Senate Health and Human Services Committee, February 11, 2026 Video: https://vimeo.com/1164094021 (a timestamp t plays at https://vimeo.com/1164094021#t=s) Page: https://georgiacommons.org/meetings/2026-02-11/senate-health-and-human-services 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. [0:19:02] Health and Human Services Committee to order. And we have two bills today. And thank you everyone from finance who is getting here. Uh, we much appreciate, uh, the finance chairman, uh, adjourning the meeting just for HHS. All righty. Thank you. Uh, so, um, with that, Chairman Brass, do you mind, uh, saying a little prayer for us, please, sir? [0:19:33] Let's bow our heads. Heads with me. Dear Lord, thank you for this day. Thank you for all that you do for us. Thank you for sending your Son, Jesus Christ, down the cross for our sins. And we're sorry there are many. Amen. [0:19:53] Holy brass. Yeah. Holy brass. [0:19:55] Speak for yourself. [0:19:57] Holy brass. [0:19:59] You speak for yourself. [0:20:00] I wasn't invited. [0:20:02] Sydney, is there any way we can edit that, uh, you know? We're good. All right. That is ever so true. There are many. So all right, SB 440, Senator Kay Kirkpatrick. Uh, you can stay in your seat or go around. Whatever you'd like today. [0:20:14] Okay. Yeah. [0:20:15] All righty. Uh, and then, uh, next up is Senate Bill 462. Um, if we can get those sign-up sheets. Everybody signed up that wants to be? And, um, so that's good. So W- witness one, witness two. All righty. So they're both on. [0:20:34] Thank you, Mr. Chair. [0:20:34] Floor is yours. [0:20:36] I brought a friend with me, uh, Megan Andrews from the Department of Public Health, because she has, uh, even deeper knowledge of this bill than I do. And so it's complicated, and you can tell that because I have all these sticky notes on my bill. And, um, w- but it's really simple. It's simple and complicated at the same time because what it is, this is an agency bill for DPH. It's a cleanup bill, and it does not affect any programs. [0:21:08] It does not get rid of programs that are currently operating, and it just removes obsolete and unused code sections and updates the statute. So right now, DPH technically is out of compliance with multiple code sections tied to things that don't really exist. And so if we clean this up, it'll improve transparency and reduce confusion about their responsibilities and free up staff time from fulfilling mandates that really don't make any sense. [0:21:43] So there are several major categories in here that I'll go through, and, um, we can ask Ms. Andrews for additional detail on any specific ones. But the first, uh, thing I'm gonna talk about is there are outdated marriage-related health requirements. Um, we have brochures that we really don't do paper brochures too much anymore about HIV, listing test sites, and things like that. [0:22:14] That was written, that language was written in the '80s and is not really relevant anymore. Sickle cell testing, another brochure that is being handled in a more modern way now. And then also, DPH has a marriage manual requirement, and that one was written in 1973. So these materials are not how we educate Georgians about these things today. Um, then also, there are some dormant boards, commissions, and positions that are covered in the bill. [0:22:51] The PDMP, um, you're very familiar with, and that's operational and has been for years. And there used to be an advisory committee which was put together at the startup of the PDMP, a physician- [0:23:08] P- prescription drug monitoring program [0:23:10] ... prescription. Yeah, p- it's where physicians record the prescriptions, and they can search the database to see if someone's doctor shopping or whatever. But that has been operational for I don't know how many years, but a long time. [0:23:23] Over 10 maybe. Came in about 15 years ago. Uh, came in, if I remember correctly, Buddy Carter carried it, and i- it's been a really, Georgia's been- [0:23:33] Mm-hmm [0:23:34] ... one of the first ones to do it. We do cooperate with other, other states, so you're, it markedly reduced the, um, doctor shopping for opioids, and that's- [0:23:45] Mm-hmm [0:23:45] ... been a tremendous help- [0:23:47] Mm-hmm [0:23:47] ... uh, ER-wise and primary care, and listen, pain management too. So I, I, I can talk for a while on that one. [0:23:54] So it's- [0:23:54] So sorry about that [0:23:54] ... anyway, that program is working well, and we don't need that startup advisory committee anymore. There also was a cancer advisory committee and a cancer control officer that was put in code in the '80s, but that committee does not exist, and that position has been vacant for years. There's also a commission for saving the cure, which has to do with cord blood. Um, no appointments have been made to that since 2008. [0:24:25] And this bill keeps Georgia's ability to have postnatal tissue and fluid banks, but it does not require DPH to oversee a commission that does not exist. There are some e- existing taxpayer-donated funds, because this is a check-off, that, um, are going to be addressed between DPH and the Office of Planning and Budget in the budget process. There are unfunded or non-operational chronic disease programs too, are osteoporosis and arthritis programs. [0:25:01] They were established in statute but never funded or implemented The, um, there's also, um, a section of the bill that aligns statutes with current operations. So in other words, blindness education, screening, and treatment is reassigned to the Georgia Vocational Rehab Agency, which is more appropriate to handle that program. There's a home visiting pilot. The pilot phase is over. [0:25:30] Yeah. [0:25:30] Home visiting is now a permanent DCH service, and the statute's updated to remove that obsolete pilot language. There's a newborn hearing screening, and the screening and reporting are intact in the bill, but there's an advisory committee that's already been eliminated, and so this just cleans up a scrivener's error in the bill. Neonatal abstinence syndrome. DPH has an annual report requirement, but they really don't have the in-house experts to do an annual report. [0:26:03] They do get information reported to them about, uh, neonatal abstinence syndrome, but the agency that deals more with substance use and things like that is DBHDD. And then there's, um, some unfunded mandates and other requirements. For example, EpiPens. There's a requirement in statute that every administration of EpiPen be reported to DPH and compiled into an annual report, which clearly is not normally reported to DPH. [0:26:39] Stroke centers and emergi- emergency cardiac care center grants. These grant programs are still on the books. [0:26:46] Yeah. [0:26:46] But the annual reporting requirement is, uh, will be, uh, subject to appropriations in the bill. And this keeps DPH from having to file zero activity reports in years when no grant funds are appropriated. There's a Georgia Volunteer Healthcare Program report, and the bill modernizes the required report to focus on utilization and access, and updates the committee names to match the current House and Senate committee structure. [0:27:18] Um, so that's sort of a brief summary. We can go into more detail on anything that is of interest to the committee, but the important point is that no Georgians lose services as a result of this bill. The bill does not shut down any active programs. And, um, in summary, this bill cleans up outdated and unused sections of the Georgia Code, aligns the statute with current DPH programs and partnerships, and reduces unfunded mandates without affecting services. [0:27:49] Thank you. [0:27:49] Thank you so much. Ms. Andrews, do you have anything to add? [0:27:52] Nope. I'm here for questions if there are any. [0:27:53] Great. Any, any questions from the committee? All right. B- over here first. [0:27:59] Senator Merritt. [0:27:59] Uh, Senator Merritt, you are on number- [0:28:01] Thank you [0:28:02] ... 10. Okay. [0:28:02] Mr. Chairman. So why remove the, uh, AIDS requirement and the sickle cell requirement? [0:28:08] So right now that information is posted and shared on our website. These, um, these brochures were required back before internet websites were readily accessible. So that's how we share information now as opposed to handing out brochures in probate courts when people are- [0:28:25] Just g- [0:28:25] ... applying for their marriage license. [0:28:27] Wh- when you require, when you ... For a marriage license, I gotcha. [0:28:30] It's for marriage license- [0:28:31] Yeah [0:28:31] ... applicants are required to receive these brochures. [0:28:34] All right. [0:28:35] Okay. [0:28:35] Yes. [0:28:37] Uh, Senator Huffstetler, number 11. [0:28:39] All right. Great to have Ms. Andrews here, our, our intern from a decade or so ago, who still looks as young. [0:28:45] I've already started. [0:28:46] Um, but- [0:28:46] And aged today. [0:28:47] But, uh, I, I was just thinking that that 1973 marriage manual, if it had been read by Senator Robertson, maybe he wouldn't have entered into all those marriages he's entered into, so. [0:28:58] I don't think it would've helped. [0:29:02] Okay. All right. Senator Brass, uh, with a serious question, I hope. Here we go. [0:29:08] I doubt it. [0:29:09] My serious question's first. Um, all right. On line 247 we're striking president of the Senate and putting lieutenant governor. What if we don't have a lieutenant governor but we have a president of the Senate is the question. If the governor dies, the lieutenant governor goes to governor. The, the president pro tem becomes the president of the Senate, but he's not the lieutenant governor. [0:29:36] I would actually ask legislative counsel to help with that because they, in drafting, this was language they added. [0:29:45] So the president pro tem would go to president, and you're saying there would be no lieutenant governor? [0:29:49] But I don't think ... And there is debate over that, but- [0:29:52] And there'd be- [0:29:52] ... I feel like there may not be ... We may be solving the debate with this, and I don't know that- [0:29:57] Yeah [0:29:57] ... this is the right- [0:29:58] I get it. I get it. I know [0:29:59] ... avenue to solve that debate. [0:30:03] What do you ... All right. [0:30:04] The president seems to use- [0:30:06] We usually use the different title for the different role. It's the legislative role versus the executive role. It's how [0:30:16] our office [0:30:16] So, okay. Um, ask- [0:30:19] Could you repeat what she said? She didn't- [0:30:21] So she said we usually use executive versus legislative, uh, titles. Instead of lieutenant governor, you'd use president of the Senate. And president pro tem would be president of the Senate if, um, at that point. That's why they pro- president pro tem. [0:30:38] So if the lieutenant governor passed away or the lieutenant governor was appointed a governor, then you just wouldn't send it to the Senate? [0:30:46] It would go to the president. [0:30:48] No, it would ... There wouldn't be a lieutenant governor to send it to. [0:30:51] That's right. [0:30:51] It still goes- [0:30:51] Oh, you changed it to lieutenant governor. [0:30:53] Right. [0:30:53] Governor. [0:30:53] Oh, yeah. [0:30:54] And it still goes to the chair of the health committees on those items. [0:30:57] There you go. That's all you need really. [0:30:59] Okay. I was just curious on that. And then I guess this next question on all of these reporting, we're adding subject to appropriations. Are we ... Is that subject to additional appropriations or? [0:31:13] Neither one of these grant programs have ever been funded. [0:31:16] Okay. [0:31:16] Um, so right now we're required to submit annual reports, but there is nothing to report. [0:31:22] Okay. I got you. And then I guess my final question, I saw we were eliminating the cancer control officer. Have they been notified? [0:31:31] That, um, that position is vacant and has been vacant for, um, gosh, I would have to call on Senator Orrock. How long ago was Dr. Toomey the- [0:31:43] The state- [0:31:43] ... state health officer? [0:31:45] The state- [0:31:45] I think in the '90s [0:31:46] ... the state of, of, or- [0:31:48] Yeah. [0:31:50] Can- this is cancer control officer. [0:31:51] Yes. I'm saying back in the '90s when she was here then- [0:31:55] Uh-huh [0:31:55] ... there was th- this position was never- [0:31:56] So what my- [0:31:57] ... appointed [0:31:58] ... detailed notes say is the statute was passed in 1977, and there's no record of this position ever being appointed or filled. [0:32:06] Yes. [0:32:06] Interesting. Okay. Same with the Cancer Advisory Committee? [0:32:11] Yes. [0:32:13] All right. Good bill. [0:32:15] Less government. [0:32:16] Sort of red tape rollback. [0:32:18] That's right. [0:32:19] Yes. [0:32:19] There we go. All righty. Uh, anybody want to... Any other questions? [0:32:26] Yes, Senator Chairman. [0:32:27] All right. Sh- Senator Mangham. [0:32:29] So Ms. Glass has really hit on what I was dealing with, but is there anyone dealing with cancer and the prevention of cancer a- anywhere in the state of... Who does that and why? Um, that's something I'm very interested in. [0:32:41] Yes. [0:32:41] I lost my wife two years ago. [0:32:43] I actually have this, the cancer state plan in my bag over there. I will give it to you. [0:32:48] Who- [0:32:48] So DPH- [0:32:50] ... what department- [0:32:50] The department leads it, but these positions and, um, the requirements of that committee are not functional and haven't been for many years. We oversee it with federal funds in partnership with, um, Georgia CORE and Georgia State University, and have work group meetings. They're actually meeting tomorrow. [0:33:07] So it's very active. [0:33:08] It is very active. [0:33:08] Georgia CORE is the- [0:33:10] Georgia CORE [0:33:10] ... main organism along with, uh, others. [0:33:12] With DPH, yes. [0:33:13] Who is Georgia CORE? [0:33:15] All right, so w- why don't we do this offline, and then, uh- [0:33:17] Okay [0:33:17] ... all right? Anything relating- [0:33:19] She can get you a lot of information- [0:33:21] Yes [0:33:21] ... about how the state's dealing with- [0:33:22] Her- [0:33:22] ... cancer- [0:33:22] The coolest of- [0:33:23] ... right now [0:33:23] ... we appreciate that. [0:33:23] Thank you. [0:33:24] Yes. [0:33:26] When the time is right. I wanted to, I wanted to, Senator Orrock, to do the motion for red tape rollback for DPH. What do you think? [0:33:37] Oh, Mr. Chairman, I'll let you dispose of it. [0:33:39] All right. Let's, let's do that. [0:33:42] And, and are we naming this, uh, w- uh, bill in the motion? [0:33:46] The Nan Orrock Red Tape Rollback. [0:33:50] You can call it that. I didn't name the bill. [0:33:53] That's all right. [0:33:53] And it is an agency bill, so they probably didn't want anybody's name on it. [0:33:56] It, it, uh, I, I- [0:33:57] I- [0:33:57] You can call it whatever you want, though [0:33:58] ... concur, I concur with the author of the bill. [0:34:01] Okay. Thank you. [0:34:01] Call it- [0:34:02] And second here by, uh, Senator Robertson. [0:34:05] I second. [0:34:07] Yeah. With, with Senator Orrock. [0:34:09] Okay. There we go. [0:34:10] Oh. [0:34:10] We got it. All right. [0:34:11] You don't have to- [0:34:12] All those in favor, raise your right hand. Okay, it is unanimous. Thank you very much. [0:34:18] Thank you. [0:34:23] Thank you. [0:34:23] Thank you. [0:34:33] All right, so we got another, uh, um, update here. Ambulance surprise billing. Senator Still, SB 462. And we do have-- We had no one to sign up for the red tape rollback bill, but we do have, um, we do have a few. And so Jesse Wetherington, we're gonna give you seven minutes or less. [0:35:03] Jesse in the audience? Yes. Thank you. And we have, ooh, one, two, three, four, five, six, seven. So I'm gonna give the other side 15 minutes, and y'all decide on how y'all want to speak, and we're gonna keep good time. But right now, the stage is Senator Still and our caucus chair, and he's gonna introduce his guest. And the floor is yours, sir. [0:35:35] Thank you, Chairman. Thank you, Committee. Good to see y'all again. It's been a long time, and, uh, I don't spend enough time in Senate Health. Um, with me today is, uh, Mr. Bud Owens. He is a county commissioner, he is an EMS expert, and he is gonna be testifying with me today and helping to answer any technical questions. But I can certainly give you my perspective on the bill first. So, um, many, many years ago, uh, as a young college man, I made extra money in the summers working as an EMT. Uh, I understand the inside and out of the back of an ambulance, and I understand the stress of transport of someone in a medical emergency, and then trying to collect money and get them to sign a contract or a bill of sale when you get them to their destination, usually a hospital, and then trying to collect that on the back end. [0:36:28] It's stressful for the patient, it's stressful for the EMT, and it's incredibly difficult by, um, by the owner or the finance team of that ambulance company to try to collect on that. This bill seeks to rectify the problem with in-network versus out-of-network on that collection. Uh, it, uh, defines what that rate maximum will be. [0:37:00] And if you know anyone who's had to be transported in a medical emergency, it can sometimes be thousands of dollars. This simplifies that and gets a uniformity to that for all, uh, transport companies that, that do that. Uh, it does not get into air. Uh, I was asked that earlier today. This is strictly ground. And I think the most important thing to realize in this is this has been a work in progress for years. This has not been something that just popped up. [0:37:30] Uh, I think we've all been hearing about this since at least the '22 session, if not earlier. I know that some of our friends in the, um, in the insurance world, um, don't like this because of reimbursement rates. And that's ultimately what this boils down to, and what the committee will need to decide, is, um, not to define what the rate is, but do we want consumers to have to deal with surprise billing in that critical emergency time? [0:38:01] Or if they do have a health plan, should they be able to have a negotiated rate that is reasonable, uh, for them to be able to agree to? So with that, I'll walk you through the bill, and then I'll hand it over to, to Bud. But, um, going onto, uh, to page two of the bill. Clean claim, line 21, right? So we're, we're... A clean claim for reimbursement of services rendered. Covered service, line 24. [0:38:34] An emergency transport service which a covered person is entitled to receive under the terms of their healthcare plan. [0:38:42] Lines 26 through 29 just defines what an emergency transport service is. Line 30 goes to first responder. Any firefighter of a municipal, county, or volunteer fire department, paramedic, emergency medical technician, which is what I used to be. A peace officer, which Randy used to be and sometimes still is, is defined in Code Section 35-8-2. Healthcare plan shall consider emergency transport as a covered service when such emergency transport is requested by a first respondent or healthcare practitioner. [0:39:15] So this is ensuring that we're talking about emergency services. This is not just, um, you know, anything outside of that. Line 37 is very important. The minimum allowable reimbursement rate under any healthcare plan other than a state healthcare plan for covered service to an out-of-network ambulance provider. Now, question has come up, in-network versus out-of-network. The in-network rates are pretty low. [0:39:46] And I will tell you that in my conversations, and I'll certainly let Bud speak to this, but this is really important 'cause a lot of y'all have asked me about this. The negotiated rates with the insurance companies are not one... They would rather just remain surprise billing, because it's not at a sustainable rate for them to be able to make an affordable living. Ambulance companies can't work under some of the, the low offered rates that they're at. And that gets us to line 45, which is what they're wanting to do, is 325% of the reimbursement rate under the Medicare program. [0:40:22] So they're already set here on Medicare, it's just saying that for insured rates it'll be three and a quarter times that. There was a bill introduced, uh, about two weeks ago in the House by Chairman Powell that was at 400. This is a lower amount, and this is something that all of the EMS service providers that are here today have agreed to. Um, it says that they will, uh, be paid within 30 days of service. And I've also heard from EMS companies that are in-network with some providers that are having to wait 12 months or more to be paid on those rates. [0:40:55] So this ensures that they'll be paid in a timely fashion. These aren't large publicly traded companies. These are, for the most part, small, privately owned ambulance services. And having to wait a year or more for their money is- [0:41:07] Crazy [0:41:07] ... really unacceptable. And that pretty much is the bill. Um, Bud, would you like to say a little bit about your background and add to it? [0:41:17] Sure. Uh, I'm, I... Really, uh, today I'm representing ACCG, serving as chair of the Health and Human Services policy coun- on the Policy Council. And- [0:41:26] Get that mic a little bit closer to you. And Bud, what's your last name, and where are you from? [0:41:30] Owens. [0:41:30] Owens. And where are you from? [0:41:31] Yes. I'm actually from Calhoun, Georgia. [0:41:33] Okay. [0:41:34] I serve as vice president of Mobile Medicine for Georgia and Alabama for Atrium Health. Currently, we are operating EMS services in 13 Georgia counties, and in eight of those counties we're providing 911 services. [0:41:47] Mm. [0:41:47] So it really hits home to me. But working as a county commissioner and through the ACCG process of policy recommendations each year, uh, this has been one of the top things that we've discussed for the last three years, uh, at that level. One of the most critical issues that we have in this industry is reimbursement. Reimbursement has not changed through Medicare in many years. We continue to see insurance companies that are working as hard as they can to not pay the ambulance bills. [0:42:19] But it's a service that we have to have in our communities. And we have to have readiness, where those ambulances are prepared and ready to respond, whatever that situation might be, because it is typically life or death at that moment. So this is one opportunity that we have seen that we can really improve the reimbursement issue that we're facing. Another part of this bill here i- it really addresses the issues that we have with those insurance providers that, uh, do pay. They will send the checks, instead of to the EMS providers, they will send them directly to the patients. [0:42:54] And then the patients have the responsibility to either pay that bill or spend that check on something else. So they will typically go out and spend the check on their own personal needs instead of paying their EMS bills. And that has become a consistent problem. Uh, won't name the insurance companies that are doing that, but we're struggling with some of the larger insurers in doing that as well. [0:43:19] This is one step in helping the EMS industry to be able to stay afloat and to provide the services that our citizens expect and need. So we're, uh, we're appealing to you for support in this, and I'm glad to answer any questions that I might be able to answer for you. [0:43:39] Thank you. I do have one question. You were talking about the patient getting the reimbursement whenever it shows up. Is that in the bill anywhere? I don't see it. [0:43:49] Uh, uh, well, I was thinking it was- [0:43:50] I'm sorry. [0:43:51] The, the patient- [0:43:52] I understand the question [0:43:52] ... receiving the reimbursement, he was saying. [0:43:55] He's saying in practice- [0:43:57] Right [0:43:57] ... for those carriers that are in network- [0:44:00] Right [0:44:00] ... with some of the insurance companies- [0:44:01] Okay [0:44:01] ... that frequently the insurance company will send, remit payment to their, to their client, not to the person who billed it, therefore making the liability ... It, it would be like if you were providing patient care. [0:44:14] Yeah, I get it. [0:44:14] Right? So- [0:44:16] Believe me. Okay. [0:44:17] Line 57. That's what it says. [0:44:17] That's what I want to know. [0:44:19] It's saying that they're gonna pay them directly to, to- [0:44:22] It is. That's, that's line 57. I, I, I did mark that line. [0:44:24] 57 says they'll be paid directly. [0:44:25] Thank you. [0:44:26] But in the, in the question- [0:44:27] Thank you, Mr. Finance Chair. We're good. All right, any other questions? Uh, Senator Orrock. [0:44:32] Uh, thank you, Mr. Chair. Um, uh, thank you all for bringing this issue to us. Uh, what are the... what's the meaning of, on page two, lines 34 through 36, that a healthcare plan shall consider emergency transport service as a covered service when it's requested by a first responder or healthcare practitioner responsible for the care of the individual? There's another, there's another whole scenario where somebody determines, the, or their, they or their loved ones determine that they need to, to call an ambulance. [0:45:08] Is, is that not covered? Uh, does that m- uh, uh, is that type of call- [0:45:13] Well, I mean, the- [0:45:13] ... to the amb- for an ambulance service, uh, not under the healthcare plan? [0:45:18] I presume the, a healthcare practitioner would include an, uh, EMT or paramedic, right? [0:45:21] Yes. [0:45:22] It would also cl- include a 911 dispatcher, and that's where those calls are coming from. [0:45:26] It would include a 911 dispatcher. [0:45:29] Yes, ma'am. [0:45:29] How, how, how, how, how, how... where do they fall on that d- in that, that definition? [0:45:32] For, for- [0:45:33] 'Cause this looks like, this language looks like it- [0:45:35] Line 33 [0:45:36] ... it, it, it- [0:45:36] Communications officer as defined by. [0:45:39] First res- oh, the, the definition of the first responder. Uh, so- [0:45:45] EMT, police officer [0:45:46] ... by dialing 911, then there's a tech- th- then there's a communications officer who- [0:45:52] Yes, ma'am [0:45:52] ... uh, uh, gets the ambulance on the way, and that's considered, um, uh, a covered a- ambulance run that the healthcare plan should recognize. [0:46:01] Yes, ma'am. [0:46:01] Okay. I, I don't want to throw a wrench into this, but I mean, there are calls that ambulances r- r- run to or they have the run for, they go to the patient, and it may be that, um, it, it may not be indicated, and many times they'll call the ER and say, "Uh, you know, this patient's stable. It's actually just a doctor's appointment. They want, they need non-emergency transport." That does happen. Um, so just because, uh... But otherwise, I mean, that's what the EMTs are there for. [0:46:31] But increasingly, what doctor's offices say is call 911. Call, you know, go to the emergency room. That's what they say. Go to the emergency room. [0:46:37] Absolutely. [0:46:38] Yeah. [0:46:38] And that's indicated. So, uh, and- [0:46:40] Nope. Well- [0:46:40] ... Senator Harrell had a question. [0:46:43] Yes. So I had a constituent who contacted me early in the session, and I'm gonna describe the situation. You can tell me whether this bill would help. So it was a 59-year-old gentleman who was living, um, with his 24-year-old daughter, and he had symptoms of a stroke. And so she called 911. The ambulance came. He was taken three miles to Northside Hospital, was treated for a stroke. And, um, he later received an ambulance bill for, like, $2,400. He was Anthem, and they said it was out of network. [0:47:16] That's right. [0:47:17] So he had no choice about who, which ambulance got sent because I think that's chosen by the county. So how can... He has no choice. How can it be out of network? Can you explain that to me? [0:47:30] Bud, do you wanna go first and I'll add color to that? [0:47:32] Oh, you can add color and then I'll, uh, I'll wrap it up. [0:47:34] Okay. [0:47:34] How about that? [0:47:35] So in, in DeKalb County, it's not just the county. It could be, um, independent providers as well, right? [0:47:43] Right. [0:47:43] So it's gonna be the first one that gets there. If that ambulance, uh, service is not in-network with the provider, then they're gonna have to bill, uh, self-pay on that. There, there's nothing- [0:47:56] But he, there's no opportunity for him to call in-network or know if the ambulance is in-network, so- [0:48:01] Because it, when it's a life and death situation- [0:48:03] Yeah [0:48:03] ... it's who gets there first. [0:48:04] Right. [0:48:04] So, so that, that's what this bill is for. [0:48:06] Well, but will this bill help that? [0:48:08] Yes. [0:48:08] How? [0:48:09] Because it's going to ensure that if he had Anthem, that they're gonna be reimbursed. They're gonna have to bill. The ambulance service is going to have to bill at that rate. It's, it's gonna be a fixed rate for everyone. [0:48:19] So he would get a lower rate, or would it be in-network? [0:48:21] He would've been a much lower rate. He would've been a much, much lower rate. [0:48:25] Okay. [0:48:25] It would probably would've been half. [0:48:27] So it would still be out-of-network, but it would be a lower rate. [0:48:30] Because it was emergency. [0:48:31] Be- because it was an emergency. [0:48:32] Correct. [0:48:32] I mean, that, this is what lines 40, 42 through, you know, 65 are all about. All right? [0:48:39] So this would help him. [0:48:40] Yes. 100%. [0:48:40] Yes. That's what this is partly aimed for. [0:48:42] Okay. I, I thought so. That's why I co-signed it. [0:48:43] Yes, ma'am. [0:48:44] You're good. Um, Senator, uh, Kirkpatrick had a question and then, uh- [0:48:48] Yeah, just on the process of, I know a lot about billing as a physician, but I don't know a lot about, of how the process works for ambulances. Would you normally be submitting the bill to the patient or to the insurance company? [0:49:05] To the insurance company. [0:49:08] So in an emergency situation, you would get that information later and then submit the claim? Or, I mean, how does that work? [0:49:15] W- we gather that information upfront at when the patient is transported, and then that, if it's an insurance involved, then we bill directly to the insurance company. [0:49:27] I'm sure there are circumstances where the patient may not, you may not have the insurance information. And I presume you circle back or somebody circles back on that. [0:49:36] We, we do. [0:49:37] Right. [0:49:37] The billing goes to the patient. The patient contacts us to let us know that they have insurance. [0:49:42] All right, uh- [0:49:43] I hope I answered that correctly [0:49:44] ... Chairman of Finance. [0:49:45] All right. Thank, thank you, Mr. Chairman, and great to have, um, Commissioner Owens up here from my Senate district, and- [0:49:52] Mm-hmm [0:49:52] ... we've both worked at Atrium- [0:49:54] Uh-huh [0:49:54] ... um, at, at times. My last time was New Year's Eve. They don't see much of me anymore. And I was originally worked on surprise billing some years back. We got it passed out after a few years of struggling. Uh, we left ambulances out because it was like the one fight I couldn't solve, and I wanted to get a bill out, and I, I hate that it got left out. Um, but I've seen both sides of this where, you know, insurance companies don't do what they should, but I, I know other situations in the metro where somebody say, "I need $5,000 to take your child to Children's Hospital," which- [0:50:29] Right [0:50:29] ... I think is, is terrible on, on that side as well. The change in this particular thing for... And, and I, I'm supportive of this, but the change is that we put in arbitration and all the others, and it was, uh, baseball-style arbitration that says the arbitrator has to pick a number. So you wanted to pick a number, you wanted your number to get picked. You didn't put something way out here and hope that it came to average, driving the numbers closer together. The only thing I would say in this, and I don't know if 325% of M- of Medicare is a good rate or not, I, I have no idea, but we're, we're just specifically setting a rate which is, which is really completely different than what we did in everything else for surprise billing. [0:51:15] So I just have no idea if that's a reasonable number or not, I guess. [0:51:21] I believe Indiana is the state that actually set it at 400%. [0:51:25] Mm-hmm. [0:51:26] And the other states that have passed this type of billing have established, uh, um, a foundation, a platform for that rate. [0:51:34] Of 325? [0:51:35] Yes. [0:51:36] Okay. He is the champion of surprise billings, no doubt about that. [0:51:41] I, I don't, don't wanna go back to that. [0:51:43] Yeah, I'm sure. I'm sure. That was a long thing. Senator Brass. [0:51:49] So I've got a similar story with a constituent to Senator Harrell. I had a constituent, she went to the hospital, I believe it was a attempted suicide, if I remember the story correctly. And then got, was it 1013'd? [0:52:06] Yeah. [0:52:06] Yeah, so she gets 1013'd, put in a ambulance, and I think brought maybe to Grady or somewhere up here. Um, and, uh, she got her, we'll call it, surprise bill, and it was $5,200. And from Newnan to... Well, Newnan to the capital's just under 40 miles, so it's not a huge distance. But anyway, 5,200. Her insurance covered 400 of it. Um, and so she came out of pocket for 4,800 bucks. [0:52:39] And I'm just... So I'd wanna make sure I understand the bill correctly. Th- that insur- w- this bill would require the insurance company to pay not the 400, but either that 5,200 or the 325% of the- [0:52:58] Med- [0:52:59] ... Medicare rate, which is what? What is the Medicare rate? [0:53:03] Uh, great question. I don't know today. [0:53:05] Okay. [0:53:06] Uh- [0:53:06] Can I phone a friend? [0:53:08] I, I'm not the chairman. [0:53:10] Sir. [0:53:11] Can I just speak? [0:53:11] Yeah. [0:53:12] Thank you for letting me speak. Um, so- [0:53:13] Uh, w- no, no, no, no, no. [0:53:15] No. [0:53:15] You mind going to the podium, introduce yourself- [0:53:17] Sure [0:53:17] ... and tell us that? I'm glad to have an expert in the crowd. [0:53:22] Good afternoon. Thank you, Mr. Chairman. Um, thank you. Um, I can answer that. So the American A- [0:53:26] And, and you're? [0:53:27] I'm sorry. Terence Ramthar with the Georgia Ambulance Providers Association, also the American Ambulance Association. We're doing a lot of work with CMS. CMS pr- produced a study to show what the costs are for EMS across the country, and they did it geographically. So the co- so their reimbursement rates, which are right now about 22 years old- [0:53:44] Mm-hmm [0:53:44] ... are less than a third of the cost, and that's why you're seeing across the states people, uh, these states landing at about 325 to 350, 'cause that's really covering where the cost is. So the trade-off is you can't balance bill the patients- [0:53:58] Okay [0:53:58] ... but you're getting your costs covered. [0:53:59] So do you have a, like a rough estimate of what his scenario would be? 40 miles, uh, attempted suicide. [0:54:06] So I'm assuming that's a BLS rate. So, uh, if it was a Medicare patient and we were just strictly Medicare... Now understand these are discount programs. That's not the cost, right? [0:54:13] Right. [0:54:13] The Medicare rate for that is about 300 and, um, roughly, don't quote, about $388- [0:54:20] So about 400 bucks then [0:54:20] ... plus mileage. [0:54:21] I got you. [0:54:21] So if you do three and a quarter to that, that's where you end up at the cost around the state. Um, so we- [0:54:28] So say- [0:54:28] ... we were very strategic on where that number is and worked with DOI to make sure we're covering costs, not too h- too much higher. We really can't go that much lower because we're below cost. Thank you. [0:54:39] So, so we have a AI-generated number if you'd like that. It's pretty close to what he's saying. [0:54:43] So I gue- or a follow-up. [0:54:45] Yes, please. [0:54:46] 378. [0:54:48] Okay. [0:54:49] A follow-up, I guess. So what if... So let's say it got to, I don't know, $2,500 is 325%, so would she still be on the hook for the difference of that 2,500 and 5,200 that she was charged? I mean, I know it's gonna be much better than 400, 4,800, what she was responsible for, but- [0:55:14] She, the, the patient would still be responsible for their copay, so- [0:55:16] But the, it, but the insurance company would be- [0:55:19] But I'm saying for the difference. If, if that 325 is less than the rate, than the bill, would, would the patient still be responsible for the remaining balance? [0:55:32] It's the lesser, and it's A or B is or. [0:55:35] Mm-hmm. Right. [0:55:36] So it's the or. [0:55:37] Doctor or. [0:55:38] B, the lesser. [0:55:38] So if they have the deductible- [0:55:40] Yeah [0:55:40] ... then it's- [0:55:40] So that 325 could be less than the bill So then are they still on the hook for the remaining balance? [0:55:46] So line number 52, any co-payment, co-insurance, or deductible paid for coverage service provided by an out-of-network ambulance provider shall not exceed the amount of a co-payment, co-insurance, or deductible amount owed for similar service provided by an ambulance provider that belongs to the provider network in a healthcare plan. [0:56:03] So then the, in that case, a follow-up, if you'll allow. So in, so in that case, if it, there was a, a delta there, then the provider, the ambulance provider eats the rest- [0:56:14] Correct [0:56:14] ... essentially? Okay. [0:56:15] That's correct. [0:56:16] All right. [0:56:17] Medicaid [0:56:17] That's fair. Okay. I just wanna make sure I understand. Thanks. [0:56:21] All right. Good question. [0:56:22] Before we circle back to Senator Orrock, any balance with questions? We're going back to Senator Orrock. All right. [0:56:27] Thank you, Mr. Chair. I, I, I have a, a, a question about how the whole system works, because you'll often see, uh, three, uh, emergency vehicles showing up at a home that's called in saying there's a heart attack, uh, patient here. J- j- pick anything, stroke, whatever. [0:56:45] Right. [0:56:46] What... H- h- how... Explain the, uh, economics of that, that people, uh, entities, uh, are, seem to be competing with each other to run to this thing. A- a- and, and, uh, and then I have one more question after that. [0:57:00] The 911 system really prohibits that. They, they, they have the designated EMS provider for that residence or that location, and that is the one that is dispatched. You may see a fire department vehicle there as well, because in the 911 system, that closest appropriate vehicle that is a first responder would be dispatched first in a critical life-saving situation. So you may have a fire department or some type of fire department vehicle on scene before the actual transport ambulance arrives because they may have been closer. [0:57:32] So that's simply to try to save the life- [0:57:34] Right [0:57:34] ... to get care to them closer and quicker. [0:57:35] Right. Get some, get a, a medical- [0:57:37] Yes [0:57:37] ... medically competent, a person that can respond. [0:57:39] But the charges don't happen, and they happen only with the service that is transporting the patient. [0:57:45] Okay. Okay. A second que- question, and that is that there's a Grady Ambulance Service- [0:57:51] Mm-hmm [0:57:51] ... th- very near my home, and I'm very... I'm not far from Grady Hospital. Are they in this, in, any of these entities that are promoting this bill? [0:58:02] Do we have anyone from Grady here? [0:58:04] There's somebody here. Put their hand up at the top. [0:58:06] Okay. [0:58:09] So they're, they're, uh, th- they're part, they're part of the... I wanted to be sure of that. I wanted to be sure of that because, uh, I've gotten good information from them, uh, uh, uh, in the past on, on this type of issue. [0:58:21] Very good. They're the best. [0:58:23] All right. [0:58:25] All right. [0:58:28] Okay, so let's have some testimony. Um, Mr. Owens, you got, you signed up, so I presume you're, you have testified and- [0:58:35] I, I'm good [0:58:36] ... you're good. So, uh, Mr. Wetherington, you wanna go first or last? [0:58:41] Uh, Chairman's discretion, sir. [0:58:42] J- j- uh, come on, Jesse. Come on down. Mr. Wetherington. [0:58:49] GAHP. [0:58:49] GAHP. Is that right? [0:58:51] Yes, Mr. Chairman. [0:58:51] You, you can- [0:58:53] I'd like to [0:58:53] ... that'd be great. Um, thank you. [0:58:58] Uh, where would you like me to go, Chairman? [0:58:59] Podium, please, sir. [0:59:02] Thank you. [0:59:02] Mr. Wetherington has been around Capitol for quite some time. He was with DCH a long time ago, if I remember correctly. [0:59:08] Yes, sir. Way back when. Um- [0:59:10] Yeah, way back when [0:59:10] ... again, I'm, uh, Jesse Wetherington. I'm the president of the Georgia Association of Health Plans. It's, uh, been a couple of years before I have, since I've been in front of the Senate Health and Human Services Committee, but I'm glad to be back here today. Um, we would like to, uh, give the committee, uh, some things for consideration in regards to this bill. Um, as health plans, uh, we do have a concern really, and I'll, I'll limit my comments to, to very narrow ones. Um, I don't think I'll go close to my seven minutes, uh, Mr. Chairman. Um, our concern is that that statutory rate of 325% of Medicare, um, may be a bit too high to strike an appropriate balance. [0:59:47] Um, as Senator Hufstetler, uh, remarks are very well taken, um, I came to this role kind of at the tail end of the conclusion of the negotiations on the Surprise Billing Consumer Protection Act, which was adopted by the General Assembly several years ago. Um, and of course, emergency medical services were left out of that process as relating to ambulance transportation. But there was a treatment both of non-emergency medical services kind of after you get off the ambulance, and then a separate treatment for non-emergency medical services that you had the th- you had the ability to shop for in advance or schedule, uh, things of that nature. [1:00:21] Uh, and the approach that was ultimately taken by the General Assembly, um, in that s- code section, uh, for non-emergency medical services was a little bit different than the one that you see here. Uh, and the reason that that was adopted was, uh, this concern that if the, the government sort of picked a number, if it was too low, there was an incentive for the insurance industry not to try to negotiate and get providers in network. And if it was too high, kind of the countervailing position applied, and there would be a strong incentive for the providers to not contract and just sort of take the statutory network that was fixed, you know, be on their way. [1:00:58] The patient was taken out of the middle, so to speak. And I do think that is a big benefit of the bill you see in front of you, is the prohibition on balance billing, so at least that patient, you know, is not getting caught with a huge sum after they've had this transport. And again, emergency medical services, ground ambulance transportation is a very different medical service than kinda anything else you see. You don't have the ability to shop. The network is a little bit less of an issue. It's very different in urban areas versus rural areas in terms of the number of providers that you have. So I would submit to you, uh, it's our contention that the 325 is a little bit high. [1:01:30] We do think that would sort of err on the side of a bias towards not contracting, and we would ask for consideration of a lower amount, or alternatively, a treatment similar to, uh, the existing Surprise Billing and Consumer Protection Act, where one of the sort of payment prongs referenced a median in-network rate for contracted providers, uh, that currently exists in the code elsewhere. Um, beyond that, I would, uh, submit for your consideration, uh, a development that is so brand new, we are just getting around to, uh, dealing with it ourselves. [1:02:04] That's the piece of paper we just had distributed to the members of the committee. Um, like very many other things, uh, there's a lot of surprises coming down from Washington, DC these days, uh, and this, uh, I think would fall squarely within that category. Um, for those of you that are in the insurance or healthcare world, you may be familiar with something, uh, known as the Annual Notice of Benefit and Payment Parameters. Uh, that's published annually by the Centers for Medicare and Medicaid Services, an office called CCIIO, which regulates, uh, the healthcare plans that are covered under the Affordable Care Act and those that are sold on exchanges like Georgia Access, formerly called, you know, healthcare.gov until a couple years ago here. [1:02:45] There's a longstanding provision in the Affordable Care Act related to something known as the Essential Health Benefits Package or the Minimum Essential Health Benefits Package, which drew a floor under what a health plan had to cover to be considered a qualified health plan under the exchange. Um, traditionally, there has been this provision related to state-mandated benefits where, uh, the law and then CMS had asked, uh, had sort of set a date and time where whatever your state's essential health benefit package was would be sort of snapshotted at a date. [1:03:18] Uh, that date was December 31st, 2011. And then that would be sort of what was covered by the federal government through the premium tax credits that flow through exchange, uh, exchanges to customers who buy their insurance on the individual market through the exchange to make those plans more affordable. Um, this rule has traditionally not been enforced. Uh, but in the NBPP for 2027 that was published on Monday, uh, in the Federal Register, uh, it's buried in the middle of a 144-page document, um, they have announced that they will no longer allow state-mandated benefits to receive these premium tax credits and that the state itself would be responsible for covering the cost of any mandates that exceed whatever that essential health benefits package was as it stood December 20- December 31st, 2011. [1:04:11] Uh, so this is a monumental change, uh, the far-reaching consequences kind of beyond what's in this bill before you. [1:04:16] Mm-hmm. [1:04:17] Uh, but we wanted to make the committee aware of this. I shared this with the sponsor, um, earlier in the day. Um, he and I agreed that this was probably good for the m- for the committee to consider. Um, but I think there's a strong indication, at least initially, that at least the cost of this as related to individuals who purchase their coverage through the exchange would be borne by the state treasury. Uh, and the way that that defrayal works is the cost of coverage over that essential benefits floor is either remitted from the treasury to the health plan or to the insured for the cost of that coverage. [1:04:49] So I wanted to have the committee be aware of that concern as you're considering this legislation. But really, our association's position is that we would like for the enumerated amount to be something closer to what the contracted rates are so there's not a strong bias towards not contracting. So thank you, Mr. Chairman. If there's any questions, I'd be happy to take them. [1:05:10] Question. One more. [1:05:11] Question here. Um, two things, and the first one, I, I think, just to make sure I'm right, the, the federal surprise billing, which was done after Georgia's, didn't cover ambulances either, did it? [1:05:22] I believe that's correct. [1:05:24] Um, but the other question, uh, along those lines is I know we could not, um, regulate ERISA plans. [1:05:32] Mm-hmm. [1:05:32] So would this, would this legislation not apply to ERISA plans? [1:05:36] I don't believe so. You'd have to look at the definition of health plan in, uh, 33-20E, but I believe that there is an exemption in the definition section in 33-20E, if I'm not mistaken. [1:05:49] So how, how many plans would it not cover in that case, would you guess? [1:05:52] Um, the state-regulated small group market, traditionally we thought, you know, 9 to 10% of the covered lives. Um, that's shifted a little bit as we've had more individuals get their coverage on the exchange. But it is a s- it's a, it's a smaller slice of the market. [1:06:06] But the, the, the bigger employer-type plans are, are the ones under ERISA, or is that- [1:06:12] Yes, sir [1:06:12] ... is that correct? [1:06:12] Yes, sir. [1:06:12] I'm trying to remember this stuff. Yeah. Okay. [1:06:14] That's probably seve- you know, 65, 70% of the covered lives in the- [1:06:18] Okay [1:06:19] ... market. [1:06:20] So I, I'm, I think it's a good, good thing, but I do have concerns, you know, that we're not, we're, we're still gonna have people getting surprise bills. I don't wanna go out there and say nobody's getting it because of the ERISA plan, so that's just making sure we're all, all aware of that. That was my only questions. Thank you, Mr. Chairman. [1:06:38] Okay. Uh, Vice Chair. [1:06:39] Sorry, one more question. Um, from the standpoint of how the bills are looked at, I would imagine that they're submitted as the base rate plus mileage, and is that all included in the Medicare, uh, rate? So in other words, this bill, it says 325% of the Medicare rate. Would that include the mileage also? [1:07:11] I believe that's correct. I'm by no means an expert on EMS billing. I know there's, like, the levels of life support. There's modifiers for if you're in a rural, urban, or super rural area, and I think that there is a mileage aspect that's added to the claim, but I'm not at all sure if that's universal. [1:07:24] I'm getting a bunch of nods in the, in the audience. Thank, thank you. Any other questions? All right. Senator Burns. [1:07:32] Do we have any idea what kind of cost, like a guess, fiscal impact for this, s- for the state benefit plan? [1:07:43] Uh, the, particular to this bill, the state plans are excluded in the definition healthcare plan that's in the front- [1:07:49] Right, I get that [1:07:50] ... part of the- [1:07:50] So you're saying the state would have to, through appropriations, I assume, pick up the extra? [1:07:56] I, I understand your question. So, uh, there's not a... The state health plans aren't covered in this bill in terms of, like, somebody who's enrolled in Medicaid or the SHBP. The, the related piece about what we'll be on the hook for next year potentially, um- We're just getting around... We've just realized this was even a thing, so I would need to- some time to get back to you on a cost estimate ball park for it. [1:08:18] Okay. Just curious. I'm sure it'll come up at some point. [1:08:22] Any other questions? [1:08:24] That's it. [1:08:25] Thank you, Mr. Wetherington. [1:08:26] Thank you, Mr. Chairman. [1:08:27] Appreciate it. We'll go ahead and start with the, uh, uh, the, those in favor. Um, you know, I can't read some of these names. I got Tim Kibler down, the, the, uh, uh... And Thomas... I don't know. What did he say? [1:08:49] Thomas. Thomas somebody. Thomas McEntee. Okay. How'd that do? Is that right? All right. Thomas somebody with, uh, American Pro Health. Ameri Pro Health. Nobody... There we go. [1:09:04] Merritt. [1:09:04] All righty. And then Tim Kibler's in the chute, and then, uh, Chad Black, Jeff Adams, Sam Polk, and Terrence Ramoutar. All right, just, uh, if, if everybody wouldn't mind, um, telling us who you're with- [1:09:20] Sure [1:09:20] ... name, and so forth. [1:09:22] Uh, uh, thank you, Mr. Chairman. Thank you, Committee. Uh, Thomas McEntee. I'm with Ameri Pro Health, which is a... We're an ambulance service provider here in Georgia. We provide, uh, ambulance services to 11 rural counties in Georgia. We're part of the, uh, GAPA Association, as well as the American Ambulance Association, and we're s- we're speaking in support of this effort, of this bill. Uh, a number of states around the country are engaged in similar efforts to sort of put some rationality around this and, uh, uh, establish- [1:09:56] I'm sorry [1:09:56] ... a reasonable ceiling that, uh, protects the consumer, first of all, the patient, and then also protects the, uh, the, the ambulance service providers. Ambulance service providers are made up of a patchwork of, um, m- m- many different types of providers, some commercial, some municipal. And th- th- the, the structure of this bill really addresses, uh, sort of what's a sort of a, the best case scenario for everyone. [1:10:27] And th- th- the fact that emergency services were, uh, uh, omitted from other efforts on surprise medical billing, uh, is because there's just a different level of complexity. And so, uh, we, for the, for the people that we serve here in the State of Georgia, uh, we support this bill and, uh, uh, ask that you approve it. Thank you. Any questions? [1:10:52] All right, any questions? No questions. Thank you, sir. [1:10:55] Yep. [1:10:56] Um, here we go. [1:11:03] Thank you, Mr. Chairman. Tim Kibler with the Georgia Alliance of Community Hospitals. We're Georgia's not-for-profit hospitals. We're in support of Senator Still's bill. I think you're gonna hear more from the ambulance folks that probably have more to share with you than I do, so in the, in the, uh, in, in, in consideration time, I'll yield back whatever else, uh, I may have, unless there are any questions. [1:11:22] Thank you. [1:11:26] Also Chad Black, Jeff Adams next, and then Sam Polk, Terrence Ramoutar, who's already up here. [1:11:36] Thank you, Mr. Chairman. My name's Chad Black, and I'm the chairman for the Georgia Emergency Medical Service Association, and also serve as governmental affairs director for Metro Atlanta Ambulance. We are in support of Senate Bill 462, and GEMS, our organization, we represent all the providers and the services in the State of Georgia, private, uh, government, and hospital-based providers. As you know, when someone calls nine- and it's been talked about, when someone calls 911 on one of their worst days, and the 911 agency responsible for that zone, we don't get to choose if they're in-network. [1:12:08] We simply respond and transport. It's that simple. We don't do the wallet biopsy on scene, as we call it. Uh, when we go to the doctor, you know, they'll come in and say, "Here's what you're responsible for. Here's what the insurance will pay. Sign this form." Uh, so we simply bill the insurance company, and overwhelmingly, 90% of those or more in the State of Georgia are classified as out-of-network, so that puts the patient with a balance bill. And we were kept out of surprise billing. Uh, it would've been catastrophic if we had not have been. That would've left 159 counties and roughly 170 911 zone providers increasing the taxes on the citizens, the taxpayers, and the constituents in those counties to offset what reimbursement doesn't cover. [1:12:50] Our reimbursements from Medicare, Medicaid, and insurance doesn't even cover the preparedness cost, of buying the ambulance, equipping it, training the people, salaries, benefits, and much less cover the cost when we actually respond on a call and have to transport. Uh, that is up, and you'll hear some where 50% of their budget is paid by reimbursement. The other 50% is covered by the taxpayers on a, a tax that is assessed to them. Uh, some places it's higher. If we go into surprise billing, which we are told we're gonna have to, and we agree with that, and we don't have a fair reimbursement floor, that is gonna increase the taxes in almost all 159 counties on the 911 zones to offset what we're not able to balance bill. [1:13:34] So, um, you know, this will help ke- keep EMS solvent. Hope- [1:13:39] Okay. I, I appreciate that. You know, I've sort of limited y'all's time, your- [1:13:43] Sure [1:13:43] ... till about here. Are you able to address what Mr. Wetherington said? [1:13:48] On which, which one? [1:13:49] I, I guess you're not. All right. So if you don't mind, if I could get Mr. Ramoutar back up here. Mr. Ramoutar. [1:14:00] Good afternoon, Mr. Chairman, committee members. [1:14:02] Yes, sir. Introduce yourself again, and, uh, really would like for you to address what Mr. Wetherington said. Thank you. [1:14:08] Yes. Um, Terrence Ramoutar with the Georgia Ambulance Providers Association, the American Ambulance Association, um, here real, uh, again, uh, representing ambulance services across the state. Uh, we're obviously in support of this. 17 states, uh, have passed this legislation almost verbatim. You'll see that rate pretty uniform across... I think I explained what, what, how we, uh, the science behind that, that rate is to make sure that we're covering costs. Um- [1:14:34] And w- uh, before I address that, um, one, one other thing I wanna mention that's fairly new in terms of an anecdote, um, and this happens all the time. This happened last week in DeKalb County. Ambulance service responds. This gentleman had a GI bleed for three days, and he noticed it. It was mild. And the gentleman is now in the bathroom three days later, and there's blood. It's just a mess. Um, this gentleman is now in kidney failure. Um, and what happened was when the, when the family and the provider said, "How long did you notice this was a problem?" He said, "Three, four days." [1:15:09] That's not enough. [1:15:10] And, uh, they said, they said, "Well, why are you calling now?" He goes, "I don't wanna get a bill." So there's ... This is solving so much. Um, to address ... Um, uh, I, I know, um, Mr. Wellington said a lot, but to address, uh, what portion of that? [1:15:25] Do you have this? [1:15:26] Uh, from the printout from the Federal Register that came out yesterday, I don't have that. Um, I will tell you that I, I do, uh, familiar with some other states, um, on the essential health benefit plan. The Affordable Care Act actually did define EMS as a part of the essential health benefit plan to be reimbursed. [1:15:47] Mm-hmm. [1:15:47] It didn't say ... It didn't go on to say reimbursed in full. So we're closing a loophole here. Um, I- I'm familiar with some states that trigger, that there's a, a dollar amount that triggers, um, uh, that triggers that mandate. I'm, I'm not an expert at, at that, but I will tell you that EMS is less than 1% of the expenditures, and so rarely ha- do we ... Uh, in this sector of healthcare, uh, we're so small, we typically don't get triggered into these types of things. So that's the best I can answer to that. [1:16:18] I have a question for him. [1:16:20] Sure. [1:16:21] Um, I thought of something that we've done in some previous bills. Whenever we've tied anything to Medicare, and we did this in our contracting when I was in practice, we would tie it to a specific year of Medicare because Medicare doesn't always go up, and in the medical world, it frequently goes down. [1:16:41] Yes. [1:16:41] So I don't know if you'd entertain tying it to a specific year. [1:16:44] I, I can answer that. So, um, so Medicare has ... And the why we like this rate in the ambulance world is, uh, there's an ambulance inflation factor that's assessed every year on the Medicare rate. So it, it does keep up with inflation. Every once in a while it does go backwards, um, but ev- but every year it's typically around 1 to 3%, uh, of an increase. So it does, it does keep up with, with inflation. It hasn't been rebased in 20 years, or 25 years actually. Um, however, there's an inflation factor that adjusts every year. [1:17:19] So you're not worried about if it were to go down rather than up? [1:17:22] Um, no, it's just simply a matter of inflation, right? So there's a, there's a formula involved in that, and it's fair. [1:17:29] Thank you. Appreciate it. [1:17:30] So if prices do go down, so, so will that. [1:17:32] So you're saying from a surprise billing standpoint from the ACA, then it allows the state to take precedent, uh, in this situation- [1:17:41] Yes [1:17:41] ... regarding ambulances? [1:17:42] Uh, as a matter of fact, in the, in the, um, No Surprises Act in 2020, '19, uh, established it, established the Ground Ambulance Patient Billing Advisory Committee. That was a, a national committee with health insurers, providers, citizens, um, and they actually published recommendations that went back to Congress on how to fill the gap for balance billing for ambulance services. This bill, along with the other 17 states, is, uh, uh, is reflective of, of the federal recommendations. [1:18:13] So the state's recommendations take precedent over the federal and the ACA? [1:18:19] That's ... Uh, so in the No Surpri- in the federal- [1:18:22] In the No Surprises- [1:18:22] ... No Surprises Act- [1:18:23] I gotcha [1:18:23] ... allows the states to come up with their solutions. [1:18:26] Is the, is the committee clear on this? [1:18:33] Okay. All right. Uh, Senator Cowsert. [1:18:35] Bill. Thank you, Mr. Chairman. I'm just curious why we're going 325% of Medicare reimbursement rate. [1:18:43] Yeah. Um, so we've been working with CMS for 25 years to update the base rates. Um, I did mention before there was a cost study. There is a process. Uh, the federal government does work. Uh, they're currently in a multi-year process that evaluates the rates. Um, w- so we're, we're finally getting looked at. It may be a couple years if, if, if we, if MD PAC does get to it. Um, but right now the study that was published, it was, CMS did a cost study nationwide, uh, published a study about costs, and the costs are roughly about 1/3, and that's how we end up at the 325. [1:19:18] Someone talked about finding that fair balance between keeping the ambulance service sustainable, but also m- you know, making sure that it's not, uh, you know, too high and keeping a, keeping a ceiling. Um, so that's why th- that 325 or 350, uh, you're seeing in multiple states because the CMS Medicare rate is about 1/3 of the cost. [1:19:38] But you would get a higher rate if they had private insurance. [1:19:43] So we're talking about commercial out of network, right? So, um, these out of network commercial bills, uh, the way this bill is structured, they either pay the county rate, and if there's not one, they pay the lesser of two, either the bill charges or 325% of the Medicare rate. So, uh- [1:20:00] Why not just- [1:20:00] ... for commercial plans that are out of net- I, I apologize. Sorry. Go ahead. [1:20:03] I, I was wondering, why not just either the billed rate or the in-network rate? S- [1:20:09] Oh, go ahead. [1:20:09] That would be a lot lower than three times Medicare. [1:20:11] All right. Senator Still. [1:20:13] The in-network rate for many of the insurance companies is either, if you take the Medicare rate of, of a baseline, some of them are at 75% of the Medicare rate, and on the high end, maybe only 125% that, so it's only about a 25% plus or minus on either side of the Medicare rate, which is already significantly lower. If we run the math models of some of the examples that we've already heard, this 325 times Medicare rate is still about half of what the self pay out of network amount is. [1:20:43] But, but that's the negotiated rate between the insurance company and the ambulance services. How can they complain about that? [1:20:49] And that's why ... Well, that's why 90% of them don't take the in-network rate, because it's so low They'd rather pursue the self-pay out of network. [1:20:58] Good. Thank you. So, and that's why there's surprisability f- uh, apparently 90% of the time. Hmm. Any questions for the, our federal partner? Clarification there. All right. Um, thank you for, um, uh... If you don't mind just- [1:21:14] Yep. Thank you. Appreciate your support [1:21:15] ... sitting around. I sort of gave a little bit more time there. Still have Jeff Adams and Sam Polk. I think we probably got- Two minutes ... two minutes and 45 seconds. Still better than, um And I cut off somebody. Mr. Black, if you'd like to get back up there. All right, so. Why do you always expand that? Got about two and a half minutes. Y'all wanna do it together or separate or whatever you wanna do? That's pretty shitty coverage. [1:21:38] Um, good afternoon, senators. Uh, I'm Sam Polk. I'm the assistant chief in charge of EMS operations for Henry County Fire Rescue, as well as the chair for the Region 4 EMS Advisory Council and vice-chair for the Georgia EMS Association. Senate Bill 462 ensures reliable reimbursement, uh, that's gonna offset the burden on my taxpayers in my county. We have increasingly more expensive costs to operate. Um, we balance in Henry County how much we charge against what's in the best interest of our taxpayers as well as our patients. [1:22:14] In 2025, if this bill had been in place, we would have received an additional 1.9 million in revenue. Um, however, with that, we would not have, um, um, billed patients for that, uh, same amount during that time or turned over to collections. But this reduces the burden on our taxpayers, so we don't have to raise any, any additional taxes to fund the provision of our care. As mentioned before, we have the same issues with, uh, commercial insurances that don't actually pay us. [1:22:51] They pay the patient even though we sent the bill. This adds stress to our patients, the insured, uh, as well as stresses our ability to actually collect. Our citizens deserve, um, to be cared for economically and physically responsibly. We deserve that we pr- They deserve that we provide those services, um, in a efficient and, um, timely manner. [1:23:21] This bill's not the final solution in addressing the ongoing needs for EMS in Georgia, but it is a crucial step in the right direction. [1:23:32] Any questions? Thank you. Didn't look like there were any questions, uh, so we got, uh, less than a minute, Mr. Polk. [1:23:41] I could do mine that fast. [1:23:43] All righty. [1:23:43] My name is Jeff Adams. I'm the fire chief and EMS director for Habersham County. Um, I'm also a member of the Region 2 EMS Advisory Council and AGEMSA board member. And I just wanna give you the scenario that I have, that I'm working with in Habersham County. I've got a population of about 50,000 people, a current budget of about 5.3 million. We're going through that lovely process now. Revenued, um, so they take that $5.3 million, and they project what is gonna be collected by the billing of the patients, which is about, like, uh, Chad, Mr. [1:24:21] Black said earlier, 50%. So my, along with what Sam was saying, if we can get this, this bill in place, it's gonna reduce the burden on those taxpayers. EMS is expensive. Ambulances cost 350, $400,000 a piece. Um, the staff, the training, the, the, the salary and benefits of these people, it's expensive. Um, the cost per day to put, for, for my, the EMS services in my county is 14, about $14,500 a day. [1:25:02] About $3,000 per med unit. We ran, we were dispatched on 8,600 calls last year. We transported 50, or 5,000, okay? And as Mr. Ellen said earlier, we only get paid for those we transport, leaving a, uh, cost of transport of about $682. So this bill is important. It's important we all get on the same page. We gotta take care of the taxpayers. We gotta look out for them. Thank you. [1:25:34] All right. Uh, I think that's it for testimony. Thank you so much. Got those names reversed. Mr. Polk and Mr. Adams, thank you. Um, any further questions from the committee? No. All right, Senator Lucas. [1:25:53] With this bill, uh, uh, are we saying we, we got a rate, and that's the rate that's gonna be paid in the state on, on EMS services? [1:26:08] For those with health plans, yes, Senator. [1:26:11] Well, I know y'all wanna get your money, but what I'm saying is this would be a rate set statewide that they would have to pay [1:26:24] if they don't- [1:26:25] It is, it is a statewide, but it doesn't apply to everyone. [1:26:30] Well, who, who is it that they would not apply to, uh, out of network? [1:26:35] No, this addresses out of network. [1:26:37] This is for people with, for people that don't have any insurance, [1:26:43] uh, uh, of any kind. Like, if they're not on the Affordable Care Act, they don't have a market plan or, uh, anything, then they would have to self-pay, just like they would, they're self-paying for their healthcare now. But if they have a health plan- [1:27:00] This would be the rate? [1:27:01] Yes, sir. And Medicare and Medicaid- [1:27:03] I, I just wanna, I just wanna make sure when we doing that, we, we are saying what the rate is if you have insurance. This is what you, you are going to be paid and not have folks coming back saying, "Well, we need, we need to raise it." [1:27:19] If, if it's a, if they're on Medicaid, they've got a rate. If they're on Medicare, they've got a rate. If they have insurance, this sets that rate. [1:27:26] All right. That, that's, that's what I wanna make sure. [1:27:28] Yes, sir. [1:27:29] Thank you. Thanks for clarification. Appreciate it. Any other questions? Be happy to entertain a motion here. Motion. Motion. Second. Uh, we'll rec- recognize the former deputy sheriff here, uh, Senator Chairman Robertson, second by the chairman of rules, the powerful rules chairman. And, uh, any further discussion? All those in favor, raise your right hand. [1:28:02] This, uh, looks unanimous. All righty. Thank you very much. We appreciate that, uh- It's a good bill ... it is a good bill. Um, meeting next Monday. Meeting adjourned. Session's 10- Oh. Meeting next Monday. Meeting next Wednesday. Wednesday. Yeah, that's right, 'cause we're not here on Monday. We're not here Monday. We're not here Monday. All right. Meeting adjourned.