can make it work, and if not, we're gonna let our person in the back take care of that for us.

70. 0:54:40

    I like optometry because I love to help people. You give them glasses and they're like, "There's leaves on trees," you know, and so that's just a great feeling. I work at the Chamblee office and we see kids. We also see under-insured patients. We see underprivileged patients. Then we also go to the schools. We go in, we set up the equipment and we utilize it. They pick out the glasses they... which is my favorite part. It's like a field day all day.

71. 0:55:08

    School system is beyond the needs of kids. Every school that I've served in a community with one school, that's 100% below the medic- their... If they were able to output the help.

72. 0:55:23

    A lot of these kids that are poor at school and think that maybe they're not, you know, they don't learn. They were given up on. They don't feel like they can succeed. If you can't succeed, you can't do well in school, then that could change your whole trajectory of what your life feel like. In general, I'm getting a lot of our kids reading glasses.

73. 0:55:49

    There's usually 40% of children at each school that are in need of glasses. Kids don't have textbooks anymore. They have phones. So 24/7 they're looking at a screen which related to small eye condition is...

74. 0:56:11

    Giving them glasses, it warms my heart. Makes me appreciate them every day. I love to... For any of us, um, actually, everyone's already here to say, "Well, this makes the world a better place," so I love everyone who does this.

75. 0:56:39

    Uh,

76. 0:56:44

    so we have a group from, um-

77. 0:56:46

    I think-

78. 0:56:46

    ... Augusta Medical and Emory Ophthalmology students-

79. 0:56:49

    Beth, we've got a quick question before you move on.

80. 0:56:52

    Yes.

81. 0:56:52

    Uh, Vice Chair Campbell has a question. He wanted to go ahead.

82. 0:56:55

    Okay.

83. 0:56:57

    Is it on? Mm- Okay. No, just a question. If I remember correctly, the Lions Club, the Lighthouse, was very involved in the starting of the Peach Bowl.

84. 0:57:07

    Mm-hmm.

85. 0:57:08

    Are y'all s- are y'all still involved in that or, or-

86. 0:57:10

    Yes, we are still involved with the Peach Bowl as well. Yes, yes. We're not-- The Lions are not running the Peach Bowl anymore. There's a corporation that's running the Peach Bowl, but we're very active. Um, our biggest fundraiser of the year is actually called, uh, A Night of Spectacles. Quotes, "A night..." I mean, sorry, Evening in the End Zone: A Night of Spectacles. And it's an opportunity for us to raise money to help, uh, a lot of the services that we provide.

87. 0:57:41

    Um, and we do partner with the Peach Bowl for that event still. When the Peach Bowl was founded, which was founded by a Lion, George Crumbly, um, the idea was to raise money solely for Georgia Lions Lighthouse Foundation. But the Peach Bowl is now actually the largest charitable bowl in the United States, and they raise money, obviously, not just for Georgia Lions Lighthouse Foundation, but for many nonprofits across the state. Yeah.

88. 0:58:08

    Thank you.

89. 0:58:09

    Thank you. Our upcoming event is October 6th, and we'd love for anybody who'd like to come to let me know. Anyway, we are doing some research with Augusta Medical and Emory Ophthalmology students to let us know exactly where we are in the state of screenings in rural, um, districts. Um, it's very preliminary at this point. We've had fifty-five responses out of fifty-two counties, which is only about thirty-three percent response rate. We still have a lot of, um, researchers that are helping us making more calls.

90. 0:58:41

    We started out with making calls to superintendents and sending emails with the survey in it. We've updated that, and we're reaching out again to really push to get more of that percentage higher on responses. But this left picture shows you the percentage of schools with Title I in the rural areas, uh, the Georgia counties that are conducting some kind of vision screenings, and then counties with vision service, services responses to our survey. So one of the things that we are finding though is what h- we're asking our second part of the questions is, what happens when you find a student that needs further care?

91. 0:59:19

    Is there an optometrist in your area, or how do you handle that? 'Cause we want to know where the big deserts are so that we can get in there and provide those services.

92. 0:59:32

    Okay.

93. 0:59:36

    Sorry, it's not moving.

94. 0:59:43

    There we go. Okay, we're gonna do the teleoptometry video now.

95. 1:00:20

    The campaign, Georgia Lions School of Vision doctors decided to return to volunteer with the 501[c][3].

96. 1:00:29

    Hundred eye teleoptometry.

97. 1:00:45

    Really?

98. 1:00:47

    And, um, you, you need to find solutions that you can carry the solutions with you. When it comes to being very Georgian, we face certain challenges. In fact, creating a three eye center-

99. 1:01:02

    featured counties in Georgia

100. 1:01:04

     ... would be a solution to the city at all. Vision care providers are unevenly distributed throughout the city. Given the large number of factors, including an aging population and an increasing number of youth living in poverty, create challenges for both providers and patients. Our teleoptometry service will be huge. They send you. These teleoptometry eye exams and these-

101. 1:01:33

     Scheduled

102. 1:01:33

     ... federally qualified health centers.

103. 1:01:36

     That have the most.

104. 1:01:40

     Three.

105. 1:01:43

     Yeah.

106. 1:01:45

     Testing. Georgia Blindness Lighthouse Foundation offered them teleoptometry. Then, through secure telehealth technology, an optician performs the refraction. Word about the benefits of the three eye exams spread. Georgia licensed optometrists remotely did issues with the search. They recently just go along with the patient, lots of patients selected for this. Finally, as they developed, the vision correction between the patient and the doctor was established.

107. 1:02:23

     New telehealth even reached patients in rural areas. The doctors are not in person, but they provide excellent care virtually. What do you think of the founding the routine with the vision problem in these cases? Can you see number one or number two? Which one's better for you? How about three or four? The doctor comes on and this gives them the results. Now the patient can absolutely see what kind of vision they've had in the past, if glasses will work for them.

108. 1:02:58

     It's amazing.

109. 1:03:02

     One of the patients told me that they had not had an eye exam in five years, and so the doctor was able to see her vision issues and already provided glasses, and already started that. She was so pleased and could not believe that she could get the exam that was so comprehensive. We have benefited so much from connecting Georgia Lighthouse. Come to us, because quality of service is a vision care issue.

110. 1:03:34

     We are changing the statistics one patient, one community at a time. If you or someone you know needs vision services, type blindlight housestopword/services.org. Georgia Lighthouse Foundation, bringing clear vision to those who need it most.

111. 1:04:14

     Sorry.

112. 1:04:19

     Okay. So we found this to be such a game chang-changer that im-immediately before our first trial year was up, we started raising funds to have a second lane of the equipment. So we have two lanes where we can be out in the state in different locations on the same day. Um, we've expanded, like I said, to 48 teleoptometry clinics statewide. These are some of the locations that we have. As of June of '26, we've served a total of four thousand four hundred and forty patients through three hundred and seventy-seven clinics since the program launch in April of 2022.

113. 1:04:56

     That number has been increasing each year. So this year, we're-- our goal is to be out there and provide services four days a week with both lanes so that we can serve more patients. Um, and we serve children ages ten and above. So we've also been very involved with the literacy issue for Georgians in that if a child can't see clearly, they can't read, um, and or succeed in school.

114. 1:05:29

     The Atlanta Vision Project has become a new partner of ours. We work with a company called Learn for Life, which was identified-- has also identified the literacy truths of lack of vision care. Our partners in this Atlanta Vision Project, which covers Metro Atlanta areas, include Prevent Blind-Blindness and Vision to Learn. Vision to Learn, if anybody doesn't-- hasn't heard of them, their focus is purely on schools and providing those services, uh, vision services. And Prevent Blindness is similar to us, founded, uh, later here in Georgia, um, and is a smaller organization than we are.

115. 1:06:07

     They do not have teleoptometry. That's one of the distinguishing factors, as well as recycling center. I'm not gonna read to you the Georgia s-literacy state milestones. I believe you all know that. You all have a packet that has this PowerPoint in there as well. Uh, our ties also are with economic development. Again, if people are unable to- see well to drive, to operate machinery, to be able to work, um, whether it's long distance vision or they can't see close up to read their medic- medicine bottles.

116. 1:06:43

     Um, those kind of things will affect their ability, uh, to work and will affect our nation and state as well. Uh, we've, we've seen patients who have needed to have cataract surgery, but they had no resource and didn't know about us. For years, they basically were unable to work, were dependent upon other people, and just needed to have that surgery. Once they had the surgery, they were able to go right back to work. It's just amazing and so simple. Uh, with our, with our surgery program, we assist with cataracts, glaucoma, macular degeneration, and retinopathy.

117. 1:07:22

     But there are lots of showing things here, the statistics that show that if we can connect this vision issue and resolve it in our state with those counties that don't have the services, we're gonna have people that are productive. They're gonna do better in school. We had one child that one of the Lions did a screening on recently, uh, um, was in a special ed class, and within two months, that child was out of a special ed class after getting their glasses. I mean, it can make a huge difference.

118. 1:07:56

     So what's needed, again, to fill those gaps here in Georgia are a screening program that would check our children that annually on a basis to make sure that their eyes have not changed, and then helping them to get glasses afterwards with an exam. Access for rural Georgians who need that care. We've been to, uh, some of the rural areas here in Georgia where there's literally not a big enough space. We need three rooms. We, we try to cram in as much as we can, but our teleoptometry equipment requires a little bit more space.

119. 1:08:31

     We've been there. We've tried the Public Health Nursing Agency. We've tried the Federally Qualified Health Center, and it just wasn't big enough for us. And so we definitely are asking for some sort of waiver so that we can go into schools or to community centers or churches, something that's large enough to house us and provide that care. And again, we're asking for funding of $350,000, which would cover the cost of our optometrists. So Georgia Lions Lighthouse is committed to maximizing the quality of life for Georgians by setting the standard for vision services and equal access to vision care for all.

120. 1:09:10

     We do this by filling the gaps for uninsured and under-insured Georgians by providing access to low-cost vision services.

121. 1:09:21

     Thank you so much for your time. Um, and in your packets, you not only have the handout that we have of our PowerPoint, but you also have a schedule for our teleoptometry clinics. We'd love for you to come if you haven't had a chance. And I, I know you were able to come, and thank you so much for coming to see one of our clinics. Uh, I don't know if you'd like to just say something about your experience.

122. 1:09:43

     Yes, I would. Uh, thank you for your presentation, by the way. And members, if you have any questions you want to ask, we'll, we'll, we've got a couple minutes, we can do that. I was able to visit, um, in, at the Mercy Ministries in Graham, which is in Appling County, last week or the week before, I can't remember. But it, it was, um, it was very interesting. There are people there that don't have access to healthcare. They're uninsured, and they were s- they were seeing an optometrist there remotely through teleoptometry.

123. 1:10:20

     So, um, thank y'all for the... If any of you that have the opportunity to go and see that yourselves at a location near you, I, I would encourage you to do that. Do I have any committee members that have a question right now? Okay, Representative O'Steen.

124. 1:10:35

     Thank you so much, Chair. Thank you so much for this presentation. I have been a proud member of the Douglas Lions Club for 15 years now, and, um, I am very grateful for the work that you do. I'm also a former school nurse before I became an oncology nurse. And, um, I, I thought until last, until this year, when, uh, Chair Lady Hagan had a bill, I thought that every school had to offer, uh, ear and dentals for pre-K, for pre-K students through third grade.

125. 1:11:07

     So because all the schools I worked in, I, we always had to do that. Either I did it as a school nurse or, uh, that was a donated machine from a L- from a Lions club, or our health departments came into the schools and offered eye, ear, and dental. So I didn't realize that every school system didn't, every school didn't, elementary school didn't do that in the state until Chair brought that, that bill, and it is a great bill, and we need to bring it back up. So yes, great. I'm, I'm your wing girl. Um, I just had two quick questions.

126. 1:11:37

     Mm-hmm.

127. 1:11:40

     Is it your position that, that you th- that you would agree that a lot of our literacy rates, especially those that fall in that percentage where they cannot read in pre-K, I mean, not pre-K, but in elementary school and middle school, if we had captured their vision problems earlier on, that they would not be in the position that they're in now? Do you believe that?

128. 1:12:05

     I definitely believe that.

129. 1:12:06

     I definitely believe that with you.

130. 1:12:08

     Yes.

131. 1:12:08

     The other question that I had is about your, um, opticians and your optometrists through the, through the telemedicine. It is optometrist, right? Not ophthalmologist.

132. 1:12:18

     Yes. Optometrist.

133. 1:12:19

     Okay. Where are they located? Are they located in state, out of state, somewhere else?

134. 1:12:26

     A little of both. Um, there are some Geor- they're all Georgia-licensed optometrists. Some of them are here. I've actually met one that's in Duluth that was so amazed to see what we had, because she was only seeing the laptop kind of par- portion, and to see all the equipment that we had and everything. Um, some of the doctors may not actually be in Georgia, but they are licensed by Georgia. You can go on vacation anywhere in the world and plug into your laptop as an optometrist and be able to be a

135. 1:12:59

     ... a part of that.

136. 1:13:00

     Mm.

137. 1:13:00

     So it's kind of cool how that works.

138. 1:13:02

     Mm-hmm. Okay. All right. Thank you so much. And then the two o- that you're asking for funding for two optometrists, two additional optometrists, is that right?

139. 1:13:09

     Well, g- to help us cover the cost of our optometrists.

140. 1:13:12

     Of your current optometrists.

141. 1:13:13

     Yeah, yeah, yeah.

142. 1:13:14

     Okay.

143. 1:13:14

     Mm-hmm.

144. 1:13:14

     So you wanna have two.

145. 1:13:16

     We have two right now.

146. 1:13:17

     Okay.

147. 1:13:18

     Um, one started this last month, and one started in June.

148. 1:13:21

     Where are they housed?

149. 1:13:23

     Um, kind of in our Chamblee clinic, but we have them doing a lot of school clinics. One of the things that we have found as well in our optometry, our, our t- uh, teleoptometry clinics, is that, uh, some of the doctors will recommend that a patient actually get a dilated eye exam because we don't do a dilation-

150. 1:13:43

     Right

151. 1:13:43

     ... in that clinic. And so we actually have one of our doctors going to where we have a full clinic in another location and, and providing that service is at one of the federally qualified health centers as well. So we follow up. We wanna make sure that everybody gets the care they need.

152. 1:14:00

     Okay. Thank you so much.

153. 1:14:01

     Absolutely.

154. 1:14:02

     Great work. All right. Thank you so much.

155. 1:14:07

     Thank you.

156. 1:14:07

     I know you and I will be having some conversations in the next few weeks, but I appreciate you being here and presenting to us today.

157. 1:14:12

     Thank you so much. Appreciate it.

158. 1:14:17

     Okay. Next, I'm gonna recognize, uh, Larry Richardson, the CEO of AmeriPro. And if he wants to call anyone else t- to help present, you feel free to do that. If y'all intro- you'll introduce them when you get here. Yeah, you'll, you'll... Well, that way nobody can blame, you can't blame anybody but yourself. Thank you for being here and presenting to us today.

159. 1:14:40

     Yeah. Thank you for having us. Um, I'm Larry Richardson, uh, founder and CEO of, uh, o- of AmeriPro. And, uh, you know, we, uh, we started here in Georgia, so, um, we'll get our slide up here shortly. But while that's coming up, I just kinda will tell you a little bit about myself of how AmeriPro came about 'cause that kinda tells a little bit of the story. Um, I, uh, went to the Marine Corps straight out for high school, uh, got into that and started in fire and EMS, and, uh, spent around 18 years in fire and EMS and said, "I'm done with it." So I came home to my wife, who had a two-week-old and a 22-month-old, and said, uh...

160. 1:15:14

     who was also a firefighter paramedic, and, uh, said, "I'm gon- I'm gonna go do something else." And, uh, so I started to do something else, and I went to Clayton State University in Morrow, Georgia, and I did a four-year degree in three years. And then I decided to go to our, our beloved Georgia Bulldogs, and, uh, I got a business degree there. And, uh, when I finished there, I was like, "You know what? I'm gonna try to do something different in EMS." So, uh, I started doing it. Uh, we started April the 4th, 2018. And, uh, and today we've, we're kind of a little bit bigger than that.

161. 1:15:45

     And what I wanted to do was impact how we get access to healthcare by delivering it through, uh, paramedics and EMTs that are on ambulance services and utilizing technology. So we started out as an ambulance company having a little bit of technology, and now we're moving as a technology company that's leveraging ambulance services and paramedics and EMTs and physicians to get access to healthcare to rural parts of our country.

162. 1:16:13

     How do I change the slide?

163. 1:16:24

     It's froze. Sorry.

164. 1:16:31

     Uh-huh.

165. 1:16:31

     Mm-hmm.

166. 1:16:33

     It's back.

167. 1:16:34

     Okay, great. Thank you.

168. 1:16:35

     Yeah.

169. 1:16:42

     So, uh, kinda start where we started at. Uh, Georgia, Georgia built AmeriPro. We started right here. Uh, now we're one of the fastest-growing EMS companies in the United States, uh, founded in Stockbridge, Georgia, where, you know, I, uh, graduated high school. We are now in 10 states with 300 ambulances, and, uh, that's a little outdated at 1,500, but we're about 1,600 employees now as of yesterday. Um, we're more than a ambulance company. We're a tech-enabled healthcare platform. Uh, we're doing things, and right now we are stretched from the city of Jacksonville all the way up to the city of Detroit.

170. 1:17:15

     Uh, we do a lot of rural, uh, 911 and n- uh, 911 healthcare services in very rural environments in Georgia, Tennessee, Alabama, Mississippi, Kentucky, and, and so on. Uh, the reality in rural Georgia is we got about 2.4 million citizens that live in rural Georgia, 53 counties with no hospital, and a 14% uninsured rate. Uh, 23% higher all-case mortality happens in rural Georgia. So when we think about that, the three problems are, are, our problems are we have access to quality healthcare, uh, 911 coverage is in, in poorly funded counties.

171. 1:17:53

     Uh, we're in multiple counties in South Georgia, and it's just the tax burden to play, to what it takes to be able to provide adequate healthcare services just supersedes what those counties can adequately or what they adequately need. And then we have some, uh... You know, Georgia's got... You know, like I said, we're in 10 states, and Georgia has some poor quality standards as it relates to ambulance services that I think we could do a better job on. Where there is no doctor, 911 becomes the doctor's office. I see some folks in the crowd there that look like they're, they're, they're shaking their head because this is exactly what happens.

172. 1:18:27

     When hospital leaves, usually there's no referrals, there's no PCP, there's no anything, and 911 becomes the healthcare. And one thing about EMS is, is nobody thinks about it until you need it. And then when you need it, that's when it's, it's too late then. We have to start thinking more proactively as a state than we are as a reactive So, uh, the ER becomes our primary care. No local physicians, no anything like that. Everything is take them to the ER. And when we look at that in South Georgia, sometimes we're traveling forty-six miles in an ambulance to a hospital, whether it's in another state.

173. 1:19:05

     If we're in Randolph Clay in Quitman County, we're going to Alabama, we're going to Dothan, we're going to Albany, we're going to Columbus. So when you think about that resource leaving that, leaving that county, it's leaving a vacuum of services for that community. Um, 14% of rural Georgians are uninsured, and far more are under-insured. So for them, every path to care just runs through the most expensive room, uh, th- through the expensive forms of medicine, which is the ER. We all know how expensive it is to go to the ER.

174. 1:19:38

     So when we have healthcare deserts, uh, we, uh, healthcare deserts have county lines. When we look at how many hospitals have shut down in Georgia across the state, you know, fifty-three, like I said, have no hospitals. Uh, 102 out of 59 counties where EMS resources do not meet the need. Uh, residents have twenty-five plus minutes from the nearest ambulance station. Uh, 11 rural Georgia counties, where AmeriProgram is today, uh, uh, they're all in navy. And a lot of those, what we have done in some of those counties is be able to develop a regional 911 system.

175. 1:20:09

     So particularly, I'll use as an example is Randolph, Clay, and Quitman County. Um, those counties don't have a lot of funding, but what we did is we built a system there that now when one co-ambulance goes out of a county, Quitman County, Clay provides that resource, or, or, or Randolph provides that resource, but it's still not adequate enough 'cause we still have just pure geography of having to cover that with four ambulances in those three counties. I think it's roughly 1,400 square miles. Costs.

176. 1:20:39

     Costs and, costs compounds faster than our rates. So, uh, s- some of this I'm speaking from experience. So since 2018, we have had 50% increase in paramedic and EMT market wages. Uh, in the same time, we have had 31% CPI over that same timeframe. So when we're thinking about that, we're thinking about ambulances, cardiac monitors, all the soft supplies, all of those things that it takes. We all know, see, fuel today is just rising exponentially. And in our business, we don't have any kind of market equilibrium.

177. 1:21:13

     We can't charge Medicare more. I mean, we can, but they're not gonna pay it. Same thing with Medicaid. So when we look at that, when we look at 2018 to current, we've only had the, the rates, as you can see it year over year, and COVID having the biggest year, it was, we've only had 26.6% increase from government payers on, on our Medicare and Medicaid. So the formula lags by law. The ACA sets the Medicare update and the CPU minus the productivity. Um, we're not gonna get into out and belabor you with all the, the, the analytics of that.

178. 1:21:46

     But, um, and it pays a year later, so we've already provided the service. The service has already cost us, and the rates come later. So the experience premium is now gone. That is what the product has happened. So now an 18-year critical, critical care paramedic who made $42,000 in 2018, this guy, uh, you know, it now exceeds $57,000. And that is base pay. That is not including when we're talking about overtime, when we're talking about all the other nuances of what it takes to provide services.

179. 1:22:19

     There are now paramedics in the state of Georgia that are making in excess of $120,000, $130,000, $140,000 because, one, of our shortage, and two, of what the wage impact is.

180. 1:22:31

     This bill lands on our counties. That's just what it is. Uh, the counties have to subsidize at some level, whether it's government or whether it's private. They're having to support the funding. EMS billing, our, our transports just do not cover the cost what- no matter what it is. And, and Georgia counties have 64% of EMS resources that still are twenty-five minutes from getting a resource to, uh, uh, and we're talking about not just to our lower-level calls, but cardiac arrest, pediatric arrest, all of those things.

181. 1:23:01

     So every county has an a- has an ambulance in the, in the state, but some only have one. I can speak to that because Clay County, we serve Clay County and Quitman County, they only have one. Um, so when we look at one trul- rural transport in some of those counties, we're looking at a four-hour time on task. So when that call comes in till the time that unit is back in the co- whoops, sorry, to the time that unit is back in the county, we're looking at four hours. A lot can happen in four hours. Um, and you know, that next caller comes, mutual aid request has to come in.

182. 1:23:36

     A mutual aid request is when you call another county to provide service. What if, what if that county only has one ambulance? So as you can see, the problem compounds. So when our below cost reimbursement forces the poorest counties to subsidize, it's, it's, it's what they have to do, and it becomes a large portion of what they spend. A lot of people don't know this, and this is not a popular thought, but I'm one of those people that I like to speak about things. I like to, uh, talk about the uncomfortable things because those are the things that what's makes us better.

183. 1:24:06

     So in Georgia, it takes more insurance to haul trash than to run an ambulance service. So I'm gonna let you think about that for a minute. Um, and that is a huge problem. Every ambulance service in the state of Georgia touches patient data. We're taking patients all over the state, whether it's an interfacility transport or a 911 transport, it doesn't matter. But we have no safeguards for patient information on any kind of security, any kind of cybersecurity coverage, anything for a breach or anything like that.

184. 1:24:36

     At our dinner last night, someone asked me, I think, uh, you know, "What is the thing that keeps you up at night?" It's a data breach. Those, that is one of the most scariest things. And when you talk to major health CEOs, and when you talk to people like that at hospitals, it's, it's a data breach You know, cyber terrorism is here. It is not going away. It is only advancing. It is speeding up. And we need to, as Georgians, provide a level of structure for our amb- ambulance services to where we're providing a pro- to the communities and to our citizens and to our paramedics and EMTs.

185. 1:25:10

     You know, the state does not require an ambulance company to have professional liability.

186. 1:25:18

     I mean, think about that. So a company can function as an ambulance company and not provide excess liability for their ambulance service. You know, that's not, that's not, that's not how we need to be. You know, there's a lot more opportunity here. There's no umbrella pr- policies. There's no performance bonds. There's no, no professional liability. There's no cybersecurity, no capitalization review. There's no capitalization review whatsoever to be able to provide services in, uh, what I think is one of our most critical services is EMS. Again, you don't think about EMS until you need it.

187. 1:25:50

     And that's one thing that we have to do better at, is being able to think about who's providing these services, how professional are they, what kind of clinical care are they delivering, how are they protecting their employees? This is being part of a good corporate citizen of your state. Um, one thing too is, you know, background checks. You know, when someone gets licensed, they get a background check. Sure, they get licensed, but after that, there's no... There-- We, we don't have to re-do it. But the State of Georgia doesn't say that anybody has to get a license or has to have a background check once they've went through their initial licensure.

188. 1:26:20

     You know, we should... They do it in hospitals. We do it everywhere else in healthcare. Why aren't we doing it in EMS? It just makes sense. And these aren't things that are big legislative things. These are just quality control things that we should be offering.

189. 1:26:35

     Other states already set higher bars that are right around us. Uh, Texas, you have to have a $100,000 letter of credit, $500,000 of professional liability. Kentucky has... We are operating in Kentucky as well. We're in Louisville. We're in Lexington. We're in several rural counties in Kentucky. Um, they have a, uh, a certific- certificate of need process. Um, you have to carry a million dollars of professional liability. Virginia, Tennessee, they all require far more than what Georgia does, so it's not like we're doing anything that's, that's not already been done before.

190. 1:27:13

     Most important thing about EMS is one reason I started AmeriPro was we are more than just transport. EMS is a clinical workforce that is spread from state border to state border 24/7/365. We have licensed EMTs, advanced EMTs, and paramedics across the entire state, and we use them to transport. But I think they are more able to do far more things than just to be able to transport. They can treat in place.

191. 1:27:44

     We have technology now to where we can have a physician at the bedside. We can have public health in the field. And one of the things that I like to say is, you know, EMS, as much as it is a public safety, it's also part of public health. And more so as we transition across the country into value-based healthcare, into other things like that, we have to look at EMS through a different lens.

192. 1:28:11

     For patients who are at home, who are at-- who are elderly, who live alone, who have all of these nuances with their healthcare that sometimes they just need to get checked up on. Um, and then there's also hospital-at-home support. There's all kinds of ways that hospital can expand their capacity using the, the resources that we already have in counties. It is agnostic of what we're suggesting to be just for private services or just for government services. It's completely agnostic. It is a platform that we can leverage through technology to be able to get access to our elderly, to our underinsured, and to our non-insured.

193. 1:28:52

     NaviCare is our product. So NaviCare is what we have built. And NaviCare, um, unfortunately he could not be here, but is our chief medical officer, Dr. Matt Thompson. Matt Thompson, uh, is, uh, an emergency room physician. He is, uh, certified in all 50 states. And what we built here, uh, with Matt and, and Telescope is be able to build... In, in Jacksonville, we have something called HealthLink Jax. It's free 24/7 physician care and a nurse navigation hotline for the underinsured residents of Duval County from any phone.

194. 1:29:26

     So the navigation connects patients to safety clinics, follow-up. There's 11-- One thousand and one. I don't have my glasses on, so 1,170 clinic referrals through six safety net partners and 70 community partners. Uh, it's clinically led again by Dr. Matt Thompson, and it's a public-private partnership with the city of Jacksonville. And what this has done is in healthcare costs del- diverted in the city of Jacksonville, and this is audited through the city of Jacksonville, is $18.5 million of healthcare cost savings.

195. 1:29:59

     12,000 c- care calls answered on a 24/7 hotline. $1.5 million a year is what the city invested into this program. And the average ER, ER visit in Duval County of 2019 is about $4,844. So approximately 124,000 uninsured residents in Duval County, uh, and one, one health system alone sees about 6,000 of those of uninsured ER visits a month. So that is a huge financial impact, and it drags the system down.

196. 1:30:31

     So NaviCare is in action. It can be done from any, from a 911 call, any PSAP. Uh, there's a glossary in the back. We're not gonna go through the glossary, but a PSAP is a public service answering point. So when you call 911, it goes into a dispatch center that goes through some level of a computer-aided dispatch. And, uh, it can be-- We can name it anything that we want. We have a, a slide that represents that. But it's a... From a 911 call, it basically, the law-- the, the, the low acuity callers get kind of hand it off to a nurse. The nurse goes to a physician, and we'll be able to see that patient.

197. 1:31:05

     In typical nurse navigation programs across the country, you may have heard of nurse navigation, community paramedicine. I look at those as more of a cul-de-sac. You go through this process, you meet the nurse nav- uh, nurse navigator, you get, yes, an assessment, and then they do, you know, whatever they wanna do, and then you're stuck. What this is, is the branch of a tree. If you look at a big oak tree, there's a pathway and there's many branches. There's several different ways you can go. There's several different ways you go, and you ultimately end up with quality care, and that's what we've done in Jacksonville.

198. 1:31:37

     In the community, a medic- our medics can see the patients where they live, vitals, social needs measured on scene. A virtual physician starts at the medic's request on a tablet. You know, we have three iPads on every single ambulance that we have. And before the, the next ER visit, we can have data analysis, uh, identi- and we can identify our frequent ED users. We can be doing outreach to those people. We can be helping different ways and divert how people are getting the access to healthcare and making sure they're getting the right care navigation from consultation, referrals, virtual visits, anything like that.

199. 1:32:12

     We saw from our previous, uh, presenter that, you know, look what they're doing with eye care. I mean, this is the wave of the future of how we diversify healthcare and how we take this impact, and we prove it to all Georgians. So every pathway ends the same way, and what we want is the right care at the right level with a follow-up plan, and ambulances are still available for the next emergency. That's solution one. Navicare Georgia is healthcare with- without a building.

200. 1:32:43

     Whoops, without a building. So we have kind of deemed it, uh, 1-888-GEORGIA-CARES, and, uh, it connects with physicians. Then we navigate, divert, and integrate, and this is a seamless solution. It's proven to work. Uh, we are gonna be spreading it across, uh, Florida as well, the state of Florida. And, you know, roads connect people to commerce. Broadband connects people to information. Navicare connects people to healthcare. And what we're doing is we're using our infrastru- existing infrastructure, uh, through broadband, through everything that we have in this state to be able to amplify access to healthcare.

201. 1:33:22

     Uh, it's not a telehealth program. It's a rural public health infrastructure. We can deploy it in about 30 days at a fraction of the cost of what it is to build a building, to build new clinics, to build all this stuff because the other thing is it's not just building and investing into a building. It's also the carry cost of being able to staff it, maintain it, and all of those nuances. We have to be able to think above what the norms are and be able to push through, uh, the new technology that the world is developing in.

202. 1:33:55

     Uh, Georgia has led, uh, in multiple ways in EMS, um, and one of the things that I have to applaud, you know, the, the administration in, in the House and Senate was, you know, the UPL, uh, the patient balancing bill protection are real wins. But when it comes to healthcare, we're still outpacing what those wins really are. Um, you know, and we need to pay for, you know, we need to be able to pay for care and not just miles. You know, we need to be able to pa- pay for what paramedics and EMTs do can leverage their experience to be able to get people quality healthcare.

203. 1:34:30

     We need to have regional public and private partnerships to be able to stabilize our rural healthcare coverage for readiness and response time while using private capital at risk. You know, there's, there's companies like us out there that wanna do this, that, that are able to do this. We have the scale to do. And then we need to shift the culture of EMS. You know, Georgia needs to lead the nation in quality EMS services, and we have to stop subscribing to, "Well, this is the way that we've always done it." We have to get away from that.

204. 1:35:00

     And, um, you know, I, I, I would love to say that our growth has been too because, uh, just, uh, of a numerous of things, but the one thing that we have failed to-- we, well, not failed, but that we do not subscribe to at AmeriPro is this is the way we've always done it. Because when somebody comes to me, that's the first thing I say. "Well, whatever that is, we're not doing it anymore. So think of a new way to do it." And, um, we have a lot of-- we've brought on a lot of experts in our industry from companies that are 10 times larger than us. He's one of them sitting right there.

205. 1:35:31

     It's Tom McEntee, uh, who is, you know, worked for one of the world's largest ambulance companies and worked with us to be able to champion this and be able to advance it forward.

206. 1:35:45

     So we need to fund readiness like we do a grid. You know, use the money that Georgia has. EMS readiness works like the power grid. However, the power companies, they say, "All right. These are the days in August. It's gonna be hot. This is what we're gonna do. We know it's gonna be there." Well, we don't know that. We don't know when our demand is gonna peak. We don't know when there's gonna be a bus crash, or we don't know when there's gonna be a mass casualty incident. And we don't know-- it's very difficult to when you have a company that is growing or a company that is declining in population to be able to keep up with those resources, depending on their growth rate.

207. 1:36:19

     So, um, and our-- and the challenges that we have in the rural environment is we have more miles. Uh, Randolph County, you know, we-- there was a hospital in Randolph County. It shut down for many years. We're looking at, you know, it's ramping back up, but still the services that it can provide are not the full gamut of services that larger hospitals that Phoebe can provide over in Albany. So we have fewer people in those regions. We have, you know... But just because there's fewer people, why do we sacrifice readiness because of fewer people?

208. 1:36:52

     You know, we still should be able to provide quality healthcare for that. And obviously, we have, you know, poorer counties that have weaker tax digest and all of that. So, um, you know, the Georgia's first, first, uh, Great Health RHTP award from S- CMS, I believe, is around two hundred and eighteen point eight. And what our model checks off or the framework is clinical integration Community access, workforce development, value-based purchas- purchasing and care, and rapid resource response with AEDs.

209. 1:37:25

     All of these things that we can start implementing to be able to get that access out to our communities.

210. 1:37:31

     Larry.

211. 1:37:32

     Yes, ma'am.

212. 1:37:32

     We've got a committee member with a question.

213. 1:37:35

     Yes.

214. 1:37:36

     And, um, I don't want you to not finish your presentation, but we, we got- we need to-

215. 1:37:42

     Great

216. 1:37:42

     ... move. But, um-

217. 1:37:44

     Great

218. 1:37:45

     So I'm gonna recognize Representative Chastain, and then I want you to continue on with your, your presentation.

219. 1:37:49

     Yes, sir.

220. 1:37:54

     Thanks, Larry. Great presentation so far. Just I've got tons of questions. I know I can't ask all of them.

221. 1:38:00

     Oh, we can. I mean-

222. 1:38:01

     Just a couple. But could you address or do you have any idea why, like, the paramedics, the EMS of Georgia is showing our paramedic numbers down? Not being... Like, when if they're, when they retire or whatever reason, we're not replacing those paramedics. Do you have any idea? Any-

223. 1:38:16

     Yes, sir. So it's not just Georgia, it's across the nation.

224. 1:38:19

     Na- It's national. Yeah.

225. 1:38:20

     It's national. So the problem is, is a lot of people don't talk about this, but we look at what our competitors are now. Our competitors are now, as if you're, you're looking at the pe- com- competitor landscape of the pay band that paramedics and EMTs are, especially in urban areas and highly densely suburban areas, is I can go and run DoorDash and I can go and work at Uber and make the same thing. I make my own schedule, I make my own thing, and I can go out and do it.

226. 1:38:51

     So it used to be that a lot of them were going into the nursing field or going into some other field. What we're finding now is burnout is a real thing, and a lot of it is because the only thing that they do is transport. There's so much more that they can offer. So it doesn't have a visible career ladder for people to go, "Hey, look, I can grow in this career." And we have done that at Meripro, is we have the highest retention. Uh, we're about... I can't remember exactly what it is, so but significantly less what the national average is on turnover.

227. 1:39:25

     But that doesn't... You know, we're, we're just, we're one hole in the dam. We're not the whole dam. So what has to happen is we have to be able to attract people more to this industry by diversifying the career ladders, diversifying the capabilities of what they can do and the impact that they can make. And I think that is the biggest thing. Also, is we have less schools. So, um, schools are difficult to set up. Um, they have, especially for paramedic, they have to be accredited. It's cost-prohibitive for companies probably smaller than us.

228. 1:39:59

     We are going through... We have several schools, uh, across our, uh, across our footprint. But still, though, the schools are down, the interest is down. The competitive landscape of where people can go and work in a warehouse, they get a set schedule, they get this. They're not exposed to the elements. They're not exposed to diseases. So it's a difficult, it's a difficult, uh, industry right now when it comes to recruiting. I think it is turning a corner. We're getting more, uh, people coming in now. Uh, as the trades, AI, and all of this, they're making things better.

229. 1:40:33

     Uh, we're able to reduce the stresses on our employees, so it's making it l- easier for them. And I think that, you know, there's a lot of talk about AI. Um, I actually did a podcast on this, but, uh, there's a lot of talk about AI and, and the fears of it. But one of the things that I think about it is it's going to be able to modernize the EMS industry across our nation, and EMS has kind of been a little antiquated for many, many, many years. A lot of it is because of the reimbursement structure of what's been imposed on it. So there's other ways that we are growing that.

230. 1:41:05

     Does that answer your question? Thank you.

231. 1:41:10

     One more. On, on the E-911, when that call comes in-

232. 1:41:14

     Yes, sir

233. 1:41:15

     ... um, who or how do they determine real quick if that's high priority or low priority?

234. 1:41:21

     So there's, there's several ways to do it. Um, we have a, a 911 center. We do... So there's something called EMD dispatching. So we have soft hands-off to where we can prioritize that. We do, uh, EMD dispatching for four or five different states in one center. So technology has allowed us to be able to... You know, a county, that's another thing that counties, like, look, we don't, we don't have the money to send our people to go do EMD. We don't have the continuing education. That's fine.

235. 1:41:51

     All you have to do is we do a CAD to CAD interface. They hit a button, it goes straight to us. We do the EMD, and we say, "Hey, look." And then we can soft hand off to Navicare, or we can say, "Nope, you're getting an ambulance right now."

236. 1:42:04

     Yes. Any more questions? Okay.

237. 1:42:12

     I'm not running the slides, so it'll take a minute.

238. 1:42:21

     All right. So, uh, you know, proven fundable. The clinical model behind Navicare anchors, uh, it's, uh, the, the model behind the bones of it, the infrastructure of what Navicare is, is, is a telescope product, but it was just awarded a $43 million for a contract for, by, by AHCA in Florida to be able to impact these health questions that we're talking about today. So solution three is let's raise the standard.

239. 1:42:52

     You know, we need to really take a look at our EMS industry across the state to elevate it. When we elevate it, then we can reward it, and we can then bolster on it and again grow the access to healthcare. You know, we need to look at how many ambulance services do we have? Do we need this many? Are they meeting requirements? Are they quality providers? Are they not? And if they're not, you know, how can we either bring them up or what do we need to do? Uh, every operator should have to prove capitalization. Somebody should have to... The state should have to look at me and say, "All right, Larry, can, can you, can you do what you say you're gonna be able to do?

240. 1:43:26

     Are you gonna be able to provide the level of service for a Georgia citizen to make sure that it's top-notch and that we have the best care for our patients?" 'Cause make no bones about it, when you're transporting a patient, you are taking care of a patient's medical needs. Whether we are tr- we are discharging a grandmother from the third floor of the hospital to back to a nursing home, or we're taking somebody to the hospital, you're still taking care of a patient. You still have someone's mother, you still have one's, someone's sister, father, whatever.

241. 1:43:57

     We need to make sure those citizens are getting the best, no matter what. Um, we should require cyber- cyber security insurance. I mean, we all touch patient data. Why should we not have some level of coverage and some level of protection for Georgia citizens when it comes to their HIPAA, to their HIPAA data? And, you know, w- we need to have background checks. We need to make sure that we're putting the right people in the right ambulance, and that we're making sure that they have... that we're providing... Again, this is all about quality. And I'm, I am by no means saying that, you know, I should not have to do this or anything like this.

242. 1:44:32

     I think this should just be the standard. And, you know, when we have standards then we have something to build off of. And, you know, we need to raise the insurance. I mean, if a trac- a trash truck has to have more insurance than an ambulance company, I think we have a fundamental question that we need to ask ourselves there. Um, you know, we need to have some auto, some professional, some, some things that help us as an industry to be able to drive quality. And then we have to make, you know, our providers earn the earmark of, "Hey, look, you g- you're good.

243. 1:45:03

     You've got this, you've got this. Then you can access these programs and be able to provide quality access to healthcare."

244. 1:45:11

     Um, this is kind of your own blueprint. You know, you've already wrote this plan, and here's where the scorecard is. This is from the 2024 Rural Development Council's, uh, report. Um, we've all... W- I mean, you guys know what this is better than I do. So, you know, of our three asks, it's not a vendor's wish list. It's, it's a plan that we can commit to, that we can raise the standard in quality access to healthcare. I think that's the biggest thing here is, is getting and looking at technology, looking at the existing workforce, looking at the paramedics and EMTs that we have across the state, and really giving them the power and the assessment and the tools to be able to get quality access to the areas that we don't have health, that we don't have good hospitals, that we don't have enough hospitals to be able to just provide that better, that better quality of life.

245. 1:46:07

     Three actions for rural Georgia. What would be our suggestion, would be able to pilot a NaviCare in Georgia. We can start small and then encompass and grow to the entire state. We need to look at funding rural counties, and these counties that we're talking about that are extremely poverty-stricken in Souther- Southwest Georgia, Southeast Georgia, that don't have the resources to provide. They don't have tourism. They don't have anything. They have agriculture, and that's all they have. And I don't know if y'all have looked at the price of cotton and peanuts and corn lately. It's not a farmer's world right now.

246. 1:46:39

     And when we look at our counties in Georgia, my family's farmed for two generations, it's tough. I mean, it, it is tough in those rural counties, especially for farmers. And when a lot of our counties are agriculture-based, it's just extremely tough for them to be able to support infrastructure in their communities. And then lastly is obviously, I've kind of beat this horse, is to elevate the standard. We need to elevate the standard in the state to where we are the beacon in the United States for quality healthcare and quality EMS.

247. 1:47:09

     Uh, this is the team. Obviously me. Uh, there's Matt Thompson, Tom McEntee, who's our chief business officer, and Carly Dodson, who's our director of partner integration. And, uh, beyond this is a, a FAQ. If everyone would like to go to it, it's in your pamphlets, as well as the sources that we pulled this data from and our contact information on, you know, what, what we can do. So, um, there's multiple different sources in there. Please, if you have questions, get in touch. I, I can answer any question and, and, and be anywhere at a drop, at a drop of a hat.

248. 1:47:40

     So, uh, with that, thank you again for having us here, and, uh, I'll answer any questions. Thank you, Larry. Um, as the, the great chairman, Butch Parrish, likes to say frequently, we wanna make sure Georgians have access to quality, affordable healthcare. And in rural Georgia, we, uh, there, there are challenges and opportunities throughout the entire state. We definitely have some unique ones in rural areas. But I think that talking about ways to use technology and innovation and new ideas and thinking outside the box is, is gonna be key.

249. 1:48:19

     So th- this is interesting information for us to think about and consider. We, I've... Uh, Representative Chastain, did you have one more question? And- Just in thank- ... you have one too as well, Chairman? Okay. Well, we'll get to you in a little bit. Got to tell y'all. One more question, Larry. On, on one of your asks, you're talking about the rural counties. How many counties in Georgia have less than one ambulance? I would have to pull that information. I can get that to you. Mm-hmm. But for our footprint, I think we have, a majority of our coun- counties either have two or one.

250. 1:48:50

     Yeah. So when we get to Upson, Pike, and Lamar County, uh, kind of middle Georgia, uh, Upson County has three, two in Lamar, two in Pike. And we get... And the lower we get, uh, Sumter County, I think, believe we have three. In Terrell County we have two. Uh, Randolph we have one and a half. We have one that runs 24 hours a day, then one that just runs 12. And we were running two, but this is another example, is they were like, you know, because of their tax digest they, it, they just couldn't afford two, so they had to cut down to one and a half. And Clay qui- Clay County's one, Quitman County's one.

251. 1:49:21

     We don't do Baker County, but I know that Baker County, I believe, has one. Um, Ben Hill, we're in Ben Hill. Ben Hill has, I believe Ben Hill has two, plus a quick response vehicle. Um, Cook County, Clinch County has one. We're in Clinch County as well. And so we have a lot of different- We have a lot of different counties out there that are suffering from this, and it's, I mean, it's, it's a big deal. And look, when we had a lot of hospitals, you know, from 15 years ago, it was okay. But now when we're looking at a time on task of four hours because we're transporting from Randolph County to Phoebe, we get to Phoebe, we may be there 30, 45 minutes because everybody transports there.

252. 1:50:02

     Mm-hmm.

253. 1:50:02

     So we may be hung up there, and then we have to come back. You know, we can't run emergency coming back. You know, we may be able to run emergency there, but, um, you know, we're just across the border here in, uh, Polk County, Tennessee as well.

254. 1:50:13

     Mm-hmm.

255. 1:50:14

     And we have four counties in Polk County, Tennessee, but the reason we do is 'cause, you know, there's, there's really two counties there that's under one because there's one, they're east side and the west side of the county. And, um, you know, they funded that county, uh, just for the pure geogra- geography of it. Uh, it's difficult to get around Polk County. So, um, you know, there's, there's the numerous, numerous counties that are probably one, two maybe. Um, but you're not gonna see that in southeast, southwest Georgia as a predominant.

256. 1:50:44

     Okay. Thank you.

257. 1:50:45

     We are very pressed for, for time, but I wanna recognize a couple more committee members for quick questions.

258. 1:50:51

     Yes.

259. 1:50:51

     Chairman Corbett.

260. 1:50:53

     Thank, thank you, Madam Chair, and, and enjoyed having dinner with you last night, and you answered most of my questions last night.

261. 1:50:57

     Okay.

262. 1:50:58

     Very, very thorough. I appreciate that. And, and I live in one of those counties that we, we do not have a hospital, we don't have an ambulance. We, you know, somebody gets hurt, we, you, you put them in a car. If it's, it's serious, you, you, you take off to the, to the emergency room. But, uh, my question, on the, the Navicare, uh, e- explain to me how that works again. You get a 911 call, dispatch an ambulance, uh, or EMS to that?

263. 1:51:22

     So it, it goes through a tr- kind of a triage process. Uh, I won't get into the too technicalities of it, but we have AI listening software that's listening to keys as to what things we're gonna be doing, and h- and it's going into a, into how we're looking at, all right, and there's also a human on there that's sitting there going, "Okay, you're calling in 'cause you have a sore throat. Okay, well, this is someone that you're eligible for our Navicare program. Would you like to talk to a physician right now?"

264. 1:51:48

     Yeah.

265. 1:51:48

     "Yes, I would." Bing, they get a text on their phone. They click it. Boom, a physician pops up, and they can start having an assessment right then. Or it's I call in 911, and, "Hey, look, my mother is down. She's not breathing."

266. 1:51:59

     Mm-hmm.

267. 1:51:59

     The Navicare does not even step into that. We don't even, it doesn't even get, boom, an ambulance is on its way.

268. 1:52:04

     Okay.

269. 1:52:04

     You know, we're not delaying patient care by anything. What we're doing is we're utilizing those resources and those ambulances for what they're designed to do. Um, and we, when we, we run, you know, I spent 18 years in the back of an ambulance before I started Ameriprobe. That's why I got a bad... But the thing about it is, is a lot of the calls that EMS currently runs on, and this isn't in Georgia, this is everywhere, is we run a lot of calls that probably shouldn't be transported to the hospital, but it's because it's the only where to go.

270. 1:52:35

     There's not another way to get that access to that healthcare. We've built a technology platform to now deliver that.

271. 1:52:43

     Yeah, you basically just, there, a lot of people are using the, uh, ambulance or EMS as a taxi service-

272. 1:52:50

     Yes

273. 1:52:50

     ... to, to get them to healthcare where this, uh, much, much better option-

274. 1:52:54

     Some of that is, some of that is not the fault of anyone in this room or anything. It's just the nature of the business. We're not gonna ever get around that. I tell, you know, our 1,600 employees are like, "Well, it wouldn't be so bad if we didn't have to take all this stuff to the hospital." I'm like, "Look, y- you can't get around that." That is a culture that has built, been built in America for, you know, decades. And the o- you know, we can't just right the ship and stop doing that. We have to provide access to healthcare to be able to start to divert some of that-

275. 1:53:22

     Okay

276. 1:53:23

     ... and decompress some of the EDs. 'Cause a lot of the EDs are inundated with this low acuity care, and you're having a hard time getting into a hospital. I mean, every hospital sees this.

277. 1:53:34

     Mm-hmm.

278. 1:53:35

     So it's being able to not, one, this doesn't replace FQHCs, hospitals, or anything. It empowers them. It gives them data. It gives them access.

279. 1:53:44

     Right. O- o- on these l- low, not, not serious s- you know, situations, low acute care or whatever.

280. 1:53:51

     Mm-hmm.

281. 1:53:52

     Uh, you'll say, uh, uh, connect them with a physician. Is there a limit on the number of, uh, EMC, EMS personnel that one physician can serve? I know, like, walk-in clinics, you know, nurse practitioners is who you see in there.

282. 1:54:08

     Right.

283. 1:54:08

     There's a limit of-

284. 1:54:09

     So we have-

285. 1:54:10

     ... per doctor or something.

286. 1:54:11

     So what this is, is we don't have just one physician. We are contracted with multiple physicians. Our chief medical officer heads this up, and he has I don't even know how many physicians at his disposal to be able to leverage different physicians in different categories to do different things. And, um, it's a really, really neat, uh, product. Uh, and you know, it's, it's funny when you click it up and they're like, "Hey, how are you doing?" And you know, they're, and we use athenahelp, which is, uh, the EMR record that, that a lot of people that integrates into Epic, it integrates into Cerner, it inter- so we're getting that information, and we know like, hey, you were, so you were seen last week for abdominal pain, you know, and you're, what's going on today?

287. 1:54:52

     Well, I got a toothache. Okay, well, you know. So we're able to leverage some of that, and also the data that we collect we can then give back to the hospitals. So in the age that we're moving into now, data collection is everything. And as we're collecting this data, we're able to be able to strategize about how to be able to amplify the quality of healthcare, uh, in areas that we didn't have data before. Does that answer your question?

288. 1:55:17

     Yes. Thank you.

289. 1:55:17

     Yes, sir.

290. 1:55:18

     Representative O'Steen

291. 1:55:20

     I was just gonna make a, a comment on what Chairman, um, Corbett just said, is that, um, he was asking how many counties don't have, uh, an ambulance service and a hospital. Do you know that number? Do y'all know that number?

292. 1:55:32

     I don't know the exact number. I don't know how many ... Like, there's 159 counties in Georgia, so I don't know if, which ones don't have. I'm speaking on our behalf, of which, we, like, how many we have that only have one. Um, I don't know how many, I can't remember exactly how many counties don't have a hospital, but it's a lot.

293. 1:55:48

     And so, without a, without a hospital and without an EMS, what we miss in that whole thing, and Chairman Corbett mentioned that, was that if something happens, um, at home, somebody's cutting down a tree and they, you know-

294. 1:56:00

     Mm-hmm

295. 1:56:00

     ... we had a lot of that during Hurricane Helene.

296. 1:56:02

     Yep.

297. 1:56:02

     I'm from Coffee County, and, um, there was a lot of, a lot of injuries that, you know, were serious and, and still continue to happen.

298. 1:56:10

     Yes.

299. 1:56:10

     Um, is that from the moment that EMS arrives at that emergent situation, they're already starting to stabilize that patient.

300. 1:56:18

     Yes.

301. 1:56:19

     Whereas if, if I throw my mama in the car in Echols County, it's on me and God and whatever preacher I can call-

302. 1:56:27

     To hope and a prayer

303. 1:56:28

     ... to get her there. Right. So we need to look at that as a state-

304. 1:56:31

     Yep

305. 1:56:31

     ... because we say, a lot of things I've learned s- I've only been serving two years, but a lot of things I've learned, we have a, a, a great catchphrase, "Such and such shouldn't be dependent upon your ZIP Code. Such and such, your a- your access to education or access to healthcare." Well, you know what it is. And so when you know there's a problem, then it's on us to do something about it. So I don't know what that looks like, but I'm so glad that you brought this. It's very, um, enlightening to see the, the real problems that we have, and that there are solutions.

306. 1:57:02

     We just need to be willing to listen to them and be willing to adapt to new, to new ideas.

307. 1:57:07

     And I think, like I said, raising the standards, making EMS an essential service, I think we can all agree in this room that if you want, if you call 911, you want an ambulance to show up, you want the best-trained person to show up.

308. 1:57:22

     Absolutely.

309. 1:57:22

     You want to make sure that you're protected or your family member's protected, and that they're gonna have the best possible outcome of making it to the hospital alive.

310. 1:57:30

     Right.

311. 1:57:30

     I think that is a universal fact.

312. 1:57:32

     Right.

313. 1:57:32

     I don't think anybody wants to go, "Nah, I don't care. You know, put them in a wheelbarrow." No, that's, that's not, that is not what we think. So I think collectively, you know, if we can push forward this, and we can move forward with these innovative programs, and we can move forward with being able to raise the quality of healthcare through the EMS lens in this state, you will see a huge amplification of quality access to healthcare.

314. 1:57:56

     Yeah. And, and then the second thing was, uh, we need to look at, um, making sure that we don't have people that slip through the cracks that are, that are going into people's homes and taking care of them that have, you know, maybe passed the criminal background check initially, but haven't had one in 15 years since they first were, you know? I mean, that's, that's a serious thing to me, too. Thank you so much.

315. 1:58:21

     Well, I, like I said, I th- I just, uh, to me, it just blows my mind that you have to have more ... If you want to get into the trash business, you gotta have more insurance than you do to get in the ambulance business.

316. 1:58:30

     That's right. Okay, we've got one last question, and that is Representative Patty Stinson.

317. 1:58:36

     Hi. Is that it? Okay. Got it. All right. I just, I'll be very brief for the sake of time. Um, thank you, Larry, for your-

318. 1:58:46

     Yeah

319. 1:58:46

     ... presentation. And, um, as you were presenting, I was texting back home to my rural counties that don't have hospitals, uh, but they do have EMS services. And, uh, I want to invite you to, uh, speak with them, along-

320. 1:59:00

     Yeah

321. 1:59:00

     ... with myself about how we can maybe, um, um, have some partnerships.

322. 1:59:05

     Definitely.

323. 1:59:05

     And so Department of Community Health, just know I'll be calling on you as well. But, uh, quickly, I just, I just gotta say this right quick, Madam Chair. Uh, a big shout-out to the mayor and the county commissioner for being here, especially the mayor. I was excited to hear that they are in compliance with the audit. So shout out to you. Thank you. Thank you.

324. 1:59:24

     Hmm.

325. 1:59:25

     Thank you.

326. 1:59:27

     I want to appreciate you, uh, Representative, for pointing that out, because that is also a major concern-

327. 1:59:33

     Yeah

328. 1:59:33

     ... with a lot of rural-

329. 1:59:34

     That's right

330. 1:59:34

     ... legislators-

331. 1:59:35

     That's right

332. 1:59:35

     ... is whether their, uh, localities are in compliance with their audits. So congratulations on that, Mr. Mayor.

333. 1:59:42

     Thank you.

334. 1:59:42

     Good point.

335. 1:59:43

     Thank you, Madam Chair.

336. 1:59:44

     Larry, thank you.

337. 1:59:45

     Thank you.

338. 1:59:45

     This has been fascinating. I wish we did have more time for some more questions, but in the packet we've got his contact information. So members-

339. 1:59:53

     Yes

340. 1:59:53

     ... if you have more questions or need more information about that, um, we'll return it-

341. 1:59:57

     Anytime, anywhere. I drive.

342. 1:59:58

     Get that to you. Yes.

343. 1:59:59

     My office is the front seat of my car, so that'll work.

344. 2:00:01

     Thank you very much.

345. 2:00:02

     Thanks everyone.

346. 2:00:03

     Okay. We ... We're woefully, uh, behind schedule, but you know, when you get this group together, we're gonna have a lot of questions. Um, but I want to move on quickly to talk about railroads in rural Georgia. They're so important. Um, Ben Wright W- um, represents, uh, Georgia Railroad Association. I, I'm gonna have Ben just introduce whoever you've-

347. 2:00:29

     Ben

348. 2:00:29

     ... got lined up to talk.

349. 2:00:30

     Yep.

350. 2:00:30

     Um, and we're gonna have some, some good, uh, conversation here. Members, let's just wait till the end if we've got questions for them for the sake of time, and I'll, I'll call on you at the end, and we'll get to any questions or comments that we've got. Thank you, Ben.

351. 2:00:45

     Well, good morning Chair Lady Hagan and committee members, and thank you for the opportunity to present today. My name is Ben Wright. I work with Brian Hudson, and we represent the Georgia Railroad Association. The Georgia Railroad Association represents the interests of Georgia's railroad industry at the State Capitol and across the state. And today I'm joined with two of our members, Connor Poe with Norfolk Southern, and David Bevins with Patriot Rail.

352. 2:01:17

     The Georgia rail network is comprised of, uh, 28 railroads, uh, which includes two Class 1 railroads, Norfolk Southern and CSX, as well as 26 Class 3 shortline railroads.

353. 2:01:33

     One second. Sorry about that.

354. 2:01:35

     Good.

355. 2:01:42

     And as you can see from the map on the slide that should be coming up shortly, as well as in the handout that we provided, uh, the committee, the rail industry covers the entire state of Georgia, operating on more than forty-eight hundred miles of track owned by either Class I railroads, Class III short line railroads, or the state of Georgia. And the rail industry plays a vital role in Georgia's economy by employing, either directly or indirectly, over twelve thousand Georgians and carrying over eight point seven million truckloads worth of goods and commodities across the state each year, including construction materials and agricultural products, among others.

356. 2:02:17

     Our Class I railroads provide long-haul connectivity across the state and region and invest over three hundred and eighty million dollars into Georgia each year just through capital investment. Our Class III short line railroads act as the critical first-mile, last-mile service providers, picking up localized freight from rural areas, agricultural regions, and industrial parks in order to connect them back to the Class I network. And together, both Class I and Class III short line railroads have seen our infrastructure costs rise over the last couple of years.

357. 2:02:49

     Currently, it costs around three million dollars to build one mile of new track, up from twenty twenty-two when rail ranged from around one point five to two million per new mile. And right now, it costs over twenty thousand dollars per mile per year to maintain each mile of railroad track. This maintenance continues to be a very, uh, critical investment, not just for railroads, but for the state, as by twenty-fifty, the freight volume moving through Georgia is expected to increase by around ninety-one percent. To go into more detail on the Georgia rail industry and these issues, I'd like to turn it over now to Connor Poe with Norfolk Southern.

358. 2:03:34

     Hey, good morning.

359. 2:03:38

     So I'm sitting in the David Ralston building here. I gotta give a David Ralston story. I'm sorry, Chairwoman, if you can g- allow me for a second. So he, Da- David Ralston would not call me unless he had some kind of major issue that he was trying to deal with or I was in trouble at the Capitol, he'd call me into his office. You guys have all, a lot of y'all have been called into that office before. It's wasn't a great feeling unless he was, he wasn't gonna call you in for anything good. It was usually he'd get onto you about something. So about six or sev- maybe eight, eight years ago, I get a phone call.

360. 2:04:11

     I'm quail hunting down in, uh, over near Charleston, and I get a phone call. And I'm not gonna take a phone call if I'm quail hunting unless it's important. Well, I see David Ralston's name pop up, so of course I take it. And it's not David Ralston, it's our former chief of staff who's outside of the room right now doing what he does best, br- talking, S- Spiro. And he says, "Connor, we got a problem." I said, "Oh God, what is it?" He said, uh, "We're trying to head to some event over in Waycross for this guy Burchett, who's running for, for State House.

361. 2:04:45

     And we gotta get there, and we can't because there's a damn train blocking the- ... the way we're going." I said, "Well, Spiro, why don't y'all just, you know, there's a way around this train. You just gotta go a little bit further south to get around it." And he said, "Well, hold on a second." So I get, he passes the phone to somebody else. And I get on there, this guy from down in Newington, chairman of Game, Fish and Parks, gets on the phone, John Burns, says, "Connor, you gotta get this train moved. Speaker's not happy, you need to get it moved." I said, "John, I'm working on it.

362. 2:05:16

     I'm trying right now. I can't, if you're talking to me, I can't call and get this train moved." Uh, John says, "Hold on." Passes, he runs, he's literally in a different car. He runs up to another car and gives Spiro's phone, or s- speaker's ph- or to Spiro's phone or whoever it was to ano- to another, someone else. Well, then I get this deep voice on the phone. Y'all have gotten that call before too. He says, "Connor, we ain't going around. I need you to move this train." I said, "All right." So I told my guys, I said, "Y'all need to...

363. 2:05:49

     I, I, I, I can't hunt anymore. I gotta figure this out." So I called dispatch. Dispatch routes me somehow to the engineer of the train, and I said, "Look, I hate asking y'all to do this, but I know y'all are on break. Get on that train and move it." Well, the train did f- eventually got moved. They're all stubborn, so they decided they were gonna sit and not go around it. And, uh, and, and the speaker was happy. And he got to the event, which obviously was raising money to get to, you know, help get that, get that, that, that candidate elected who's now our, our whip.

364. 2:06:21

     And so, uh, I will say that's customer service. I can't offer that to all y'all, unfortunately, like that. But when you get a call from the speaker, that's the kind of thing we have to do.

365. 2:06:33

     Connor-

366. 2:06:33

     So I, sorry, I had to mention that just-

367. 2:06:34

     Connor, the fact that you told that story here was you welcoming us to call you with those-

368. 2:06:39

     The h-

369. 2:06:39

     ... hats, uh

370. 2:06:40

     You all have my number. That's, you know, yeah.

371. 2:06:42

     If y'all get this number-

372. 2:06:43

     Anyways

373. 2:06:43

     ... let me know.

374. 2:06:44

     David Ralst- David Ralston was a great... I just, I couldn't be in this building and not talk s- talk about him. He was a great man and a g- and like a father figure to me, Spiro, and many others. So, um, I'm happy to be in this building. So Connor Poe, Norfolk Southern. Um, I represent 14 of our 22 state network. Um, I've been with the railroad 10 years, um, which is a very short time, um, compared to other railroad workers. There's folks that, in my company, that have been there 40 years. So I'm still a rookie.

375. 2:07:14

     I'm still a new hire basically there. Um, and so, um, I, but, you know, we, we love it and, um, that's why we're here. And we'll m- give you guys a q- couple quick facts. I'm representing Craig Camuso too, and CSX today here as well, from the Class 1s. Um, he's actually headed to Savannah for Chairman Jasperse's meeting, which is tomorrow. So just to give you a quick snapshot, um, I wanna go through... How do I do this here? I, I wanted to show you guys this map. So this is, it's a little bit older of a map.

376. 2:07:44

     Um, there's two railroads that have combined on this one. But I kinda wanted to give you an idea, uh, what it looks like outside of Georgia. So these are the current Class 1s, um, that, that serve the country. And you'll notice the purple and the, and the light blue over here on the East Coast is Norfolk Southern and CSX. And then there's a green line down the middle of the, of here. This is basically the Mississippi River or the CN, which is the Canadian National Railroad, that runs through north-south.

377. 2:08:15

     And then the yellow and the blue are the two largest railro- Class 1 railroads in the country, which is Burlington Northern Santa Fe, which is an, uh, railroad owned by Warren Buffett. And then you'll see the, um, the blue line, which is Union Pacific. So you'll see that the way this works here is that, you know, w- if we're carrying something across the Mississippi, we carry it over to this Mississippi area, Memphis, New Orleans, Chicago, St. Louis, and then we connect in these places, Chicago and others, and then we hand it off to a western railroad if it's on, if it's on way, its way to the west.

378. 2:08:52

     Same thing if it's coming from the west and it's making its way to the east, we hand it off on the Mississ- in, near the Mississippi and hand it over to the, uh, the eastern railroads. In 1976, I'll just give you an example, in 1976, 50 years ago, there was 52 Class 1 railroads. So you imagine this map, you wouldn't even be able to see these state lines on here because there were so many Class 1s. In the '80s we had a, uh, a large merger. Um, l- lot of mergers going on over the time. Um, at, you know, bankruptcies, consolidations, which has now led us to the six Class 1s that we have today.

379. 2:09:28

     You actually see, I think, seven on here, but it's actually six now because the Canadian Pacific and the, um- Uh, the, uh, CP, the, uh, Kansas City joined a couple years ago. They merged together. So I just wanted to give y'all an idea, um, kind of what it looks like nationwide. This is the Norfolk Southern. Um, I'm gonna start with the Norfolk Southern. Um, you'll see that our reach is up. We serve customers all the way north to Massachusetts. We dip into Florida, um, serving the Jacksonville, um, port, and then we can make our way down to P- Port Everglades in Miami.

380. 2:10:06

     We go as far west, um, as to, um, out in Louisiana on our track, and then we can get to Dallas, um, with a dotted line if we need to, um, on that market for, uh, for our customers. And then you'll see we terminate in to, in Kansas City. Um, so we cover a good part of the east, the eastern part of the country. You'll see that Mississippi River still just kind of is glaring there where we all kind of stop and we connect. Um, so Class 1 versus short line, I mean, it's, it's, it's long haul, revenue, miles, number of customers.

381. 2:10:41

     That's how we break it up. Um, you know, David's gonna give you guys... And we, we could have put short line at the be- at the beginning or the end of these presentation because that's what they are. They're first mile, last mile, and then you've got the Class 1s that are kind of right in the middle. Um, they bring it to us, we get it to its final destination, and then we hand off to either a truck or another short line to get to where it has to go, and vice versa. You know, it can, it can do the o- opposite way. It comes from a customer to us to its final destination on a short line or a truck.

382. 2:11:11

     Um, I want to focus real quick on the ports that we serve. You can see on the East Coast, we serve every major co- port on the East Coast, starting in New York, New Jersey, um, Charleston, Virgi- and N- Norfolk, Virginia, um, uh, Baltimore, Savannah, Brunswick, Jacksonville. So we serve all the eastern, all the eastern ports as well as the two Gulf ports, which is Mobile and New Orleans. Um, you know, like I said, on the, as far as combined here, Norfolk Southern, CSX, this is-- I'm, I'm proud of these numbers.

383. 2:11:44

     We invest three hundred and eighty-five million dollars a year between Norfolk Southern and CSX. And y'all will be surprised how many legislators who will come up to me, who don't maybe live in an area where there's no railroads, and they'll say, "Y'all, y'all get so much money in the budget for rail." No, we don't. We don't. Every, every dollar that is spent on a Norfolk Southern or a CSX track is from our revenue. We pay for our own infrastructure. We keep up our own infrastructure, and we're proud of that.

384. 2:12:15

     I mean, we have to keep it up. And we got some damn good infrastructure in Georgia when it comes to rail lines. Uh, where does the money go? It goes to track. It goes to ties. It goes to bridge improvements, crossings. We maintain every crossing in Georgia that we, that we travel over. A lot of other states, the DOTs will carry that cost. In Georgia, we pay for our crossings. Um, facilities, uh, new sidings. So as you can see, we're-- I mean, I can t- show you on the Georgia slide, we're working on a siding right now.

385. 2:12:47

     And what's a siding? A siding is basically a, i- it's a, it's a, it's a caution lane for a, for a railroad. See, we're what-- In the South, we're made up of single line rail, which means we have long haul on single line. We do not have double tracks in a lot of places. We don't have multiple tracks. You go up to New Jersey, Pennsylvania, Ohio, they might have eight tracks they can use. We don't have that in the South. And so what we have to do to get around that is that we build what, what's called a siding, so we can allow our faster trains, which is our timed trains, which is gonna be your, your intermodal, your autos, to get to where they need to get to on time.

386. 2:13:27

     So we have to then build a siding track to be able to keep trains, maybe like your, maybe you're moving lumber, maybe you're moving stone, things that are not necessarily timed, so we can ke- continue the intermodal market moving like it should, and Amtrak and the other kind of commuter rail. That's why we build these sidings. We've got a siding project that we've been partnering with the state, actually, um, we are getting ready to open down in Henry County, that'll give us about twenty-five thousand feet of double track in Henry County. And if y'all have d- traveled through Henry County out- outside of the interstate, I mean, there's railroad crossings everywhere.

387. 2:14:03

     There's, there's no bridges. So this is gonna allow us to be able to get trains and put them in places so we don't block traffic in downtown McDonough or downtown Locust Grove and those places. So that's what we use sidings for. Um, employees, I'll say we're, we're proud of this number also. Um, Norfolk Southern has forty-one hundred employees total in Georgia right now. Um, twenty-two hundred of those are in the Atlanta office. CSX has a little over eighteen hundred, so fifty-nine hundred employees, um, total, which is we're a very large presence in Georgia.

388. 2:14:37

     The ma- the majority of that presence is gonna be on our, what we call our craft side, which is our union workers, which is gonna be your, uh, engineers and, um, and conductors. So those folks live in Georgia. They start in Georgia their day. They might end up in, in, up in Ohio at night, and then they're back to Georgia the next day. Um, the largest commodities that we move, um, are... I mean, it used to be coal. Coal was king for forever. I mean, that's what really started the railroad was moving coal. Well, coal has obviously gone way down because of the use of cleaner, cleaner energy.

389. 2:15:11

     We still move coal. Don't get me wrong. We still move a good amount of coal, but not near what we mo- we're, we're moving. So intermodal is the new coal, and intermodal is your autos and your containers that are coming out of Savannah or term-- are going to Savannah to get somewhere else. That's a large part of what you guys see. Those are the longer trains with containers. Those trains don't stop. If they are stopped, the CEO is getting a call. Those trains are timed. They need to get somewhere. They're gonna get there. The ones that are stopped, like I said, usually are your traditional freight.

390. 2:15:42

     Um, I, I wanna mention real quick the two inland ports that are now online in the state. Um, if you look up that, what I'm showing you, this little, um, this little map here, Atlanta, and you kinda follow it up 85, which is that line going northwest. There should be a little triangle up there. There's not right now, but that's where the new Hall County, um, Blue Ridge Connector inland port is. Um, and then you've got the Chatsworth inland port, which is not far from here, um, over, um, over in Chatsworth. So these, these inland port program has been extremely successful for GPA.

391. 2:16:15

     We love partnering with them on these things. It's a great way to connect northwest and northeast Georgia to Savannah without having to put it on a truck and move it through Atlanta. This is the way you get there. It's a shuttle service, basically. Let's look at it that way. It's a shuttle service between Blue- between Hall County and Savannah, Brunswick. So we're proud of these places as well. Um, then I wanna talk about, so do we compete with the other Class I? So we do compete. When it comes to market share, we compete.

392. 2:16:47

     We compete in areas like Savannah, for instance. So, you know, that's, that's on the marketing side. So we do compete with CSX. Norfolk Southern does. Um, but you know what? At the Capitol, I will tell you this, we're a team. We're a team with the short lines, and we're a team with all the Class Is, and we agree on 99.9% of usually what we're working on at the Capitol. So we're, you know, very proud of that relationship as well. Um, you know, we're all look- looking for, to get the same thing. So where do we really compete? We're competing with truck.

393. 2:17:17

     Truck is our competitor. So truck right now is an 85/15 split on the market share, and tr- they dominate the, they dominate the freight market. And so how do you compete with truck? Well, you gotta have more fa- you gotta have faster and more reliable service, and that's what we're trying to do every day. Every time we build a siding, every time we, we, we do some kind of infrastructure improvements at a facility, it's to get our service faster. So when we travel through a community in rural Georgia, and let's say there's seven crossings that are at-grade crossing, which is your roa- your road going over track, we have to slow down in that community to a ver- to a s- to a, to a slower speed that's safer.

394. 2:17:58

     Well, what does that do? It slows down those autos getting to where they need to get to. Well, a truck can get them there faster because they don't have to do these things. They're on the interstates, which by the way, they don't pay for. We pay for our infrastructure. But, so what can we do to solve that? We can ... A- and, and this goes right into the chairman's meeting down in Savannah tomorrow, is infrastructure, bridges, overpasses. Get us, get the people off the railroad tracks, and it-it will, it will, it will fa- it will, uh, it will quicken our moves on rail.

395. 2:18:30

     So that's what we're trying to do, bypasses around cities, things like that. So that's how we compete with rail. Um, you know, lastly, I wanna brag on, on Norfolk Southern real quick and talk about our community impact. And both NS and CSX both do this. You know, we're a big contributor in the, in, in, um, on locally in charities, nonprofits, to cities and counties. Both Georg- both CSX and Norfolk Southern have very successful grant programs. Um, I would encourage you, all of you, to go and have your cities, your counties, your nonprofits go to our website, look up our grant programs.

396. 2:19:09

     We gave $40 million in the last five years all over Georgia, it doesn't matter how big or how small your city is, for projects around there, as long as it's in a community where Norfolk Southern has a impact or CSX has an impact. You know, we give communi- communities come and they apply for grants. We pay for playgrounds. We pay, we pay for garden club projects. We pay for walk- walking paths, all these things, because they're a positive communi- a positive community impact, um, into that area. So I would tell you, tell them to get on there.

397. 2:19:41

     It's free money, you know, and, and you guys back it. You call me. We'll get it done and we'll ... I mean, $50,000 for a small community is a big, big deal. Um, so I would encourage you to do that. Um, so I'll just quickly go through CSX's here. CSX has the same reach we do in Georgia. We hit the same markets, the Chattanooga market, Atlanta market. Um, they have a very large facility in Waycross. Um, obviously they hit Savannah with us, and then in Brunswick.

398. 2:20:12

     So you can kinda see we're, we, we, we kinda, we, we all get to the same places, we just kinda go a different route.

399. 2:20:20

     I think that that's all for me. Um, and we're doing questions at the end, right? Okay. Thank y'all for having me.

400. 2:20:28

     While we wait for Dave to get up here, I want to acknowledge the presence that has entered the room, and that is Senator Steve Gooch.

401. 2:20:43

     Thank you for being here with us today, Senator.

402. 2:20:46

     Hello. Uh, my name is David Bevins, and I appreciate the opportunity to be here. I am, uh, vice president of operations at Patriot Rail. We operate two of the, uh, short lines in the, uh, state, the Georgia Northeastern and Georgia Southern. Uh, and the scenic operation that's here in Blue Ridge, and I appreciate, uh, the chamber's mention of our operation here. Um, it's been very successful, I think, for the entire community and for our company. But, um, look, I, I'm more of a straight shooter, so I'm gonna piggyback.

403. 2:21:17

     You know, Conner teed it up very well for what I wanna mention today. Uh, and, um- You know, short line, we're, we're the first mile, last mile, as he mentioned. So when it comes to what we do for a living, how do we support? Because we're a big partner to the Class Is. Without the Class Is, the short lines couldn't exist because we may originate a load, so we may have a rail car get loaded, say, in Jaspers County, and then that load may make its way down to Marietta and then on over across who knows where, um, you know, the state of Colorado.

404. 2:21:52

     I don't know. Pick a state, it can run there. Vice versa, we receive in loads also, and we bring it to these smaller customers so they have an opportunity to be connected to the general railroad network. We represent about two hundred miles of track in the state of Georgia. We've got other folks here in the room, other partners, G&W, OmniTrax, they represent other mileage in the state as well. So together, we are providing an opportunity for connectivity, whether it be to the port or the general network, to get these loads in and out that would not otherwise provide any other connectivity for customers to make those loads.

405. 2:22:31

     Um, one other thing Conner said that really strikes me and it, it, it hits my passion. I've been a railroader for, uh, 28 and a half years. Uh, second generation railroader, but he mentioned how do we pay for our, our infrastructure? How do we pay for our maintenance? And it comes out of our own pocket. It comes out of our bottom line. So, uh, besides grants, you know, the 45G, uh, state, the credit we get is a big, big tool that we need to leverage more of and, and have, uh, um, you know, have more support there, I think, in, as we move forward as a, as an industry.

406. 2:23:11

     Uh, bridge inspections, sidings, as he mentioned, mainline track, all of this comes out of our pocket, and since, uh, 2015 when we actually purchased the Georgia Northeastern, uh, we put over $12 million alone in capital in that railroad alone. Over the last two years, we've put in almost $4 million between Georgia Southern down between Dover and, uh, and Metter, and then from Perry, uh, to, uh, um, Fort Valley, and from Marietta up here into, uh, Blue Ridge and up to McCaysville.

407. 2:23:46

     So it's a tremendous expense to us, but why do we do that? Well, service. We have to be able to provide service to these customers. We've got to have track that su- can sustain the heavy loads of the rail cars that are up to 286,000 pounds. We cannot connect, we cannot interchange or accept inbound loads or produce outbound movements to the Class Is if we don't have this infrastructure in place to safely move all of this across this network. So it's very critical that, uh, we have that capability and we provide that funding, uh, to, uh, to support our operations there and overall support the operations.

408. 2:24:26

     But it, it goes beyond that. Um, you know, we, we don't like to be on the news. We, you know how sensitive this world is to any type of issue when it comes to a derailment or, uh, or any kind of other incident involving rail equipment. And, uh, fortunately, you know, with that capital, that's what keeps us safe out there. But in and above that, it provides us an opportunity to have qualified employees. We employ about 70 people, uh, just on, you know, within our head count in our companies here in, uh, the state of Georgia.

409. 2:24:59

     But the domino effect is how many does our 45 customers employ, and then so on and so forth from how many, uh, uh, folks does that touch, families, communities. Without these railroads, you wouldn't have that connectivity to move these loads. It's vitally important to the overall economy of the state that, that we have that, uh, that support. So as you see on the slide here, I think I've, I've talked enough about first mile, last mile, but I'm very passionate about this industry, uh, and being my time here.

410. 2:25:31

     But we support nearly 1,000 jobs. We've got 26 short line railroads across the state. As mentioned, we operate two of those 26 and very proud to do so. Communities, ports, industrial parks, you name it, we get to touch those. It's a privilege to be able to provide that service to them. So the broader network is very well connected through the Class Is. So I'm gonna advance a slide here. Hopefully this works for me. So just to show you a little bit more about how the tax credit works, uh, right now that cost is, or, or that reimbursement, uh, is capped at 3,500, uh, per track mile.

411. 2:26:11

     It's been sustained at that number for a number of years and, and, uh, there's, you know, we have absorbed all the inflation, the CPI increases, everything. Everything costs more, as we all know, in this world, and we've continued to absorb that, but also we've continued to invest. Uh, you know, we haven't backed off on our commitment to the state and, uh, to our infrastructure to ensure we have what, what is needed there. There's been a 67% increase in the annual short line investment since 2018.

412. 2:26:44

     What does that equate to? So for every $1 of, uh, tax credit, we're putting $10 to $22 back in, so, you know, we're making that investment. We're committed to that. And the average, uh, annual maintenance cost per track mile shows about 20,000, and that's ever-increasing. Uh, we talk to vendors all the time about, "Hey, we need certain, uh, items. Is it certain type of track?" Because we operate what's called Class I railroad. So one thing that Conner talked about was building sidings so he can, you know, the, the large railroads can pass trains and stay efficient.

413. 2:27:22

     We are a single line railroad running about 110 miles from end to end just in North Georgia alone. We operate at 10 miles an hour. Now, if you've driven up to, uh, North Georgia, there's a few things called, uh, hills. The railroads have a lot of hills. We have a lot of curves. It takes a lot. A mountain railroad requires so much more capital, uh, to maintain than, I'll say, and I'm not, you know, downplaying any railroad.

414. 2:27:53

     It takes a lot of money to run a railroad. But when you get into just the curvature alone and the amount of capital, you got drainage issues. We've got trees grow a lot in the state of Georgia, so you've got the tree canopy. There's so much that goes into maintaining a railroad, uh, it, it can be quite daunting to think about all that planning and all that, that it takes. So these are costs that we've got to absorb, we've got to plan for. Uh, it's a seasonal approach as well because certain times of year you can't do a lot in Georgia because of the wintertime, things like that.

415. 2:28:27

     So there's a, there's a lot that really goes into that. So I just want to mention, we're running at 10 mile an hour. How long do you think if you drove your car from Blue Ridge to Marietta it would take to get there at 10 mile an hour? Okay, and really, we're probably running about eight or nine mile an hour so we don't go over the speed limit. So there's a lot that goes into this. So without that, that support for the bridges, everything is safe. We can run our entire railroad now is at 286K. It's huge.

416. 2:28:58

     All right. Ooh, jumped a slide. Maybe that is my last slide. So, so look, uh, I'll, I'll just close with this. Look, we, we have, um, as I mentioned, we, we put several billion dollars into our, our committed capital, operating about 200 miles of track, uh, overall. The 45G program is so, so important to our company. Um, you know, it's helped us to, uh, to, to realize tax credits about a half million dollars a year, uh, over the last couple years alone.

417. 2:29:30

     So, uh, we're very active with that. But again, we have to be committed to making those investments in that infrastructure to realize those qualified, uh, returns on that. And I'll close with this. With the Blue Ridge Scenic here, if you haven't ridden that train, it's a phenomenal scenic ride. Uh, we're, we're about sixth in the country right now. This year we're probably gonna have 175,000 people ride the train, just the train alone. I work with, uh, another group, uh, with a broader group, with excursions, uh, across the country.

418. 2:30:03

     And just to give you some idea on revenue, excursions across the country, you may not realize this, but that revenue equates to about 750 million per year. But it also equates to 6.6 million riders per year. That's bringing more people into this area. We get people from all over the world that come here. So they get to see this state, and a lot of them come and they stay. So we want to better serve and continue to serve from a safety standpoint, and also from just our commitment to making sure the great state of Georgia has a railroad infrastructure it needs.

419. 2:30:41

     I'll close with that.

420. 2:30:45

     Thank you so much. We do have at least one question here. I'm not sure whi- which one of the three of you will need to answer it, but I will recognize Representative Buckner.

421. 2:30:55

     Well, it's, it's really, um, a follow-up to the story about Speaker Burns and Speaker Ralston and the railroad crossing being blocked. Um, several years ago, we started noticing in rural Georgia the trains getting much, much longer, and the blo- blocking the roads was, took a little longer. And I want to say to Connor and to, uh, Craig's credit, they came over to Warm Springs and met with five mayors in the area that had had their railroads blocked for different re- for, um, extended periods of time, um, and came up with a resolution, of course.

422. 2:31:37

     And, and it's kind of been, um, supported by the Rural Caucus, and ultimately a letter from the governor went to the railroads. But basically, if it's blocked more than 30 minutes, um, they are supposed to either uncouple or move. If there's construction going on, and I've got one city that's got three crossings, and they were doing construction and they blocked all three crossings for two weeks, and it was a problem. So they can't do that.

423. 2:32:09

     The, the city can pick one crossing that they want to be left open while that construction's going on. And, um, I thought that it was a really nice thing that everybody came together, came up with a solution that worked for the cities and for the railroads, and it's worked very well, except when new people come to work and aren't familiar with the arrangement. So sometimes that happens with all industry. But if we can keep everybody in the loop that this is an opportunity for them to not have state representatives called about the railroad being blocked, and if you are called, then you know that there are some guidelines that have been set up.

424. 2:32:53

     It's just a gentleman's agreement, so to speak, but it's worked quite nicely because of the nice work of Connor and Craig.

425. 2:33:02

     Thank you for that. Representative O'Steen.

426. 2:33:05

     Yes, ma'am. Thank you so much, Chair. Just real quick. I get phone calls from time to time about just some frustrations about the, the rails that are left, old rails and crossties. Is there an internal, like, target time to have those things, once you change them out, to have them moved and, you know, disposed of? Or how does that work? Whose responsibility is that? Especially the ones like the state, you know, has. So I'm curious about that question.

427. 2:33:36

     I can speak just for the, I know the Class I's, the way we handle it. Once those rail ties leave the ground, they're no longer our property. We don't own them. We have sold those off to a salvage company that we contract with that we have one that, um, uh, that we work with, National Salvage, which is huge. You guys have all probably heard of them. They cover all 22,000 miles of our track, so they have to go around the entire network and pick up all those rails. So you can imagine of what you have in your community times 22,000 miles of track.

428. 2:34:09

     It- And I'm gonna be honest with you, it could be a year in some instances when those sit there. If you have specific cases where we get folks, maybe they have a pile of them that's 25 feet tall that's blocking a business or things like that, then you just call Craig or I, and, and we will get with them and try to expedite those. Um, it's not an easy thing to do, um, because, you know, you do have to have certain kind of cars down there, and you have to have a whole different train for these things. But my-- Our guys have been pretty good about that. Um, but like I said, once they leave the ground, we're at the mercy of the salvage company for them to come along our rail and pick them up.

429. 2:34:44

     Um, it's just an annual maintenance issue that we deal with everywhere. Um, and we have nowhere else to put them. I mean, that's-- it's our property, we know, and we just y- we-- they drop them, these guys turn and burn. They go as quickly as they can through the community and try to get out of there, 'cause they gotta go hit another community, and they gotta hit all the communities in one year. So, you know, they get them and put them in the closest location, and then, you know, unfortunately, they do have to sit there for a while until they're picked up. But no, just call us if you have one that's been there for a long time, we'll get it moved for you.

430. 2:35:14

     Just give us a call. Yep.

431. 2:35:16

     Representative Chastain.

432. 2:35:19

     Thank you, Madam Chair. Thank you, gentlemen, for the, uh, presentation. I want to just say thank you. Uh, I don't even know how to put it in words how blessed we are to have the Blue Ridge Mountain Rail, uh, Scenic Railroad, Railway here in Fannin and in McCaysville. But a few weeks ago we had a, a major, major flood down in McCaysville, as many of you know, and terrible. Uh, the business owners, uh, it's just a, it was devastating. And immediately we got word that some of the track was damaged. And these gentlemen, they, it was unbelievable, the work.

433. 2:35:49

     That, that railway is the lifeline to McCaysville, Georgia. I mean, you can, as many of you know, it's, that knows about that. But thank you so much for that. The, the tracks were... I don't know how you guys fixed it as quick as you did, but it was up and running, and they had the train running that next weekend on Sunday for two trips. So we very much appreciate it. Thank you.

434. 2:36:11

     Thank you. We, we have a really good team. Thank you.

435. 2:36:14

     Representative Stinson.

436. 2:36:16

     Uh-huh. Thank you. Thank you for your presentation. And, Korner, you've been to my area of the state before, and love to have you back, 'cause I want to learn more about these grants that you referenced earlier. Um, but you talked some about some of the, um, projects and, and activities that's gone on in some certain parts of rural Georgia. Are there any other activities or things in other parts of, of the rural part of the state that, uh, you're gonna be working on?

437. 2:36:41

     Uh, y- yeah, we're identifying some areas right now that where we, um, are having capacity issues, which mean we have too many trains and not enough track. Um, and, you know, some of those are gonna be out in, um, out in west Georgia. Um, bet- our line between Birmingham and Atlanta. We're looking at some between Atlanta and Chattanooga. Um, South Georgia, no, not right now, anything more. We've done so much work between Atlanta, I'm sorry, Savannah and Macon already-

438. 2:37:10

     Mm-hmm

439. 2:37:10

     ... to try to keep those GPA trains moving, um, that we've already added, I think, three, three or four sidings between, um, the, the Savannah and Macon. So we've done a lot of work there. But, you know, the trains within your community, I mean, you're on a highway, you're on the Georgia, Florida, um, line, which those trains move very fairly quickly through there. Um, so yeah, no, we- we're identifying areas, and we're going through a little merger of our company with another company right now, and we're trying to get ready for that as well and the growth that that's gonna cause.

440. 2:37:41

     So.

441. 2:37:42

     I know the train that comes by the funeral home is mighty loud, so.

442. 2:37:45

     Unfortunately, we can't make them quieter.

443. 2:37:47

     It work, yeah, waking my customers. But thank you. Thank you for your work.

444. 2:37:51

     No, no.

445. 2:37:51

     And I do want to learn more about the grant that you, that... John said, that I'm just repeating what he said.

446. 2:37:57

     No.

447. 2:37:57

     Repeating what he's saying, Madam Chair.

448. 2:37:59

     No, we appreciate you. You've been a great supporter of the rail, of the industry.

449. 2:38:02

     Yeah.

450. 2:38:02

     So we, we appreciate you too.

451. 2:38:04

     Absolutely. Thank you. Good to see you, Linda.

452. 2:38:06

     Thank you very much for the presentation.

453. 2:38:07

     Yep, yep.

454. 2:38:07

     And we do, uh, appreciate what you do for our rural communities and for the state as a whole. We have one more presentation before we break for a very quick lunch. Commissioner Dean Burt, thank you for being here today and for being so patient with us. You want to come on up and, uh, uh, Commissioner Burt with Department of Community Health. And I also want to acknowledge Emily Hatchett, um, the legend herself. It's not quite the same up on the fourth floor without you, but, but it's so good to see you.

455. 2:38:41

     Thank you all for being here with us today to talk to us about Rural Transformation Fund updates.

456. 2:38:49

     Thank you, Chair Lady. Appreciate the invitation. Um, um, I will, uh, try to be a little bit, uh, brief because, uh, I know I'm standing between y'all and, and lunch, and I haven't had breakfast, so you're probably gonna be hearing my stomach growl here in a minute. And as a physician, I probably should make a- all of y'all stand up a minute and stretch because you're, been sitting all day long. Yeah, you too, Patty. Uh, although I've seen you wandering around, so that's the, one of the things that, that being old helps you do. I have to go to the bathroom every hour.

457. 2:39:21

     So, uh, I'm always getting up and moving. Um, nice to be in a, in, in a building that's, uh, named after the former speaker. Um, um, uh, I saw Gooch come in. Uh, Steve and, and I, uh, I think Spiro can confirm, we're, we're probably, like, the only senators that- Uh, might, might have had some, some brown-colored liquid on day forty after s- session over, you know, around midnight. It was just kind of a tradition every year to, to, to go over there.

458. 2:39:51

     Um, J-Jay Powell, of course, uh, uh, one of your former colleagues that's from my neck of the woods. He and I were friends long where he was in the House, uh, and, uh, he was I think the first chairperson of this committee when it was first started, uh, and, uh, we, we were actually had y'all in Bainbridge, where I'm from, uh, uh, early in, in the, the, uh, mission of this, this Rural Development Council. And, uh, I know Joe has, uh, had a, a challenge trying to, to live up to, to the good work that, that Jay did.

459. 2:40:26

     But he and, he and I both, uh, knew Jay very well and, and, uh, appreciated the, the service that he gave to, to the state, and miss him every day. I think about him just about every day. Um, the agency that I'm, uh, the commissioner of, just a quick, because not all of y'all are in healthcare, is the Department of Community Health. Uh, Georgia's, uh, uh, a little bit different in that, uh, some states have a, a, a agency that handles everything healthcare.

460. 2:40:59

     And our, our, uh, state probably twenty years ago, uh, made the decision to separate the health agencies. So we have the Department of Public Health with, with Dr. Toomey as commissioner, and we have, uh, DBHDD, you know, one of your former colleagues who's the commissioner, uh, and, uh, we have, uh, DHS, uh, uh, with Commissioner Broyles. So, uh, it's sometimes complicated for, for you guys that are not healthcare, uh, related to, to know who to call and yell at.

461. 2:41:32

     And, uh, you know, uh, because I've served in the Senate for eight years, most of y'all have my cell phone and, and you, you text me or call me when you need something, which is, is perfectly fine. Um, uh, and we, we try to work every year with, with the membership to, to send out with Brandy Sylvan's help. I don't know where Brandy got off to. Oh, there she is. She's our, our government relations, uh, guru, uh, to, to educate people on who to call for what kind of issues.

462. 2:42:02

     So, uh, if there's anything we can do to make that part, uh, go better, uh, let us know. Um, our agency's is, is kind of, uh, uh, like the, the, they were talking about Warren Buffett. We, we've got a lot of divisions that, that, they're, they're healthcare adjacent. They're, they're not the same, and, and so it can be pretty confusing. But our bigger, uh, divisions are, of course, um, State Health Benefit Plan, which provides the health insurance for all state employees and you and I.

463. 2:42:34

     Uh, we have the, uh, what we call Medical Assistance Plan, which most people call Medicaid. Uh, so we have that, which is one of our bigger divisions. Uh, we have the Health Planning, which is most people know as CON. Uh, and then we also have the Health Facility Regulation division, and that, that division licenses, uh, healthcare facilities like hospitals and, and nursing homes. And then in, in, uh, conjunction with the CMS, our federal partner, we do the, the surveys to make sure that the quality of those facilities meets the, the federal and, and state standards.

464. 2:43:16

     Uh, and then we also have, uh, our own internal Office of Inspector General. Uh, as most of you know, Medicaid fraud has been in the, uh, spotlight lately and, uh, uh, our team is, uh, uh, small but, but mighty in trying to make sure that the state dollars that we're a-appropriated, uh, go to where they're supposed to go and, and not to some criminal enterprise that's taking advantage of, of the system. And we, we take that role very, very seriously, even though it is, like I said, a very small part of our, our infrastructure.

465. 2:43:52

     Um, great to be in a, in a small town. Uh, I'm familiar with this region because my in-laws, uh, moved to, uh, Pickens County when they were, uh, retiring, and they lived there for twenty-five years. They're, they're now passed, but, uh, this is a beautiful part of the state, and, uh, even though I, I get nervous because I'm a flatlander and don't, don't really like hills and curves, but it's, it is beautiful to be here, and I thank the facility for inviting us. Now we're gonna get quickly into the, the meat of the program, which is the, the Great Health, uh, Plan that was part of H.R.1, a federal law that passed last summer, uh, uh, in the, uh, Trump administration.

466. 2:44:35

     And as part of that omnibus bill that is, is, has huge implications across, uh, many, uh, areas, one of the things that came out of that was this grant program fed- from the federal government to focus on rural health for, for states. And, um, the, uh, timeline on that, uh, award was unprecedented in that the bill passed in the middle of the summer, and they expected a, a, uh, application in by, what was it?

467. 2:45:07

     Middle of the fall. Uh, so, uh, i- i- in, from a federal government to work that fast, most of us would, would just think that's impossible. You can't do it. Um, and I can promise you every week between when that was announced, when the deadline, the, the kept changing. Uh, the, the, they would come out with what they call frequently asked questions, which really weren't questions. They were directives to say, "This is what you're gonna do with this, and here's things you can do.

468. 2:45:38

     Here's things you can't do." So fortunately for, for, for Georgia, the governor's, um- Was the designee for this money just to understand the process. This is a federal grant that, that as part of the legislation, the, the money was given to the, or the process was given to the governor to decide how to apply and then how to implement. And the governor designated our agency to, to be, uh, uh, the lead on it. And then, you know, as it, as it goes downhill, I appointed our, uh, Medicaid director, Stuart Portman, to, to lead the project, uh, internally.

469. 2:46:16

     Uh, and Stuart, for those of you who haven't met him, we hired him. Uh, he was a staffer in the U.S. Senate in, in healthcare and had been there for over 10 years and had written, uh, many of the, the laws that affect healthcare, uh, across the country. And, uh, it, it really helped us because he knew the people that were actually writing the, the legislation and knew the people that were gonna be regulating us o- uh, from an oversight standpoint at the CMS.

470. 2:46:48

     So, uh, we, we've got kind of a heads on a lot of people, and I credit him for us being one of the first to send in a complete application. And, uh, we, we've gotten a lot of positive feedback from CMS on, on the work we're doing internally to kind of meet the, the, the standards that they have set for this program. Uh, it's very ambitious, uh, and, but it's also, um, targeted.

471. 2:47:19

     And, you know, we have to follow those guardrails that they have implemented or they take the money back, you know. And, and they've been very clear that if we, we get outside of the guidelines, that, that, uh, that, that money can be taken a- away from us. So as you see on the slide, there's some, some of the timeline there that we, we did submit our application in November. We got, uh, the funding released in, in February. Now, that, that just means that, that we could start the process of spending money, didn't mean we got any money yet.

472. 2:47:54

     Uh, these, uh, grants are, um, the type of grant that's pretty common in, in that we, we have the awardees that, that Emily, uh, will get into. They have to send invoices, and we pay those invoices. So th- this is not we give you money and you go spend it. It's you go spend the money, and then we re- we, we pay it back. And that's a, a critical piece of this type of grant that a lot of people just don't understand.

473. 2:48:25

     And when you have organizations like small, tiny rural hospitals that are struggling to m- to make payroll, sometimes they don't have the money to spend to be paid back. And so we're having to, to work on, on those issues. But again, our, our hands are tied to the degree that we, we just can't do it outside of the, the guardrails that are set, set by the federal government. Or like I said, they'll just disallow it, and the money goes away, and that doesn't do us any good. But one of the things that, that when we first got the award, uh, and we sat down internally as a leadership team, um, 'cause those of you that know, uh, my background is in healthcare.

474. 2:49:06

     Uh, I, I delivered babies in a, in a small town for 30 years. Um, I was a hospital administrator, uh, during my latter part of my years in practice, uh, working as a chief medical officer, which in a small hospital, there were only three out of four of us in the leadership room. It's not like we had 40 people and a, you know, a, a, or a budget. Uh, but I saw firsthand the struggles of making payroll, paying vendors, uh, and the fact that the business model in rural healthcare when it comes to service delivery is broken.

475. 2:49:39

     Um, you know, there is no, um, um, uh, margin to, uh, to invest new infrastructure to do the things that you need to do to keep an organization going, um, when, when you're barely making payroll. You know, that, that business model is, is not viable, and it's a complicated reason. And, and one of the previous speak- speakers mentioned the fact that, you know, our healthcare system has developed over the last 100 years, uh, and it's trying to move from reimbursement-based of service, you do a service, you get paid X, to a quality-based, value-based model, which means if you do really well, you're gonna get more money.

476. 2:50:25

     If you're not doing well, you're gonna get less money, which is the proper incentive, uh, from my standpoint. When I was practicing medicine, the idea that somebody that did a very poor job got paid the same as, as me that was p- trying to bend over backwards to do a good job was als- always a- an issue that I just thought was, was unfair. Um, but for hospitals to succeed and do better financially, they've got to be able to invest in new service lines. They've got to start thinking, uh, about, uh, IT infrastructure, uh, all of the, the different things that go into being able to manage a patient in this modern world.

477. 2:51:05

     It is not when, when I first started, and I had my black bag, and I actually went to some of my patients' houses when they needed something. That, that world just is gone a long time ago, and we've got to, to utilize technology and, and, uh, all of the, the, the modern systems in place to make sure that, that people have, have access to care. And that's what we designed this program was to look at individual counties' health systems, what, what are their positives, what are their negatives, and then we're going to try to work with CMS to develop a, um, payment reform system that will actually Award-- reward hospitals that, that invest in this infrastructure and begin to have better outcomes.

478. 2:51:54

     And, uh, that's our, our goal, is to make sure that we stabilize rural facilities from a financial standpoint and use this, uh, new infrastructure to reward them for actually delivering the services and make sure that it's sustainable from the standpoint of they can keep their doors open, which is what, of course, is the bottom line. You wanna go to the next slide. There you go. Um, we've talked a little bit about the, uh, the program itself.

479. 2:52:28

     The, the darker counties on this map are the, are the ones that actually c- are considered rural by the federal government. Um, we also have in this, uh, initiative some of the hospitals that are in referral centers because the, the care network is so complicated that a rural hospital is, is doing primary care and some specialty care, but you've got to have the access to the tertiary centers where i- if somebody needs a heart transplant or somebody needs advanced cardiac surgery, you've got to get the systems in place for that transfer to, to happen.

480. 2:53:05

     So although we focus on rural hospitals, there are certainly, uh, what we call rural referral centers that are also engaged in this initiative with us. And people like, um, Phoebe and, uh, Navicent in Macon and, uh, um, Valdosta, the, the, uh, Savannah, uh, Columbus. So th- those facilities that take care of a lot of rural patients because they're in the middle of rural Georgia are also partnering with us.

481. 2:53:35

     And I'm going to, uh, turn it over to Emily now to go into more details on the different, uh, buckets and some of the, the-- go over some-- where some of the dollars are being spent. We don't have time to go into really, really deep detail, but, uh, anybody that needs more information, of course, reach out to, to, to Brandy. We've spoke to, uh, one of your other study committees yesterday in Macon. Emily gave a presentation to, to, to some of the healthcare folks there.

482. 2:54:07

     Uh, and so we are trying to make sure we educate the legislature on, on the process. And again, sometimes it's, uh, what we can do and what we can't do with the money because of our, our federal requirements.

483. 2:54:22

     Thank you, Dr. Burke, and good afternoon. Great to see everybody. Um, my name's Emily Hatchett. I work with the Department of Community Health as senior advisor to the Medicaid director. Um, started about a year ago, so I'm about as old as, as the Great Health program itself. Um, but has-- it's been a really great opportunity to get to, to work with Commissioner Burke and, and the rest of the team at DCH. Um, so we'll just share, like you said, very high-level details of, of what we are, are doing with the Great Health program, and, and happy to answer any questions as you have them.

484. 2:54:56

     Um, so for year one, important to note this is a five-year program. Um, and we do receive our funds one year at a time from the federal government. So for our first year, Georgia was awarded two hundred and eighteen point eight million dollars. Um, with that two hundred and eighteen million, we have divided it amongst five initiatives, and within those initiatives, there are twenty-nine strategies. So, um, the goals of, of those different strategies and initiatives are to improve health outcomes, increase access to care.

485. 2:55:30

     We've heard a lot about that today. Um, and then of course, like Dr. Burke was mentioning, strengthening rural healthcare systems and supporting the long-term financial stability of, of health in rural Georgia.

486. 2:55:43

     So we, we had that first little timeline slide about what happened kind of from, from July fourth when the Rural Health Transformation program was created, um, all the way up until, you know, we, we received our award and started implementing. So since then, we have been working with lots of sub-grantees. Um, we awarded the first five in April to be able to, um, get started on their projects. These were, um, sub-grantees that we have worked with in the past who are ready to roll, ready to, to get, you know, started on their projects.

487. 2:56:17

     So because we have about a hundred and sixteen different sub-grantees, we had to divide them out. We, you know, building everything from the ground up, grants management system, staffing, um, we really needed to, to phase out as to not overwhelm ourselves and, uh, also the sub-grantees as we were-- we're trying to build everything. So progressively, um, have, have awarded all, all a hundred and sixteen sub-grantees, um, through the month of July and, um, as of July thirty-first had fully obligated our first-year award of two hundred and eighteen point eight million.

488. 2:56:54

     And this is a high-level overview of, of the five different initiatives that we have. Um, there is a lot more detail for these on our website. Um, and I'm happy to, you know, if you have any specific questions, once again, answer those in relation to this. But that first, um, initiative, transforming for a sustainable health system, really focuses on, on what Dr. Burke was talking about a moment ago. So, um, that is the project that will, um, you know, is focused primarily on our rural hospitals. So, um, within that initiative, we have granted seven hundred and fifty thousand dollars to each of the, um, eighty-seven hospitals that signed on to, to work through the pre-implementation, um, stage with us.

489. 2:57:37

     So there were ninety-three eligible Of those 93 that were eligible based on their geographics and the populations they serve, um, 87 of them decided to work with us. So we're really excited about that, um, and are working very closely with each of those hospital CEOs and CFOs to, um, you know, make sure that they have as much information as they can and, um, you know, utilize those funds to go towards what their rural community sees as a need. So, um, we realize not every rural community is obviously going to be the same, and so making sure that we have projects that are tailored specifically to the needs in that community, um, were really important to us as we were building this out.

490. 2:58:16

     The second initiative, um, is really where we have a lot of our partnerships with our other state agencies. So the Department of Behavioral Health and Developmental Disabilities, the Department of Public Health, um, both have quite a few projects in, in that, and we're also working with the University of Georgia on a disaster preparedness initiative, um, just based on the devastation from Hurricane Helene, working with some of our, um, rural hospitals and nursing homes to build up their infrastructure as much as we can within the, um, parameters of, of the grant we were given.

491. 2:58:49

     Um, the third project is all about connecting to care. So, um, that is where we have, um, some telehealth projects, um, working with our, our rural hospitals through stabilization grants, um, similar but a little different than the ones that, that are funded at the state level. Um, and then also some mobile health services that will be starting to be fund- when we hopefully, fingers crossed, get our year two award in October. So the fourth one is focused exclusively on healthcare workforce, so that includes both, um, early exposure to healthcare careers as well as graduate medical education, um, some emergency, um, EMS, paramedic, um, education and training awards that were mentioned earlier.

492. 2:59:42

     So those will fall into that fourth initiative, um, as well as a project with the Alzheimer's Association on, um, provider training for, for dementia. And finally, um, the fifth initiative is all about technology. So through that initiative, we will be, um, working with hospitals and providers on en- enhancing their electronic medical records, um, working on cybersecurity, um, other AI and digital tools that may be of use to hospitals, um, as well as we've awarded several surgical robots to hospitals, um, rural hospitals in the state to be able to expand their surgical services, um, through, through that mechanism.

493. 3:00:23

     So very high level, like I said, lots, lots more detail on, on the website. Um, but wanted to, to share this. We've already talked about 218.8. It's all been obligated, so, um, with our 116 different sub-grantees. There are a couple that have multiple awards, um, but all of those dollars have, have been obligated, as Dr. Burke said. It's reimbursement basis, so, um, the mon- That does not mean it has been spent yet, but we have an additional year to, to actually do the spending, um, on this 218.

494. 3:00:57

     So we are working hard with our sub-grantees now to make sure they have full plans and are, you know, know how and when they're gonna spend those dollars.

495. 3:01:10

     And the most important thing I want to kind of like point out up here, uh, on the top right corner, um, is, is the year distinction. So, um, our, our first year does end this year in, at the end of October. Um, so when we say we have year, year two awards coming, it is imminently upon us. We are, we are awaiting that number from CMS. Um, hopefully, we're keeping our fingers crossed, it will, will be even a little more than this first year. Um, but, but once we receive that award from CMS, we will be able to, um, proceed with, with further grant activities other than the ones we- I've mentioned today.

496. 3:01:49

     Um, but with that in mind, it is, I guess, important to note that the-- since the program is for five years, um, CMS did tell us at the time of application, um, that this would be one application for all five years. So we are not authorized at this time to add any additional projects. Um, there may be, there will be, there are competitive grants within this, so between years, there may be different sub-grantees that, that receive funds. But as far as, like, the actual projects that are within, that will be funded from the program, those are set at this point.

497. 3:02:25

     Um, so just a good distinction, I guess, for everybody to know.

498. 3:02:32

     And as we look towards year two, um, we're expecting to get our, our year two award sometime in October. Um, and that year two award will be based on, um, the, all of the rurality considerations they had from the year before, um, as well as our performance in, in year one. So, um, like Dr. Burke said, we've had, we've had good, um, reports back from CMS, so we are hopeful. Um, but we'll be building on, on the progress we made in year one with, with these year, year two dollars.

499. 3:03:04

     And this is where you can-- the types of information you can find on our website. Um, it's greathealth.georgia.gov. There's lots of information on it. Um, and we do h- we are holding quarterly public awareness webinars. Um, so would, would definitely encourage y'all to, to sign up for our updates, um, and to attend those if, if you have any interest in learning a little bit more. Um, we have sub-grantees that present on those. Um, we'll share updates and, and share out our, our year two award as soon as that is in our hands.

500. 3:03:37

     So anything else you want to add?

501. 3:03:41

     Well, one, one thing that's, uh- Uh, I- important to note is, is as, as, as Emily mentioned, uh, w- we still have people say, "How can I get some of that money," uh, a- a year later. Uh, and we are always interested in vendors that have something to bring to the table that might help us deliver care better. Our, our door is always open. I, I, I, I unfortunately have to have two meetings a week just to plan my calendar because of all the requests that, that we get for, for FaceTimes for people to say, "I've got something that you- that would save the state a, a billion dollars.

502. 3:04:19

     It might make me 10 billion dollars." They don't tell us that part. Uh, but anyway, the, the innovation part of this, uh, Dr. Oz actually came to Georgia last, uh, fall, and, uh, he was speaking at a, at a conference, uh, in Atlanta. Uh, and he came by the Capitol, and he, he couldn't say the word innovation, you know, uh, 100 times i- in a- in 15 minutes, but he did. Uh, that they are looking for us to try new things, and we talked a little bit about earlier, I heard y'all talk about doing things the same way, uh, because that's the way we've always done it.

503. 3:04:56

     And, and that's the, the furthest from our mindset on this as possible. We, we wanted people to bring us ideas of things that would be, uh, innovative. And a small part of this grant also allows us to, uh, do, uh, awards to startup companies in Georgia that are investing in, uh, innovating in healthcare technology that we're working with Georgia Tech, uh, because they already do that. Uh, uh, so we're, we're working with them to actually let Georgia be the leader in, in investing and, uh, developing new, new things that will help Georgia lead in, in rural healthcare.

504. 3:05:35

     And, and I'm excited about that. Um, glad to answer questions, uh, and if there, there are not any, you know-

505. 3:05:45

     Thank you

506. 3:05:45

     ... ready to eat.

507. 3:05:46

     Thank you, Emily. Thank you, Commissioner Burke. Is it true that you're gonna be joining us for lunch?

508. 3:05:51

     Uh-

509. 3:05:51

     We would like to-

510. 3:05:52

     I'm gonna try to. My-

511. 3:05:53

     Okay. Well, I think what we might do in the interest of time, since we're, we're running kind of late, and to keep our afternoon, um, presenters as close to on schedule as we can, if it's okay with you and our members if, if maybe if we've got questions, we could talk to you as we're eating lunch.

512. 3:06:10

     Absolutely.

513. 3:06:10

     That... Okay.

514. 3:06:11

     Yeah.

515. 3:06:11

     So okay, great. Thank you for that flexibility. Well, our food is ready. And I, I just want to say, I really appreciate understanding the way this money is, is coming out. I didn't... I did not have that clear understanding, and so I want to thank you for that. That was, that was really good for us to know.

516. 3:06:32

     The whole grant.

517. 3:06:33

     Right.

518. 3:06:33

     It's not that color, but those would be normal appropriation funds.

519. 3:06:37

     Mm-hmm.

520. 3:06:37

     So, you know, we did our best to make sure we communicated with the, the House and Senate leadership, and we had open houses and town halls all over the state last August-

521. 3:06:50

     Mm-hmm

522. 3:06:50

     ... to develop our plan. And I think we ended up with almost $2 billion of recommendations. We only had 218 million to spend, so we had to say no to a lot of great ideas, but that's just, you know-

523. 3:07:03

     Right

524. 3:07:03

     ... not enough resources to go around.

525. 3:07:05

     Right. Well, I, I do thank you for administering this and for, for clarifying this with us and for, for... So committee members at lunch will have time to speak with Commissioner Burke and with Emily with any questions. Our food is ready. Committee staff and any, uh, presenters and sponsors are welcome to join us, uh, for lunch in the same room where coffee and donuts were earlier. Also, committee members, Leo will email out all of the presentations from today. Um, and House Media Services will post that on the House website as well.

526. 3:07:35

     So we'll have access to that. And also, uh, he's, he's out there in the hallway, but I did want to acknowledge that Chris Dockery is here with us. He is candidate for, uh, State House for, to rep- Um, h- what big shoes to fill, but he's... Somebody's gonna have to. So if you haven't had a chance to meet Chris, he, he's out here in the hallway. Hi, Chris. There, there he is. Yeah, ha- Say, say a few words to Chris over lunch if you can.

527. 3:08:06

     So we will stand adjourned until 1:20. We'll take a shorter lunch than planned, but that'll get us back in here as quickly as we can for our after- first afternoon presentation. Okay.

528. 3:41:06

     Yeah.

529. 3:41:08

     Speaking to me.

530. 3:41:25

     We get it.

531. 3:41:28

     Uh-huh.

532. 3:41:32

     Beating me somewhat. I know. The two days, uh-huh. Amen.

533. 3:42:56

     I'm gonna call the meeting back to order. I've realized the only way to get anybody in here to sit down is to just call the meeting back to order.

534. 3:43:05

     So, so that means, uh, Danny O'Steen's gonna have to sit down.

535. 3:43:12

     Danny, we appreciate you.

536. 3:43:17

     You look like you're doing okay.

537. 3:43:19

     Let me switch screen.

538. 3:43:22

     Well, somebody asked before we, uh, broke for, right after we broke for lunch if they would let just anybody in this building. And to prove that, yes, they will, Chairman Kasey Carpenter has arrived to join us. He is here.

539. 3:43:44

     Yeah, because I'm not service.

540. 3:43:48

     And you loved every minute of it.

541. 3:43:50

     Yeah.

542. 3:43:50

     Okay. All right.

543. 3:43:52

     Let's get control.

544. 3:43:52

     Let's get serious.

545. 3:43:58

     Okay, first up, we've got, we've got two more presentations here this afternoon, and I think we still may get out of here at 2:00 as expected. We're gonna try, but we want to, um, uh, hear the, the good people that have come to present to us today. Uh, first from the Georgia Association of Community Care Providers, James Pettus, the president, is here, and I see Holly there with him. Thank y'all for being here to talk to us today, and the floor is yours. And, uh, members, we'll, let's save questions to the end of the presentation.

546. 3:44:30

     I think that'll be quickest way to do it.

547. 3:44:31

     That'd be great. Thank you. Uh, Chair Hagan, uh, Vice Chair Campbell, Secretary Buckner, all members of the committee, and hopefully from the ones that are watching, you know, from home or other, uh, meetings, uh, thank you all for the opportunity to come and speak on behalf of GACCP. We are the Georgia Association of Community Care Service Providers. So I was, as I was preparing for this meeting today, I was reminded of a song by, I know him as John Cougar Mellencamp, but could just be John Mellencamp now he's changed it up a little bit, but, uh, Small Towns.

548. 3:45:16

     Now, y'all don't worry, I'm not gonna break into song and start singing, so y'all can relax. I probably still got a little lunch hangover coming in, so, uh, but I'm not gonna sing you to sleep, so we're good there. But I do want to talk to you today about what it takes for people to keep calling these rural communities home. Now, I come to this meeting today with a very well-traveled Georgia, uh, map. So I do business throughout many rural communities and, and it's by choice.

549. 3:45:50

     So some of those cities are Jeffersonville, Cochran, Soperton, Hazlehurst, Sparks, uh, Donalsonville, there with Chairman Burk at Great Grands Personal Care Home, uh, Colquitt, and then Edison, both of which are in, uh, Representative Greene's, but he was not able to be here today. So at this point, I think if rural Georgia needs a poster child, y'all just let me know where to submit my application and I will be very, very glad to, uh, to assist in that process, because I'm very familiar with all things rural.

550. 3:46:24

     Uh, one thing I would like to mention, and, and then, uh, Representative Stinson, thank you very much. Great to see you again from, uh, Reynolds, Taylor County. Uh, she and I work very closely together on bringing, uh, Mercer Medicine to, uh, Taylor County. So, uh, so when I say that rural health in rural Georgia is near and dear to me, it is, but it's substantially more than just having a building. Uh, it's about having care close enough to those for the people to use.

551. 3:46:54

     So rural Georgia is not, you know, abstract to me. This day and time you hear rural hospitals or rural Georgia, but I know rural Georgia very well. So we talk about rural development, I want us to talk more than where people can just earn a living, but we also need part of that conversation to be what it takes for the people to keep living there when they need help. So as I referenced earlier, John Mellencamp gave Small Towns a song, but today I want to talk with you all about helping people stay in theirs.

552. 3:47:32

     So who is GACCP? Well, I'm here as a provider, owner-operator, but I'm speaking on behalf of a organization whose work reaches well beyond my own businesses. So GACCP, we represent aging Georgians, uh, people with disabilities, uh, both intellectual and developmental disabilities, uh, adults that receive care at home or, or in their communities, and also under this is the medically frail children.

553. 3:48:08

     So as you can see, with GACCP and the waivers, we cover the gamut. Now of course those are, you know, all different needs at, at different ages of life, but what connects them is the importance of having the right support available where a person lives. So instead of speaking in abstract art like the Pendley hanging on the wall out there, who was a dear favorite arborist of mine until he changed his tone, but nonetheless, but I wanna give these individuals names.

554. 3:48:39

     So I want you to picture Ms. Ethel. She had no children by choice. She has outlived all of her family members. Her health is failing, but she really wants to live at home, but certainly in her community because she chose to live in rural Georgia by choice. But now she might need help with bathing or dressing, maybe just getting through the day safely. She's also lonely.

555. 3:49:10

     Or a- another name that comes to mind is, uh, Stacey, who she's working, single mom, taking care of her mom, who didn't think she would be in this position, but because of her mom having a stroke, now she's cho- you know, faced with the choice of, uh, what am I going to do? Mom can't care for herself. She could stay home. Maybe she'll take her medicine. Maybe she'll eat. If she does eat, will she burn the house down? I, I hope not, but these are all very real, very real decisions that Stacey will have to face.

556. 3:49:47

     And then finally, I'll say Ms. Smith, 'cause this really resonates with me, is, uh, Ms. Smith sent her son to school, 13-year-old, as any other day. He was playing on the playground, playing soccer. Tragic accident, soccer goal falls, hits John in the head, traumatic brain injury. So now here is Ms. Smith, 30 years later, is still taking care of her son.

557. 3:50:20

     So what does she do? And all of these people that I've just, the abstract names are, they all qualify for services that are under GACCP. So none of these examples I listed, I mean, they're not asking for anything extraordinary. You know, they're just trying to make the ordinary day, you know, work, kind of the daily grind, the ins and the outs. So I really want you all to keep these families in mind as we talk about what these services I'm about to list, what we actually do.

558. 3:50:54

     You might have heard this topic, HCBS, Home and Community Based Services. So what are these? Well, do not fret, I am going to tell you. For these names I just mentioned, it could be Ms. Ethel. She could stay in her home, maybe go to the adult day health. It could be that maybe she, for the socialization aspect, she wants to go ahead and, and move into a personal care home. Or Stacey, that working daughter who's taking care of her mom, it could mean that she could bring in a caregiver through patient support services.

559. 3:51:28

     Uh, she could help mom get dressed with the meds, maybe even have Meals on Wheels delivered so mom doesn't have to worry about cooking, and we know she was, uh, very well fed, or in some cases, maybe even an emergency medical device. And back to, uh, John and Ms. Smith. Uh, John, he attends our adult day health. He also, uh, has a aide that comes in the morning and the afternoon. And then because he will eventually age and his health will probably deteriorate given his conditions, he will probably have placement in a personal care home.

560. 3:52:04

     So as you see, there are many different services that are under the GACCP umbrella. But that's what we mean by Home and Community Based Services. HCBS is not one service, but it's a range of supports ma- to match the different need. So you may have seen some of these in your own community, even if nobody has introduced it to you by, you know, its initials. But back to Stacey, you know, the mom, Ms. Smith, with the right s- with the right support, they can receive the help that they need, and they can find their new normal in their home, or preferably in that same rural community where they chose to grow up.

561. 3:52:49

     They can make a plan for tomorrow without starting from scratch. And this maybe doesn't sound dramatic, but that's the whole point. Sometimes in life, just the ordinary day can be a, a great outcome. Hey, family's still family. We're not trying to take the place of family. We know we cannot do that. But we can help by making care sustainable. Instead of asking the family to fill every gap, burn the candle at both ends, there are services that are out there.

562. 3:53:21

     But behind those everyday supports are several different Medicaid programs.

563. 3:53:29

     Now, as you look right here, this kind of looks like a eye chart, I think. I don't know if you've been to the eye doctor lately, but, uh, I kinda refer this to as, uh, our alphabet slide. So I do not know why state government likes to use so many acronyms, but I'm going to kind of break these down for you. So you'll see some names like CCSP, Source, now in comp, ICWP, GAPP, ElementOP.

564. 3:54:00

     All right, uh, uh, I got to chuckle. Somebody is paying attention. That's not on there. That was a test. But you'll see G- GACCP represents the providers helping older Georgians, the people with disabilities, both intellectual and develop- you know, developmental, as well as that TBI client I referenced earlier. These adults can receive care at home or in their communities.

565. 3:54:24

     While the eligibility and the rules and the services, they all differ, those distinctions do matter, but I'm not going to try to tackle that today. But y'all just remember Stacey, her mom, Ms. Smith and her son, and Ms. Ethel. It's a common purpose, but the goal is to help eligible Georgians receive the support they need and to continue to live in rural Georgia. And first, that question with Stacey, with her, you know, working, it's what am I gonna do with mom?

566. 3:54:59

     But once we solve that, like in rural Georgia with the changes that could be facing, you know, well, the, what, what will we do with her? And what do we do if no one is available?

567. 3:55:17

     So here you will see a, uh, chart of home and community-based services to help protect rural healthcare capacity.

568. 3:55:29

     So the local provider in some of these, as we're facing some of these challenges, the local provider can no longer may be able to s- deliver the service in rural Georgia. Maybe there's no placement nearby. The mom still needs help. The need hasn't changed, but the change is their ability to manage it. And we understand that every missed service is not necessarily a, uh, an emergency. But when gaps persist, families are referred to the emergency room, hospitals or institutional care.

569. 3:56:01

     And don't get me wrong, hospitals and institutional cares, they certainly have their proper place and essential roles, but they're certainly the more expensive options of healthcare delivery. So based on the Georgia Rural Health Transformation, it reports that there are 53 counties in rural Georgia that do not have a hospital. So you heard some of that earlier, and the ones that are in rural Georgia, their resources are strained, and it's a very, very expensive cost of delivery.

570. 3:56:33

     So when we talk about protecting local healthcare, we can't as- we can't assume there's just another option down the road. If we were to lose providers in these rural counties, it would leave the family trying to solve the problem. By the home and community-based services and GACCP, we belong in the rural healthcare conversation. It's a rural health provider reality.

571. 3:57:00

     This is where my operator hat comes back on, delivering care in rural communities. Now, rural communities can be challenging. You have a smaller workforce, further distances to cover, distances to travel. You can have two people that need the same help. One may live closer than the other receiving the services, it could be a long drive away. The need's the same, but the resources to meet those needs are th- not required. That's why when you hear the phrase, uh, provider st- stability, I wanna give that a human translation to kinda tell you what that means from the provider/operator standpoint.

572. 3:57:37

     So in rural Georgia, if someone is available to deliver the care, it means service can continue to the next month. It means the family doesn't have to start over because the practical provider stopped serving the area. Now, in a larger market, if you lose services, maybe you go to the next provider, you more than likely have other choices. But in a rural community, it can mean losing the service itself. Provider stability is access to care, and one of the things that makes that stable is sustainable reimbursement.

573. 3:58:15

     So I certainly want to acknowledge the, uh, investments that the state of Georgia has made for reimbursement rates pertaining to the EDWP services and Medicaid reimbursements. Uh, y'all have made tremendous progress, and thank you very much for that. Had it not been for those rate increases, I can tell you several small businesses in rural Georgia pertaining to personal care and adult day health would be out of business. But the question is now is, how do we keep reimbursement connected to the actual cost of delivering the care? Like for example, a rate study was conducted in 2023, fully funded in 2024, but what does that mean?

574. 3:58:53

     It means that I, my businesses, I'm paying 2026 prices for rates that were based on 2023 rate study. Now, I'm, I'm not an actuary. I, I did not stay at the Holiday Inn Express last night, but as my wife says often, it's just math, not magic. So when you're tr- and the reimbursement for personal care homes is $67.04 per day. And some calculations regarding AI, things like that, if you consider, there are several calculations, consumer price index, household goods, all of that, apples to apples considering we're in north Georgia, instead of that rate being $67.04 a day, it should be $77 per day in 2026.

575. 3:59:39

     And for example, and we- hopefully the gas increase is just temporary, but all of our employees, all of our caregivers, all of our people traveling to and from are still absorbing those prices and are still getting the same reimbursement rates. As I said, in rural Georgia, that's just different. You know, you don't have as many possibly employees to choose from, you know, but just because you're being approved for care and being able to get the care, it's not the same thing. So a Senate bill was passed, 610, that requested a rate study be conducted every, uh...

576. 4:00:15

     a comprehensive HCBS rate study conducted every four years with public and provider and stakeholder input. So my request is that we use that process to bring real delivery costs into the conversation and including rural costs that we've just discussed. And hey, we understand a review is not an automatic increase, but it's a way to put evidence in front and make people-- of the people making the funding decisions. So in rural Georgia, you know, we want our members to expect good care. A- And we understand this res- you know, you have a lot of responsibility with public use of dollars.

577. 4:00:50

     So we need a payment structure that makes delivering that care possible. And again, I wanna remind you of Miss Ethel, Miss Smith, and Miss Stacy. The goal was for the help to be there, for them to receive that help, and then to be able to keep it. So I'll touch briefly on, uh, when home and community-based services move to managed care and what would that look like. And to be honest with you, uh, we really don't know. Lots of moving parts. We really just do not know. But the home and community-based services, if it were to move into managed care, it's not just simply who would process the bill, but it's who makes the decisions that affects the care, whether it reaches the person.

578. 4:01:32

     So as you see on the man- uh, on the model on the right, you know, under managed care, the organization receives a per-member payment, assumes financial risk. It also takes on a role in provider networks, payment rates, and authoriza- and authorizations and level of service.

579. 4:01:49

     But many of you probably know senior citizens and how many of them like change. So there's a good chance that they normally want to go to their same provider at the same place the same time. They have their caregivers that they like. They have the personal care homes they want to live in. They have a choice. But with managed care coming, and it's not very clear what that might look like, but we're counting on these providers out in rural Georgia to be able to decipher the contracts, to negotiate potentially their own rates.

580. 4:02:22

     And I found the people that in the business-- I've been asked several times, like, "Why are you still in this business, and what are you doing?" And I say, "Well, I was a very ambitious twenty-something-year-old, and I'm kinda stuck, and I can't get out of it." I mean, to the point that my kids are like, "Yeah, Dad, I'm coming to work with you." And I'm like, "Hang on a minute, Junior. I don't know that that's really what we wanna dip our toe in that water." So but regarding managed care, the biggest questions that, you know, need to be asked is what will happen to the person who needs to-- the person who needs to care, what will happen to them under managed care?

581. 4:02:56

     Will they get it, and will they be significantly impacted? So in rural Georgia and communities with very few providers, we just need to ask those questions before a change, not after you've lost that option. As I said earlier, uh, rural Georgia's different. So certainly managed care could very well potentially hit different in rural Georgia. Uh, the provider who's been helping, you know, Stacy's mom or Miss Ethel or John, the member of our adult day, we're not sure they'll secure that contract.

582. 4:03:34

     I heard it mentioned earlier, kinda like with, uh, with-- kinda same with rural banks. So I have several businesses in rural Georgia, so I understand it. But banking is probably one of the best, uh, examples I can think of. A, a dear friend of mine who has passed, uh, Mr. Charlie Curry over in, uh, Calhoun County, very small rural bank. Same exact rules and regulations as every single large bank. Exponentially fewer resources. His asset list was not the same as some of these large banks that were held to that same accountability.

583. 4:04:08

     But that's the exact same. People are familiar with banks. We have to use them. But with, you know, providers, it's the exact same thing. It's a smaller, they don't have the same resources, same quality of care, same rules, uh, it's the pr- owner-operator, you know, that's wearing all the hats. Now I'm wearing the attorney hat, trying to decipher all the code and the conduct and hopefully renew a contract.

584. 4:04:38

     So kind of I'd ask probably four practical commitments just to kinda keep in mind as, you know, managed care is, is coming. Uh, just consider if it were your loved one or some of the examples that I've used today. Uh, after being on the front lines, I would pr- highly encourage to keep, keep care local. People like to, again, go to the same physicians at the same place they've always gone to. Secondly, I'd ask that you protect the people and the providers that deliver that care. You're looking at reimbursement, staffing, trial, administration requirements.

585. 4:05:11

     The service has to be workable in the place where someone is willing to provide it. I know in some rural counties, there are members who are approved for Medicaid, but it is not economically feasible for that provider to send their caregiver to receive those services. Third, I would say before changing the system, let's ask what happens locally. Now, I fully understand in law and passing, uh, laws that there are always some unintended consequences that happen. It, it just does.

586. 4:05:41

     And thank goodness sometimes y'all go in the next session and clean up some of those unintended consequences. But maybe we should have a real in-depth conversation of what that might look like or, or what could happen. And then finally, uh, connect the whole system of care. And then Chairman Burr mentioned that earlier along with that great health rollout. Th- That is a really, really big part. And I think if we could get the hospitals working with these GACC providers who are delivering these Medicaid services, not so much a holistic approach, but everybody is on the same page because we see our individuals so many times that we know if this is their baseline or not.

587. 4:06:21

     So instead of them going to that emergency room, then we could refer them to the local healthcare provider.

588. 4:06:30

     And as you know, on behalf of GACCP, we would certainly really welcome, you know, any opportunity to help, you know, pursue what it might look like, you know, have the conversation You know, a- and more importantly, just making sure that we continue to give the Georgians the, uh, health that they certainly deserve. So, I mean, home and community-based services and all the waivers that you saw here mentioned, we are a vital part of that rural healthcare infrastructure.

589. 4:07:03

     So at this time, open it up. Any... Went a little longer than intended.

590. 4:07:13

     Thank you, Mr. Pettus. And, um, you do have some questions. I'll start with, uh, Representative Stinson.

591. 4:07:21

     Thank you, Madam Chair. And thank you, James, for being here, so good to see you and Holly today. Um, but my question's quickly. Um, what does-- for these changes that you referenced, what does this mean for home health, um, workers, uh, individuals that are, you know, going around serving, uh, helping individuals with their managed care? What does this ch- these changes mean for those workers? And secondly, what could you say to, or what advice can you give to, um, uh, individuals that may be interested in starting such, uh, such a business as, as, as home health service-

592. 4:08:02

     A- as home health, I would-

593. 4:08:03

     Or personal care homes or-

594. 4:08:04

     Yes, ma'am. I would, uh...

595. 4:08:06

     If you would-

596. 4:08:06

     Well, thank you very much, Representative, for the, uh, question. So with managed care, the caregivers that are out working that are being employed in rural Georgia, if their provider were not be selected as to r- if they did not sign up with the contract or they have a different contract, let's just say the employee had been going to the same house several days, you know, a week, and maybe that their employer did not receive a contract from that managed care provider, then they would not go to the same place. So I mean, could it result in a loss of service?

597. 4:08:38

     Yes. Could it be that the caregiver might have to go work with another provider who did enroll under that contract? Absolutely. And, uh, the last question regarding, uh, people wanting to get in the business, uh, I would really say count your costs and, uh, you th- develop a timeline and a budget and then honestly double it because, uh, r- I'm in the wrong, in front of the wrong audience to say the word bureaucracy, but oh my goodness gracious, when hospitals are opening adult day health and they have all the horsepower and the plethora of teams and it still takes them exponentially longer than it should, or a provider who I know very well who's been a personal care home provider for 20 years and in great standing, when she chooses to open an adult day health, which is a completely different delivery model, granted she has had that Medicaid provider number for a decade and been flawless, it takes her 24 months to open that business.

598. 4:09:45

     24 months of paying the rent, the insurance, the phone bill, the light bill, all utilities, all costs, 24 months. So I would probably encourage, not to, to discourage them, but I would highly encourage them to, you know, count the cost. So thank you for your question, and I hope that answered it.

599. 4:10:00

     It does. Thank you.

600. 4:10:01

     Thank you.

601. 4:10:01

     Representative Buckner.

602. 4:10:04

     I'm a big fan of home and, um, community care and appreciate what you do. Uh, I- in some of the other things that we've been talking about in regards to community health, there's a, a thread that's constant, and it's where different agencies either don't or can't share information. And we live in a computer world where it ought to be a click of a button and it would save a lot of time, and, and I would think coordinated services would improve.

603. 4:10:35

     Um, I think I heard you say that there's an issue with that with you guys as well, of getting the information you need, timely manner, sharing information so the same people aren't doing to the patient the same thing-

604. 4:10:50

     Repeatedly, right.

605. 4:10:51

     Yeah. Thank you.

606. 4:10:52

     That's a good one.

607. 4:10:53

     Y- y- yes. Uh, I was trying to-- There are many examples, so I was trying to think of one that might resonate where, uh, goodness, the-- Say which, people can be eligible for a service-

608. 4:11:11

     Mm-hmm

609. 4:11:12

     ... and they can be approved. Now sometimes it crosses not even party lines, but it goes from D- Georgia DCH over to, uh, uh, the umbrella that DFCS falls under. So the client would go over, not the client, but the process, the approval process to determine something called a cost share. And then once it was finished up in that department, it would get sent back, and then it would be entered, and assumed if it would be entered correctly, then the case manager would be-- So case managers are like brokers.

610. 4:11:42

     Think about like an insurance broker. So you get on Medicaid, come down to Medicaid, and you're in the case management holding pattern, and that case manager, based on the needs assessment, will then have, you know, certainly communicate, uh, with the client their needs and requests, but also the level of care or the care plan. And then those services would be, uh, brokered out to what would be the highest and best, you know, need of that. And sometimes there have been some snags. I think, uh, we went through a system upgrade, uh, in July, I believe it was, 1st of July, and I think they have got most of those kinks worked out, but there were just some times where some providers probably went about, you know, two or three weeks, I don't wanna misconstrue, uh, you know, without receiving that reimbursement because with the transition of the PAs being uploaded.

611. 4:12:33

     But, uh, that has since been resolved or to a percentage that's ex- manageable. So I'm not sure if I answered your question, but there are several examples of just-- It's almost like the left hand doesn't know what the right one's doing. I don't know how to solve that, but it's, uh- Surely there's a way.

612. 4:12:50

     Well, but so there's been some relief in that area from what I've heard in the past, sounds like. That's good.

613. 4:12:59

     Yeah, you want to speak?

614. 4:13:06

     Okay. Sorry. I thought there might be a bit more back and forth.

615. 4:13:08

     I was gonna say, her information coming through.

616. 4:13:11

     Chairman Carpenter.

617. 4:13:12

     Yeah. If I, you know, I'm just visiting obviously, but, uh, I appreciate your presentation and appreciate the struggles that I can imagine you facing as you, as, as folks are having to travel so far to provide care. My question is, has anybody had conversations, and this may not be a question for you, but maybe somebody in the audience. Has anybody had conversations about a possibility of say, a s- South Georgia sales tax, a quarter of a penny or something to help, help communities off support funding the, the, the needs that they have?

618. 4:13:46

     Because the reality is there's never gonna be enough money to do what everybody needs to be done. But w- I would think that the importance of it, you know, we, we, you dri- sometimes you drive into small communities that have these beautiful football stadiums and brand new high schools that they've taken a penny to do, and I would think this issue's as important or maybe more important sometimes as that issue. And so I don't know if anybody's having conversations about that possibility, but I mean, I think it would be, um, I mean, if Atlanta can have money for MARTA, I don't know why South Georgia can't have a penny for, for, for healthcare and things such as this.

619. 4:14:23

     So I mean, I think as we start to, I think as we start, 'cause the reality is there's never gonna be enough money, so we've got to find funding mechanisms that are dedicated to such things and, and we've made bold decisions with transportation back in 2015, and I think it's probably time to open another box and try to figure out another funding mechanism for this, because this problem is only gonna get worse. As the population ages, it's only gonna get worse. So-

620. 4:14:50

     It will

621. 4:14:50

     ... I, I, I think that's a, I think that's a conversation that needs to start to be had because we're not g- I mean, we're just, we just keep trying to squeeze more juice out of the same orange, and that orange is not gonna get bigger, and the, and the j- and the need for the juice is gonna grow. So I think they need to have conversations.

622. 4:15:06

     That's a good point. I think that's an interesting point. Um, we don't have a limitless supply of funds, but we do, uh, sometimes I think, uh, look at, like you said, stadiums, um, things that are not unimportant or n- are needed, but the, the priority sometimes you look at it and wonder if basic, basic needs aren't cared for, um, you know, what are we doing? Thank you. That's an interesting...

623. 4:15:36

     It, I think the last question I've got here is Representative O'Steen, unless any other committee... Okay, let's have one more question, Representative O'Steen. Why do you, wh- what is the hangup i- with the set, I mean, t- somebody that has pr- provided services for 20 years with a Medicaid number and it takes 24 months to set up, is that federal problems? It's state problems?

624. 4:16:01

     There's, there's a chance that CMS made those rules. I'm not sure where the rules originated or where they came from, but it's just the unfortunate things that it just, I, the short answer is, I don't know. It, it, it does not make, there's, there's no rhyme or reason as a provider. Like-

625. 4:16:24

     I mean, I'm just thinking about the, the people that are at the mercy of the 24 months of, you know, waiting around trying to manage things at home by themselves. And I mean, my daddy became an amputee at 82 years old this year before he, he passed away nine weeks later, but you wanna talk about challenging, I mean, that w- that's tough and, and it's everywhere. It is, so I, I don't understand why that is, but that is absolutely something that we need to look at.

626. 4:16:51

     It also, it also kind of goes back to Representative Buckner's point about the different agencies and-

627. 4:16:58

     Communication

628. 4:17:00

     ... communication. Communication. It's, that's a good example. They have different processes for different things, and you have to use all the different agencies, and when they're not communicating and one agency doesn't do something in the timeframe that the other agency wants it to be done-

629. 4:17:14

     Then they have to start back. They get back in the queue.

630. 4:17:16

     And it just, it just, yeah.

631. 4:17:17

     Like, they're just spinning in the queue.

632. 4:17:18

     Exactly.

633. 4:17:18

     I get you. I get you. So, so the, um, in the age of, of technology, we need to get all of our systems like that. If you're in that system of healthcare for Georgia, then you all need to be commun- th- those systems need to be able to communicate with one a- and I understand privacy and HIPAA and stuff, but, you know, there needs to be a reason to, to access that. But I don't know, I just, I thank you for bringing this up.

634. 4:17:44

     It, and, and-

635. 4:17:45

     It's very important

636. 4:17:45

     ... and to that point, one thing, there are providers who would want to expand their current business lines or other lines. Like, for example, I started in personal care home. I opened an adult day health.

637. 4:17:57

     Mm-hmm.

638. 4:17:57

     It, it's continuing. I had considered, uh, private home care serving the same members, but in order for me to open a private home care business, I would have to open for one year, could not receive any Medicaid funds. Then at the beginning of the second year, once approved, then I could receive those Medicaid funds. So-

639. 4:18:18

     So for a solid year, you're bankrolling that whole?

640. 4:18:21

     Oh, yes, ma'am. My friend in Soperton, Georgia bankrolled it for 23 months.

641. 4:18:26

     Lord have mercy.

642. 4:18:28

     Don't shoot the messenger. I'm just, a- again, these are the I can't believe that problems that Medicaid providers face r- in Georgia.

643. 4:18:39

     James, is that, so for that first period of time where they are not able to, to access those funds, can they go back and claim them later, or is that period of time just-

644. 4:18:50

     Oh, no, no, no

645. 4:18:50

     ... that's gone?

646. 4:18:50

     It's, it's not that true. Like recently, uh, I owned a building in Jeffersonville, Georgia, Twiggs County, a-

647. 4:18:56

     The inverse, so a, uh, a lady who has been providing private home care for twenty-five years in good standings with the state, she said, "Hey, I want to lease your building and open a personal care home." And she has just turned off the lights and closed the doors after one year of trying to struggle with just private pay. Because in rural Georgia, people are not private pay citizens. In Twiggs County, uh, so I mean, she would come in and accept them as a private pay, for example, for their Social Security, which would make...

648. 4:19:26

     I mean, it's a permitted home, so everything is above board. I don't want to misconstrue. There's a Georgia DCH permit hanging on the wall, 'cause there's two separate conversations, and I know them over time, so this will be a conversation we can have outside. But you get your permit from Georgia DCH, but then you have to get your provider numbers under Medicaid. That's where you get paid. So my tenant was, uh, trying to operate a personal care home where for someone's Social Security, so she should be receiving roughly $2,800 per month for that Medicaid client.

649. 4:19:58

     She might, even in some cases, $800 or maybe $1,100. And then after 11 months, well, no, it was more than that, 'cause she made it the year, and I was cheering for her. I'm like, "Listen, you know, I, I'm, I'm working with you. Please don't throw in the towel. We are so, so close." And she just couldn't. And again, in Twiggs County, because at one time I did own the only personal care home in Twiggs County of 15 beds or more, and then she tried it, and it's closed. So the people of Twiggs County will have to go find other, you know, services elsewhere.

650. 4:20:31

     We have one follow-up question from Representative Stinson.

651. 4:20:38

     I- I'm just out there just to hear all of this. Wow. I, I think my question has been answered already, but that's what I was trying to, um, get a clear understanding of what are, that, after that first year, what are they waiting on to, to get their Medicaid provider number? Correct? And that's what's gonna help them be able to bring some funds in to help operate their business. Is that correct, James?

652. 4:21:01

     Y- yes, ma'am. That's correct. So it's when, uh... I really think the way it operates is like Georgia DCH really has a very far-reaching authority of... I mean, they control the, the, the Medicaid provider number. So it's not anything the provider has done or not done, it's just they, uh, uh, it, it just takes time as, as, you know, as, as what we're, what we're being told. So, and again, hear me, I'm very thankful for Georgia DCH. I mean, I own and operate a personal care home in Donaldsonville, Georgia, you know, home of Chairman Burke.

653. 4:21:34

     So, uh, I do b- a lot of business in a lot of these rural communities, but it just, uh, red tape would be the short answer, which is clear as mud, but yeah, that's my that's the reason.

654. 4:21:46

     Thank you. Thank you for sharing.

655. 4:21:48

     All right.

656. 4:21:48

     Thank you.

657. 4:21:48

     Th- thank you, Mr. Pettus. We, we got... I'm only going an hour from here. I've got all day. Go ahead. Represent-

658. 4:21:58

     Just gonna say that I don't know if you've ever had to help a constituent or some doctors out with getting their Medicaid number, 'cause they'll build a surgery center, and they take private pay i- you know, immediately, and then it takes forever to get that. And I don't know why it takes so long. Everybody seems to be working, but it's, you know, we almost need to, you have to light a fire under them. It's a, it's a real, it's a tough process. And he's in a difficult position to talk about it because he, he has to pay they pay him, so you can't really yell too loud. But for us at, for us as legislators, we need to insert ourself in those positions and push-

659. 4:22:32

     Yeah

660. 4:22:32

     ... 'cause sometimes they have to be pushed. And i- and if it's a, and if it's a conversation where they don't have enough staff, then let's have those conversations. But we got to get people in the process of taking money. I mean, it's a business. And I don't know about y'all, but if, you know, w- if nobody's paying for their funerals, it's hard for the funeral home to operate, and it's, and the doctors are the same way, so. You know, uh, what do they say in the funeral home business? You hold the body till you get paid. Well, th- these folks can't do that, so it's a little tricky, so.

661. 4:22:59

     The, what great conversation here. And I really had a smart comment to make, and I totally forgot it there with that last exchange. I mean, people are dying to see Representative Stinson. So we don't... It's bad. Thank you for being here and for, um, sharing this information with us. Um, I think that frequently, um, we forget that healthcare is also a business.

662. 4:23:32

     It has to be, and, and we don't take that into consideration frequently from our side of things, um, that y'all need in an efficient manner so that you can operate your business so that you can help people, um, with their healthcare needs and their personal needs. So I think that is definitely, um, something we need to remind ourselves of frequently.

663. 4:23:56

     I have one burning question, Chair.

664. 4:23:58

     Oh, one more burning question.

665. 4:23:59

     It's a burning question. Why are you being moved to, to managed care, do you think?

666. 4:24:04

     So y'all were talking about broad authority and state contracts and so on and so forth. It kind of falls into that category. So in twenty twenty-three, DCH had the re-procurement cycle. They put out the RFP for Georgia Families, which is the managed care program for the foster care children, uh, adoption services, and juvenile justice. And because they have very broad authority to write these contracts and administer these contracts, um, it doesn't involve the legislative process, and so they included the long-term services and supports and ABD, which is age, blind, and disabled.

667. 4:24:40

     And, um, that includes gossip. That includes all those waivers on the alphabet eye chart that he was talking about earlier. And so it, it doesn't go through the legislative process, so a lot of people aren't necessarily aware of it, but it's just underneath the broad statutory authority from DCH. And so we're being moved away from fee-for-service. So you're a Medicaid provider, you're approved for these services, you go and do those services, you get reimbursed for Medicaid by that. Underneath managed care, you're entering a third party And they're essentially given like a capitated amount per member, and so they ha-

668. 4:25:17

     Mm

669. 4:25:17

     ... now the fiscal risk is on them, right? So they have to do different things with cost control or deciding what is medically necessary or if they're even gonna let this provider in the network. And so those are the way they, they control their costs. And so earlier when we were talking about the risk with rural Georgia and managed care, that's kind of part of the conversation. So if a CMO doesn't want to work with the provider in that area because the cost is expensive, 'cause they have to drive, what, 30 miles to each house or something like that, and they choose not to put them in their network, well, then that provider can no longer provide services in rural Georgia.

670. 4:25:56

     And so it's, it's a thing, it's a huge issue, but it's not going through the legislative process. DCH has really broad authority to write Medicaid contracts and administer them through state law. And so we, we're really glad that we got to come and tell y'all who we are, but there's a lot more at play. There's the red tape, there's Medicaid contracts being changed. It's a big issue, so...

671. 4:26:24

     Branch from that question. Anyone else?

672. 4:26:29

     Okay. Thank you very much for being here today.

673. 4:26:32

     Thank you very much for having us.

674. 4:26:34

     Mm-hmm. Okay. Finally, we are to Georgia Mountains Health, and I'm gonna recognize the s- their senior advisor, Steven Miracle, for his comments.

675. 4:26:58

     You know, I, I don't know if it's good or bad to be the last speaker of a long day for y'all, uh, but I will tell you that Representative Chastain said I need to be very short and succinct or he was going to push the button to eject me out of the building. So, um, I'll, I'll live up to that, Johnny. Um, I've, I've been told there was a study that I saw somewhere that said that the length of your talk is proportionate to the number of slides that you have. Well, you'll be happy to know that I have no slides today, so we'll be very succinct.

676. 4:27:31

     Uh, Chairman Hagan, Representative Chastain, members of the Rural Development Committee, welcome to North Georgia, and thank you for the opportunity to highlight one of Fannin County's and Georgia's safety net medical providers, Georgia Mountains Health. I'm Steven Miracle. Am I too loud?

677. 4:27:50

     No.

678. 4:27:51

     Oh.

679. 4:27:51

     Sorry about that.

680. 4:27:53

     Ah, there we go. I'm Steven Miracle, recently retired from 23 years working at, at an FQHC, Georgia Mountains Health. You heard about FQHCs earlier this morning. I, I'm gonna tell you a little bit about our FQHC and, um, and la- and then Becky is going to talk more broadly about the network of FQHCs through the state of Georgia. With me today is Becky Ryals, who, uh, is with the Georgia Primary Care Association, and Andrew Stewart, who is the CEO of Georgia Mountains Health.

681. 4:28:28

     Georgia Mountains Health was founded in Morganton, Georgia, over 40 years ago as a charitable, nonprofit organization. Our mission is to provide access to care for the medical, dental, and behavioral health needs of families. We do that by providing professional, compassionate, affordable, quality healthcare for our communities. I'll tell you a little bit about, um, a little bit more about our organization. We, we serve as the medical home for over 14,000 individuals in North Georgia, 55% of whom are either uninsured or are covered by Medicaid or the CHIP program.

682. 4:29:09

     Often referred to as a community health centers, organizations like mine are seen as medical offices providing primary care to those with, with minor cuts, aches, and pains, as well as those with serious chronic conditions. In many respects, we appear to be a traditional doctor's office, but we are so much more than that. So how are we different than a traditional doctor's office? I can articulate dozens of ways, but let me highlight three.

683. 4:29:39

     One is we have a emphasis on health and wellness. A substantial number of our patients face barriers to care, including, uh, reimbursement, uh, and transportation issues. And, and so our approach to patient care has to be a holistic approach where we reduce those ba- barriers by focusing on preventive health services, health screenings, and wellness. Our medical staff often work to the limits of their training when managing patients' conditions.

684. 4:30:13

     Two, behavioral health integration. Behavioral health services provided by licensed professionals such as psychologists, licensed clinical social workers, licensed professional counselors, peer support specialists, and others are embedded in our medical team. If you need a referral to behavioral health, you walk down the hall in our office as opposed to being referred to another organization. The team approach to a patient's behavioral health ensures that behavioral health and medical, and medical health professionals address all aspects of patients' mental health needs.

685. 4:30:54

     A friend of mine referred to the, the, our approach to mental health as dealing with the walking wounded. We don't address the severe, severe and medically, medically, a- and, excuse me, we don't address severe mental illness, but we do a- address the, the walking wounded, the everyday depression and, um, anxiety. And we do that in a coordinated fashion. The third way that we're different from traditional doctor's offices is that we are community and patient controlled.

686. 4:31:26

     All, all community health centers are governed by a board of directors representing the community that we serve. In addition, our board is required to be made up of 51% of patients. That makes us uniquely responsive to the medical needs of our community and our patients. I'm happy to say that Speaker Ralston was a member of our board of directors and, uh, and, and therefore was a champion of community health centers in the legislature.

687. 4:31:57

     I mentioned that we serve as the medical home for patients in our community. When I talk about medical home, I'm referring to more than a location in a physical building. When I talk about a medical home, I talk specifically about a patient-centered medical home. What are the elements of a patient-centered medical home? There are, are several that I'd like to highlight. One is that we're patient-centered, treating the whole person by recognizing individual needs and the environment in which the, the patient lives.

688. 4:32:30

     Clinician directed, care that is led by a physician, nurse practitioner, or physician assistant who head, who heads a collaborative team of medical professionals. Medical homes are comprehensive and coordinated care. We have care coordinators, and we actively manage referrals to specialists, hospitals, and community services. We're accessible. Accessible care features scheduling options like after-hours, open communication, and reducing barriers to, to obtaining timely care.

689. 4:33:10

     And then quality services. Have I clicked the button again?

690. 4:33:14

     You're okay. I apologize.

691. 4:33:17

     Sorry about that.

692. 4:33:18

     You're all right. There you go.

693. 4:33:21

     Quality, uh, quality and safety, using health information technology to track results and continuously improve patient performance.

694. 4:33:32

     The- these are the qualities of a patient-centered medical home. Georgia Mountains Health is a, a nationally, an NCQA qualified patient-center medical home, and many of the organizations in Georgia, um, like ours, are also, uh, certified as such.

695. 4:33:52

     As a, a, as a center, as a patient-centered medical home, we address barriers to care, help patients navigate the medical system, and we focus on health and wellness. The 14,000 people who choose Georgia Mountains Health as their medical home in part do that due to the patient-centeredness of our approach to care.

696. 4:34:16

     Georgia Mountains Health is part of a network of care that with experience in addressing patients in the af- in the affordable and accessible and quality way. Becky Wa- Rollins will now talk about the medical home network that is FQHC based across the g- uh, Georgia. Becky?

697. 4:34:37

     Thank you, Steven. Madam Chair, members of the committee, thank you for the opportunity for Georgia Mountains Health and the rest of the health centers to be part of your conversation today. I'm Becky Riles. I have the privilege of representing all of the health centers in Georgia. You have in front of you a map, I believe, that shows you the 36 health center organizations that exist in Georgia, in large part because of your support over the last 50 plus years that health centers have existed in Georgia.

698. 4:35:12

     Um, we are grateful for the support that the legislature has provided, particularly in the ways of seed dollars so that a Georgia Mountains could open a new site in Fannin County, Gilmer County, Lumpkin County, for example, and that's how to read this map. Um, the color shows you the footprint of that particular health center organization. The number then correlates to the name of that organization. But each organization on this map are indeed an FQHC, a federally qualified health center, which means they operate exactly like Georgia Mountains Health from a governance perspective.

699. 4:35:58

     All of them provide primary care services, but their span of services may change according to their community and what is needed. As a health center, as a safety net provider for primary care, a health center looks to accentuate the services in the community. So for example, if there are plenty of psychologists or mental health providers, then the health center does not need to be as broad in the services that they offer at the health center, but can be, again, the medical home for primary care.

700. 4:36:36

     But in many places, particularly in rural Georgia, health centers are in 142 counties in Georgia and 331 clinical sites. So in other words, each organization has multiple sites, right? It's, it's the math as the previous speaker said. So th- the point here is that as a safety net provider, um, their goal is to bring healthcare close to home. That's the reason that health centers were started, um, by, um, the United States Congress.

701. 4:37:10

     It's designed to be a public-private partnership as well as a state and federal government partnership. Health centers receive a federal grant. That grant can be used- For a very specific purpose, as Dean Burt, Dr. Burt said so eloquently, when you receive federal dollars, there are specific ways that you can spend them. And so for a health center, and there are specific ways you cannot spend them. For a health center, those federal grant dollars are used solely to provide healthcare services for those who are uninsured and under-insured.

702. 4:37:48

     If you don't have healthcare coverage, you are charged on a sliding fee scale. Um, Madam Chair, I will stop there, and we will be glad to answer any questions that you may have. And I also recognize your focus on rural healthcare today was, a large part of it was on EMS services and, and transportation challenges in rural Georgia. We believe that health centers could be part of a solution as you look to, um, help offer solutions in the, in the legislature next session.

703. 4:38:24

     Health centers would be very willing to work with the EMS providers, as you heard this morning, to be part of a system to get patients to the right setting for the right care at the appropriate time. Thank you.

704. 4:38:40

     All right. Members, any questions?

705. 4:38:46

     No? No one? Do you-

706. 4:38:49

     I have just a-

707. 4:38:50

     Rep- rep- You, go ahead, Representative Buckner.

708. 4:38:53

     I was gonna ask, but you answered it before I asked it. If, if, um, if we change some of our EMS where it was, like, urgent, non-urgent, and the non-urgent could come to the centers all across the state. And it, and I, we were just talking, wonder if some of that federal money could be used to set that up and make that happen. Um, yeah, those are all-

709. 4:39:16

     That's, yep. A two-part question. Part number one, absolutely. We would welcome the opportunity to be part of the solution. And in fact, there was a program in this area of the state, it, that was, um, funded with grant dollars, that was specifically designed to be an ER diversion program. And it worked beautifully because when a patient goes to the emergency room unnecessarily, for one, um, they have a different provider, they don't have their medical history, they don't know everything that, you know, brought that patient to the emergency room, and a lot of times it is not an emergency situation, right?

710. 4:39:57

     And so when those patients were then diverted to a health center, and then the health center becomes the medical home, then the patient, not only do they receive health services, they have a case manager. They have someone who is helping them manage their chronic disease. Diabetes, if, if diab- I mean, that's one of the biggest drivers of an individual to go to, um, the emergency room if they're not compliant with their insulin, or they haven't been able to access their insulin, or keep it refrigerated, for example.

711. 4:40:29

     So yes, absolutely, we, we, um, could be, um, that partner. Now, whether there are federal dollars available, I do not know, but that is a great question and certainly glad to explore that possibility.

712. 4:40:43

     Let me, let me add one, one comment to that is, is that a- as part of our, uh, requirement in fulfilling the, uh, requirements for the federal dollars that we receive, all FQHCs are required to have extended hours of operation. So one of the issues in diverting to a, a private office is are they closed or are they open? And so FQHCs all across the state have extended hours. They're, they may be different, but, uh, some opens early, some open, uh, later in the evenings, and some are open on the weekend.

713. 4:41:14

     So, uh, as a network we are, are ready to, uh, to address those ER, uh, diversion issues.

714. 4:41:22

     And the other, um, thing I would add to that is the health centers that you see listed on this map, they truly work together as a system. And so Georgia Mountains Health works closely with the other health centers in North Georgia. They all work very well together to share ideas. If there is a health issue that comes up in a health center in, um, another part of the state, um, they share ideas about how they best managed that to maintain quality of care and quality of life, um, for the patients who are served at health centers.

715. 4:41:58

     Health centers collectively last year served nearly 800,000 patients across the state. Um, so thank you and, and-

716. 4:42:08

     We have, we have one-

717. 4:42:09

     Okay

718. 4:42:09

     ... more question.

719. 4:42:10

     Sure.

720. 4:42:10

     Representative Stinson has a question.

721. 4:42:12

     Yes. Thank you, Madam Chair, and thank you, uh, Becky, for the work that you all do, um, throughout the state. I'm very fortunate to, that there's a, a couple of centers in my district, particularly in Fort Valley, very close by Blue Bird Body Company, which will be celebrating 100 years next year. And I hosted a kickoff for their 100 anniversary, uh, the other day, so you'll be hearing more about that. But my question: What can we do for you? Can, how can we boot, be your boots on the ground, um, to help in these endeavors in our districts?

722. 4:42:46

     So particularly on the EMS issue and the transportation and getting patients to the right setting at the right time, we would welcome the opportunity to work with you to change whatever policies or, um, if, if legislation is required, we are glad to work with you, um, and the EMS providers, um, as, as far as finding a solution because those patients, um, need to get to care, and we just want them to get to the right care. Um, so that is, that is our focus today, and we appreciate, um, all the support that you've given, um, over the years and we look forward to, to working with you, um, in the next legislative session.

723. 4:43:28

     And always available to have other conversation, um, outside of meetings like this as well. Thank you.

724. 4:43:35

     Thank you so much, both of you, for being here to present to us today, and for all you do for our communities, particularly our rural communities. Thank you.

725. 4:43:44

     Thank you.

726. 4:43:46

     Um, the, I think that we got a lot of very valuable information today that we can take forward to have some good conversations with. I appreciate your dedication and, and your willingness to come to these meetings and, um, do, do the work that we need to do for rural Georgia. Um, we may have a third meeting before we go back to session. Um, I'll be in touch with you about that. And, um, Chairman Carpenter, you're welcome at our meetings anytime.

727. 4:44:18

     We appreciate you being here with us today. Thank you, everyone.

728. 4:44:49

     This meeting is adjourned.