House Health Committee, February 2, 2026 Video: https://vimeo.com/1159758465 (a timestamp t plays at https://vimeo.com/1159758465#t=s) Page: https://georgiacommons.org/meetings/2026-02-02/house-health This is a machine transcript of the General Assembly's video, made by a speech-recognition model. It is not an official record and can mishear words, names, and numbers. Speakers are not identified. The video is the record: every timestamp links to the moment it plays. [0:15:29] Uh, there's a s- sign-up sheet for anyone who wants to speak to the, uh, three bills we have at the end of this table on my right. [0:20:04] Okay, [0:20:46] good afternoon. I think we've got enough for a quorum here. Um, the agenda has, uh, 326 up first, but we have a number of people speaking on that bill, and, uh, so I'm gonna put 629 on first. Uh, this is a bill that, um, I had last year on, on, on AEDs. That body of the bill passed through the Senate, um, last week. So I had a request to, um, add the bleed kits to this bill. [0:21:19] I'm gonna get up there and, and, and, and present the bill. And then, um, and, uh, Representative Kelly is gonna be chair of this. [0:21:38] Good day, Mr. Chairman. [0:21:52] I am. [0:21:52] All right. And I have you working off LC461386S. [0:21:57] That's correct. [0:21:57] Chairman Hawkins. [0:22:00] Thank you, sir. Uh, as you know, we have done quite a bit of legislation in the last few years on AEDs, and actually added AEDs to, uh, K through 12, um, two years ago. We had had AEDs in high schools, now we've- we've gone into grammar school and elementary schools. Um, the original 629 was actually, uh, uh, substituted onto a Senate bill which passed this last, I think, Thursday in the Senate. [0:22:32] So we've taken what, uh, is or was 629, and at the re- request of Northeast Georgia Medical Center and others, put in the bleeding kit, uh, control kits. Um, we have Mr. Kyle Gibson here to speak to the bill, and I'll go ahead and let him speak to the bill. Mr. Gibson. [0:23:02] You got it, Mr. Smith. [0:23:03] I have it. [0:23:04] All right. All right. Thank you, Mr. Chairman. Uh, thank you for the committee for the opportunity, uh, to speak on behalf of Northeast Georgia, uh, the Regional Trauma Advisory Committee, uh, and Region 2, which the 13 counties what make up Northeast Georgia, uh, that corridor. Uh, by trade, I'm a trauma and acute care, uh, surgery nurse practitioner, uh, but I also serve as the RTAC coordinator as I mentioned, uh, earlier. Uh, but this is the bleeding control kits that we were able to outfit, uh, all the public schools, uh, in Georgia. [0:23:37] Uh, we're, uh, about 99% complete with that project. But the goal is to ensure that the educators, uh, continue their education with Stop the Bleed. Uh, as we mentioned earlier with the AED program, uh, and the education requirements, uh, that we're requesting with the, uh, the, I guess you could say the, uh, safety team. I guess that's probably the proper identification of that, the response team. We just want to ensure that Stop the Bleed training is included with CPR and AED education. [0:24:14] Thank you, Mr. Gibson. Do we have any- [0:24:15] Questions? [0:24:19] Can I make one more comment? [0:24:21] Yes, sir, Mr. Chairman. [0:24:22] Um, also you'll see section two, I had them include a section two, uh, uh, addressing appropriations. Um, the- the funding for this has been coming through the Trauma Commission, which we hope that continues. But with the changes in, uh, healthcare funding, uh, coming from the national, uh, arena, I thought it'd be appropriate for us to put in upon appropriations just to safeguard the- the system. That's it. [0:24:53] Thank you, Mr. Chairman. Representative Douglas. [0:24:57] Thank you, Mr. Chair. I have a quick question. Um, I see we have, um, taken the responsibility a- away from the physicians to have a physician present or teaching the class. Why is that? And why is the lia- would that create liability for different counties going forward? [0:25:18] Yeah, I'll answer that. That's- that's actually what, um, 629 was doing. Uh, we have now w- with the changes in that, and changes with AEDs, you know, AEDs used to be fa- you know, sort of complicated. Now, put the pads on, touch the button, and it tells you what to do. [0:25:37] Okay. [0:25:37] So we took the physician out of that requirement, uh, which- you know, back in, in the day before they were so automated and when they were only in high schools, that was reasonable for a physician to look over the program and check off. But, ah, Choi came to me last year and said that they were having problems, ah, with, with the number of elementary schools and finding physicians. And I f- I felt like it was reasonable with the, the new AEDs that, that, ah, whoever's teaching CPR could do the AEDs, which they're doing already. [0:26:13] I mean, if you take a CPR course, you're gonna get an AED course. [0:26:16] Okay. [0:26:17] So just makes sense to, to relieve them of that. Yeah. [0:26:21] S- so across the board in our elementary schools, it, it... they ar- are also going to teach the, the A- AEDs to the students. Is that correct? [0:26:32] No, no. To the response team. [0:26:34] Oh. [0:26:34] Each school has, uh, they choose, uh, and they, they name them different names. I mean, they, you know, alpha one, alpha two, whatever. But they are trained for CPR and AED presently. Um, and so those folks respond, and they have to have... They practice twice a year. They have a, a one hands-on, and they have to go get the machine so they know where the, the AEDs are, and the second one's a bench. This is adding the bleed kits to that where they will- [0:27:05] Okay [0:27:05] ... train them how to use the bleed kits on the kids. [0:27:08] Great. Thank you. [0:27:09] Uh-huh. [0:27:12] All right. Brought up doctors. Let's hear it from one. Chairman Newton. [0:27:17] Thank you, Mr. Vice Chair. Acting Chairman. Um, I, I do appreciate you bringing this bill. I think it's a, it, it is a very appropriate step in the, and, and as you accurately determined that, that these were pretty complicated. They were a step below what paramedics carried. A little, little more automated when they first came out, but, but a lot more complicated. The, the software's gotten better. The hardware's gotten better. They've come down in price, and that's been nice, so they're able to be in many, many m- more places than maybe they used to be. I'm thrilled that we have several here at the Capitol, um, i- if we ever need them. [0:27:51] So I think this is a good step forward, and I can really appreciate how it, it, challenging it would be as you start trying to get... When we have students every year somewhere in Georgia that in spite of having a school sports physical or whatever, basketball practice or whatever it might be, football practice, somebody has an event. And these can be lifesaving, and getting them out to there by removing that, um, that requirement that a physician oversee it all. These are very appropriate for people who've taken a CPR class, and, and a bleeding class, too. Both of those devices are made for really non- [0:28:24] Right [0:28:24] ... medically trained people- [0:28:25] Right [0:28:25] ... but people who have, citizens who have gotten a little bit of extra training. So I think this is a great step. Thank you. [0:28:31] Thank you. And, you know, we've got more to come probably next y- or the following year. I've had requests about including AED requirements for field trips. [0:28:41] Oh. [0:28:42] Now, i- that's a great idea, but how, how many field trips are going on at one time, and how are we gonna fund that? Right now, the funding is a little bit in the air with the lot, so. But that's something we will address in the future. Yeah, we had a child die this year- [0:28:59] Yeah [0:28:59] ... in a swimming accident, you know, that maybe, maybe could've been saved possibly, I don't know, if an AED had been there. But, um- [0:29:07] It's still occasionally nice to have a doctor around to do your own appendectomy or- [0:29:11] That's right [0:29:11] ... delivery, you know, whatever. [0:29:16] Swalley, have you hear Dr. Newton? Representative Davis. [0:29:21] Thank you, Chair. My question, when you were talking about section two and the funding, did we do a physical note on this? [0:29:28] No. No, no, no, no. [0:29:30] Okay. [0:29:30] Right now it's being funded outside of state funds, is through the trauma commission. So we, we don't need a fiscal note. I'm just looking out to the future and, and if that funding, um, is halted, then the function of this bill will halt at that time until we find o- other funding. But it's gotta be appropriated. [0:29:55] Well, I wanted to say thank you for this bill, because I went and I asked in research what effect it would have on underserved and under-resourced communities, and it showed that it would actually help. So thank you. [0:30:11] Yeah. [0:30:16] Yeah. [0:30:16] Representative Stinson. [0:30:18] Well, thank you. Thank you. Uh, Mr. Chairman had already answered my question. [0:30:25] No, you're back on. [0:30:26] Okay. Thank you. M- Mr. Chairman, you, you've already addressed my qu- my question relating to field trips, 'cause I had just heard that this morning about a- [0:30:33] Yeah [0:30:34] ... a young student passing away. [0:30:35] Yeah. [0:30:35] And so, again, thank you for your work on this legislation. And I'm hoping that we can one day soon, uh, extend to field trips. So thank you. [0:30:43] Thank you. [0:30:49] Karen Mathiak. [0:30:51] At the appropriate time, I'd like to say do pass. [0:30:56] I don't see any other questions. Mr. Chairman, do you have anything else to add? [0:31:00] Nope. [0:31:01] All right. W- we have a motion and multiple seconds. The bill is now before the committee for discussion. LC461386, any discussion? Hearing none, all those in favor make it known by saying aye. [0:31:19] Aye. [0:31:19] All opposed like same. The bill passes unanimously. [0:31:22] Thank you. [0:31:40] Congratulations, Mr. Chairman. [0:31:56] We're back on the agenda. The top of the agenda, House Bill 326. Michelle Au. Representative Michelle Au. [0:32:14] This room is very weird. Wasn't sure where to sit. [0:32:18] Wherever. [0:32:18] So thank you so much, uh, Chairman Hawkins, for hearing this bill. [0:32:23] Yeah. [0:32:23] And for co-sponsoring this bill. I appreciate that. Um, today I'm here to present HB 326, the Non-Opioid Coverage Parity Act. We are working off of LC461006. So, um, you know, as a practicing anesthesiologist, it is my job to think about pain and how best to treat it, and part of that job is determining how best to treat pain while minimizing risk to the patient. Right? So I don't need to tell this committee, who's done so much work in this area, that the United States and Georgia is experiencing an opioid epidemic, and currently over 180,000 Georgians are struggling with opioid use disorder, with even more at risk for an opioid overdose. [0:33:06] So when it comes to postoperative, meaning like after surgery, or post-injury opioid use, the risk of opioid dependence and addiction increases significantly, even just after a few days of yours- use. We're talking like three to five days of use can sharply increase the risk of addiction and dependence. So these are commonly prescribed medications like, I don't like to use trade names, but just so people know what we're talking about, Percocet, OxyContin, Lortab, Vicodin, these types of medications, right? Um, since we recognized in the 1990s and early 2000s that, um, the medical profession, myself included, were maybe, uh, over-liberal in prescribing some of these medications in treating pain, we have tried to move towards, um, a different way to treat patients having acute pain. [0:33:52] Now, just to be clear, sometimes opioids are necessary and appropriate to treat pain, but there are also many other medications and therapies available that can work just as well for opioids in certain clinical situations while mitigating that risk of addiction and dependence. And if anyone wants to go through some of those other medications, we can, but I'm gonna skip it in the interest of time. Um, the problem that we're trying to address here is that while insurance will generally cover opioid prescription costs, they sometimes will not cover some of these opioid alternative medications or treatments, even if they work just as well and decrease the patient cost and patient risk. [0:34:30] So what this does is that it creates a bias in prescription patterns towards opioids, right? Not because they're necessarily better or safer for all patients, but because it's simply what insurance will pay for, right? So that is the problem that this bill aims to address. Essentially, if you wanna flip through the bill, it's not very long, but the crux of the bill is essentially in lines 47 through 50, indicating that the state health benefit plan will cover qualifying non-opioid pain medications at rates no less favorable than those for covered opioid-based pain medications. [0:35:02] If anyone wants a list of the full, um, pharmacopeia that the state health benefit plan does cover, I do have that with me here and anyone can look through it, but I did not make copies 'cause it's 40 pages long. So this is actually a fairly modest proposal that can even be viewed as maybe even like a pilot for future policy in that it does not include coverage of non-medication treatments. For example, things like radiofrequency ablation or nerve blocks, and it also does not include Medicaid, though I am open to both of these suggestions if it's in the committee's interest. The reason we kept it narrowly focused is, um, it's a better way to assess its effectiveness and to make the calculation of a fiscal note, given that we might be looking at some fluctuations in Medicaid enrollment and the state health benefit plan is a more stable patient population that's just easy to calculate off of. [0:35:50] So in the interest of taking less time and talking less and allowing more time for testimony, I've actually taken the liberty of assembling a packet for you guys that you should all have in front of you. It looks like this, with the tabs. I'm just gonna walk you through it, and please do take it back to your office, um, and look through it, um, because it has a lot of informing, um, some information that's gonna help guide your vote. Okay. The first document is actually the final study report from 2024. It was a committee that I think several of you were on. This was a study committee chaired by, uh, Chairwoman Dempsey on alternatives to opioids for pain management. [0:36:23] Um, and one of the policy recommendations from this committee, that's item four on page five of this report, in fact encouraged a bill exactly like this, which is coverage for non-opioid-based pain medications to mitigate opioid dependence and addiction risk. The second document, that's the orange tab, is a federal bill. You can tell 'cause the font is crazy and gigantic. Uh, it is the US Senate's Alternatives to Pain Act. PAIN is an acronym. It's a bipartisan bill in the US Senate. [0:36:54] This bill aims to do largely the same thing that HB 326 does, although as we know, the federal government's purview is a different set of insurance plans, whereas we can regulate our state-run insurance plans. So between these two, we should be able to cover more patients. Uh, I am more confident though that we, uh, are more effective at working together than the US Congress. So, uh, the third document, that is the yellow tab, details the state-level costs of opioid use disorder and fatal overdose. [0:37:26] The combined use of opioid use disorder and fatal opioid overdose annually in Georgia, if you flip to that page, is just, uh, is just shy of $21 billion. Right? These costs include things like healthcare costs, the cost of substance use treatment, criminal justice costs, the cost of lost productivity for our workforce, and reduced quality of life. This fiscal burden demonstrates that this is a worthy area in which for the state to invest. Fourth tab, it's the green one, shares the most recent surveillance report from the Department of Public Health on drug overdose emergency department visits. [0:38:04] This is actually a really good handout. Uh, it looks even better in color, but we do not have color copiers. So I would just indicate one thing, which is on the, um, third page, shares the most recent surveillance report from DPH on drug overdose emergency department treatment, and the most common type of or- overdose is secondary to opioids. But I just wanna note that this line, which is the top line showing in this line graph, is teased out from fentanyl. You know, we talk about fentanyl a lot when it comes to, uh, opioid overdoses because it's a synthetic opioid that often other drugs are adulterated with or contaminated with. [0:38:40] But this top line is actually separate from the fentanyl overdose rate, which, uh, tends to make my point that a lot of the opioid risk is seeded by and perpetuated by prescription opioid drugs that may be taken or, uh, taken for too long or diverted and sold. Okay? The fifth document is pretty short, but just so we know what we're talking about, this is a list of other medications and treatments that work just as well as opioids for certain types of, um, conditions, so just so people understand. [0:39:11] Okay? So that's it. I think you see this bill as a smart investment in our patients and our state. It would be a meaningful first step in reducing the toll of this epidemic, which has claimed far too many lives and it'll ultimately save the state some money. So we do have a number of people here to testify, but, uh, before that, I'm happy to answer any questions from the committee. [0:39:33] I see no questions at this time. [0:39:38] Uh, Representative Schofield? [0:39:40] Uh, yes. Thank you, Mr. Chair. Uh, thank you, Representative Au. How does this bill, um, impact people that are living in chronic, with chronic disease, uh, such as sickle cell, lupus and others- [0:39:51] Right [0:39:51] ... autoimmune and others? [0:39:53] Right. So nothing in this bill overrides what the medical recommendations are for treatment of chronic and acute pain. And like I said, there are certain disease conditions for which opioids are appropriate, right? We certainly don't wanna swing too far and over-correct to the other side where patients who are suffering from cancer pain or sickle cell pain can't get opioid-based medications if that is what is more suitable, right? We just want to allow for other treatment options and to not make it, uh, to not preclude physicians from prescribing other adjuncts to pain medications if it works better for patients and minimizes that risk. [0:40:29] Okay. [0:40:29] So it'll give them more options. [0:40:31] Okay. Just follow up, because I've heard a number of calls. I was on the phone with about, uh, 50 people in rural Georgia that are having real challenges of getting their pain medication, and they've been on these medications for a long period of time, and they're not using it because they h- they want to use it. It is the thing that takes them off the edge. So I wanna make sure that people are having access to the pain meds that they need, and they're not being stigmatized or asked to take drug tests, uh, urine tests just to get it, or they're not being told by the pharmacist that their medications are no longer in stock, or they're reducing the number of pain medications they're allowed to get. [0:41:09] I, I totally understand. And as an anesthesiologist, we also do chronic pain rounds in the hospital, and I will often hear from especially sickle cell patients that it is sometimes hard for them to fill their prescriptions or that people are immediately, and I would say unfairly, suspicious of patients who have been on opioid medications for a long time, even if they have a very good reason to, right? So this bill does not aim to restrict that in any way if it is the appropriate medical treatment. It just aims to offer more choices that may be safer, especially for different types of conditions. [0:41:37] Thank you. [0:41:39] Representative Newton. [0:41:41] Thank you for this bill, and thank you, Mr. Chairman. Um, I, I like the idea of, of the alternatives, one in particular. I know a family member with, uh, a joint replacement, and there's certainly a lot of those at all ages, knees, hips, and things like that. There's some long-acting, as you know, 72-hour- [0:41:56] Yep [0:41:56] ... uh, basically like a numbing medicine from your dentist- [0:41:58] Mm-hmm [0:41:58] ... but it lasts for three days and can be greatly helpful in the immediate recovery from not starting on opiates. Does this bill allow Exparel, which is a liposomal bupivacaine, would it, would it allow patients to have that option to discuss it ahead of time with their surgeon or their anesthesiologist so that they could plan for that? I don't know if it's just a best practice now on every joint replacement or if, if, uh, if the lack of this bill is one of the reasons patients aren't getting it. [0:42:26] Well, I'm really glad you- [0:42:26] And this does not touch hospital care. [0:42:29] It, it covers specific types of insurance plans. [0:42:32] Okay. [0:42:32] Right? So it would cover all types of care. But I'm really glad you brought that up. I actually think we've had this conversation in regards to this bill and generally with opioid risk mitigation, 'cause we work together quite a lot, is that the use of liposomal bupivacaine, the time-release, long-acting local anesthetic, is one of the reasons I started looking into this because it has been a medication that, especially in a larger hospital system that is sensitive to cost, has been restricted for our use even though we've demonstrated it works particularly well for total joint replacements and major ortho surgery. So, um, yes, the goal is to allow use of that type of medication as well as other medications that work better, that may be newer and therefore may be, uh, more expensive. [0:43:12] Well, I know the immediate postoperative period is the greatest pain, and if you can avoid that... You know, you, sometimes about day three, people are on Motrin or Tylenol even, but they gotta get to day three, and if they get addicted to something in the meantime, which is possible- [0:43:24] Mm-hmm [0:43:24] ... with opiates. Um, I really appreciate this. Thank you. [0:43:27] Thank you. And I've had patients that I've done anesthesia for, for total joint surgeries who we've done a liposomal bupivacaine block for, and they did not need a single Percocet at all after getting a total joint replacement. It's quite remarkable. Thank you for bringing that up. [0:43:44] It does work. I had my anesthesiologist give me Marcaine, about triple dose what I was used to giving, same dose we gave for third molars, and I was numb for a day and a half. [0:43:54] Well, it's a- [0:43:55] Never took a pain pill, you know, shoulder Okay. I see no other questions. We do have some people signed up, uh, to speak. [0:44:03] First. [0:44:04] First is Dr. John Gleason. [0:44:17] Try that mic next. [0:44:19] This one? [0:44:20] Yeah, that one right there. [0:44:21] Sound good? [0:44:22] Yeah. Can you hear me? Is that on? I think it is. [0:44:25] Seems to be. It's green. Yeah, it was. [0:44:27] You can use this one. [0:44:29] That one. [0:44:33] It's blinking. [0:44:34] Uh, go ahead and use, uh- [0:44:35] Use mine [0:44:35] ... the other mic. Yeah. [0:44:38] Is that better? [0:44:39] Yeah, that's better. [0:44:40] All right. Sorry about that. [0:44:41] He's loud, Senator. [0:44:44] As you know. [0:44:46] I do. [0:44:46] So Chairman Hawkins, committee managers, thank you for allowing me to speak in support of this bill, House Bill 326. Um, as background, I am a recently retired orthopedic surgeon, and unlike Dr. Au, I'm used to causing pain, not stopping pain. Um, was past president of Resurgens Orthopaedics, the largest orthopedic group in the State of Georgia, and managing partner of the outpatient surgery center at our largest facility. [0:45:18] So we all know about the opioid crisis and the things that have come about because of that. Um, with that, there have been things also to improve some of the opioid crisis, and that includes things that were passed here. One, the education of the public, education of the physicians, the CME requirements for physicians that prescribe opioids, the PDMP requirements that have been in place, naloxone availability at the pharmacies, and limiting the number of prescribers who can prescribe Schedule I and Schedule II drugs. [0:46:01] So those have helped to reduce the number of opioid issues, but not eliminate it. House Bill 326 is just another tool to help to reduce the need for narcotics, and this is more for acute pain than it is for chronic pain. Chronic pain is treated with opioids on a regular basis. Reducing the number of opioids also reduces the possibility of diversion of medications, accidental misuse, and possibly, uh, addiction. [0:46:34] Opioids are not the only option to treat acute and chronic pain. Other alternatives are available, whether it's, um, pharmacological or non-pharmacological, but non-opioid pharmacological methods, um, can be used to help with post-surgical pain without the use of opioids. So these different types of medications, whether it's, as Dr., uh, Newton said, you know, using Celebrex or Motrin or atypical non-steroidal anti-inflammatories like Ketorolac or Toradol, um, long-acting bupivacaine, such as the, uh, Exparel, and newer medications like sodium channel blockers are effectively helping to control pain in patients without having to, uh, prescribe as many opioids as, as we have. [0:47:29] And all of these things that we're discussing are already FDA-approved for pain treatment. So it's not like we're using them out of context of what they are, and they just need to be made more readily available for providers and for patients. And the availability process, uh, is hindered somewhat with a lot of the prior authorizations for these medications because either they're newer or they're not on the standard formulary, and limiting the formulary limits the availability of these to the patients and to the providers and to the facilities. [0:48:09] The facilities themselves can take these drugs off of their formulary and just not order it, so it's not available for the providers to use in the facility that they're at. The limitations of these, um, medications, the, the safety and the efficacy of that with the patient and their comorbidities should be a decision that the physician and the patient makes and not the insurance company. So at Resurgens Surgery Center, where I worked before I retired, where Dr. [0:48:42] Au has worked, um, you know, we chose to keep these medications on our formulary because in the best interest of our patients, so it improved patient satisfaction. People were happy. They didn't have as much pain. They also had, um, improvements in their outcomes because they were able to do things quicker and better and recover without the side effects of some of the opioids. Um, as y'all have discussed, uh, I mean, I had a total knee replacement done, outpatient, with an Exparel block, and I took no opioid medications. [0:49:19] It's a frequent and a common problem. Doesn't mean that you don't give them. And in my practice, causing pain, I mean, everybody had some form of multimodal pain relief. They had a block, they had non-steroidal anti-inflammatories, and they were given one prescription for an opioid for a short three to five-day course, and after that, they weren't given any more. And most people did not take the full prescription that they were given because of that. [0:49:49] And these types of options are available, but their availability is being limited by what the insurers or the facilities will allow them to have. [0:50:04] So this is a good option, a tool that we should be using to help our patients and to get better outcomes with them and to reduce the number of opioids that are out there. People that need opioids need them, but when you have excess number of opioids in the marketplace, they end up in the wrong hands. So I speak in support of this bill for MAG and for myself and for my medical colleague, Dr. [0:50:34] Al. Thank you for allowing me to speak. [0:50:37] Thank you. Any questions? Any questions? [0:50:44] Done, Ms. Crawford? [0:50:46] Representative Lim. [0:50:46] Representative Lim. [0:50:48] I, I just had a... First of all, thank, thank you for this bill. Fully supportive. I just had a question on lines 47 through 50 where it says the SHBP shall cover these qualifying drugs to the same, subject to the same annual deductible, co-insurance, co-payment, et cetera. I just want to be absolutely sure, because I understand that the primary thrust is some of these are more expensive. I also see on your pretty pink tab that some of them in the national formularies, uh, being a non-expert, might be less expensive. [0:51:20] Mm-hmm. [0:51:20] So I wanna make sure that that language has that flexibility in there so that there, those that might be less expensive, um, are not, that, that people don't end up paying more for them. [0:51:32] Correct. Uh, what the goal of the bill is and what is stated is it should be covered at a rate no less favorable than it would cover, cover medication. I'm gonna give you an example of where this comes up. Again, with this liposomal bupivacaine, which is a time-released, longer-acting local anesthetic, is what is determined now and why it is no longer on formulary at the hospital at which I work, though on formulary at the surgery center, is that insurance would only cover the cost of the sort of regular- [0:52:00] Bupivacaine [0:52:00] ... original flavor bupivacaine, which is- [0:52:03] Oh, wow. Mm-hmm [0:52:04] ... cheap, but only lasts for 12, maybe 24 hours, depending on where you use it. Um, but that's the level to which it would reimburse at. So often, I'll, I'll let Dr. Gleason speak to this, but whether it's worth it for a center depends on... [0:52:19] Yeah. And it, at the facility where I worked at, the surgery center, we were across the street from, uh, the hospital, and the hospital took it off of their formulary by choice, um, for reimbursement issues, 'cause they weren't getting reimbursed for it for the extra cost per case. Uh, we, on the other hand, kept it on our formulary, whether we were getting reimbursed or not, just because of patient satisfaction and patient outcomes were better. And realistically, it's not an expensive drug compared to the other drugs that are out there. [0:52:57] Uh, yeah, you can get Motrin for 10 cents, and this may cost $200, but if you're having a total knee or you're having a total hip or you're having a shoulder replacement, the $200 is well worth it. Some facilities will actually offer it to patients and have them pay the cost of it. Uh, but we just covered the cost. We just build it into the facility, and that's the fee that we did. So we would rather patients have a great outcome and not be in pain than to worry about the extra cost of that formulary drug. [0:53:33] That was very observant for an attorney. Um, and this is a hearing only because there are some, uh, discussions going on with DCH very similar to what you, um, pointed out. So, um, this is good bill. Um, I guess mechanics sometimes gets, gets in the way, right? Okay. Any other questions? Seeing none, we've got, let's see, who else? [0:54:05] Jeff Boyd would love to speak. [0:54:06] Oh, wait. Well, I think we have Dr. Lane with anesthesia. Just to provide the other side of it. Sorry. [0:54:12] Uh- [0:54:13] Is that okay? [0:54:14] Oh, okay. I, I'm sorry. Yeah, go ahead. D- Is it Dr. L- Lane? I can't read his handwriting. [0:54:20] That's, that's right. [0:54:22] He's a doctor. No. I mean, I couldn't even read 326, so. [0:54:29] Entirely consistent with what I do. [0:54:31] How acceptable. [0:54:35] Thank you for having me here. I'm Bob Lane. I'm the chief of anesthesiology at the medical center in Macon, and, uh, my 39th year of practice. And have, uh, when I first came to Macon, I was also the only guy that took care of chronic pain conditions for a little while until I was able to hire people with fellowship training for that. But we do an awful lot of, uh, a lot of what Dr. Gleason was relating to, which was, uh, enhanced recovery after surgery, which is actually the product of a, uh, a Dutch surgeon who found that with the right patient education and the right patient motivation, uh, the right set of adjuvant drugs, you could do even big surgeries like colon resections without any opioid whatsoever and have patients very happy. [0:55:21] And not only were they very happy, they had less blood loss. They went home at least a day, day and a half earlier. Uh, there are just ways that we are learning to be better for our patients. And, and sadly, uh, we've gotta get some people to let go of the opioids. And these medications that we've mentioned, and, uh, someone mentioned the new sodium channel blockers, they're, they're gonna be very good. They're, they're completely non-opioid, uh, non-addicting. They don't hit the happy center. [0:55:52] They don't make you feel good that you took the medicine. Uh, they just make the pain not be there. And so, uh, this bill just gives parity. I love the word parity in the bill because it just gives parity. It says if we're gonna pay for the, uh, for these opioids, we ought to at least be able to pay the same, uh, thing for, uh, the, these other drugs that are gonna help us stay away from opioids. About, if you look at all comers, uh, thousand patients, about, you know, between one and 10 will become opioid addicted. [0:56:24] If you give them enough to have opioids for about five weeks, about one in 50 will become addicted. So it's, it's a real big thing and, and, uh, uh, it's, it's the old Pogo cartoon. We, you know, we've seen the enemy and he is us. Speaking to the medical profession, we, we've, we've done this, uh, out, out of some ignorance and some bad science in the past, but we, uh, uh, it's, it's time to get it straight. I'm also here, uh, as a past president of the Amer- of the, uh, Georgia Society of Anesthesiologists, uh, sort of representing that viewpoint for the, uh, entire group of anesthesiologists in the state of Georgia that, that are all on board with this, this very same idea that we, uh, need to find a way to do this with less opioids, better medicines, better education, better patient outcomes. [0:57:09] It, it just, it wins all the way around. [0:57:13] You know, I appreciate your comment. Sometimes it seems like the docs sort of blame themselves for all of this opioid issue, but, you know, if you look back, especially the, uh, Thomas Gay project and all, um, it was actually the grandchildren getting a hold of some pain control medicines that were prescribed to his grandfather. So it's not always the, the fault of the doc. [0:57:38] Uh-huh. [0:57:39] Uh, and, you know, and being a retired dentist, I, I used to get a lot of requests, you know, when, when you got pain in a tooth, it's real close to your brain. And it's hard to say no when you have a patient crying right in front of you. [0:57:53] Mm-hmm. [0:57:54] So ... But, but I sure like, I like this new approach. [0:57:58] Yeah. [0:57:58] This is a much better approach. [0:57:59] Better for us. [0:58:00] Any questions? Seeing none, okay. Uh, thank you. [0:58:05] Thank you. [0:58:06] How about Janelle Adams? You signed up in front of Jeff, then we'll let Jeff go. [0:58:18] Thank you, Mr. Chairman. I'm Janelle Adams, uh, with the Georgia Dental Association. Um, I just wanna echo some of the comments from the Medical Association. Um, in dentistry, we do a lot of very painful extractions, um, and our dentists are very strong in trying to only prescribe ibuprofen or acetaminophen, um, especially because a lot of the extractions we do happen in people under 25, the most at-risk youth, um, to be addicted to opioids. So we support House Bill 326, um, to provide more options and more ways for our dentists to provide care, um, and pain relief after some very painful tooth extractions, um, and give us more opportunities, um, to care for those patients. [0:59:03] So thank you. [0:59:04] Okay. Any questions? Seeing none, thank you. [0:59:08] Mm-hmm. [0:59:08] Jeff Breedlove. [0:59:20] Thank you, Mr. Chairman. If you please, the committee, I'm Jeff Breedlove, and I'm with the Georgia Council for Recovery, but much more importantly, I'm a person in long-term recovery from addiction, and I'm also a former state employee. I used to work for the general assembly, so I have that perspective, too, as a former state employee. And I just wanna begin with a thank you to Representative Al, to Chair Lady Dempsey, and the study committee. Uh, it was a great policy discussion. It was an honor to be on that study committee, um, it's the first time, and it was kinda cool. [0:59:52] And, and we learned a lot. And to Representative Schofield's important point, you know, I, as a survivor of addiction, I would be the last person that would support a piece of legislation that would take legitimate medicine away from one of my brothers and sisters who are suffering from a chronic pain disease, and I, I don't think that's the intent, and I would hope that would never happen between a doctor and their patient. But for people who are vulnerable to addiction, I think it's smart for this general assembly to move forward with more choices and more opportunities, and I think it will save lives. [1:00:27] Um, even though I'm not currently a state employee, um, I had a procedure on January 21st and, uh, at Piedmont, and, uh, you know, uh, even though my primary care physician knows, you know, I meet the anesthesiologist and all the people that came in the room, and I told every one of them. I said, "I'm not a doctor. I don't know what's gonna go on today medicine-wise, but I'm in recovery, and I just hope whatever choices you make would be non-opioid." And that started a conversation with one of them, and they were like, "Thanks for telling us." And the more that you pass laws like this, it'll give somebody, maybe not even a state employee, the courage to speak up to their doctor and, and medical team and say, "Are there choices?" And, and that might prevent somebody else from either having a setback or entering into active addiction. [1:01:16] So I believe this legislation not only will save taxpayer dollars, I believe it will prevent addiction and maybe save somebody's life. So I thank you for your consideration. [1:01:28] Thank you. Any questions? I see none. Thank you, Jeff. [1:01:32] Thank you, Chairman. [1:01:33] Up next, Christina Vandiver. Vandiver. [1:01:50] Hello. Thank you. I'm gonna share a little bit. Sorry. My name is Christina Vandiver, and I'm with Nick's New Beginnings, a nonprofit recovery community organization in Butts County, Georgia. I am also a person in long-term recovery, and what this means for me is I've not had to use alcohol to solve my problems in almost four years. However, today I am here as a parent who's lost a child due to prescription opiates. [1:02:20] On December 5th of 2024, our family was struck by a devastation that changed our lives forever. My stepson Nick overdosed and died from smoking heroin. We were blindsided as a family and we didn't know what he was using. We were uneducated about substance use disorder and believed he was just a young adult experimenting with drugs recreationally and he would eventually grow out of it. After his death, we learned that his addiction stemmed from prescription opiates that were prescribed to him from a doctor due to a sports injury that happened in college where he threw out his pitching arm. [1:02:59] Nick's story is one s- shared by far too many families across the country. He was only 23 years old when he died from this preventable, treatable disease. Nick had a whole new life ahead of him, recently having a baby that turned seven months old three days prior. I am here to strongly support the HB 326. This crucial BARP, PAR positive, sorry, legislation will save lives. Our state employees make numerous sacrifices in their service to the taxpayers of Georgia. [1:03:33] The inability to receive non-opiate pain management drugs should no longer be one of them. Passing this legislation will not only save lives, but will also significantly decrease the likelihood of a person in recovery experience a setback or return into active addiction because of a medical procedure. In this turn, we will save pa- taxpayer dollars by ensuring that state employees remain employed and paying taxes, as opposed to losing a job and becoming dependent on tax-funded programs, being arrested, occurring costs with our criminal justice system, and tragically dying from an overdose because a non-addictive medical option was unavailable due to cost. [1:04:22] I just recently was with my mother, who was 83 years old, getting a knee replacement and her doctor recommended a non-addicted pain pill for her, but however, due to her insurance she was not allowed to have. So as a family we had to count her pills and make sure that there was no issues there at 83 years old. Thank you for your consideration. I honest- earnestly hope that no other mother or father has to attend their child's funeral. [1:04:54] This legislation will assure that this doesn't happen to our dedicated s- state employees. Help us affirm that Georgia recovers in communities. Thank you for letting me share. [1:05:06] Thank you. Any questions? I see none. Thank you. [1:05:11] Thank you. [1:05:12] Uh, that concludes the testimony. Um, Representative Allen, I appreciate you bringing this bill. You know, this is a hearing only, not because that this is not good legislation, but more of a mechanical, uh, part of the bill with the Department of Community Health working out some bugs and some of the wording. So look forward to having you back once you get everything, uh, worked out with them. [1:05:37] Absolutely, and I was happy to meet with them a little bit earlier today to talk about, uh, some of the logistics and I would love to have your help in getting that fiscal note- [1:05:44] Okay [1:05:45] ... in place. [1:05:45] We'll work on that. [1:05:46] Appreciate it. [1:05:47] Thank you. Up next, House Bill 1002, Representative Camp. [1:05:57] This is a hearing also, hearing only also on this piece of legislation. Uh, we're gonna need a fiscal note on this. [1:06:08] Thank you so much. Oh, gracious. Thank you so much, Mr. Chairman. It is an honor to be here. This is my first time presenting in health, so, um, feel free to ask questions. I'm, um, House Bill 1002, and it's LC339857. And this bill was something that kinda came up from the hearings that we had on December 18th. Uh, we had a joint session with, um, health appropriations and, um, well, Katie Dempsey's committee and, um, juvenile, judiciary juvenile, discussing issues that were facing our children who are in foster care. [1:06:53] And this is something that came up during that time, um, that managed care sometimes makes it more challenging rather than less challenging for our children in foster care. Typically they're a more complex population. I think we're all aware of that fact. And I am not a practicing healthcare professional as the last two bill presenters, but I was an EMT many years ago and I got to see first hand, tragically, people who were in crisis, and sometimes they are children. [1:07:24] When those children or adults are in crisis, they have to have immediate care. And one of the challenges that we're hearing, um, or that we heard was the fact that getting access to beds was a challenge at times, getting approvals for various things, or I, I'm sure I'm, I'm seeing some nodding heads. Even before this, um, I've gotten many calls over the years from constituents bringing up issues that they had with children in their homes who were in foster care, and they wanted to do what was right and what was best for those children. [1:07:58] But sometimes they were not getting approvals for things such as, um, teeth cleaning and, and other things that just seem intuitive. And we have a responsibility, first and foremost, as the state of Georgia. If those children are in care at DFCS or Department of Juvenile Justice, whatever they're in care of, w- we have a s- responsibility as the state to treat them as we would treat our own children and provide them all the services they need to be successful adults, even given the complex situations many of them are facing now And, um, going through the bill, it- it's pretty simple. [1:08:35] It's, um, only 34 lines, and, uh, f- we've got a definition on the first page. It identifies, um, this is for children less than 18 and less year old that are in foster homes, and then, um, 6- 26, up to 26, in foster care, otherwise in foster care systems that were receiving Medicaid services. And, um, on line 23, it talks about that this would only go in effect upon expiration or renewal of the contract, or earlier if authorized under the terms of the contract. [1:09:07] Um, so understanding this is gonna be a big move because right now we've got a company that is managing this. This bill would take where actually the State of Georgia or some other entity would be managing this care. So this would be a big haul for Department of Community Health or, or wherever this falls to help manage this care. Um, it is a direct fee for service, and you may hear that we're doing fee for service now. I would say that we're not doing fee for service if there's a middleman. [1:09:41] If you have to get approval from someone, um, it, it may be fee for service because there's a reimbursement, but if you're having to go through someone else to get it approved, that kinda negates the system. And, uh, Mr. Chairman, I'm open for any questions. [1:09:58] All right. I see no questions. [1:10:00] Okay. [1:10:00] You did a good job. [1:10:02] Well, thank you. [1:10:03] We have somebody who wants to speak to it. Oh, thank you. We do have someone who wants to speak to the bill, Mike Dudgeon. I think some of you will remember this guy if you're old enough. He was in the House with us. [1:10:15] The old guys will remember. [1:10:15] Yeah. What year did you retire from the House? [1:10:20] Uh, my last year in the House was 2016, and then this, uh, joker named Todd Jones took my spot, and I apologized for Todd, so I don't know what to do. [1:10:28] Todd who? [1:10:28] Todd Jones. You've never heard of him? Backbench guy. I don't know. Something. Anyway, um, anyway, I appreciate it, Mr. Chairman, the opp- opportunity to come speak today. Um, I speak both as a former legislator, I speak also as the policy director of the lieutenant governor from 2019 to 2021, and also as a foster parent since 2016. Um, so I bring quite a different, um, combination of perspectives on this issue. This issue of how to give the best medical delivery to our foster kids has been going on for a long time. [1:11:00] Um, back when I was a, um, rep was on the table, and then when the lieutenant governor's office, we did quite a deep dive at the time with Senate budget and several others on how well we were delivering care. In the meanwhile, I had two, um, young girls for almost three years that were in our care. They were two and six when they came in our care, and we kept them for three years before they were adopted with a much younger family, and that's been a great success story, so we're very happy it worked out for them. But I lived the managed service, um, with the current vendor and, um, I'll just put it this way, it just wasn't very good. [1:11:37] One thing about foster kids is, is managed care, the idea is, okay, we're gonna think about it holistically. We're gonna make sure this doctor is talking to this doctor and this pharmacy is whatever. And that may work good for a regular kid, but fo- foster kids bounce around for number one. They may change from place to place. They had a doctor over here, and then six months later they have another doctor. Um, getting their services, by definition, most of these people come from way more challenging physical and emotional situations. Most of the kids that I've kept, my wife and I have kept up 30 kids, um, most of them are short-term, um, have a lot of sexual abuse and other things that cause some very significant trauma. [1:12:19] And one of the first things we had to do as foster parents is fight Amerigroup, the managed care provider, um, because they said that the little girl who was abused when she was two, was sexually abused, was not eligible for more therapy even though there was blatant manifestations, and I'll just get that without being, um, privacy. And we had to fight them and eventually lost, and so we just paid for it ourselves 'cause we could, and we were blessed to be able to do that. [1:12:50] But the bottom line from the provider point of view is that it's just not the right model for these kids. They're going to multiple care providers. They have multiple locations. They have much more complex services than the average kid needs. And the motivation of a managed care group, I get that, is to make sure that the client, the medical user, doesn't use too much care and is inefficient about how they use their care. And I think, yeah, that makes sense. I'm not against managed care in general. [1:13:20] But for this population, it doesn't really work. Um, in the lieutenant governor's office, we did some budget analysis, and I testified in front of a Senate study committee a few years ago. Um, looked like that, um, the managed care providers are making a pretty healthy profit off of, um, off this, uh, population, which I'm a, I'm a, I'm a g- for-profit capitalist guy, but it just seemed, it seemed wrong to me and the numbers we were able to come up with when we worked on it. Um, the, the people this has touched, it has really made a profound influence. [1:13:55] I mean, the team that was trying to work on this in 2019 really just felt like it was something that just was a, a moral issue, that we needed to really provide the right answer for these kids. And some of you may remember, um, Chairman Jack Hill, longtime Senate Appropriations chairman from South Georgia. Um, just before he was passed away, um, in early 2020, Jack had this bill to run it because Jack, and I don't think anybody in a long time has known the budget backward and forward other than Jack and Terry England when they were running the show down here. [1:14:27] And Jack knows how everything worked. He knew how Medicaid worked. He knew how the foster care system worked. He knew the state budget upside down and backwards, and he had decided this was the right thing for foster kids. So, um, I really appreciate Representative Camp, who I met today. I did not know her, but I heard rumors about this bill this morning, and I changed my schedule to come down here. Um, didn't prepare any testimony 'cause I just wanted to speak from my heart. But, you know, when you're a legislator, sometimes you get things that are technical, sometimes you get things that are political, sometimes you get things that, you know, make social media headlines, and sometimes you just work on stuff that you, you gotta do the right thing. [1:15:02] And in my opinion, um, um, Mr. Chairman, the committee, that hopefully we can work through this and get it done. Like I said, this has been in the works for several years. Um, you know, the contract's about to change up with the managed care organization. Just the wrong model for this population, and, um, you know, I would love to see, um, this bill make it to the end. Anyway, so appreciate y'all's, uh, attention and time to, to talk today. [1:15:25] Well, thank you. You know, one thing that you remember- [1:15:28] Yeah [1:15:28] ... that you learned is that if you talk long enough, you get a question. [1:15:32] I know. [1:15:33] And you've got one. [1:15:33] Get out of the well. Get out of the well. [1:15:35] Congratulations. You've got one, Representative Kelley. [1:15:38] Oh, goodness. [1:15:39] Thank you, Mr. Chairman. Mike, it's good to see you again. [1:15:41] Good to see you, sir. Yeah. [1:15:43] I, uh... One thing I always respected, uh, of you when you were here in the House is that when we would address a problem, you would think through what we do next to it. [1:15:52] Mm-hmm. [1:15:52] And we have a system in place today, I agree with you, I don't think it works. [1:15:56] Mm-hmm. [1:15:57] But what are some considerations you think we should be mindful of if we're going to blow this up and start over? [1:16:04] Uh, I mean, I, I, I would, mis- But tell you it's not really blowing it up 'cause we have fee for service Medicaid is already a thing. In other words, it's not like we're inventing a new, um, path for, you know, there are people on fee for service Medicaid. We've moved more people, the population, I don't know, the health committee probably, so more, more and more are moving to the managed care. But we're just moving to a model that we've known works. Some may argue it's a little bit more expensive. A fiscal note will do that. I think we ran a fiscal note back in 2020 or whatever it is. I don't know if we can dredge that out. I don't know if it's accurate anymore. [1:16:35] But, um, um, I don't think that there's any, um, downside really. You know, one of the other challenges too, just for foster kids, is just finding, you know, like everybody on Medicaid, finding a provider. A lot of providers don't take Medicaid, right? So that's another issue you gotta kind of work through in trying to find someone in network that's gonna take your kids anyway. So, but if the provider thinks the service is mandated, um, we don't have to, um, constantly have a war with the managed provider who says, "Well, you only can have five therapies or whatever." So you just kinda get out of that war. [1:17:07] Thank you. And just one follow up question. [1:17:08] Sure. [1:17:09] Could you speak to what you think the increased amount of time you would have to spend scheduling doctor's appointment and needed care for your foster children would be as a parent versus other times for children not under managed care that you've experienced? [1:17:28] Well, I mean, I think I would hopefully spend less time arguing with insurance companies and calling around and trying to... You kn- you, all of y'all been down that road, where you're trying to fight, you know, to get something that you wanted to have care for, right? You know, the, the people that I've seen in the foster care community, no one... I mean, they, they all do it because they feel a calling. They love these kids. They wanna help out, and so they really want the kids to be helped, right? And so if they think they need to go to the doctor, especially get them, I guess you get a mama with her kids or even a mom with her foster kids, she wants the best thing for those kids, and they're, they're gonna do whatever. [1:17:59] What they don't wanna hear is no, and then, you know, like I said, we were able to afford some stuff 'cause we were blessed to be able to do that, but a lot of families can't do that. So I, I believe that it, it, to me, just takes a, uh, less out of it, which means that if I find a Medicaid doctor, he approves the service, then we're gonna get it paid, and we're not gonna have to worry about it. [1:18:19] Thank you, Mike. [1:18:19] Sure. [1:18:22] Thank you so much. Oh, you've got one more question. [1:18:24] Yes, sir. [1:18:25] Representative Lim. [1:18:27] Yes, sir. [1:18:28] I, I just want to, again, very supportive of this. I just wanna clarify, the problem is not the current entity that holds the contract. I'm, I'm seeing a lot about the problems. In y'all's opinion, it is not something that DHS could rebid and find a better provider that would not have any of these problems. [1:18:49] Um, my opinion is that both of those things are true. I don't think the current provider has done a good job. That's my personal opinion. Also, it was the result of a lot of research I did a couple years ago, and I testified in front of the Senate about that. Uh, but s- second, as I said, I just don't think it's the right model because, again, the idea of managed care is I'm looking holistically as child, and I'm looking at this doctor and this physician and this and making sure it's all working together, but, uh, foster care is a fragmented life. And so, you know, again, I've come from this house, and I get dropped on my doorstep, and I'm like, "I don't know this kid's medical history. [1:19:21] This doctor's next two counties over. I gotta take a new doctor," and then they get moved to another, another place, and this doctor doesn't know. And, and to be fair, I mean, I, I, the first call I received from the current provider about the managed care for my foster kids, which I had for almost three years, was a week after I testified in the Senate. I just d- I just don't think it works. And, and so I, again, I don't think the current provider did a good job, and I've been on the record saying that multiple times. But two, I just don't think it's the ideal system for these kids. [1:19:52] Thank you. [1:19:53] Thank you. [1:19:53] Sure. [1:19:54] That's, uh, d- We got one more question. Representative Clark. [1:19:59] Um, thank you, Mr. Chair. Um, so you said two things that piqued my interest. [1:20:04] Uh-oh. [1:20:04] Um, one, you said, um, this is probably gonna cost a little bit more, and, um, the second thing you said, uh, that piqued my interest was, um, that a lot of providers don't take Medicaid. [1:20:19] Mm-hmm. [1:20:20] And so are there any concerns that by doing it this way, that we actually might be creating a new problem because of those two things that you brought up earlier? [1:20:33] Um, one, I don't, I don't think the fiscal note's gonna be that much. To be honest with you, I really don't know. But two, I mean, uh, Medicaid fee for service and Medicaid, um, um, uh, managed care, I mean, it's really finding a Medicaid doctor, so as long as we're within the Medicaid universe, I don't think we're gonna restrict the, uh, restrict the care, as far as my understanding. [1:20:54] Right. We have ABD, age blind disabled, which is- [1:20:57] Yeah [1:20:57] ... fee for service. [1:20:58] Mm-hmm. [1:20:58] We had dentists in that program. Unfortunately, when we passed, or actually did not pass legislation, but the move in DCH was to include adults with Medicaid. On that same waiver swept the kids and young adults that are disabled or mentally challenged, whatever, so they went from fee for service to the CMOs. [1:21:21] Got it. [1:21:22] Fee for service dentists and physicians- [1:21:24] Mm [1:21:25] ... do not have to be Medicaid providers. [1:21:26] Yep. [1:21:26] Those fees are, are different. They're typically higher, does cost more because it takes more to manage these patients. You know, you, you're talking about sedation. [1:21:36] Mm. [1:21:36] You're talking about taking a lot more time. Uh, so this makes sense to me- [1:21:42] Yeah [1:21:42] ... 'cause I've, I've, I've- [1:21:43] And thank you, Mr. Chairman. I actually, I'm, I'm glad you clarified that. I didn't say that very well about the fee for service opening up more. In other words, it's, it doesn't restrict. If anything, it opens up to more, more providers. [1:21:51] Prior to 2003- [1:21:52] If people take the Medicaid fee for service, yeah. [1:21:55] Right. Prior to 2003, we were all fee for service. [1:21:57] That's right. [1:21:58] That's when the CMOs came into being- [1:21:59] Yeah [1:21:59] ... in the state of Georgia. [1:22:00] Gotcha. [1:22:01] Any more questions? Okay. [1:22:04] All right. [1:22:05] Well, I look forward to having you back. If you get a fiscal note, we'll have some more discussion about this. Thank you very much. [1:22:10] Thank you. [1:22:10] Thank you. [1:22:11] All right. Thank you. Uh, at this time, we've concluded, uh, our work here today. Thank you all for attending. [1:22:24] Thank you.