House Public and Community Health Committee, February 24, 2026

Transcript

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1. 0:19:52

   Uh, uh, thank you every- okay. Thank you everybody for coming, but we don't have a quorum, so we're sitting here waiting on a quorum. I think we're two short,

2. 0:20:08

   and we're sending out phone calls.

3. 0:28:02

   Okay.

4. 0:28:03

   Wait, we did it.

5. 0:28:04

   Okay.

6. 0:28:05

   It doesn't look right.

7. 0:28:05

   Don't look right.

8. 0:28:06

   We're talking about it.

9. 0:28:10

   Uh, okay, here we go.

10. 0:28:12

    Hello.

11. 0:28:12

    All right. Let me, uh... We have reached what we need, and so let me call this meeting of the public health and commun- public and community health meeting together, uh, and let's get started. Uh, Commissioner, I hope you will forgive me. I'm gonna let one of our members go, 'cause he's supposed to be chairing another sub- sub- subdivision of Appropriations. Um, for those that you don't know, we're running late, uh, with a lot of bills on education. We did a lot of good work today, I feel like, on moving forward in the state, especially about teaching our kids to read.

12. 0:28:45

    And because of that, Appropriations is still working on the first, the, the, on that, the first preparation bill we have to take up. And so it's a very big committee with lots of vice, vice chairs that stand like chairs, and so they're all meeting right now, and that's the problem we're running into. Uh, why anybody wants to serve on Appropriations, I do not know. Um, they wouldn't let me, I'm sure, because I give all the money to health. You know, and we would have no state parks or whatever.

13. 0:29:15

    It might be a little problem to let me, let me loose on, uh, Appropriations. Okay, we're ready. We're ready to go. Come on. And that would be House Bill 668.

14. 0:29:34

    And it's the substitute-

15. 0:29:35

    It is

16. 0:29:35

    ... 'cause House Bill 68, now we're working off LC462005S.

17. 0:29:42

    Um, thank you, uh, Chair Lady and Committee. I'll make this really brief. This bill has passed through this committee. I'm sure you've remembered it several times, the Service Animal Bill. Um, obviously it got a little hung up. Uh, we didn't get it through Rules, so it's gotten recommitted, uh, which actually turned out to be a good thing. Um, PAC has actually given us a little bit more time to do some more tightening up and housecleaning. PAC has, uh, changed a little bit of the language, and they're here today to explain why w- they did that and what we did.

18. 0:30:12

    Uh, I think it's made a really good bill even a better bill. So if you don't mind.

19. 0:30:16

    Okay.

20. 0:30:17

    W- to refresh, we've been gone for almost a year. Very quickly, one, two, three, four, what does the bill do?

21. 0:30:24

    Uh, updates the state law to be congruent with federal laws and regulations regarding service dogs, establishes rules against harassment or physical harm to service dogs, and grants more legal protections to those who engage in owner training.

22. 0:30:36

    Okay.

23. 0:30:36

    So that's, that's it.

24. 0:30:37

    All right. And what changes did PAC make to it?

25. 0:30:41

    Um, good afternoon, uh, members of the committee. I am Jessica Rock. I am the Animal Crimes Resource Prosecutor with the Prosecuting Attorneys' Council. Um, and Representative Thomas had just asked me to take a look at this bill. Um, if this committee recalls, we passed a bill, um, called Figo's Law in 2023 that dealt with, um, heightening penalties for certain proscribed conduct with working dogs, specifically, um, with, um, search and rescue dogs and with police dogs.

26. 0:31:12

    That was, um, SB 155 that was signed into law in August of 2023, and essentially what we did is we went and mirrored the proscribed conduct and the penalties for service dogs, um, in line with what that law already states. There's a misdemeanor section, and high and aggravated misdemeanor code section, and then a felony code section that essentially mirrors that same language.

27. 0:31:38

    Questions from the committee?

28. 0:31:45

    Give 'em a minute to catch their breath.

29. 0:31:49

    Okay, no questions?

30. 0:31:51

    Motion.

31. 0:31:52

    Okay. Uh, what is the posture of the committee?

32. 0:31:56

    Motion to do pass.

33. 0:31:57

    Do pass. Second?

34. 0:31:58

    Second.

35. 0:31:58

    Got a do pass and second. Um, is there any other discussion from the committee? Okay. Uh, are there people that are just dying to testify on the bill? No? Okay. Everybody... Whoo, are you lucky.

36. 0:32:15

    Out, out of expediency, I think they've agreed to just watch today.

37. 0:32:18

    To let you. Okay. Uh-

38. 0:32:19

    It's a good bill.

39. 0:32:20

    Wait a minute. What happened? You got somebody? Yeah, okay. Representative Cannon.

40. 0:32:24

    Thank you, uh, for bringing this. Just a question about the definition of trainer. If somebody is not... What does it take to be a trainer, certified trainer, and what if they're not? How does this bill affect them? But they have a service dog, that they have been getting to do the right things.

41. 0:32:43

    S- so this is something we, we covered in, in, in detail in committee. I'd be more than happy to get one of the experts up here to talk to you about it, um, if you don't mind.

42. 0:32:52

    I don't mind.

43. 0:32:52

    Like, come on.

44. 0:33:01

    Can you get on the other side of that?

45. 0:33:02

    And Casey, can you... Yeah, can you-

46. 0:33:03

    Thank you.

47. 0:33:09

    Hi, Ms. Park.

48. 0:33:10

    Hey, good to see you. Sit. All right, stop moving. Done? Okay, can you ask the question again, please?

49. 0:33:19

    It's what, what-

50. 0:33:21

    Representative.

51. 0:33:22

    Sure. Thank you. Lines 144 discuss what a trainer is, and so how does this bill impact who a trainer is, and what happens if somebody is not a certified trainer and they've been getting the dogs to do the right thing?

52. 0:33:36

    Yeah. Um, so in the state of Georgia, there's no requirements or certification for trainers. Um, the Georg- There's, Georgia doesn't require trainers to be certified. Um, I can say I'm a dog trainer and just train dogs. There's no schooling for it. There's no nothing for it in the state of Georgia. Um, so what we, I believe the bill states that trainers are individuals with disabilities who are actively training the dog task, and also schools like Service Dogs of Georgia and Service Dogs, or I think it's Blind Dogs, uh, forget all the school names that are located in the state, um, but they have their own criteria per an company that those trainers must go through.

53. 0:34:30

    Um, so we- we've kinda laid it out that way. So...

54. 0:34:34

    Do you wanna mention, I'll let you, costs to buy a- a, or to-

55. 0:34:38

    Purchase

56. 0:34:38

    ... I think purchase a dog-

57. 0:34:40

    Yeah

58. 0:34:40

    ... but you know what I mean. Could you-

59. 0:34:41

    Yeah. So if you were to, so, um, if all you could probably see my dog down here, um, she, if I was to get her through an organization, I would probably be charged anywhere between $10,000 to $30,000, depending on the task that I need and the training that requires to do those task, and how many tasks do I need her to help me with, right? Um, I ended up owner training. Um, I trained her myself because I, A, have the college background in animal behavior and training, um, which kinda helped me do that, and it saved me that 10 to $30,000.

60. 0:35:23

    Representative Thomas, it is loose because it says in the process of training their own dog, uh, and then, "And there aren't individual who's competent to train service animals and is involved in such processes." There really is no definition of that. Did you plan for it to be that way and-

61. 0:35:40

    That's the federal law.

62. 0:35:42

    Uh, yeah.

63. 0:35:42

    The-

64. 0:35:42

    Okay.

65. 0:35:43

    My understanding is that's the line of the federal-

66. 0:35:45

    Yeah

67. 0:35:45

    ... code.

68. 0:35:46

    The, the federal law's, that's the federal law's definition of a trainer as well.

69. 0:35:50

    Okay, 'cause I can't remember-

70. 0:35:51

    Yeah

71. 0:35:51

    ... last year's.

72. 0:35:52

    Yeah. Well, no, it's okay.

73. 0:35:52

    I'm sorry.

74. 0:35:53

    We, we, we-

75. 0:35:53

    We discussed this last year, but I can't remember.

76. 0:35:55

    No, it's not a problem.

77. 0:35:56

    Okay.

78. 0:35:56

    And I appreciate y'all listening to this again, so it's important.

79. 0:36:01

    Okay, so this just mirrors the federal law-

80. 0:36:03

    Yeah

81. 0:36:03

    ... and what they just thought is a trainer.

82. 0:36:05

    Yes, ma'am.

83. 0:36:06

    Okay. Well, I guess we can go along with that until we decide that there's problem with it, and we have to come back and look at it. Okay, anyone else want to speak on the law or ask a question? Representative Cannon, was that all you needed to know?

84. 0:36:19

    That's right.

85. 0:36:19

    Okay. All right, I'm ready for a vote. Everyone in favor of the passage of the substitute to House Bill 668, say aye.

86. 0:36:27

    Aye.

87. 0:36:27

    Anyone opposed, no. Okay, the ayes have it. Thank you.

88. 0:36:30

    Thank you, committee. Thank you, Chair Lady.

89. 0:36:32

    Okay. We're gonna go next to, uh, the commissioner's bill. And let's see, what's the number on that? I should know it, what number is it? Where's the bill? Okay. No, it's not it. Oh, all right, here we go. No, it's... Okay. Uh, this is House, this is House Bill 1368. Uh, I'm going to turn off, Mr. Commissioner, you wanna come up and have a seat?

90. 0:37:02

    I'm gonna be carrying the bill in the House. Um, I will tell you a little bit history on, uh, from my personal history of being here for quite a few years. We have had very, very good community service boards, uh, the state's divided into regions, um, and we have had really, really bad problems with some. Uh, one of the one... Uh, often it is very good people from the community that are trying to run these, uh, but it seems like they do not have, uh, financial training to run them, uh, and run a business.

91. 0:37:42

    And so we've had them on the point of bankruptcy where the state has had to go in and take over. Uh, there's just been general problems throughout the state with CSPs. I, I won't go into all of them, but I'd like to with... But one of the CSPs that was in deep financial trouble, just about to go under, voted to give, uh, their head something like $132,000 a year for life.

92. 0:38:13

    And then when, you know, it was discussed with, discussed with them that they were in such a bad financial situation that they basically almost, they couldn't pay the bills, they still said, "Oh, but she deserves more money." I, I... And there's doesn't seem to be any consistency in, in what they do. I mean, uh, you know, some of them, if they come out of our jails and they need help, and they've been on a certain medicine, they'll keep them on that medicine.

93. 0:38:43

    If they don't like that medicine, they'll change them, and anytime you change somebody's, uh, their medicine, it takes a while for it to take over, and they often, you know, go back and have problems. So the commissioner, in all his wisdom, and I really mean that seriously because he has done so much good work, uh, to help us begin to be more effective in taking care of people in our community that have mental health problems, um, has seen the need almost like they, we had in public health, um, to have somebody with a bus- more business background, uh, that is sort of seeing, overseeing, and, and the head person in these areas, and then let, uh, the people that are the professional, uh, people in treating mental health more or less take care of that job, and that we're consistent across the state.

94. 0:39:34

    Does that sort of meet the problems you've run into here?

95. 0:39:38

    Yes, ma'am.

96. 0:39:38

    If I'm wrong, please tell me.

97. 0:39:39

    No, no, no, you're always right on.

98. 0:39:41

    And, uh, you know, they are our safety net, and we need to be able for them to be running at top-notch efficiency and doing what's best for the patients at the same time. So with that, I'm gonna turn it over to the commissioner because basically, uh, what the bill does is give him-

99. 0:39:59

    The right to hire the CEOs. And I'm going to let you explain anything else you want to about it, and I'll go with that. Thank you, Madam Chair, and I, as always, appreciate your support and your leadership in this area and everything relating to health in our state for so many years. So I think most folks on the committee know this, but I just want to give you a quick reminder. There are 22 community service boards in the state of Georgia. Those have been set up by the state to be the safety net of the system for mental health services around Georgia. They serve as the backbone of providing services to those that are uninsured and those who are underinsured in the state.

100. 0:40:36

     They typically run our state crisis centers that we have around Georgia. Recently, we have just opened a new one here in Fulton County. We have another one in Fulton County that's going to be under construction, and we have really exciting news that we're going to announce for Clayton County here soon with another crisis center being built in Clayton County. So our CSBs run our crisis centers. We have had, to the chair lady's point, we've had some challenges over the last couple of decades, and most recently there's been three that have basically failed, and without our intervention they would have failed.

101. 0:41:11

     And we cannot just, we can't allow that to happen because there's no one else to provide that level of care to our uninsured population. And you hear about conversations around a new hospital, et cetera, and that is needed. But individuals don't need to be institutionalized, and individuals need to be taken care of in the community. So when they get out of the hospital, we have to have a robust safety net for them to be able to provide services. So we have worked extremely close with the CSB Association because those of you who know me know that I try my best to get consensus on everything that we do.

102. 0:41:50

     So we've worked closely with the CSB Association. We started out with the first draft they had some concerns with, but David Kidd is here behind me, and he is the president of the CSB Association, and he can tell you that the CSB Association is in support of this legislation. ACCG appoints the board members, or well, the county commissioners appoint the board members, the CSB boards. ACCG yesterday took a vote in support of this legislation. So their members appoint the boards that we're making the changes to, and they support it.

103. 0:42:23

     They had a committee two years ago, ACCG did, that met on this issue. They came and met with me and asked me to make some changes to allow us to have more oversight over the network. So that's what this does. With that, I'll walk you through quickly through each section of changes and then make a few other comments and answer any questions. So starting on lines 23 through 30, definition update. This just redefines key terms. A lot of this just has to do with you all know when legislative council drafts a bill like this that makes changes, they redefine some of it.

104. 0:42:55

     But the community service board stays intact the way it is today with the governing body appointed by the local county commissioners. All that remains the same. In line 37, there is a new definition for executive director. It establishes executive director as the chief operating officer of the CSB. The CSBs today all have a CEO in law. Those CEOs have to be approved by me, by the commissioner, and their salaries have to be approved by me before they can be hired. And that, we make some tweaks to that.

105. 0:43:25

     We'll discuss that in a later part of the bill. Section three, lines 66 through 67 there recreates all existing CSBs. Again, this is just a way legislative council drafted the bill. So CSBs remain the same. They're just all reconstituted the same way they are today. It does restructure the governing board to include an executive director. So that executive director who's a CEO will also serve on that CSB board. It also, and this is something that's very important, it requires that our agency establish unified bylaws by the end of this calendar year and that all CSBs have to adopt those bylaws.

106. 0:44:04

     Because what we have today is, to Madam Chair's point, some CSBs are knocking it out of the ballpark. Some are struggling. We want you to receive the same level of care regardless of your zip code in Georgia. So we want to bring all CSBs up to a very high standard. It also strengthens ethical standards and training requirements for board members. This was something that Mr. Kidd and the other people on our ad hoc group we worked with was very passionate about, is they want to provide training to board members, certification to board members to help make sure board members have the level of knowledge they need to.

107. 0:44:40

     Because one example of this, in Northwest Georgia, our CSB, it's an $80 million healthcare organization. So that is a very large healthcare provider for our state. So very important that the boards are able to manage that. It shifts the appointment of the executive director over to our agency effective July 1st, making them an employee of our department. So the important part of that is operationally we'll have more operational control over the CSB network. One of the things we heard from the CSBs, and we took this to heart, some of those directors have been in place in their organization for a long time.

108. 0:45:18

     So they have retirement, they have leave, et cetera. So we made a tweak to it that's in the legislation, which allows instead of them coming to us, we can do a three-way employment contract. They can remain a CSB employee, but they'll have a contract with their board, with us, and with them that just defines operationally how it'll be managed. And that'll allow them to continue to keep that retirement, days off, et cetera. It also allows in section five, organizational conversion.

109. 0:45:53

     So This is really just i- in current law, CSBs can choose to, if, if they desire, I don't know that we've ever had one do this, they can basically close up shop as a CSB and convert their operation to a nonprofit or another unit of government, um, and that would just require that we would sign off on that. Currently, uh, it requires the governor also sign off on that, but it would also give us an opportunity to have some input. Don't foresee that ever being an issue, but it's, uh, it's there.

110. 0:46:24

     Section six is, establishes a process for CSBs to cease operations. Again, this is currently allowed in the law, but this just, again, makes some more clarifying statements there about the things that they would do, the involvement the department would have. Again, the effort being that we wanna make 100% certain that we have, uh, a smooth transition if that otherha- ever happens because, again, we have a lot of very vulnerable citizens relying on our CSBs. Um, section seven just deals with if, uh, someone's gonna sue a CSB, were to file, uh, the, that l- lawsuit, they'd have to serve at the principal office, 'cause a lot of our CSBs cover a very broad area, but they have a county they're headquartered in, and that would be where their principal office is located.

111. 0:47:09

     That's where the executive director or top administrator is housed. And then, uh, it also allows for, like you all have done with a lot of other boards, uh, it allows for them to hold teleconference or, or virtual meetings, um, and, um, that is important for some of our CSBs more than others because some of our CSBs are very large, 23 or so counties, and they're all volunteer boards. So these people are not getting paid anything, so having to all drive to a central location sometimes is pretty challenging to get a quorum, so this would just allow that participation.

112. 0:47:45

     Uh, but it also requires public access. So public access has to be made available, public commentary has to be made available through, uh, through that virtual option. Um, and that, uh, Madam Chair, I'll just say that, again, uh, David Kidd's here with us today. Uh, he is the chairman of Advantage CSB, which is headquartered out in the Athens area. He's also the president of the CSB Association, and I appreciate his leadership. I appreciate the ad hoc group that he appointed to help work on this and their support.

113. 0:48:15

     I appreciate ACCG on Monday adopting a support stance for this bill. Um, and I just wanna reiterate that the, the existing governing bodies remain in place. The board members remain in place. They're still gonna be appointed by the counties. They're still gonna have to vote on their budgets. They're still gonna g- vote on their services, et cetera. But this does give the state more oversight to, uh, hopefully hold the system more accountable so that we can make sure our most vulnerable citizens continue to be served in the way that they need to be served.

114. 0:48:46

     With that, Madam Chair, I'm happy to answer any questions or go into any additional detail. Thank you. Thank you, Commissioner, for that explanation. Do we have questions?

115. 0:48:59

     Okay. Uh, Representative Frye. Oh, I'm sorry. I- I'll get you r- next. Sorry. Thank you, Chairman Tanner, for bringing this bill. I appreciate the work that you do. I have a- all confidence that you're gonna do a great job. And you brought us a bill that creates accountability while maintaining the autonomy of the boards and sets up a universal structure, a uniform structure with which to operate. I think this is very efficient, and I appreciate the work that you do, man. Thank you.

116. 0:49:29

     I, I appreciate you saying that. One of the things that's important to us is to maintain the local ability for the local government to have that input and control, but also setting some safety measures in place, and, uh, that's the balance we attempted to strike, so thank you for that. Uh, Representative Howard. Thank you, Chair. And thank you, Commissioner, for that. Thank you for all you do in your office. Thank you. I've had to call on you several times in, in, in the Augusta area. But when it comes to the, um, appointment of the governing authority, are th- are these new criterias that you have, uh, psychiatrists, behavior health, uh, development, disabilities person, on...

117. 0:50:08

     I'm actually on line 115 through 121. Are those new, uh, distinctions for appointments? No, no. Okay, 115 through 121. No, sir. That's an existing law today, so there's no changes being made in that section there. Okay. So, and, and with this transition, would there be any in- interruptions in services while we, while we're putting this into place? No, sir. None, none at all. We've, uh, that's one of the reasons the, we met, uh, David appointed a group of six other CEOs of CSBs that we met, and, uh, we tried to be very methodical and careful to make sure everything we were doing would not, uh, do anything but improve the service, but there would be no interruptions at all.

118. 0:50:51

     Okay. Thank you. Thank you. Representative Drenner. Thank you, Madam Chair, and thank you, Commissioner, for bringing the bill. I know you've worked very hard on this, and we appreciate your efforts. I, I just have an operational question. Yes. So who, who fires the executive director? So if, um, if they needed to be terminated for cause, then that would be, uh, be me. Okay. How would that w- how does that change from what happens now?

119. 0:51:25

     So currently, the executive director's hired and fired by the board, but I have to approve that person. So it, it would give me, and give our agency more operational control over that individual. But, uh, so they, the buck would stop with me. And, and I'll give you an, just a quick example. So, uh, I think, are you in DeKalb? I am. So I, I actually have a letter on my phone that just came from the CEO of DeKalb, uh, just wanting to let me know how much they support this legislation, because she has come to me, uh, along with a lot of your other counties, with concerns.

120. 0:52:00

     And I would have to point out that I don't have the ability to affect that change. Um, and this would give me the ability to have some ... When, when your CEO at DeKalb comes with a concern, I would have the ability to do something about it. Uh, so that, that's really what has driven a lot of this is, is ki- is concerns from legislators and from, um, and from local governing authorities. But, uh, the buck would stop with me.

121. 0:52:29

     Thank, thank you, Madam Chair. I would like that. Representative Cannon.

122. 0:52:33

     Thank you, Madam Chair. Just another operational question. Lines 380 through 386, can you just help us understand the no break in service and, um, particularly 384 and 385, that they may continue to serve as ED only with the express agreement of the commissioner?

123. 0:52:59

     Yeah. So couple of things going on there. One, any, any CEO that's currently in place automatically stays in place. So they don't have to go through an interview process. They don't have to do anything. If they're a current CEO, they're, they're there. Um, and they can choose to stay a CSB employee if they w- if they want to. Uh, what this specifically talks about, and this came up from a CSB CEO that said, "My succession plan ha- is someone within our shop who's been with our CSB for a long time." So they probably are not gonna wanna leave their employment at the CSB to come to work for the state five years from now if they're getting closer to retirement and they're vested with a retirement system.

124. 0:53:46

     So this just allows us, if the CSB board's okay with it and if we're okay with it, to let them remain a CSB employee, but step into that CEO role. Uh, and again, that's just an effort to, um, to really thread a needle to make sure we have the accountability, but we're not harming that individual and taking, hurting their retirement or hurting their days off or benefits. That's, that's what that appli- applies, applies to.

125. 0:54:12

     Okay, thanks. Last of the questions. Uh, we have people that wanna speak on it. Uh, Brooke Kubick. Ku-

126. 0:54:25

     tell us who you are and ...

127. 0:54:33

     Good afternoon. Uh, my name is Brooke Kubick, and, um, I work for the Georgia Council on Developmental Disabilities. Thank you so much for giving me just a minute to, uh, make a comment on this. Um, first of all, I'd like to say, uh, Commissioner Tanner, we really appreciate the department's leadership and the work that's been done to expand waiver capacity and strengthen services, but our concern today with this legislation is that the structural shift that it creates. Um, today, group homes, host homes, and day programs are delivered through a community provider network.

128. 0:55:03

     If we implement HB 1368, um, then that would move those services into direct state operation. So for families that raise serious questions about, uh, for families that would raise serious questions about whether we are moving away from a flexible community-based service system towards a more centr- centralized model that begins to resemble institutions. Um, Georgia spent decades working to move beyond institutionalization.

129. 0:55:34

     So we want to be very clear, our goal is the same as the department's, to create strong, stable, high-quality services, but we're concerned about maintaining community, um, integration, provider capacity, and the individualized supports that people rely on every day. Thank you so much for hearing my concerns.

130. 0:55:53

     Okay. Uh, does anybody have questions for the ... Okay. Do I have a question? Uh, Representative Sharper.

131. 0:56:00

     All right. Thank you, Chair. Um, if you will, can you give me an example, um, of that? Of, of basically a community, uh, operation is gone and what kind of, uh, services may be affected?

132. 0:56:18

     Are you, are you asking me how, how this would make, how this would, uh, resemble institutionalization?

133. 0:56:24

     Yeah. Basically you said it coming from a community-based, and then what they're going to look at doing will make it more institutionalized. Can you give me an example of the difference?

134. 0:56:35

     Well, right, because if, if it's community-based, then each community, um, you know, each, each community board can decide what those services look like and how they implement that, right? So they have their autonomy under a CSB to do that. If you take that autonomy away and you put it directly under s- under state control, then you take that, you change the whole model of that board from a community-based to an executive director base.

135. 0:57:05

     And so then the executive director is the one that, that has all the power. So it, it becomes more like i- institutions because you have one state entity that's controlling everything instead of each community deciding what is right and good for their residents.

136. 0:57:24

     Okay. Can I interject right here? I, I think we need to ask the commissioner. C- c- can you respond to this? That's m- m- I didn't think that this affected those boards at all and then my- Um, in what she's worried about. So we just need to clear this up.

137. 0:57:43

     Yeah, so there's nothing in the legislation that takes the autonomy away from the community service board to operate. There's still the governing authority of that board. They still get to make their policy decisions. They still get to vote on their budget. They have to determine what level of services they want to provide. It gives us the authority to set a baseline of services so that we can bring all community service boards up to a certain standard, but they're able to expand that, operate in the way that they see fit in their local community. Most of our DD community service homes are not provided by community service boards anyway.

138. 0:58:16

     They're provided by one of our 600 DD providers who are private providers, um, and, uh, not community service boards. Uh, we actually, uh, we have some community service boards who do a really good job serving the de-developmentally disabled population and some who don't do a good-- don't serve them at all. Um, and we have a lot of folks who have co-occurring developmental disabilities with mental illness, and, uh, we need our community service boards to be able to do a better job serving that population. But this would have no effect on, uh, the autonomy of that board, and it 100% is not making anything more institutional.

139. 0:58:54

     These folks will still be served in, in community, not in a hospital.

140. 0:58:59

     Uh, Representative Burchett.

141. 0:59:03

     Thank you, Madam Chair. How you doing, Mr. Commissioner?

142. 0:59:05

     I'm good, sir.

143. 0:59:06

     Good to see you again. Um, so I was reading in, in line 354, and you may have gone over this, and I apologize for coming in late. Um, in the-- i-i-it looks like the structure of the bill requires that the executive director is now a direct report of the commissioner. And so, and maybe in these other sections, then if the executive director works for you directly, then, uh, I think what I'm-- maybe what, um, the witness is talking about is if, if the board gives direction one way and you give direction the other way, who do they-- who does the executive listen to?

144. 0:59:48

     Well, so we're able to set some overarching policies and guidelines. Uh, the commis- the CEO will be a direct report of the agency, but the board still keeps all of its autonomy to determine how to operate their CSB. Um, one of the things when the governor approached me about this legislation a few years ago was some of the challenges around, uh, every CSB operating in a different manner, and the fact that we had some doing certain things really well, some doing things not so well, is to bring them all up to a similar standard, and that's the goal here.

145. 1:00:24

     Developmental disability services in community are typically, again, provided, uh, in our, in our community homes, not by community service boards. Now, we are trying to get our community service more, more integrated in providing some of those services for the r-real high-end need individuals. But on a-- most of those are operated by other private providers.

146. 1:00:45

     Very good. Thank you.

147. 1:00:46

     Thank you.

148. 1:00:48

     Does that answer your questions, Ms. Kubek?

149. 1:00:51

     I mean, I, I, I guess our, you know, a, a big concern is that if you take those private providers that, um, that are practicing, they then-- If you're switching this model to under DBHDD, DBHDD control, then you are making those private providers subcontractors of DBHDD.

150. 1:01:10

     Well, the, the bill doesn't in-- do that at all.

151. 1:01:13

     In a sense.

152. 1:01:14

     No, ma'am. The, the bill doesn't have any effect on private providers at all. It's very narrow, focused only to community service boards, which are already quasi state entities created by the General Assembly. Jesse Petrea, for instance, that serves with you all, he is an owner of a priv-private DD providers. They provide that service. We don't have-- The only control the state has over that is because we're paying Medicaid funds. We have some level of control, us and DCH, but this bill has no effect on that at all.

153. 1:01:47

     Thank you.

154. 1:01:48

     Thank you. And one thing that we do. Uh, you know, I trust the commissioner. I've known him a long, long time. But if one of the community service boards should ever, um, try to do something like that, uh, I'm planning on staying around. Just let me know. I'll go with you to the commissioner. But we can always come back and change something should there be something that really we didn't catch or something. And he's looked over this bill very carefully because, you know, the CSBs need to do what they do best, which is the treatment.

155. 1:02:25

     But as far as housing and all and being in the community, it's really done better by people in the community, and that's what you're concerned, that it stay that way, and you're right about that. They-- I have wonderful ones in Cobb County, uh, and they need that autonomy. And my reading of the bill, it doesn't do that either. So Representative Sharper.

156. 1:02:47

     Thank you. So, you know, just hearing everything, uh, when we look at the consu-- uh, community service board, all right, and this is to the young lady, uh, what-- and let, let's make sure I'm understanding you and also what Commissioner is saying. Are you more concerned that the ability to let the community service board treat a community as it is a community versus having a cookie cutter system of says, "This is how we're gonna do it from the executive board, and we want every community to do this," when maybe it's something totally different that needs to happen that's custom-made for that community?

157. 1:03:27

     Is that what your, your concern is?

158. 1:03:29

     That-- Yes, sir. That is a big concern. Um, you know, when you switch to a, a, a government-run model, you're taking it away. You know, so you have one size fits all, and it doesn't always fit all.

159. 1:03:40

     Okay. And, and so the Commissioner, you're basically saying that you're gonna make sure that each community tailors their program to the community and not say, "This is the cookie cutter and this is the way we want every community to work."

160. 1:03:57

     Yeah, that- that's right, 'cause it's a balance. Um, and that's why ACCG is endorsing the legislation because their members are appointing those local board members. And you know as well as I do, ACCG doesn't like anybody taking local control away.

161. 1:04:12

     Right.

162. 1:04:12

     They're about more local control. So we have been very careful to thread that needle to make sure that they're satisfied with the language, and that's why the large counties here in Atlanta have sent letters in support, and that's why ACCG as a whole has sent letters of support, 'cause we do maintain the local control of the CSB.

163. 1:04:31

     Okay. All right. Commissioner,

164. 1:04:35

     uh, clarify for me now, the communities that you're talking about, the CSBs don't run them now or have contracts with them, do they?

165. 1:04:48

     Uh, it, the, the... These homes that serve-

166. 1:04:51

     Right

167. 1:04:51

     ... individuals with intellectual and developmental disabilities-

168. 1:04:54

     Right

169. 1:04:54

     ... uh, they fall under the CSBs.

170. 1:04:59

     Yeah, no. We... So we have some community service boards that may do some DD work. Most of our, uh, DD providers have a direct contract with the department, and now, and that doesn't change in this at all. There's still gonna be... This doesn't have anything to do with the provider relationships. SPAD is a, uh, is a entity that represents those. We have a very close working relationship with them. If they thought we were trying to somehow take over those private operations, they would be up screaming and jumping up and down.

171. 1:05:32

     It, it just doesn't do that.

172. 1:05:34

     Okay. Okay.

173. 1:05:37

     Thank you.

174. 1:05:37

     Thank you. Thank you for coming to talk to us about it. Uh, we couldn't do without people like you that are very concerned about, um, those in our communities with, um, disabilities, and thank you for that service.

175. 1:05:51

     Thank you, ma'am.

176. 1:05:51

     Uh- Representative Burchett.

177. 1:05:53

     Oh. Thank you again, Madam Chair. Commissioner, have you had, uh... What is the overall, um, consensus out of the CSBs, uh, with regard to the legislation? I know you've had an extensive conversation with them. Um, could you give us, give us that?

178. 1:06:09

     Yeah. So David Kidd's here. He's the president of the CSB Association. Um, he had appointed an ad hoc committee made up of some of the CSBs, um, and we met extensively both in person, over email, over the phone, and, uh, we made a lot of changes to the legislation and we got to a place where the CSB Association supports the legislation.

179. 1:06:31

     Very good. Thank you.

180. 1:06:31

     Thank you.

181. 1:06:33

     Representative Burchett, would you like for him, the head of that group, to speak?

182. 1:06:40

     Sir?

183. 1:06:41

     Yeah.

184. 1:06:41

     Would you like for the head of that board-

185. 1:06:44

     Sure.

186. 1:06:44

     Okay.

187. 1:06:44

     Sure. Yeah, 'cause the, the information that I'm getting is that the GCSB does not have a position as of yet.

188. 1:06:51

     Yeah, and

189. 1:06:54

     thank you, Madam Chairman. Uh, we actually have been waiting on the final draft of the legislation to convene our board and vote on the legislation, uh, and that's gonna happen tomorrow morning. And I don't wanna come up here and predict how that vote's gonna go, but I know that in our last CEO call last Thursday, we had no comments around this legislation.

190. 1:07:30

     The, uh, the CEOs that are on the ad hoc committee that the chairman referred to have all worked real hard around this legislation, and it was a typical... Well, I don't wanna say typical. It was a classic collaborative effort between the commissioner and his staff and the CEOs and our board members, too, because our board members had questions around this legislation. And i- in that collaborative effort, there was compromise, as the commissioner mentioned, and I think we're in, uh, certainly the commissioner and I are in total agreement that we came up with the best piece of legislation we could.

191. 1:08:16

     Is everybody happy? No. Are y'all happy about everything you do here every day? No. But, um, but is this needed? Yes. Is it necessary? Yes. Uh, it's, uh, I, I personally, just speaking as myself and a longtime board member in the community that Advantage Behavioral Health Services serves, but also as a board member for the association that served in this role a couple of times as president, uh, I, I see the necessity for this.

192. 1:08:58

     I see the necessity for strengthening the state safety net, and I believe that this legislation will do that. And that's why I'm glad to be sitting up here with the commissioner today s- supporting it to you and this committee.

193. 1:09:16

     Well, I'm gl- I'm glad to hear you say that. I know the Commissioner Tanner to be a m- man of his word and very capable in negotiating a good deal. Um, my, my folks, uh, have said in the past that they, uh, did not support this, but it sounds like you guys have gotten to a place where they are at least supportive. My wife was a, a, uh, employee of Unison Behavioral Health, so, um, um, my advocate stays in my house and, um, I, I wanna make sure that we do, we do right by them.

194. 1:09:46

     Uh, and so I appreciate your hard work on this, Commissioner Tanner, and thank you.

195. 1:09:52

     Ma'am? I ask if you were worried about going home- Oh, yeah ... if we didn't get it right. I'm teasing you. It's not just my wife. It's my wife's aunt and everybody else, so I mean, getting text messages left and right. And, and I'll just say they're, they're one of the best CSBs we have in the state. They do a really good job. And, uh, Jennifer Dunn's our deputy assistant commissioner of that area, and she works very closely with them. Very good. Thank you. Thank you. And I was teasing you. I mean, about whether you'd go home or not if we didn't get it right. And I will say, I c- I live in Cobb County, and i- i- as another example, you know, time flies, so it may have been three years ago.

196. 1:10:28

     It seems like it was just yesterday. Uh, our whole legislative, uh, caucus had to go down and threaten to take back for the state our CSB because of mismanagement. Uh, the board ha- ha- on the board was a very popular Cobb County doctor, OBGYN, that everybody loved, and he knew everybody, and they hired his son, and he had literally run it into the ground.

197. 1:10:59

     And at that point, our commissioner was not willing, didn't wanna let it go, 'cause she said it wouldn't belong to Cobb County anymore because somebody from another area was gonna take it over, and had come in and, at no cost, been running it for about eight or nine months trying to get it better, uh, and said they couldn't do that anymore when they weren't charging anything, and they, we either needed to go with them or, you know, they're g- we'd be back with it. Uh, nobody likes to relinquish what they think is their little community.

198. 1:11:33

     We had it with the hospitals. We, we had hospital boards that were run by the finest people in their community that knew nothing about running a hospital, and we had to go in and require that they have education, and if they didn't do the education, literally the person who wrote the bill was very up high in leadership, and he, I went bounding down to him when I read the final version of the bill. He says, "You're gonna take away their Medicaid? It'll close the hospital if they don't." And he said, "Yes, if they don't do the education, we'll take away the Medicaid." And so it seems to be a problem that they have.

199. 1:12:11

     You have well-meaning community people who wanna do the best for everybody, but they don't always have the training. And when you spoke of the training that you're gonna do in helping these people on financial matters, on the way, uh, the treatment and this kind of thing, that's really important. And- Yeah ... I appreciate you bringing the bill. Thank you. Is there anybody else? We have no other questions. Oh, there's somebody out there that wants to speak. Okay. So sorry. Sorry, Madam Chair. I think I wrote down the wrong number. I apologize. Oh. Kim Jones, um, executive director for NAMI Georgia.

200. 1:12:41

     Um, and the CSBs affect the members that we serve very, um, very much, and so we have had concerns over the year. We have spoken to Commissioner Tanner. He has come and spoken to our Georgia Mental Health Policy Partnership. We support the bill. Um, and our Georgia Mental Health Policy Partnership, uh, is going to vote on whether we support the bill fully on Friday as well. But I just wanted to let you know so far we, similar to what, um, uh, Mr. King said, we have no oppositions that we've heard of so far. So thank you very much.

201. 1:13:13

     Okay. All right. Anybody else that wants to speak on it that didn't get to sign up sheet? Okay, we don't have anybody. What is the committee's, wh- what's the, what does the committee wish to do? Move to pass. All right, I've got a motion that, move to pass. Do I have a second? So second. Got a second. Any further discussion? No further discussion from the committee. Okay, everybody in favor of the substitute to House Bill 1, uh, 1368, say aye. Aye. Anyone opposed?

202. 1:13:44

     Okay, the ayes have it. Thank you. Commissioner, thank you very much for coming. And thank you to, to our board president. When you go back and talk to people, please let them know that we appreciate everything they do for the people in our communities, and, uh, that this is not a step backward, a step forward, I feel like, of more con- you know, accountability, but also more education and more support, and I think that's very, very important.

203. 1:14:15

     And if you let them know that that's the way we're looking at it, not, not as a punishment, not that, you know, but just support, and trying to just reach our optimal best in being able to take care of some of our most needy citizens. Thank you. Thank you. Okay. Mind if I go? Okay. You want to go?

204. 1:14:38

     House Bill 1250. Hold on, Ben.

205. 1:14:59

     Yeah.

206. 1:15:04

     Thank you, Madam Chair, members of the committee. Honored to be here before you to present House Bill 1250. Um, I will be reading by, uh, LC461409. And before I begin on the bill, I wanna introdu- introduce the lovely lady to my left here, uh, your right. This is a neighbor, constituent, and good friend of mine, Ashley Waters, and I'm gonna ask her to speak, uh, for most of this time and a little bit here to, to let you know her story and, and what the bill does.

207. 1:15:36

     But I will not put her on the spot yet. I'll, I'll walk you through, uh, the legislation. This is the Daniel Waters Act, uh, named in memory of, uh, Brandon and Ashley Waters', uh, son, and then we'll get into why that is here in a bit. The first portion of the bill, uh, really lines 16 to four, 42 are definitional. It really starts on page three here. The legislation creates a grant program to equip hospitals across the state, perinatal hospitals, with what's called a, uh, a perinatal bereavement device, is a fancy word for a cooling cradle.

208. 1:16:14

     Uh, this is for children who are born stillborn, uh, and allows the parents to have more time with that child to grieve, uh, do the things that, that need to get done, uh, and, and, and be with that child as they w- they work through the process. And so, um-

209. 1:16:31

     I'll let Ashley talk about her foundation and the work they've done in that area. Uh, it- it's been incredible and, and just gives parents across our state, uh, which there are very, very many, uh, that, that are impacted by this. Um, this is all subject to appropriation, which you'll see on line 45 there. And if you skip to line 71, we would have until July 1st, 2029, uh, should this bill pass, to, to fund it at some point prior to that. With that said, one of the great questions I got asked was, well, you know, there's great work Ashley and others are doing, uh, to raise money to equip hospitals with this device, uh, which is why we inserted line 60 and 61 there.

210. 1:17:12

     Uh, the, the department, and the department in this case stands with, uh, for DPH, Department of Public Health, who has been a very good partner in this, in drafting this legislation. They are supportive and have worked closely on this, can accept monetary gifts to help equip hospitals, of which there's roughly, I believe the number was 50 or so, that are still in need of, of this type of equipment. So, um, I know I've also worked with Anna Adams and the Hospital Association. They've been a good partner on this as well. And, uh, with that, I'm gonna, I'm gonna pause and, uh, turn it over to Ashley and let her share your story.

211. 1:17:46

     Um... Okay. Yeah. Madam Chairman and members of committee, thank you for taking time to hear about House Bill 1250 today. I'm Ashley Waters. I'm Daniel's mama, and this is Daniel. Um, this bill is so important because nearly 1,900 Georgia families will experience a perinatal loss each year. And in April of 2023, my family became one of those families when we lost our son, Daniel. His heart unexpectedly stopped beating the week before his due date, and he was stillborn.

212. 1:18:17

     And the hospital we delivered at did not have access to one of these cooling units, which meant our time with him was extremely limited. We only had a few hours to hold him, study his features, take photos, and decide who could meet him. And when you leave the hospital without your baby, one of the most painful parts of grief is the should have, could have, would haves. Should I have read to him and sang to him and rocked him longer? Could I have taken more photos of every detail? And would I have let his sister come meet him?

213. 1:18:49

     When time is taken from you, these are the questions that follow you for years. And after Daniel's death, we became aware of this device, the cooling unit, that if had been available at our hospital, we would have been given days with him. We discovered that access to this equipment was largely dependent upon whether another family like ours had made a donation to the hospital. That meant some hospitals had them, some did not, therefore some families got time and some didn't. And this creates a significant gap in bereavement care for families during their most vulnerable moments.

214. 1:19:22

     The families who do have access to a cooling unit, they have the opportunity for more time to slow down and to process, make thoughtful decisions instead of rushed ones. Having a cooling unit does not erase the pain, but it does help reduce some of the added regret that comes from feeling rushed, as well as ease some of the trauma that families experience when they have to say goodbye before they're ready. This legislation will help ensure that every Georgia hospital can offer every family the same opportunity during a loss, and that's the opportunity of time.

215. 1:19:53

     Thank you for hearing about House Bill 1250 and for giving me space to share my story. Well,

216. 1:20:02

     thank you for coming and being willing to share your story with us. It's, um, OB can be the happiest place in the whole wide world, having taught OB or when it goes wrong and things like a stillborn, it's the saddest place in the whole wide world. And so even though I don't think I could face doing that, uh, you know, maybe I would, I'm glad that you brought the bill and that, you know, you're trying to provide people who want to do that to have that opportunity so they don't have regrets.

217. 1:20:38

     And, and I hope that you don't have too many 'cause I'm sure that he knows that, you know- Yes, ma'am ... he's remembered and that you remember the features and all, even on that short period of time because of your concern and love. Um, questions from the committee about the bill? And then I'll jump in as members are thinking of any questions to ask. Uh, a cooling cradle unit averages, and Ashley can correct me if I'm wrong, somewhere in five, four to 7,000-ish per cradle.

218. 1:21:10

     There's a number of companies out there that provide these. Uh, and so like I said, with about 50 or so hospitals needing one, the total expense, and if there's a wealthy benefactor out there listening to this, uh, it, it really comes out to only about 300,000 to equip every hospital across the state so that families have, have this option. Well, and in case you didn't really... Uh, uh, uh, the cooling units are to preserve the body, and without that, uh, they, they couldn't let the baby be in the room with the, with the family. Uh, and so that's what the units are done to be able to keep a, um, temperature at a level, uh, that preserves the, the infant.

219. 1:21:51

     Okay. We have a question. Who's got it? Oh, Rep Cindy Au. Thank you for bringing this bill. Your baby is beautiful. Thank you. I just wondered in terms of, um, having a unit at every hospital versus doing something like we do for other, um, durable medical advi- devices for neonates like a, like a Bili blanket or something like that, that you can actually have it delivered on, like, a rental basis from a centralized depot, that that might be one practical method that you don't literally have to have one at every hospital, but if you need one, they can bring it just like they bring other equipment that's not on site.

220. 1:22:29

     Is that something you considered? Yeah, Ashley, you may be able to speak to this better than I can. I, I, I think the time is an, is an element in that, and, and you don't wanna be transporting, uh... I live in Metro Atlanta. Here it can take you two hours just to, say, go around 285. I, but I'm just speaking off the cuff. Um, Ashley, you may know more than I do. Um, my response to that would be if there was only one available to kind of be shared, or multiples- Not just one, but like multiple units

221. 1:22:55

     ... yeah. There could, uh, what we've found with hospitals is they need multiple units in their hospital just to supply the families that are coming through the, their doors with that. Um, but also it has to be passed through biomed. That's one thing when we have them delivered after we donate, before they can be used, their biomed has to clear. So I'm not sure how that would slow down the process and potentially keep the parents from spending time with their baby. Thank you. That the last question? Uh, Representative Cannon. Thank you for this. And I know I wasn't able to be here during the presentation of the bill, but have spoken with the sponsor.

222. 1:23:29

     Care a lot about this issue. Thank you for being here. Um, want to continue to be sensitive to the plethora of families that have experienced this, and I'm just curious if you would consider adding any other names to the title of the act or maybe making it a more general name, um, so that maybe we could include, you know, a Danjel and an Angela, the, you know, the, the DARE Act, whatever it would be, if you would be open to that or, or if not.

223. 1:24:00

     I, I don't, again, I don't wanna speak for Ashley, but, uh, you know, we, we care about this legislation passing and, and helping families. And so if it gets me more votes, I'll, I'll add on. You know, um, I'll call it Daniel Waters and, and everybody else, uh, 'cause this is a... unfortunately, it impacts, the reality is, a lot of families across Georgia. And so, uh, uh, the unfortunate reality is we could probably list thousands of names, um, which is the sad part. But, um, yeah, I, I'm just passionate about helping families and if that's what that, that does, absolutely.

224. 1:24:32

     Okay. Um- As long as Daniel Waters goes first. Uh, yeah.

225. 1:24:38

     I, I mean,

226. 1:24:41

     this family is the one who came to you. Yes, ma'am. We have not been approached by other families. Yes, ma'am. Yes, ma'am. They have started a foundation where they're buying some of these for people and trying to help. And so I think even though there's lots of other families that have lost children, that's really special. You know, government can't do everything, and we can't pay for everything. And that you with, and your family, having lost this child and suffering from that loss, would want to step up and start paying for these, I sort of just think deserves that one name on this bill.

227. 1:25:24

     Um, maybe there's other things that will come along, Representative Cannon, uh, but on this one I think it has a really good name, and it would be my preference not to take that amendment. Thank you, Madam Chair. So even though you're willing to do that, I, I can't thank you enough. I tell people all the time, you know, government can't do everything. And, uh, you see how long we had to put in there to see if we could get it to where we could get an appropriations because there's so many pulls on us. And, and a lot of time, I'm on a cemetery board.

228. 1:25:57

     It's historic. You try raising money for a cemetery board. You know, uh, children come first and other people come first. And so it may take us a while on that, and that, to know that you're out there trying to help people get them when we may not. As I say, sometimes government just needs to get out of the way and let people with hearts like yours and your family do what you can do to help others. Um, and hopefully we won't have to wait till that long, till what year was it, to get an appropriations.

229. 1:26:31

     But, um- And Madam Chair, I think we have a, a couple other mothers- Okay ... to speak to the bill, if that's okay. Okay. Sure. Samantha Brinson.

230. 1:26:44

     And I saw them shaking their heads when I said make it just one name. It was all right? Yeah. I thought so. Big hearts. Big hearts. Thank you, Madam Chair and the committee for the opportunity to speak with you in support of House Bill 1250. My name is Samantha Brinson, and I speak today both as a bereaved mother and as the executive, executive director and founder of Hugs for Harrison, which is a nonprofit organization that provides ongoing comfort and support to families across Georgia after the loss of a baby.

231. 1:27:21

     And my family experienced this devastating loss of our son, Harrison, shortly after he was born prematurely on January 29th, 2017. The moments that we had in the hospital with him were sacred. We held him, we kissed him, we sang to him, and we tried to memorize every single little perfect feature. We told him how proud we were to be his parents and how much we loved him. Yet those moments were far too short as the evidence of death quickly moved in.

232. 1:27:53

     We found ourselves rushed because of what we were seeing. We had no time for his big sister to meet him. Our photographs were painfully limited and, quite honestly, still very difficult to look at. And we had to hand our baby boy to a nurse well before we were ready. But I also know that through my experience leading Hugs for Harrison, that there is a gift that we can give these families, and it's the gift of more time with their precious little one through these cooling units.

233. 1:28:24

     These cooling cradles, as you've heard a little bit about, allow families more time to experience beautiful moments together with their baby in a safe and gentle way. It creates space for memory making, for siblings to come meet their baby brother or sister, for pictures that they can cherish for a lifetime.

234. 1:28:44

     Access to these cooling units can prevent compounding trauma on a, on top of an already impossible grief. And right now, access to these cradles is inconsistent across our state. Some hospitals have them, others do not, and that means that a family's ability to grieve with dignity depends on where they deliver or where their baby dies, and this is a solvable gap in compassionate care. So I'm here today asking you to support and pass House Bill 1250, the Daniel Waters Act, so that every hospital in Georgia has access to a cooling unit and the bereavement training necessary to ensure timely, tender, and compassionate care.

235. 1:29:23

     Because while unfortunately we cannot change the loss, we can absolutely change how families are cared for in it. Every single family deserves more time and more dignity, and the unrushed chance to say goodbye and kiss that little nose one more time. Thank you.

236. 1:29:42

     Thank you. Okay, and Madison Carr.

237. 1:29:47

     Yes, hi.

238. 1:29:48

     Hi.

239. 1:29:49

     Hello, my name is Madison Carr. I'm here today asking you for your support of House Bill 1250, the Daniel Waters Act. In September 2024, my husband Tyler and I learned that we were expecting our second child. After inconclusive genetic testing, multiple ul- ultrasounds, and an amniocentesis, we were told our daughter had a life-limiting diagnosis called triploidy, a spontaneous chromosomal condition resulting in 69 chromosomes instead of the typical 46.

240. 1:30:24

     Because of this, our daughter had severe growth restriction, fluid on her brain, and a large hole in her heart. We were told she might not survive the pregnancy, let alone live after birth. It was our worst nightmare.

241. 1:30:41

     Excuse me. On March 21st, 2025, we welcomed our daughter Corey Elizabeth Carr, born sleeping at 31 weeks. Without an infant cooling device, most families experiencing baby loss only have a few hours with their child before natural physical changes occur. Tyler and I were given more than 40 hours with Corey because our hospital had a caring cradle that was donated in honor of sweet Daniel Waters.

242. 1:31:16

     That extra time meant everything. We wrapped Corey in beautiful handmade blankets and took precious newborn family photos. We played our favorite songs, read our favorite books, and prayed over our little girl. On our last morning together, we watched our church's Sunday service in bed as if it was any other Sunday. Throughout each of these moments, we were able to see physical characteristics that made Corey Corey.

243. 1:31:47

     The cooling device preserved her skin from breaking down too quickly and prevented her arms and legs from becoming too stiff. Holding Corey felt like holding our daughter, just as it should. Every morning I wake up with the ache that Corey's not here. When that grief feels overwhelming, I hold onto the memories that were given to us during those 40 hours. That time fills my heart with gratitude and helps me continue healing. Ensuring that every hospital in Georgia has access to infant cooling devices and proper bereavement training is essential.

244. 1:32:23

     Every family experiencing baby loss deserves the gift of time to love their baby and create lasting memories, just as we were able to do. Tyler and I will cherish that time for the rest of our lives. Thank you.

245. 1:32:39

     Thank you, Samantha and Madison, for making the trip down here. And the difficult task of bringing up those memories again and sharing them with us, um, does make a difference, and, and for Ashley. So okay, what have we got? Representative Howard, do you have a question?

246. 1:32:59

     Yes, ma'am. Thank you. Um, and we do grieve with these families f- for these babies. Uh, my question was back on the appropriations piece.

247. 1:33:08

     Mm-hmm.

248. 1:33:08

     On line 45, it says, "Department may, upon pr- appropriations," and then on 66 it says, "Effective only if." So if we pass this bill, then what happens? How do we approach appropriations?

249. 1:33:23

     So we are simultaneously passing the bill and working with appropriations. Really, the, the main kicker line is line 71 there. Uh, so we, we can... The idea is we're gonna pass this legislation, and if, if, you know, funds are not appropriated by July 1st, 2029, then the actual stand is, is repealed.

250. 1:33:47

     But he's baby.

251. 1:33:49

     Yeah. That's what...

252. 1:33:51

     If Appropriations is listening right now. Yeah.

253. 1:33:53

     Take 20 years to get the $20 million for the, the mothers a- after they deliver for a year of care, but hopefully this won't be near.

254. 1:34:01

     It's $300,000.

255. 1:34:02

     $300,000.

256. 1:34:03

     100. Not ta-

257. 1:34:04

     If you wanna chip in, I'll chip in. Well, yeah.

258. 1:34:06

     What do, what do we gotta do?

259. 1:34:08

     But yeah, that's the-

260. 1:34:08

     Yeah.

261. 1:34:10

     And, and this is re- we have sep- I mean, you've probably seen other legislation like this, where it's subject to appropriation. Um, I know the bill we just passed on the floor, uh, for student teachers is, is subject to an appropriation as well.

262. 1:34:21

     Yeah.

263. 1:34:21

     So good question.

264. 1:34:23

     Great. Okay. Uh, Representative Sharper.

265. 1:34:27

     Thank you, Chairwoman. Uh, I was just wondering, I mean, I was just looking through here, and we, we mentioned hospitals, but where does the private hospitals come into this? Or have anybody, does anybody know that any private hospitals have these already, or anything like that? Or this, when we're looking at what we're looking at here at the hospitals, that's kind of like the public hospitals, but I was just wondering if anybody mentioned anything about the private hospitals. Are they looking at doing this as well? Just for informational purposes. Well, well just overall when it just mentions hospitals, but I'm asking are any, do we know of any private hospitals that are doing this or that, you know, overall?

266. 1:35:07

     Yeah, so a good number of hospitals already have this equipment. Uh, we're just trying to cover the gap of those that do not have one. Um, I, I don't know if anyone from DPH is in the audience here, but yeah, they provided us a list of those that do not have one. Um, and I believe that covers... So right now hospital on line 24 is defined as any, any hospital licensed by DCH.

267. 1:35:27

     Okay.

268. 1:35:27

     Um, which is initially where we started on this bill. We started with DCH, and they said, "Well, yes, we license hospitals, but DPH would actually be the one to administer this sort of grant program."

269. 1:35:37

     Okay.

270. 1:35:38

     I see a conference going on in the back. Do we not, uh, ladies, do we not license all the hospitals, whether they're private or public? Yes, we do, don't we? So that would cover-

271. 1:35:50

     Yes. Yes.

272. 1:35:51

     Okay. I'm gonna be-

273. 1:35:51

     That hospital definition is anyone that's licensed by D- DCH as a hospital.

274. 1:35:56

     And so DCH license all hospitals in the state?

275. 1:35:58

     Yes.

276. 1:35:59

     Right.

277. 1:35:59

     So we cover all-

278. 1:35:59

     So basically they'll be eligible to get it even though, you know what I mean?

279. 1:36:02

     Yes.

280. 1:36:02

     Okay.

281. 1:36:02

     Yes.

282. 1:36:03

     I was just making sure.

283. 1:36:03

     As long as they provide perinatal services or, um, or even a children's hospital we include it too.

284. 1:36:08

     Okay.

285. 1:36:09

     Uh-huh.

286. 1:36:09

     'Cause you always have this war between, you know, public, private.

287. 1:36:11

     No, it's everyone.

288. 1:36:13

     No, not on this issue.

289. 1:36:14

     Good. Awesome.

290. 1:36:14

     Yeah.

291. 1:36:15

     That's good.

292. 1:36:15

     Yeah.

293. 1:36:15

     That's good to hear.

294. 1:36:17

     All right, we got it. I, uh, see that there's no further questions. Uh, did everybody in the, our audience that wanted to speak, speak? Okay. Uh, what's- Motion to move. Okay. We have a motion to, uh, for the passage. Do I hear a second? Second. Okay. I wonder if I got the right one. Uh, Hilton. Okay. So everyone in the favor of the passage of House Bill 1250, say I. I.

295. 1:36:48

     Uh, anyone opposed, say no. All right. What, what about Drenner, did you have a question? Yeah. I'm sorry. Okay, hold on. Hold on. Okay. Representative Hilton, thank you for bringing this.

296. 1:37:04

     Thank you. I appreciate it. Thank you members of the committee, um, but thank you to the families that-

297. 1:37:09

     I need, I need to go. I thought she was gonna come up with something I needed to do before I finished. Everyone against the bill? Any, any no's? Okay, no no's? The I's have it. Now you can have it. The I's have it. The bill passes. I just was afraid that she wanted to make an amendment or something. But bye.

298. 1:37:30

     I just, I want to thank the members of the committee. I want to thank the, the parents, uh, that came here. Uh, the best ideas come from our constituents, and so I want to thank Ashley just for the courage and bravery to come down and share her story. And, uh, members of the committee, thank you, and would love to recruit you as advocates to help us get s- this bill over the finish line. So-

299. 1:37:46

     Yes

300. 1:37:46

     ... appreciate it. And Madam Chair, I'm gonna go walk them out, and I'm gonna be back-

301. 1:37:49

     Good

302. 1:37:50

     ... for the rest of the meeting, okay?

303. 1:37:51

     All right. And thank you ladies very much.

304. 1:37:53

     Thank you.

305. 1:37:54

     If it's your heart desire for other children, I hope the good Lord blesses you with healthy babies going forward.

306. 1:38:01

     Thank you.

307. 1:38:02

     Uh, and I know you'll love the ones you have, and, uh, if you don't wanna try again, we got lots of babies that need adopting that wouldn't, you know, that we push for, for adoptions that need loving and caring homes. And so whichever way it goes, wish you the best.

308. 1:38:20

     Thank you, Madam Chair.

309. 1:38:21

     Thank you for bringing it.

310. 1:38:22

     Thank you.

311. 1:38:26

     Thank you. Okay, here we go again. All right. Okay. Uh,

312. 1:38:32

     Matt, come on up. I know he thinks I was making him wait forever.

313. 1:38:38

     What? I thought it was important.

314. 1:38:39

     And he has really a nifty thing that could help a lot of our patients that get hospitalized.

315. 1:38:45

     I hope so.

316. 1:38:46

     Okay, so you have House Bill 866.

317. 1:38:51

     Thank you, Madam Chair. Uh, yes, and it's LC570258. Is that what y'all have?

318. 1:38:58

     Okay.

319. 1:38:58

     All right. W- and ju- just in case the will of the committee is willing to get an amendment to change the years because I dropped it last year.

320. 1:39:07

     Where do you get all these soft-spoken men- Good men ... in the legislature?

321. 1:39:10

     I'm sorry. I was trying not to talk too loud.

322. 1:39:12

     Okay.

323. 1:39:14

     All right. This bill creates a pilot program, uh, to improve inpatient insulin management for our rural hospitals. Um, diabetes is one of the most common and most expensive chronic, uh, conditions to deal with in Georgia. And in the, um... Ends up in the hospital, their insulin levels are hard to manage and can, and can determine whether a recovery is smoothly, uh, deal with infections, longer stays, or even readmissions. Um, rural hospitals don't have all the, um, specialty resources that the staffing of the larger hospitals, the systems do.

324. 1:39:49

     And but there's, uh, tighter operating, uh, margins as things can be stretched thin. Uh, this bill, uh, does, does three things straightforward. First, it sets up a pilot program, like I said, for rural, through the Rural Health Systems Innovi- Innovation Center, providing grants and technical support to eligible rural hospitals. Second, it focuses something measurable and clinical that we can measure, uh, inpatient, uh, insulin management, um, protocols to quickly improve patient outcomes.

325. 1:40:21

     Third, it requires reporting and evaluation so we can clearly, uh, see what works, w- uh, before we expand anything. This is data-driven and accountable. It's not a band-aid. Um, this is just a pilot that targets a solution that is needed. Um, if it works, uh, benefits are clear, better glucose control for hospitalization patients, fewer complications and readmissions, lower long-term healthcare cost, stronger rural hospitals, more equity between rural and urban care.

326. 1:40:52

     Um, um, many communities, the hospital, this is the largest employee, and this will keep them, uh, viable

327. 1:41:00

     And most importantly, DCH is not required to fund this unless the general administration, uh, assembly appropriates this. This is an assembly, uh, an appropriations thing. And so, um, it's not, it's an unfunded mandate. So that, this is targeted and for rural Georgia. Did I miss it? I mean, and I know, understand that it's for rural Georgia to help them and they're, 'cause they're tight on money. Did you say what it was, the a- the actual thing was?

328. 1:41:31

     Oh, this is for, um... Sorry. This is for, uh, devices in the, in the rural hospitals that will manage their insulin levels, um, and a- administer the insulin automatically for the patients without all the, uh, oversight of the nurses and doctors to see that the, the, the computer would, the program would automatically, if I'm saying this correctly, the, the computer pro- the program would automatically administer the levels to keep the, uh, patients at the right levels.

329. 1:42:02

     Is that, Representative Au? Yes, ma'am. I, I had a similar question just to clarify. Are you talking about having glucometers just for finger sticks for the hospital, or are you talking about a, um, an insulin pump that measures blood glucose and delivers insulin? No, they would, they would wear a device and then they would, while they're in, in the hospital, as they're, uh, connect- connected on the bed- Mm ... insulin levels could be administered while they're there. Not, it wouldn't be a...

330. 1:42:32

     Yes, ma'am. Is this a device that exists? We have a, a, a CEO that does one of the devices if you want get that information on- Yeah, I just want to clarify- ... how it exactly works. Because my second question is- You need a little help. Okay. Thank you. Yeah. My, my second question related to that is- Yeah ... Did you bring one with you? I didn't bring one, but um- I'll explain to you. Yeah, just to briefly explain, we le- we, we left those questions loose because, um... This is what happens when you're too tall. Um, we wanna have DCH really figure out how to get these systems stood up in rural hospitals.

331. 1:43:04

     The primary solution, depending on the device configurations and what they have in the hospital, is software in nature. So it's a... My client in this case is a, a company that was developed out of Piedmont Health System, uh, by the endocrinologist there, um, that helps automate this stuff. Um, so it's up to DCH really how, how they think they can best get there. But CMS has adopted a new qual- quality measure of asking hospitals to report hyper- and hyperglycemic events.

332. 1:43:34

     And so the idea, in, in, in most of the big systems, this is already in place, right? Grady, WellStar, Piedmont, um, they have automated devices and not just our software. There's multiple companies that do this. Um- I, I think what we wanna know is

333. 1:43:54

     how is this attached to the patient? You know, how, and is it a computer program that runs it? Uh- So, so this is different from an indwelling- Indwelling glucometer- ... glucometer- The, the idea is to, is- ... continuous glucometer with insulin pump. This is a different outside thing. Most of that equipment is already in place. What this aim, what the aim of this is, is to sy- systematize it and give nurses and doctors real-time information on what the patient needs in terms of insulin, as opposed to having to do a, a prick test inject approach.

334. 1:44:26

     Um, and then dashboard all that so that the hospital can get in- insight into what's going on in real time with patient outcomes. Um, am I answering the right question? No. I think I need to see it, but um- Yeah ... the second question is, you know, this, this Rural Health Transformation program that we're getting money from, obviously a lot of people are very interested in that finite pot of money because we are having a lot of money cut. Mm. Um, I think the first round is like $218 million, which obviously everyone's like, "Oh, we'll use it to pay for my thing and my thing and my thing." However, the constraints on how that money can be spent, um, are very specific.

335. 1:45:00

     Does the Rural Health Transformation program money, can it be used to pay for something like this, which is- My read of the CMS guidelines is that it could be. Um, the biggest reason we wanted to do a bill instead of just saying, "Hey, DCH, go find some money, and if you think this is good, go do it," is because we think there's some components that are important for it to be successful. Um, I think the two primary ones being that DCH runs some kind of a competitive process and looks at plans from hospitals and goes, "Okay, this will work. We can, we really think we can reduce, um, the number of adverse events with what you've submitted." The other is affiliating with a larger endocrinology group- Mm ...

336. 1:45:37

     um, so that we don't get that sort of people buy stuff and it sits in a closet problem, but that they're attached to people who are endocrinologists who do this for a living and, and really know how to help them stand it up. Sorry, I, I, I don't mean to keep asking this, but, um, a- an indwelling glucometer is pretty much standard of care now for, for insulin-dependent diabetics. Wh- why don't we just use, why don't we just use that? Like a standard, you know? All right. Guys, you're gonna have to bring it back and you're gonna have to show us what it is and be more specific.

337. 1:46:09

     Okay. Okay? We will do it. Thank you. All right. I mean, I will take that unless anybody is really wholly, I mean, 'cause you can't explain it to us. Yes. I'm sorry. Thank you. I, I like you both very much, but you know, we need to know- Yeah, we had an e- we had an endocrinologist here earlier, and then the schedule got shifted and he had to go back to clinical work and- Well, the ma- I mean, don't you even really need an endo- I, I, I don't think it... If you have... Okay, what is the equipment hooked to?

338. 1:46:40

     How do they, you know, is it, do the, do the patients wear something and it's- No. Pri- primarily this is, primarily the equipment, to your point, is present. What this is doing is funding software or an addition to your, um, EMR system or something- Okay

339. 1:47:02

     specifics please.

340. 1:47:03

     Got it. We'll be back.

341. 1:47:04

     Okay.

342. 1:47:04

     Thank you. Thank you.

343. 1:47:05

     All right. Matt, sorry.

344. 1:47:07

     We're good.

345. 1:47:08

     Okay. I know you're not on healthcare usually, so.

346. 1:47:13

     No.

347. 1:47:14

     Okay. One, two. Okay. One. Okay.

348. 1:47:24

     Representative, come on up. 'Cause you did what we asked you to do-

349. 1:47:35

     Sure did

350. 1:47:36

     ... uh, last week on the bill. Thank you very much.

351. 1:47:40

     Thank you-

352. 1:47:40

     So-

353. 1:47:40

     ... Madam Chairwoman and members of the committee.

354. 1:47:45

     It's House Bill 334.

355. 1:47:45

     Present to you House Bill 334. You should be reading from LC570194. I can be brief about what this bill does, but also I wanna talk to you about sickle cell in general. There are a few faces on the committee that were not here when I previously presented. Uh, sickle cell disease is a blood-inherited disease that impacts about 100,000 people in our country and about 14,000 people in our state, making our state one of the top three states for people that are impacted by sickle cell.

356. 1:48:18

     Uh, people that have sickle cell, their blood, red blood cells are in a crescent shape, making blood cells more difficult to pass through their bodies. And because of that, there are episodes and barriers that people that are impacted have that may lead to issues with different organs or may cause continuous pain. In fact, our governor on June 19th, 2025, had a proclamation for sickle cell recognizing just how important this is. House Bill 334 would try to address individuals that are living with sickle cell, and it would require the Department of Community Health to look at all of the medications and treatments that are prescribed and used by individuals with sickle cell to create an annual review so that we can figure out whether or not those treatments and medications are helpful to people living with sickle cell disease.

357. 1:49:11

     That is pretty much the bill. I will also go on and say that there are other states that have passed similar legislation. Tennessee was the first, kinda like the pilot state to pass this legislation. There's no fiscal note. We've had about 17 states that have passed it. And what I found out lastly is that of all of our counties, there is at least one person living with sickle cell disease in all but two counties. So I think that this is something that is widespread throughout our state, and this is something that can help change lives.

358. 1:49:41

     I will stand for any questions, but I also know we may have some people here to speak.

359. 1:49:46

     We do. And let's get the department first. Okay. Emiliana? Because I wanna know what we're doing and how we're doing on it.

360. 1:49:56

     Yeah. Good afternoon, committee. Um, Madam Chair, thank you for, uh, inviting us here today. My name is Emiliana. I'm Chief of Staff to Dr. Dean Burke, Commissioner of DCH. Um, so, uh, Representative, uh, uh, Crawford is 100% correct. This is a priority of the governor. Um, and we've been doing a lot since 2024. Madam Chair had asked me to kinda come share a little bit on that. Um, so we're doing stuff, so just so you know, and I know most of you should know this, but on, you know, DCH oversees both Medicaid and the State Health Benefit Plan. So we kinda have, you know, different p- programs on both.

361. 1:50:28

     So on the Medicaid side, we, um, started in 2024 negotiating value-based contracts with those, um, genet- uh, gene cell therapies to actually cure sickle cell. So we now have that in the state for Medicaid and SHBP. But on Medicaid, we've actually negotiated those contracts as a state to the point that we are the first in the country to negotiate and have contracts like that. Um, there has been some federal movement from CMS to kinda do that as well, but Georgia actually did that before CMS's models.

362. 1:51:02

     So just wanna be clear on that, and I think that is due to Georgia's high population of sickle cell.

363. 1:51:07

     So you're saying that we are now paying for-

364. 1:51:11

     The gene cell therapy? Um-

365. 1:51:12

     ... the gene cell therapy.

366. 1:51:14

     We are.

367. 1:51:15

     Okay.

368. 1:51:15

     We currently have, and I can't share a lot when you... What I have learned is when you negotiate an agreement like this, we can't share a lot about the agreement, you know, what drug that is and what. You know, there are criteria. As the doctors in the room can speak to this a lot better than I can, and the medical professionals, it is a very, um, intensive therapy, and so there's a lot of criteria to qualify for that. But I can say that we have two, um, individuals on the Medicaid side that are actually receiving the therapy and two that are kind of in the pre-implementation stage of screening.

369. 1:51:43

     Great.

370. 1:51:43

     So, yep. Um, so and we hope there's more. Um, and so we're also doing that, um, on the SHBP side, but we've seen that, you know, we haven't had any cases yet on the SHBP side, but we have made sure that our, um, the entities that run the SHBP have that available as well. The other thing I wanna mention that we've done, and, um, this was actually funded by you guys in partnership with the Senate and signed by the governor in the, um, '25 budget, a million dollars towards a pilot program that actually provides a patient-centered home on sickle cell.

371. 1:52:15

     Um, it's a pilot in four counties, um, mainly metro area 'cause we're starting there. It's a million dollars to provide. And these are fee-for-service members that we have put in a pilot, like I said, and it's DeKalb, Fulton, um, Clayton... Oh, five counties, excuse me, Douglas and DeKalb. And, um, we are, you know, we have a max of 300 members to see how that would go, and obviously we're reviewing that right now. But it actually provides a patient-centered home, so they're getting case management, nutrition services, all the things that they could need.

372. 1:52:45

     Um, and that's obviously for the patients that aren't the most severe, um, just the patients that are living day to day. And so like I said, at some point we may ask, you know, come and fund that more. Um, we cannot do pilots in Medicaid per se, and so we'd have to, you know, if we wanted this matched by federal funds, we'd have to expand it to the state. But our idea was start with the pilot where there are the most people and see how that goes. Um, we have just started that on the SHBP side as well. Starting in December of this year.

373. 1:53:13

     Okay.

374. 1:53:13

     So, yep. Um, regardless of, you know, we have no issues with the bill. Um, we report a lot of this already to CMS, and we report a lot of this already to state. We also have a drug utilization review board where every year, or it's actually quarterly, they meet on the drugs that we review, and we know that we do this at least annually. So no issues on our end with this legislation.

375. 1:53:34

     Are we using the le- I mean, we're using gene therapy. We're using, or moving into using the les- the best, latest infor-

376. 1:53:42

     Yeah

377. 1:53:42

     ... type of therapy. But on the drugs, are we using the-

378. 1:53:45

     We are, and that's-

379. 1:53:46

     ... the latest drugs?

380. 1:53:47

     Yes, we are, and that's the point of the drug utilization review board that meets quarterly, is to make sure they're reviewing as drugs come online, and that's for across the board, right? But that's happening quarterly to make, quarterly, excuse me, to make sure that we're con- continuing to be up to date as long as FDA approval, all the things that are happening.

381. 1:54:02

     Okay. Uh, thank you very much. Um, I mean, sometimes y'all do... I mean, you need to come and tell us what you're doing more often. You're telling us we're one of the first states to go at the gene therapy and all like that. It, it's good to hear that w- we're not always last.

382. 1:54:20

     Yeah.

383. 1:54:20

     And we're not always last.

384. 1:54:21

     We'll try to do a better job of that. But yeah-

385. 1:54:23

     We are doing-

386. 1:54:23

     I mean, we're always glad to come and educate

387. 1:54:25

     ... a better job of that. We are not always last. We're, we're moving out. So-

388. 1:54:29

     Can do a better job at educating, 'cause we are not-

389. 1:54:31

     No doubt about what we do

390. 1:54:31

     ... just to be very clear. Yep.

391. 1:54:33

     Okay.

392. 1:54:33

     Thank you very much.

393. 1:54:34

     Thank you, Mary. And, you know, we'll look forward to having, uh, an update on how it's going and how the patients do on gene therapy. And I mean, that's wonderful that they've come up with a way of curing this because it is a pain, very painful, very debilitating disease at times. Uh, Representative Howard, did you have one for...?

394. 1:54:52

     Yes. Uh, thank you, Madam Chairman. Thank you, uh, Representative Crawford for the bill. As I've talked to you offline, I'm, I'm actually all things sickle cell. Had a grandson that, that passed from sickle cell, uh, complications, three years old, um, uh, in 1995. So I thank you for bringing this to the point of, uh, updating services because we know that services are not always up to date, especially for sickle cell. Uh, my question is, why do we say, uh, services that are eligible for coverage?

395. 1:55:29

     Um, is that some criteria? What is that forms of treatment in Medi- I'm on line 14, 15. Uh, review all medications, forms of treatment and services that are eligible for coverage. So does, does that mean there's some medications or treatments that are not eligible for services? I, I don't know who needs to answer that.

396. 1:55:46

     I think we need the department.

397. 1:55:47

     Do, do you want the department to answer for you?

398. 1:55:49

     Yeah. Sure, yes.

399. 1:55:51

     All right.

400. 1:55:52

     Okay. I think that, I mean, I think that's just a catch-all as far as like cer- you know, certain drugs, they take a while to get FDA approved, come online. And like I said, we review those constantly. But my assumption to this is that that's to make sure they're eligible for, for coverage.

401. 1:56:06

     Okay.

402. 1:56:06

     'Cause we then have to... You know, when things are added to Medicaid, that's a federal process or, you know. And so I'm, I'm, my assumption is, you know, I didn't write the bill, but that's the assumption is as they come online, that's just that eligibility piece right there. But I can look at that further unless you have, you know-

403. 1:56:22

     Yeah

404. 1:56:22

     ... defer to the-

405. 1:56:22

     But that might be like on any of the diseases if, especially as we get into all the new things like, uh, uh, stem cell treatment can be hundreds and hundreds and hundreds of thousands of dollars. Mm, that we would have to go through the rigmarole of can the state afford them, who gets them-

406. 1:56:40

     We-

407. 1:56:41

     ... to see if, if they were eligible for us to pay for them.

408. 1:56:44

     And that is definitely-

409. 1:56:45

     I would think that is, is a catch-all phase. But, you know, it could be that if it cost... I mean, I, we had this come up, and somebody wanted us to put in, and the drugs for it, it was a drug, and it did not cure it. You didn't see the symptoms until a child was four years old.

410. 1:57:04

     Mm.

411. 1:57:04

     There was nothing you could do for that child in that first four years to make it better, and it was something like $2.2 million. I mean, I-

412. 1:57:14

     And, and it, yeah

413. 1:57:16

     ... it is, you know. I mean, I hate the realism, but the state only has so much money. It's gotta... And it would not cure it. It, it, it wasn't a cure-all.

414. 1:57:25

     Yeah.

415. 1:57:25

     It was just a drug.

416. 1:57:26

     And-

417. 1:57:26

     So I think-

418. 1:57:27

     ... Madam Chair is correct. You'll actually see if you look in the appropriations budget, we have a line item for sickle cell, the gene therapy. It is a very expensive treatment, and we budget every year based... I'll be honest, the first year was a, we had an idea of how many we wanna treat. And we're, we're safe right now. But if you see that in the budget, that is absolutely sure to try to, you know, guess how many patients we can treat that will go through that.

419. 1:57:47

     I love it. Yeah, love the gene cell. Yeah. That's absolutely it.

420. 1:57:51

     And you know, I had a resolution, and I think I dropped it today, so I think there's another place for you to sign on, or I'll get somebody to mark their name out. And I ask if there we had anybody, and nobody could tell me that. And so I'm so sorry about your-

421. 1:58:05

     Yeah

422. 1:58:05

     ... your grandchild. But if you wanna go, I'll find out-

423. 1:58:08

     Oh, absolutely

424. 1:58:09

     ... on that resolution, and you put your name on it 'cause it was honoring of-

425. 1:58:13

     Okay

426. 1:58:13

     ... about the sickle cell when we come. You know? Well, it's... You know, w- we say we're a family, and sometimes we just never know what happens to everybody. And, uh, I guess we could... There's so many of us that it might be make us all sad so much, but sometimes, sometimes we just need to know when it was going on and be able to give somebody a hug and say, "You know, we're thinking about you." Um, okay. So what do we wanna do with this bill?

427. 1:58:45

     So moved.

428. 1:58:46

     So moved. I got a movement and a second.

429. 1:58:47

     Second. Second.

430. 1:58:48

     Everybody in favor of the passage of, where we got it? Let me make sure I'm reading the right one if it's a substitute. It's not. House Bill 334, 334, uh, say I.

431. 1:59:01

     I.

432. 1:59:01

     And everyone, if there's any negative, say so. Yeah. No negatives. Your bill passes, and it moves on. Be sure and get the form from the rules committee and bring it to me first thing tomorrow and turn it in

433. 1:59:15

     Thank you, Madam Chair. I have to sign it. So you fill out the form and, uh, be sure you do. Okay? Thank you. And thank you members of the committee. And thank you for follow, doing the follow-up. And, uh, thank you, Emily, for letting us know and brag on our state a little bit. Thank you. Thanks. All right. What do we got left? Okay. Michelle, House Bill 1040.

434. 1:59:41

     Representative Au, you're up.

435. 1:59:46

     I need to go to, I got a call from my school that my kid missed the bus.

436. 1:59:55

     Oh. All right. Thank you, Madam Chair. We will make this quick and painless. This is actually an easy bill. Not like when other people say this. This is actually easy. Yeah, you're not supposed to say that. I, I just did. It's happening. It's happening. So thank you, uh, Madam Chair, and to the committee for sticking around for this last bill today. I'm very excited. This is House Bill 1040. Great number. I'm working off of LC521057S. So just a little bit of background on what we're talking about.

437. 2:00:27

     In, uh, 2005, a billion years ago, uh, this legislature passed, in its infinite wisdom, the Georgia Smokefree Air Act. So the intent of the bill was to, and I'm just reading from statute here what we're working on, "Preserve and improve the health, comfort, and environment of the people in this state, including children, adults, and employees by limiting exposure to tobacco smoke." And they did so by preventing exposure to secondhand smoke in most enclosed indoor public spaces. That is what is in the law. Uh, and this has worked pretty well. That's kind of why we don't smell like smoke when we leave our offices, uh, with some exceptions, or leave a movie theater, or, you know, leave restaurants.

438. 2:01:05

     Um, and it's really minimized the risk of exposure to secondhand smoke for those people who, for many reasons, um, themselves choose not to smoke. However, um, this law's been on the books for more than 20 years now, and occasionally it's worthwhile to go back and look at it and see the language of the statute and clean it up or modernize it a little bit, um, for how we live and work today. So, uh, that's how I'd like to frame this. It's essentially a cleanup bill for the statute that exists. So let's just walk through it real quick. Start with line 12. Line 12, uh, prescribes a radius of 25 feet around state, county, and municipal buildings, outside of which you can smoke outdoors.

439. 2:01:42

     And the goal of this is to prevent, um, people who don't choose to smoke from having to walk through a cloud of secondhand smoke against their will immediately upon exiting or entering a building, because they, they have to use the door. Okay? So that, I hope, makes sense, um, if smokers choose to smoke outside and congregate there. The next piece of cleanup I'm gonna point you to is lines 43 through 45, and this disallows smoking in private and semi-private rooms in healthcare facilities. Um, so let me just vocalize a thought that you're surely having at this point, which is, I can't believe that Georgia law actually currently allows smoking indoors in a healthcare facility, right?

440. 2:02:21

     Of course, uh, most hospitals already, you know, choose to disallow it in the building for many reasons that should be obvious, uh, chief among them the fact that many patients are on oxygen, and oxygen is flammable. So, um, this probably should not be in the state law anymore. So again, cleanup, cleanup bill. Next, uh, piece strikes lines 53 through 59, which accepts indoor smoking for convention facilities when they're being used for private functions. I know we've all been to private functions indoors, and it's fair to note that in a convention center, there are people there who choose not to smoke for health reasons.

441. 2:02:58

     Um, it's also important to note that even after the smoking is done and the tobacco product is consumed, um, there are harms of exposure to third-hand smoke, which is a, a term that some people might not be as familiar with, but it's when the smoke and the particulate seeps into, you know, the carpeting, the walls, furniture, all these types of things, and there are actually significant health risks, um, from that, um, off-gassing. Um, we talked about this phenomenon of third-hand smoke and its harms in the study committee that was held this summer, capably chaired by Chairwoman Cooper, um, looking at the cost of smoking and vaping in this state.

442. 2:03:32

     And I did include in your rainbow packets, uh, at the top, the final study report from that study committee. Finally, we're almost done, we struck the language in lines 74 through 77, which allows an exception currently for indoor smoking in common work areas like conference rooms and meeting rooms that are open to the general public by appointment. So just imagine for a second if we allowed people to smoke in this committee room right now during this hearing, right? That, that would seem probably inappropriate to most people.

443. 2:04:05

     Um, and I agree. And that's what this change would reflect. All right? So I think this is a pretty straightforward bill that simply aligns Georgia Code with the standards and practices we already apply in public indoor spaces today. I'm not gonna overexplain, but at this point I'm happy to take any questions. Any questions? Well, I just want you to know that what you just said was so funny, because they used to smoke in the building, in their offices, them being legislators.

444. 2:04:42

     Mm-hmm. I, in fact, I have an old office that probably still off-gasses. I think we're also familiar with what our desks look like. It's, they've been retrofitted and modernized in many ways, but, uh, we know one of the fixtures in those old desks from the days of yore, uh, used to be an ashtray, so. All right. Other questions? Well, I will tell you a funny. I'm sitting at my desk and we're in session, and all of a sudden I've got a bunch of senators coming over and saying, "You've got to kill a bill. You've got to kill a bill." And I'm going, "What?

445. 2:05:13

     What?" And they said-

446. 2:05:16

     We just passed out a total smoking ban everywhere. No, no smoking in the state and I said, "Whoopee, I'm all for that."

447. 2:05:24

     That, that is in this bill.

448. 2:05:25

     And they said, "No, no, no, no, no, no." And I said, "Well, why did it pass?" And Republicans were in charge just like we are now, and, and whose bill was it? And they said, "Well, it passed..." I said, "Did it pass by only one vote or something?" And they went, "Oh, no. Oh, no. Almost everybody voted for it." And I said, "Well, but then what are you over here for?" And they said, "Well, it was Dr. Thomas' bill." Does anybody remember Dr. Thomas? He was about 100 years old. Not really, and he was all sort of bent down all and came from Dalton.

449. 2:05:59

     He was still practicing, ran with his dog every day, and everybody loved him, and he wanted that bill. And they said, "We just didn't wanna hurt his feelings." And I said, "So you pass the bill, come over to me and tell me to kill it," 'cause, you know, he and I are great friends also and so I'm now gonna be the one to, to hurt his feelings. And it was a big house, a big fight in the house, and so what you see not knocked out here was the only thing that we could get through at the time. It was the compromise, as we so often do. And I still have...

450. 2:06:29

     It was quite the discussion and quite the fight that time to get what we got. So, um, anyway, that's the comment on. I've been here long enough to see it come back around again. Um, but sometimes it takes us a while to get around to, you know, taking further steps. So what, uh, is there anybody in the... Oh, y- oh, Cannon. Sorry. I'm sorry. Representative Cannon.

451. 2:06:52

     Oh, thank you. This is me being a new legislator of only 10 years. What does, um, what does it mean when we say reserved, like line 45, line 59, line 77? What does that mean?

452. 2:07:09

     Reserve to just means we're trying to preserve numbering is all it is. It, it doesn't affect the code in any way. It's just us saying in order not to mess up the numbering here, 'cause it's going seven, eight, nine, we're gonna keep eight and it's just gonna stay reserved in that spot.

453. 2:07:25

     Instead of seven.

454. 2:07:28

     Yeah, essentially. It's, it's just clarifying that we're holding the space not to mess up the numbering as it is.

455. 2:07:34

     Why would we do that?

456. 2:07:36

     Well, sometimes we, we can do it for several reasons. Sometimes it's, it's just it's, it makes it simpler for, for viewing rather than us writing out the whole code section and renumbering everything and gives you a lengthy bill, which people tend to dislike. Um, so, so yeah, it could be a number of, of reasons, but it's, that's typically how we reserve that spot and avoid messing up numbering.

457. 2:08:05

     Okay. So there we know. And it does, I hadn't thought about it, but it does let us see what was in it.

458. 2:08:12

     Yeah.

459. 2:08:13

     And we're knocking it out, where if they took it out, we wouldn't know what had been there before, I guess. So there could be some advantage to having it not taken out. I hadn't thought about it, so good question. Who's... Deanna Thompson? Ms. Thompson? Am I not reading it right?

460. 2:08:29

     I think she had to leave to pick up her kid.

461. 2:08:31

     Pardon?

462. 2:08:33

     I think she had to leave to pick up her kid from school.

463. 2:08:36

     Oh, she had to go pick up her kid she had to pick up her kid.

464. 2:08:37

     Yes, she had to pick up her kid.

465. 2:08:38

     Oh, yeah.

466. 2:08:38

     I will, I will just say, like, on, on behalf of folks, obviously we've been working on this issue for quite a while, and we've talked with, um, many of our community partners, including American Lung, American Heart, on the issue of secondhand smoke.

467. 2:08:49

     Okay. And I'd like to make for the... Oh, Representative Frye.

468. 2:08:52

     I might.

469. 2:08:56

     Go ahead.

470. 2:08:56

     Use his words. Actually, I'll come in.

471. 2:08:58

     Okay. Uh-

472. 2:09:00

     So thank you, Madam Chair. Uh, Representative, thanks for bringing this bill. Do you think... I don't see any penalties in this bill. Is there... Is this gonna cause us issues in some of our offices that we currently reside in with any sort of penalties?

473. 2:09:18

     Uh, no, there are no penalties in this bill, the same way that we don't really have major penalties for not smoking in some of the places we recognize are non-smoking now. I think it's good to keep it like that. It seems to be working.

474. 2:09:32

     Okay. Representative Sharper.

475. 2:09:34

     Thank you, Chairwoman. I think in some cities, local, you know, they have fines, uh, for businesses and others that if you're, you know, certain length, you do get a, you can get a fine. So we have local ordinances or even county ordinances that does address, you know, fines and everything.

476. 2:09:54

     That's it.

477. 2:09:57

     Well, I do know that re- restaurants spent, some of the restaurants spent thousands of dollars, thousands to do the, with the part that says they had to have completely different, uh, HVAC systems. I can name one of them. House, okay, which, you know, I think, uh, did a separate room and all that. And so I know that, uh, just with the law like it is, they did try to adhere and spent thousands and thousands of dollars trying to do it, so okay. All right. To the committee.

478. 2:10:28

     I guess what I was gonna say, I sure hope it's not another 10 or 20 years before we address vaping and how bad, you know, they're more and more and more finding out how bad vaping is, especially for young people and the, and the problems that we have. And I'm hoping that there'll be a movement to take and do away with that someday.

479. 2:10:53

     I've got some bills for you.

480. 2:10:54

     It really, they finding that it really causes more harm than good that they thought it was for people giving up cigarettes. And we just replaced one bad thing with something maybe even worse. Uh, could be. So anyway, that's just my personal feelings about it. All right. What's the committee want? Gotta do pa- I mean, can I have a motion?

481. 2:11:19

     So moved.

482. 2:11:20

     Oh, so moved. I've got a motion. I got a second? Anybody have a second?

483. 2:11:24

     Second.

484. 2:11:24

     All right. I've got a motion and a second. Any other discussion from the committee before we vote? Everyone in favor of the passage of the substitute to House Bill 1040, say aye.

485. 2:11:35

     Aye.

486. 2:11:35

     Anyone opposed, say no. Okay. The ayes have it. It's on its way.

487. 2:11:40

     Thank you.

488. 2:11:41

     And that is our last bill.

489. 2:11:43

     No, you didn't hurt my feelings.

490. 2:11:44

     Yeah. Thank you very much.

491. 2:11:45

     Not at all.

492. 2:11:45

     Everybody, thank you for coming and staying and let us, um, move thing and put up with this.

493. 2:11:50

     Do you mind if I

494. 2:12:18

     get-