Senate Health and Human Services Committee, February 9, 2026

Transcript

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1. 0:18:06

   It's Health and Human Services Committee to order. Um, and we're gonna go straight to prayer. Chairman Goodman, if you don't mind, uh, you're on number seven. Number three?

2. 0:18:21

   Four.

3. 0:18:21

   Number f- number four.

4. 0:18:23

   Well, thank you, Mr. Chairman. I just wanna commend you on your pre-meeting mu- background music. You're knocking it out of the park. And, uh, with that, if y'all will, uh, say a word of prayer with me. Heavenly Father, we just thank you for today, Lord. We thank you for loving us. We thank you for the gift of salvation. And Lord, those, both of those songs, Lord, that were just played, uh, um, really can apply to our daily lives, If I Can Dream and, uh, Don't Stop Believin', Lord. And, uh, we, uh, we just pray, Lord, as we go throughout this meeting, that you grant us the wisdom and discernment that we need to make the best decisions on behalf of the people that we represent of this great state, Lord.

5. 0:19:00

   We thank you for loving us, Lord, and we thank you again for all your blessings. In Jesus' name we pray, amen.

6. 0:19:05

   Amen. Amen. Thank you, Chairman. We really appreciate that. Uh,

7. 0:19:16

   we have more than a quorum, so let's get started. And, uh, we have just one bill on the agenda. Uh, we have it as a hearing only, uh, but the chairman reserves the right to change, uh, at his discretion. So we'll see how it goes. Uh, Senator Shawn Still, SB 439, uh, Fair Business Practices Act. Uh, love for have you and anybody else to present the bill, and we really appreciate you bringing this.

8. 0:19:48

   Transparency is, uh, something I think is, uh, ever so important, and, um, I didn't even know this existed, and, uh, like to hear about it, and, uh, and, and sort of go from there. I think we have people to sign up. Well, somebody will need to get that sheet if they would please. If anybody else can go to the podium and sign up. If not, uh, forever hold your peace. The floor is yours. Uh, our caucus chair, Shawn Still, on number two. Thank you.

9. 0:20:17

   Thank you, Chairman, committee. I appreciate y'all being here for this one bill. I, um, feel like I've spent more time with this committee than any other, so, uh, it, it means a lot that y'all, uh, come and listen, give it all the, uh, attention that it needs. So Senate Bill 439, uh, Fair Business Practices Act 1975. Not all of you were born when the Fair Business Practices Act was, uh, was written. So, uh, it, uh, it predates some of y'all. Uh, I was not old enough to vote then, but, um, glad that I was around nonetheless.

10. 0:20:51

    And when we're talking about consumer protections, we're talking about transparency. And other than our children, um, our elderly are, uh, in my opinion, um, are most important, most respected, and oftentimes most forgotten and taken advantage of segment of the population. So this bill, uh, comes to us, um, from our friends that are in that space.

11. 0:21:22

    Uh, this is something that they identified as a, as a huge need that we needed to work on in order to make sure that, um, those that are being cared for and their families know the truth in what's happening on referrals, uh, for them to be able to, uh, be referred out. So I can walk through the bill, uh, with you on a, a line-by-line basis. And, uh, and with me today is, is Seth Daniels, and, um, he, uh, has a deep understanding of this issue.

12. 0:21:56

    He, he lives it every day, um, and understands it. So I'll walk you through the bill, and then he can answer, uh, specific questions that, that you may have, uh, with that. So, um, starting on, um, you know, Section 1 is just getting through definitions. But if we, um, jump to, um, lines 15 through 28, it, it's just, it's a word for word on how assisted living and personal care homes are, are defined in, uh, Georgia statute, and it's just adding a few more clarifications on it.

13. 0:22:26

    Uh, particularly, you know, what defines a, uh, personal care home with a minimum of 25 beds, right? So we're-- 25 or more. These are not just private residences. So we're getting into that, that part of kind of the thinking here. Um, it's a, uh, profit or not-for-profit, uh, that, that manages the provision of housing, food service, and, and, uh, personal care services. Um, and then going down the line, um, through, uh, through 28.

14. 0:23:03

    When we get to lines 29 through 37, it's adding a new definition just for this code section for the referral agencies. So Seth can talk you through the, the daily. But the, the short version is that when someone is making a referral, uh, the study says that approximately 90% of those that referred have, have made a decision on where they're gonna go within 12 months. So it's just, um, ensuring that they know, you know, what that referral agency means and that there is a fee attached to that, and where does that fee go, and why is it collected, and, um, how is that, um, information shared.

15. 0:23:49

    Lines 38 through 54, the disclosure requirement. Lines 55 through 57, the requirement of the resident attestation that they used the agency's services.

16. 0:24:03

    Beginning line 58 through 69 states that agencies have to show an acknowledgement of the disclosure and the attestation to charge or collect the referral fee, and that fees cannot be collected for referrals after 12 months And then lines 70 through 73, uh, is the requirement that agencies confirm, uh, residences, uh, that they make referrals to, um, that they're licensed with DCH. Happy to answer any questions.

17. 0:24:38

    Question from the vice chair.

18. 0:24:40

    Thank you so much, Senator. I... My question relates to starting on line 42. Um, you know, throughout our law, we prohibit people from making referrals to things that they have an ownership interest in. But you're saying in our current law, we do allow that?

19. 0:24:58

    Yes.

20. 0:24:59

    Seth, can you speak to that?

21. 0:25:00

    Uh, sure. Uh, yes. Thank you, Senator, for the question. So, so right-

22. 0:25:04

    So, uh, Seth, identify yourself, please.

23. 0:25:06

    Yes. Sorry. Um, I'm Seth Daniels. I'm with the Georgia Senior Living Association. Um, so right now these, uh, agencies are not regulated whatsoever in Georgia statute. Uh, there are other, uh, areas, the medical profession is one, where if people are referring to services or clinics or homes where they get, you know, a fee, a referral fee, that that either has to be disclosed or it's prohibited. So, but right now in Georgia statute, um, that does not apply to this industry.

24. 0:25:36

    Just a follow-up?

25. 0:25:37

    Yeah.

26. 0:25:38

    So there's nothing federal, like the Stark Law, for example, that prohibits, um, referring someone to something where you have an ownership interest?

27. 0:25:49

    Uh, CMS actually prohibits this for skilled nursing homes. Um, but since we are assisted living, we are private pay, um, we are, we are not Medicaid in Georgia. Uh, that, that CMS prohibition does not apply here.

28. 0:26:03

    Thank you.

29. 0:26:06

    Yeah. Sure.

30. 0:26:10

    All right. Uh, Chairman Cowsert's on 12.

31. 0:26:13

    So I'm, w- I don't know, what, what's the problem? I mean, what, what's the evil you're worried about? Is this competition, people referring folks to places other than your organization's homes, or what's going on?

32. 0:26:25

    Sure. Um, so I'll, um, uh, put it this way. Um, every year thousands of families rely on these referral agencies to find an assisted living solution for their loved ones, typically their parents, um, could be a spouse, uh, or another, uh, relative. And, uh, you know, they go online like we do for everything these days, and, uh, they, they Google and they follow the first couple of links on the website, and they're taken to a referral agency website.

33. 0:26:56

    They fill out a survey, they list their needs and preferences, and the website churns out a list of results. Um, and then they, you know, they are told that this is a third-party objective group producing the best results and, you know, trusted advisors and everything. What those families are not told is that those results are only communities that have contracted with the referral agencies ahead of time to pay them a fee for people that move in. So, uh, this is an important bill.

34. 0:27:26

    The consumer and transparency for seniors and their families is at the heart of this bill. Um, just to disclose that that's how this works, um, that you may have, and the disclosure that Senator Still referenced, um, is, is spelled out on page three. Um, or, or I guess starting on page, starting on page two, line 38. Uh, but it is essentially, this is how this works. We collect a fee for making a referral, um, that you may have needs and preferences, or you may have options that meet your needs and preferences that are not on our list, and that you can opt out of our services at any time.

35. 0:28:05

    That is the disclosure. And, uh, and we think that that's important transparency for seniors and their families.

36. 0:28:11

    Why don't your organization just pay the referral agencies to refer to your groups too?

37. 0:28:16

    Uh, well, we, uh, we don't wanna get too much into, uh, contracting between private parties, uh, with s- this bill. We're just, uh, simply, uh, putting guardrails around the process. Um, our communities contract with many of these different services. Um, and we, you know, they like some better than others. Sometimes the rate is better than others. Um, but we think that this bill will, will help balance the playing field a little bit and make us better, put us in a better bargaining position with our partners.

38. 0:28:52

    Senator

39. 0:28:53

    Uh, 11.

40. 0:28:54

    11.

41. 0:28:54

    11, yeah. Thank you, Mr. Chair. This is following up. Is there, um, are there a lot of cases where these agencies are being misleading? Is that why y- we need this bill? And number two, are patients aware that they are paying a fee? Uh, I see that's trying to correct that, to disclose that. And has there been a fee charged, and has it been excessive and abused? So can you answer kind of those questions?

42. 0:29:19

    Yeah. Um, uh, Senator, typically the, um, the fees are paid by the senior living communities that I represent. It is, most of the time, free to the consumers. Uh, but the consumer is unaware that there's a fee paid on the back end. Um, and so that, this bill would require a disclosure of that fact. Um, there, I know there are some people that are signed up to speak that can talk more about, um, their experience from the provider side and the consumer side about, you know, being shocked that they knew there was a fee involved in this or how much the fees are, and, uh, that it's a significant cost driver for our assisted living providers that are all small businesses.

43. 0:30:00

    Do, do we know how much?

44. 0:30:01

    Has there been... Sorry.

45. 0:30:02

    I'm, I'm gonna interrupt you, sorry. Do we know how much the average fee is?

46. 0:30:06

    Uh, it, it varies depending on the community and who the referral agency is. Uh, we typically see between, uh, 70 and 120% of the first month's charge. So room and board, care charges, all that, it's in that range.

47. 0:30:19

    So the first month on average.

48. 0:30:21

    Yes.

49. 0:30:21

    Is the, uh... It's interesting. I, I will tell you, you know, I do geriatrics And I get the question a lot about, you know, assisted living, personal care, and/or skilled nursing facility. I, I have never heard of any money changing hands relating to referrals.

50. 0:30:42

    Me either.

51. 0:30:43

    That's interesting. Um-

52. 0:30:45

    I just had a follow-up question, Mr. Chairman.

53. 0:30:46

    Well, you know what? I'm, I'm gonna move on. We're gonna come back to you.

54. 0:30:49

    I just wanted to know if there was a prevalence of abuse as it goes.

55. 0:30:53

    Mr.-

56. 0:30:53

    We think so.

57. 0:30:54

    I, I... You know, I-

58. 0:30:59

    Mr. Chairman, can I?

59. 0:31:00

    Yeah, sure.

60. 0:31:01

    Uh, just for the record, Skin Edge, we also r- represent the Georgia Senior Living Association. Seth is in-house with them, and I'm their outside, uh, lobbyist. To really boil it down, what you're getting to in this bill, when someone contacts one of these referral agencies and they say, "I, I'd like for you to recommend a good place for my mother," and they come back to them with a list, what they're not told is, "We didn't look at the entire universe of homes.

61. 0:31:31

    We only look at the ones that are paying, that pay us a fee if someone ends up there." So there may be five others that are just as good, if not better, but if they're not paying the fee, they're saying, "No, we don't wanna do that," the people who are seeking the referral are never told that. They have no idea. That's what we're trying to get at, uh, in transparency. All this bill says is that in a situation like this, they are told that we refer to, r- refer to, uh, communities that pay us a fee, and this may not be everybody included.

62. 0:32:12

    Which, and, and we think the, it's important that the consumer know that and understand that they may not be getting all their options that they want. And it's as simple as... And they just acknowledge that and say, "Thank you. You, you've told me this. Now I know this, and I can decide how I wanna move forward." That's really it. Um, and then as the second part of the bill is once the person does move into a community, they sign a form saying that, "X, Y, Z referral agency referred me here," so they can get their fee, and that's fine. But the consumer's not paying the fee.

63. 0:32:42

    The, the community's paying the fee. The concern is the consumer's not given full information, and they're not aware of that. That's, that's all we're trying to get to.

64. 0:32:53

    I have a question.

65. 0:32:54

    I have a question.

66. 0:32:56

    Okay. Back to Vice Chair.

67. 0:32:59

    Yeah. Just, just to be clear, who's paying the fee?

68. 0:33:04

    The community.

69. 0:33:04

    The comm- the assisted living provider.

70. 0:33:07

    So the consumer is not paying the fee?

71. 0:33:10

    Correct.

72. 0:33:12

    All right, uh, we got three and four. Uh, who's first?

73. 0:33:16

    You can go first.

74. 0:33:16

    Okay.

75. 0:33:17

    How does someone find one of these referral agencies? Is it... And, and l- let me preface. My question is if you just Google it and click on an ad, and it leads you to a website of a senior living facility, is that because they generated off a Google ad? Does that allow someone to get a fee right now?

76. 0:33:38

    No. No, y- typically, you may go online, or you may talk to your physician, you may talk to whoever and get a referral to the referring agency. Just because you click on doesn't, doesn't mean they've referred you. It's, it's gotta take another step forward where you talk to them in person or by phone. They give you a list of, of, uh, communities. Then you decide you wanna pick one of those. And by definition, all of those communities have an arrangement with the referring agency that if you go to one of their people, then they get paid.

77. 0:34:12

    And the, uh, Seth mentioned that, uh, you know, the average, you know, he gave you a percentage. I think in terms of dollars, we, we were looking at somewhere, if you take first, you know, first month's rent and, and everything else, it can run anywhere from $3,000 to $5,000 they're getting paid. It's a pretty nice fee.

78. 0:34:31

    Yeah.

79. 0:34:32

    Um, so, uh, but, but in terms of just clicking on, no.

80. 0:34:37

    Mm-hmm.

81. 0:34:38

    Okay. Um, all right, Senator Goodman.

82. 0:34:40

    Thank you, Mr. Chairman. These referral agencies, are they doing anything besides operating a website?

83. 0:34:47

    Oh, yeah. A- and I think you're gonna hear from some of them.

84. 0:34:49

    Okay. I'm just curious. I mean-

85. 0:34:51

    Some of them

86. 0:34:51

    ... a real estate agent gets 6%, and you're, you're talking about this is, is 10% for the referral, so.

87. 0:34:57

    Yeah. There are a few, um, there, there are some more locally-based community referral agency models, uh, that are a little bit more hands-on that do go with the resident to tour. Um, and, uh, and, and we like working with those. And then you have, you have others that are simply just a website-

88. 0:35:14

    Gotcha

89. 0:35:15

    ... that are just sending names and contact information.

90. 0:35:19

    Thank you, Mr. Chairman.

91. 0:35:20

    All right, uh, Senator Merritt, did you have... You wanna follow up?

92. 0:35:23

    No, I'm good.

93. 0:35:24

    Okay. All right, uh, so looks like we've exhausted the questions of the committee now, and we got one, two, three, four, five, six. And I'm looking at my watch. We got, uh, six times... Let's, uh, give everybody three to four minutes, and we'll give you a warning at three, drop dead at 4:00, and we'll get questions for a minute after that, and, uh, we'll move on. So we got a timekeeper here.

94. 0:35:54

    Uh, Melinda, is it Dahli?

95. 0:35:56

    Yes.

96. 0:35:57

    Okay. Ms. Dahli, and then Leslie Finkley is on deck. And just identify yourself, and, uh, we'll go from there. Thank you.

97. 0:36:13

    Short. Sorry, I've never done this before, so this is, um... Thank you so much for, for taking time to, to talk to us today about this bill. I, um, I- I am a family-owned assisted living community in Monroe, Georgia, Great Oaks. I've been the administrator of that community for 24 years, so I have lots of experience in referral agencies, um, and the process. Um, I'm excited to support the bill today. Um, I'm here as not on- on- only an advocate for my business, but also for families, because I see them when they come in.

98. 0:36:48

    Um, when families are making decisions about assisted living, it's, it's a big decision, and often it's under a lot of pressure. Something has happened to their loved one that facilitates the need for a higher level of care. Um, they're, they're often under time constraints. Something's happened and they've gotta make a decision quickly. Um, and they wanna make the best decision for their loved one. Most have never made these decisions before, and so just like most of us, when we don't know something, we go Google.

99. 0:37:18

    Um, and, and online presence of referral agencies, they do a great job at optimizing on Google, and their name will come up at the top of the list. But people can Google my name, Great Oaks, but it will fall under one of the referral agencies. And oftentimes they don't understand that they're actually going to a referral agency. Um, they think it's us. They thought they clicked on our website. Um, they'll call them back.

100. 0:37:49

     Oftentimes they think that they're talking to us. So there isn't a lot of transparency there, um, in the process.

101. 0:38:00

     When I talk to families during the move-in process to confirm that they had a referral from an online agency, they'll be confused. Oftentimes they'll say, "I didn't talk to an online agency." And you have to explain the process. "Well, did you go online? Did somebody call you? Did you put your information in on a website?" And they'll say, "Yes." And I say, "Well, that is a referral." And oftentimes they feel very taken advantage of, that they didn't realize it was a referral. They didn't know that that was what they were doing.

102. 0:38:33

     They didn't understand there's a fee associated with that, and sometimes they even feel guilty about that, that I'm having to pay a fee for their referral. So I'm having to, to explain the process at, at the end of it instead of it being transparent in the beginning. And I think with transparency, consumers, families, residents have the ability to determine what their need is. Um, they're going into this process blind. If the agency can let them know what they're offering, then they can make an informed decision that if they need, need their services or not.

103. 0:39:08

     So all we're asking is to be upfront, let them know that this is a referral sor- referral service for a fee, um, so that they can make an informed decision. Um, I will say when we work with m- not online presence, but more of a local referral agency, there's a hands-on touch there. The clients that come to me that work with local referral agencies never question whether this is a true referral because they have somebody that's talking to them.

104. 0:39:39

     They have somebody that comes and tours with them. Um, so they have made that disclosure early. It's the online presence that's very difficult. They're really ... It's almost like clickbait. They are just clicking on a site thinking that they are coming to our site, when in fact they are ... They feel tricked. Um, they feel like they've been tricked into a process and, and into an agreement that they really didn't have all the information about. Um, so I appreciate your time, and I hope you'll consider my testimony in this, um, in voting on this bill.

105. 0:40:19

     Thank you so much. We appreciate that insight. And, uh, Leslie Finklea. Thank you.

106. 0:40:26

     Hello.

107. 0:40:27

     Thank you. Just identify yourself, and Amy, uh, Hinch- Hincher is up next.

108. 0:40:33

     Okay.

109. 0:40:33

     Go ahead.

110. 0:40:34

     I'm Leslie Finklea. Um, I manage two communities here in Georgia, one in Athens and one in Brookhaven, Georgia. Um, and I'm really here to speak for the small assisted living communities out there. Um, I wanted to start by saying that, um, I got into this, into this business to take care of people. And myself and my employees, we know every resident.

111. 0:41:05

     We know every family member that comes through our doors. Orchard is the last place that the majority of our residents will ever live. We honor their homegoings, attend their funerals, and grieve with their families. We are in the business of caring. I had to learn the hard way about online referral agencies. When we first opened a community, we were flooded with referrals from, from, um, online referral agencies. I learned that the burden is on the community to screen if we have a contract.

112. 0:41:40

     If we didn't decline the offer in 24 hours, a contract was implied. When we started in 2015, referral fees were about 65% for us. That averaged about $4,000 per resident that moved in, which is enormous when you have a startup community. Today, those online referral agencies for us averages about 95%, costing us upwards of $8,000 per resident.

113. 0:42:11

     These fees are hidden from the families. If we don't agree to these contracts, our communities are not seen, not shown to the families, not because we're not a good service, a good option for families, but because we can't afford the cost. By paying these fees for a company my size, our f- we are fi- we can financially be broken. These fees have to roll over to the consumer if we're able to compete, and that's not what we want to do.

114. 0:42:47

     So we end up being lost and unseen on the websites. The transparency we're asking for for these online referral agencies is the company that sent a, a resident to our community. The family toured without ever telling us. They had no idea they were with a referral agency. They chose our community, and we took care of their loved one for three years, and we attended that resident's funeral. We received an invoice from the referral agency, not because they stayed in contact with the family and wanted to know what was best for them, but because they scour obituaries, and they found the resident's name listed there.

115. 0:43:33

     This is the transparency we're asking for for these online referral companies. Thank you.

116. 0:43:45

     Thanks so much. Um, and Tammy Brewers is on deck, and Ms. Hensher?

117. 0:43:52

     Henshel.

118. 0:43:53

     Henshel. That's an L. Okay, sorry about that.

119. 0:43:55

     No, that's okay.

120. 0:43:56

     Okay.

121. 0:43:57

     Thank you so much. Uh, Chairman, members of the committee, thank you for the opportunity to speak today. My name is Amy Henshel, and my husband and I, who's also here as well, are owners of Senior Provisions, a Georgia-based senior care advisory company. For over 15 years, we have provided high-touch, hands-on, free guidance to families navigating senior living and care decisions. Would it surprise you to know that we have served over 15,000 families here in Georgia?

122. 0:44:28

     I speak to you, first of all, under the authority of the Kingdom of God, compelled with the power and love of Christ. Our advisors work directly with families, often during hospital discharges, rehabilitation stays, and sudden health changes, coordinating their care needs, touring communities with them. We remain involved through transition and even to end of life, all at no cost to the family. This work is personal, it's time-intensive, and it's relationship-based.

123. 0:45:01

     It is not transactional one bit at all. We're co- uh, proud co-founders and members of the Atlanta Placement Coalition and co-leaders with the National Placement Referral Alliance, Georgia Chapter. Many of our members are here in the back. We promote ethical standards, transparency, and accountability in the industry. Let me be clear. We absolutely support transparency, consumer protection, and appropriate oversight.

124. 0:45:32

     We are often the advocate for the family. SB 439, as currently written, we cannot support it because several of the provisions unintentionally disrupt how high-level senior care guidance actually functions in real time. This proposed law does not address the true consumer protection. Its focus is really about ... This law is about contract law. It's about protecting one party. So first and foremost, this, uh, any type of bill, including SB 439, includes three parties, the family, the senior care advisor, and yes, the care provider.

125. 0:46:15

     Effective outcomes depend on alignment among all three. Second, the bill imposes procedural requirements that do not reflect the time-sensitive nature of our high-touch advisory work, which you will hear from other speakers. Our role is to help families move quickly without sacrificining, uh, sacrifice, sorry, sacrificing the informed choice they have. We help advocate. We make sure. We stand in the gap with them.

126. 0:46:46

     Lastly, the increased administrative burdens that this bill would put on the Georgia small business owners as well as our Georgia families seeking help, i- is reducing the accessibility that they have to this service. High-touch guidance requires significant time, follow-through, and ongoing environment, involvement. So while and when regulatory requirements grow without improving the outcome, smaller community-based agencies such as ours could be forced to limit our service, leaving families with fewer options.

127. 0:47:23

     Another question came up of how they find us. I can tell you that I get zero online referrals, leads, families. All of my families are referred directly to me either by former families, the 15,000 that we've helped, or a pastor or a financial planner or the doctor. So finally, though this bill does have the appearance of transparency, it really does not accurately safeguard what families rely on most.

128. 0:47:54

     I think we can do better. They need experienced guidance, continuity, and advocacy across all three parties. Process alone does not ensure the protection.

129. 0:48:05

     So that's four minutes.

130. 0:48:06

     Yeah.

131. 0:48:06

     Let's see if anybody has any, uh, questions, uh, for you. Thank you.

132. 0:48:09

     Thank you.

133. 0:48:09

     Um, number three.

134. 0:48:12

     Thank you. Thank you for coming today. Um, I heard, you know, your position as to the problems with the bill and your ... But I, I know you were limited on time, but do you have a solution for how this bill would be, or how you could change the bill or

135. 0:48:33

     Are, uh, yes, we do. We have, um, been engaged with the GSLA just recently, uh, to, uh, bring forth our suggestions that would really make it, um, truly consumer protection. Uh, there's parts of it that actually are hurting and harming Georgia families, not to mention the local... I mean, we're, we have 30 agencies that are part of our organization that are small local business-

136. 0:49:01

     So you've given him specific examples, lines to-

137. 0:49:04

     Yes

138. 0:49:04

     ... that need to be fixed?

139. 0:49:05

     Uh, by noon tomorrow. We, we were-

140. 0:49:09

     So you're still waiting on it. Gotcha.

141. 0:49:10

     Yeah. We will have them to him by noon tomorrow. We- we're 30 companies trying to come to a consensi- uh, consensus about what's the most important. We're working on it.

142. 0:49:19

     Okay. All right, uh-

143. 0:49:22

     Did you say that?

144. 0:49:22

     I said hearing only, uh, but I, at, the chairman has the, uh, ability to change that. So-

145. 0:49:31

     I was just wondering-

146. 0:49:31

     Senator Merritt, you or what number are you on m-

147. 0:49:34

     I'm 11

148. 0:49:34

     ... 11. Okay.

149. 0:49:35

     Sorry, Mr. Chairman. Could you give us a couple of am- amendments that you're proposing, just so we can get an idea of what you were, were- Absolutely ... thinking? And I do have an executive summary here which outlines it, so I'll leave those for you. Something quickly. Yes. So, um, it's an increased burden on families at the moment that they're going through a crisis, sitting overnight at a hospital. If any of you have been with a loved one at the hospital, and then the social worker comes in and says, "It's time for you to take him home," and you can't take your dad home, and you need help immediately, and we have to come-

150. 0:50:06

     What, what's, what's the change you have?

151. 0:50:07

     What's the changes on there? Oh, the change is- Yeah, I want you- Yes, I'm sorry ... give me the, give me a couple of the changes- Yes ... you're proposing. Um, so the, uh, requirements of the, um, engagement letter that needs to be signed prior to us working with the family in order for our referrals to be honored and paid. That's a problem. That's a problem. And it's a problem for the families.

152. 0:50:28

     Was DocuSign doesn't... Okay, gotcha, you don't do it by-

153. 0:50:31

     And-

154. 0:50:31

     ... by a contract. Okay, what else? What else did you have?

155. 0:50:33

     And Senator, many of our clients are in their 70s and 80s and do not have smartphones.

156. 0:50:38

     South of the border. That's right.

157. 0:50:39

     Mm-hmm.

158. 0:50:39

     Okay.

159. 0:50:41

     Um, another issue is the 12, um, month deadline. I mean, I have families that took four or five years to make a decision, and I have given them geriatric care management at no cost for four to five years. Then they make a decision. We don't have as big of a problem with that waiting period because we can, w- we're re-engaged with families all the time-

160. 0:51:05

     So you want a longer or unlimited

161. 0:51:05

     ... at least a 24 month.

162. 0:51:07

     I gotcha. Yeah. O- okay. And, uh, I don't know. Transparency.

163. 0:51:12

     I will-

164. 0:51:12

     Signing a contract is pretty dang transparent generally. I gotcha.

165. 0:51:15

     I-

166. 0:51:15

     What else you got?

167. 0:51:15

     I will tell you this-

168. 0:51:16

     So you'll have those to him by noon tomorrow?

169. 0:51:19

     Yes.

170. 0:51:19

     Gotcha. All right.

171. 0:51:20

     We disclose how we're paid to every single family.

172. 0:51:24

     You know, that's interesting. I, I, I'm in geriatrics. Never heard of this service before.

173. 0:51:32

     Me either.

174. 0:51:34

     All right.

175. 0:51:34

     Okay.

176. 0:51:34

     Uh, next person.

177. 0:51:36

     Thank you.

178. 0:51:41

     All right.

179. 0:51:41

     Yeah. You have, you have one more question if you don't mind. Number four.

180. 0:51:45

     If you don't mind, I'm just gonna ask a question. Ob- obviously, I'm not saying this ab- about your agency. Obviously, if you've handled 15,000 families you've got a good reputation. But I'm just sitting here thinking, I'm a farmer, I'm not in this line of work, but I mean, has there been instances where, um, someone has ran a referral agency and perhaps there was a, a great home here that was doing a good job but did not pay referral fees, and then you had another, another home that was, um, n- not a good place there where you want grandmother to go, but they end up going there because that place is paying a referral fee?

181. 0:52:20

     I'm sitting here thinking in the back of my mind about this. I mean, are you, if you-

182. 0:52:24

     Do you know, I'm probably asked that question almost every single day because it would make sense. So, um, my answer to that is no, we don't make a referral to every single community. You know what the criteria is, is quality care and that they have availability based on the current needs of that family. So no, there may be, um, e- every community doesn't offer the same services. So there may s- be someone who doesn't offer memory care. I'm not going to refer to that community. It doesn't offer that level of care.

183. 0:52:58

     So, so do you ever refer to people not owning-

184. 0:53:00

     Yes, I do

185. 0:53:01

     ... anything? And, okay.

186. 0:53:02

     And I, I can speak on behalf of Senior Provisions, we do it all the time.

187. 0:53:07

     Okay. All right. Next up is Tammy Brewer and then Laura Banner.

188. 0:53:22

     Good afternoon Mr. Chairman, members of the committee. Thank you for the opportunity. My name is Tammy Brewer. I am the co-owner of Care Patrol of Cobb and Cherokee County. I'm also a member of the National Alliance of Placement and Referral Agents. I've been part of that organization since its inception, and I am a member of the Georgia Senior Living Association. I started my business 11 years ago. Care Patrol is a 31-year-old organization. I purchased a franchise 11 years ago because I was faced with the difficult task of caring for my mother-in-law who had dementia.

189. 0:54:02

     I had no choice but to leave my corporate career and become one of thousands of unpaid caregivers. I know the fear, the loss of income, the confusion that families face today when trying to find senior care. I'm speaking in opposition to this bill. It does pur- um, the draft of it, it creates some dangerous barriers. It could erode trust in families and it can very much jeopardize my small, small business.

190. 0:54:36

     And on its surface it sounds great, and I was actually really excited about it at first. But as you read more, I don't actually see a lot of consumer protection in there that I would like to see added. And to one of the questions earlier, adopting the ethics with the National Referral and Placement Alliance could offer some of the trans- transparency that we're looking for.

191. 0:55:01

     I see a psychological barrier. Seniors are rightfully afraid of scammed and being scammed. In an emotional situation, forcing a document in front of my family who's standing in the hospital at 9:00 at night, at that point I am positioning myself that what is most important to me is whether or not I get paid, not what is the appropriate care for your loved one, and that needs to be the focus. We need time to establish trust with this family, that we are honorable, we are trustworthy, and we are transparent.

192. 0:55:37

     I tell every client I work with in Cobb and Cherokee County, "There are four communities in Cobb and Cherokee that do not work with me," and I am happy to disclose to them which four those are. I'm also happy to tell the clients, "If that's the right environment, you are welcome to tour that. I just don't get paid and I can't tour with you." We check the violation and the care history of anything that we suggest for families, often even their food score. So each community offers different services. They offer different kinds of support.

193. 0:56:10

     One size does not fit all, so it's very important to understand who is this person, who is the family, what care do they require, what can they afford. And what a lot of the focus is the large assisted livings, there are hundreds and hundreds of three and six-person residential care homes that would not survive without the support of referral companies such as myself. We believe that welfare first should be the reality. Section 1B creates a damaging perception that, again, that our primary goal is our fee.

194. 0:56:45

     Our mission is to provide emotional and clinical support. Families need a welfare first response, not a digital form to ensure we get paid. Section 1F ties my legal compliance to verify licensing to the DCH portal. Beyond the fact that this website frequently crashes and is unavailable, the data is often dangerously outdated and misleading. The Empower Line actually uses this to provide, uh, lists to families of personal care homes, and a good portion of the homes are actually even closed.

195. 0:57:21

     Newly issued licenses take forever to show up, and we see inspection reports that drop off the site-

196. 0:57:27

     We appreciate that

197. 0:57:28

     ... so I retain them.

198. 0:57:29

     Thank you. You, you, you've had four minutes. Any, any question on-

199. 0:57:32

     Yeah, I have a question.

200. 0:57:33

     Okay.

201. 0:57:34

     I missed the website that you're talking about.

202. 0:57:36

     The Department of Community Health Georgia MAT to CARES.

203. 0:57:40

     Yes. I wanted to

204. 0:57:44

     ... You, you got answers? Thanks so much.

205. 0:57:48

     Thank you.

206. 0:57:48

     Um, and then we're at, uh, Laura Banner, and then Seth Pesik, Pesik. Okay? Thank you. Floor is yours.

207. 0:57:59

     Thank you, Mr. Chairman. Would it be okay if I handed some information out to the committee?

208. 0:58:06

     Uh, we'll get somebody to help you with that.

209. 0:58:07

     Okay. Thank you very much.

210. 0:58:18

     Thank you. Again, thank you, Mr. Chairman, and members of this committee. My name is Laura Banner. I'm the owner, the co-owner of Oasis Senior Advisors, North Georgia. By training, I am a neurology nurse practitioner. This may seem like an unusual place for me to be with my, my past career, however, I just briefly wanna tell you a quick story. About four and a half years ago, I was in clinic seeing patients, and between rooms I received a phone call, and the phone call came from Florida. And this individual told me that my uncle, who had had a traumatic injury, was going to be discharged from his rehab in 48 hours, and where did I want him to go?

211. 0:58:57

     I was like a deer in headlights, like many of you I'm sure have had similar phone calls. Here I am in the healthcare industry, and I didn't know what to do. She said, "I've got you. Let me get some information, and I will get back in touch with you." It seemed so fast that it was happening that I never really had a moment to think about what her role was. We did not get my uncle into an assisted living because he was not safe to go home within 48 hours. But within 72 hours, we had him safe in an assisted living community that is caring for him in the way that he needs.

212. 0:59:31

     What I tell our families is that I'm bilingual. I speak medical and I speak English, and that's very important for a lot of families because it's very overwhelming, especially when they're in crisis. So what I'm gonna say to the committee is today, for you, I speak industry and I speak English. As I listen to the gentleman describing the, the proposed bill and the need for the bill, I have to tell you, it did not resonate with me in terms of what they were talking about. I am one of these referral agencies.

213. 1:00:04

     The way that it's described is not the way that we run our business, nor is it the way that many of our colleagues run their business. We are fully transparent. We do tell them how we're paid. We also do refer to communities that do not pay for our services. Beyond that, we also go ahead and guide them, should they decide to tour one of those communities that does not work with us. We go ahead and send them a list of questions. We tell them what we would say if we were there because we're assuming that they've never been down this path before, and we wanna make sure that they go in fully prepared.

214. 1:00:40

     We are a small business. To go ahead and regulate our small business would have a rippling effect. It would not just impact referral agencies, it would also impact everyone that we come into contact with. This would be elder law attorneys. This would be home care companies. This would be occupational and physical therapists. It's businesses that go into the home to retrofit. The way that I see our goal is not to place a family. We don't make decisions for families. We advocate for them.

215. 1:01:11

     We guide them. We make sure they have all the information that they need. But what I tell them is ultimately, we are here to support their decisions as long as we feel that we can do it in a safe manner. So do I think that there is a need for transparency? I would answer it this way. We are providing transparency. Again, this is a business-to-business. If communities did not want to work with us, they have the right to cancel a contract or to never sign one in the first place. So I feel a little perplexed when they're coming to us when, in fact, they've signed agreements.

216. 1:01:47

     I am not comfortable with having families sign something, especially if you go with a family in crisis. Now you're asking them to go ahead and say, "This person did this or this person did that." The community knows our value. In fact, when their census goes down, they call us and say, "Is there a family that you have that's appropriate for our community?"

217. 1:02:08

     Thank you. We really appreciate that. How many, um, how many do you ... How many referrals do you make of on average?

218. 1:02:15

     Uh, goodness. I don't know that I can put a number to that. I can tell you that month over month, we receive, um, referrals coming into us from hospitals, from providers, somewhere in the 50 to 60 range. Um, how many of those go out? Well, maybe this is the way I can, I can answer it. Of those that come in, somewhere between 20 and 22% actually make the decision to move into a community with our assistance.

219. 1:02:45

     So about 10 a month. So 10 to 15 a month.

220. 1:02:47

     Correct.

221. 1:02:47

     Okay. And, um, any questions from the committee? All right. Thank so much. Last one is Seth-

222. 1:02:55

     Thank you

223. 1:02:55

     ... Pes- Pesek or Pesser?

224. 1:02:58

     Pesek.

225. 1:02:59

     Pesek. Okay. Thank you.

226. 1:03:04

     Good afternoon. I'm Seth Pesek. I'm the president of Phoenix Senior Living, headquartered in Roswell, Georgia. We operate 18 communities in Georgia. We operate a total of 55 communities in 10 states in the southeastern United States of America. We have over 3,000 associates that care for 3,400 residents across all of the communities that we operate. I'm here to support SB 439 because current practices are harming families and small businesses. Let me give you two real examples, um, from our communities.

227. 1:03:38

     First, we had three different national placement agencies, all claimed that they referred the same resident to one of our communities that we had them move into, and they demanded payment. The family was blindsided. They had no idea their initial phone calls would cause three different agencies to essentially sell their name. And my community faced material financial exposure of nearly $20,000 for a resident who resided with us for less than 12 months. Second, a resident recently moved into one of my communities who was shocked to learn that they were tagged by A Place for Mom referral.

228. 1:04:14

     They told us they had one brief conversation months earlier just to learn about options, found our community on their own, but now we owe a fee to the agency because the family said they never used them. These are isolated instances. Families navigating these emotional transition, uh, deserve transparency. They deserve the right to know when they're being referred, the right to terminate those relationships, and protection from agencies billing for placements that occurred over a year after initial inquiry. SB 439 protects Georgia families and ensures small businesses like ours aren't paying fees for residents we found ourselves.

229. 1:04:50

     This is about fairness, transparency, and putting residents first. Thank you for your leadership on this issue.

230. 1:04:59

     Okay. Um, any questions from the committee? Chairman Hatchett.

231. 1:05:04

     Thank you very much. Uh, what's the average referral fee that you pay to an agency?

232. 1:05:10

     So it varies, um, anywhere between 75% and over 100% of one month's total, um, rent and care levels. So-

233. 1:05:18

     Which is about how much?

234. 1:05:19

     Which is what?

235. 1:05:20

     It de- well, with 55 communities, you can be talking anywhere between, like, $4,500 up to, uh, $9,000 a month.

236. 1:05:28

     So 4,500 on the low end-

237. 1:05:30

     Low end

238. 1:05:30

     ... minimum-

239. 1:05:31

     Yep

240. 1:05:31

     ... up to 9,000.

241. 1:05:32

     Yeah, just vary on which community we're talking about.

242. 1:05:35

     And if I can follow up.

243. 1:05:36

     Please.

244. 1:05:37

     Um-

245. 1:05:38

     Thank you

246. 1:05:39

     ... someone brought up Florida, and I think if my research is correct, in Florida, they don't allow assisted living facilities to pay agencies. The patient has to pay the agency, and then the agency finds someone. So there's no, there's not a c-

247. 1:05:54

     That's incorrect.

248. 1:05:54

     That's incorrect? Okay. I just did a little research.

249. 1:05:57

     Nope.

250. 1:05:57

     But would that type of system be something that you think would be better or worse?

251. 1:06:04

     I, I'm okay with the communities paying it as long as there's full transparency up front that somebody knows that they're going into an engagement with a referral agency.

252. 1:06:14

     And can I ask-

253. 1:06:14

     So-

254. 1:06:14

     ... one more follow-up question?

255. 1:06:15

     Yeah, let me, let me make a comment though. I mean, CMS, Medicare, Medicaid does not allow this for skilled nursing facilities, right?

256. 1:06:23

     Correct.

257. 1:06:23

     Nursing homes, you can't do it.

258. 1:06:25

     Correct. This is-

259. 1:06:26

     Why is that?

260. 1:06:27

     This is private pay. Um-

261. 1:06:30

     Yeah.

262. 1:06:31

     So the federal government's requiring, uh, no referrals for their facilities that are regulated because they're paying for it.

263. 1:06:43

     Yep.

264. 1:06:44

     I got you. So private pay is, I guess, consumer beware there, huh?

265. 1:06:49

     Correct. Yes.

266. 1:06:49

     Okay, I got you. Okay. And, uh... All right, you had a follow-up.

267. 1:06:53

     And the example that you made about three different companies wanting a referral, are there any rules right now on, like, rules that regulate solicitation? Meaning I know someone's of a certain age, somehow they maybe have someone hanging out in the hospital. Are there any rules that put safeguards on this? 'Cause I know these families are in a very vulnerable time. Are there rules that safeguard this or, or is it, is it the Wild West when it comes to recruiting clients for these agencies?

268. 1:07:27

     I mean, I, I don't think there are any rules in place. Not like, you know, ambulance chasers, chasers.

269. 1:07:33

     Okay. Yeah.

270. 1:07:34

     So, uh, there's- Hold on just a second. So any... Let me... We didn't hear you on that one, Seth. What was that?

271. 1:07:41

     I, I just wanted to, uh, clarify for Senator Hatchett. We, we don't have anything in Georgia statute concerning referral agencies right now.

272. 1:07:49

     Any other questions from the committee for the, uh, for Mr. Peller? All right. Um, thanks so much. Appreciate that. Um, hang on just min-

273. 1:08:05

     Um, Representative

274. 1:08:08

     Sure.

275. 1:08:08

     Yeah, so, um, the reason I've been back and forth talking to alleged counsel is 'cause we do have a Georgia Anti-Kickback Law, uh, statute, and it's not clear that it applies to this. However, I, and I remember back when I passed Senate Bill 4, it does apply to substance use disorder facilities specifically, but it doesn't apply in a broader sense. So I, I feel that this may need a little more research just to be sure that we fully understand our law before we pass another law.

276. 1:08:43

     So, um, you had asked for a hearing only. I think that's a good idea.

277. 1:08:47

     Do, do we know what other states are doing?

278. 1:08:51

     Uh, yes, Mr. Chairman. Uh, about eight other states have similar legislation to this, uh, varying a little bit on some of the particulars. Uh, Texas passed theirs last year. Colorado's had it on the books for several years. Um, Maryland, Oregon, Oklahoma, um, and there's pending legislation in Wisconsin, Missouri, and Virginia right now. So this is, this is a trend all over the country, red and blue states, uh, to protect seniors.

279. 1:09:19

     Okay. All right. Uh, um, let the author have the last word here.

280. 1:09:24

     Thank you, Chairman. Thank you, Committee. Um, Senator Kirkpatrick, you're, you're right. I mean, there, there is, there's a lot to this bill. Um, prior to becoming, uh, a pool boy, I worked for 10 years in healthcare administration, and, um, worked very closely with assisted livings and home care. Um, home health nursing was, was kind of my, my core area of expertise. And, um, I've never seen a more unregulated area than private pay assisted living.

281. 1:09:58

     Um, as we've heard from some of the testimony today, it's a very lucrative business. Um, and I can understand why folks would not want more regulation and, uh, transparency in that. It, it, to me, it's, it's, it's a, it's a matter of math. Senator Hatchett asked a question about how much it is per month, and if you take that average per month, multiply it times just 75% per month, and multiply that times the number of patients that are seen, uh, none of us are doing as well as those that are in referral agencies.

282. 1:10:29

     Uh, this is not about picking winners and losers, but it is about transparency in patient care. And, um, I just hope that the committee, uh, can help us find the best solution to, uh, protect our seniors.

283. 1:10:40

     I appreciate that. Appreciate your thoughts. I don't think anybody here is looking to, uh, outlaw them like the feds did with Pete Stark and, and the Stark regulations, and that Georgia has done w- uh, with, uh, Stark regulations. Uh, but I mean, listen, I mean, you can make a case that this is healthcare. Um, and I think everybody in the room, uh, we're, it's in HHS for a reason. It is healthcare.

284. 1:11:03

     Yes.

285. 1:11:03

     And kickbacks generally do not have a place in healthcare. So let's make it not a kickback. Let's make it transparent. Um, and yes, it may be a little onerous, some of the things that happen, but I don't wanna make it onerous. Uh, but I don't want to... I don't think anybody wants to do away with it, uh, 'cause it does sound like it serves a purpose. So got till noon tomorrow to get everything done. If we need to bring it back here on, uh, uh, Wednesday, uh, we can. Hopefully can have it, um, done.

286. 1:11:35

     Mr. Chairman.

287. 1:11:36

     And then we'll sort of go from there. Uh, Rules Chair, you-

288. 1:11:39

     I got a suggestion, Mr. Chairman, if you'll allow.

289. 1:11:43

     Absolutely.

290. 1:11:44

     So there's a... The... I wasn't familiar with this industry at all, um, before today, but, uh, we, there's a similar industry within the veterans community where they refer the, uh, not really refer, but they, they work with veterans on, um, in working with the administration on, on increasing their percentage of disability. And that bill started about three years ago, and they finally got it now, I think, where, um, all parties kind of agree.

291. 1:12:22

     And just so you don't drag this out for three years, um, you may look at that bill, and you may get some ideas from that, that would help you, um, kind of navigate through this. I don't, you know, there's... You know, you say there's a lot to it. There's really... I mean, it's a, what, four-page bill, so there's not a, a whole lot, but we can protect... I think you can add transparency. Um, you know, and what I see in these types of things is you got, there's good actors and there's bad actors, and I think we're probably hearing from some of the good actors, most of the good actors.

292. 1:13:02

     Um, and trying to figure out that is gonna be the hard part. Uh, but I would just suggest y'all sit down and, and try to work something out. I, I think you can accomplish what, uh, what you need to do. 'Cause what I'm concerned for you is if 95% of your, uh, your patients are coming from referrals a- and you cut out these referring companies, I mean, you potentially could lose 95% of your clientele. So, uh, you gotta be very delicate on, on, on what we do here.

293. 1:13:36

     It, there, it's a needle that's gonna have to be threaded, and so I would encourage both sides to sit down and try to figure something out.

294. 1:13:43

     Thanks so much. Words of wisdom. Thank you so much.

295. 1:13:48

     Chairman.

296. 1:13:49

     All right. Um, I think we have another meeting on Wednesday at, Wednesday at 4:00. So, uh, we'll have plenty of time. Can go till midnight and get it all worked out. So we're all good. Uh, no, we, and we have a, we have another bill for, uh, for Wednesday, maybe two, and if we got this one worked out, we'll go with it. Thank you so much.

297. 1:14:14

     Sure.

298. 1:14:14

     Appreciate it. Thanks so much. Meeting adjourned.