House Health Committee, March 2, 2026 Video: https://vimeo.com/1169587909 (a timestamp t plays at https://vimeo.com/1169587909#t=s) Page: https://georgiacommons.org/meetings/2026-03-02/house-health This is a machine transcript of the General Assembly's video, made by a speech-recognition model. It is not an official record and can mishear words, names, and numbers. Speakers are not identified. The video is the record: every timestamp links to the moment it plays. [0:17:23] Well, good afternoon. Um, it is five past two. We're gonna go ahead and get started. We have a quorum now. And first up is Representative Stevens with HB382. [0:17:40] Oh, okay. [0:17:46] That's number two. [0:17:47] See if that's it. [0:17:52] It's number two? There you go. Thank you, Mr. Chairman. [0:17:57] Thank you. [0:17:57] Uh, House Bill 382 corrects a few problems. Uh, we have, um, strangely enough, we have two drugs that are being researched that'll be available for, um, um, for the public probably before we get back into session again, so we won't have enough time. As you might remember, we did the drug update bill, um, last week. So wouldn't have enough time to get it on there and get it done. So if you'll turn to page two, the first section, um, uh, section two in the bill talks about a drug that previously was a, a class one drug, which means it has no medical use. [0:18:34] Uh, Emory University has been, um, uh, doing some research on this drug for PTSD, first one in 36 years. And, um, under LSD, lysergic acid, this particular drug has shown an enormous amount of promise, uh, for, and it would, uh, essentially move to a class two drug. The other one's psilocybin. That, some of you might know that as a, um, um, magic mushroom drug. Um, this drug has been u- and also a class one narcotic, has no medical use. [0:19:08] But if approved in the next few days, and we expect it will be, it's used for extreme types of depression, sometimes extremely debilitating, could be life-threatening. These two drugs will be approved, and, um, uh, this would, of course, go directly from the, um, FDA, um, classification so that we can get these to some folks that severely need it. Um, class... Let's see. Moving over to section five, uh, it's talking about the pharmacies and, uh, dispensing of drugs. [0:19:45] It's talking about the pharmacies and their technicians must all be licensed and in the pharmacy all at one time. Um, on line 72, there's a something called a closed-door pharmacy, uh, which basically is just a specialized pharmacy. Um, and if you'll look on page, um, excuse me, line 91, it, of course, is talking about certified pharmacies vers- uh, pharmacy technicians, uh, versus those that are just trained under a pharmacist. [0:20:17] They have to take a test, um, and are certified under the Board of Pharmacy. Um, line 100 is talking about the supervision of interns, and externs, and technicians, and certified technicians. All of these people can be no more than six people in any combination so that pharmacists has an opportunity to, uh, make sure that they're, um, that these folks are properly supervised for the, uh, safety of the, of the patient. [0:20:50] Section six is talking about expired drugs. Two years ago, we were, um, pharmacies across the state were being hit by, um, they were forced to, crash carts and other things, were forced to stock certain drugs that were expensive, and they were short dated. They would go out, and the wholesalers were not allowing these drugs to be, um, returned. So we passed the bill, um, that all drugs ha- are, are eligible to be returned. [0:21:22] Some of these things as a result, um, these manufacturers have an issue with the, with, um, [0:21:31] with the drugs coming back. They're extremely short. One of them is sodium thiosulfate. That particular one in Georgia, uh, as I understand it, um, you can, um... Because you can't, because you're forced to send the drug back and get full credit on it, even if it's expired. Um, any other state but Georgia, the drug might cost a couple of hundred dollars. In Georgia, it's about 1,500, some, from what I'm told. So this gives the board some discretion on this particular item. [0:22:05] And Mr. Chairman, that essentially is the, um, crux of the bill. It gives some emergency powers to the board in this particular case, and I'll ask for the committee's favorable consideration. [0:22:21] Well, thank you. As I understand from the Bo- Board of Pharmacy, they brought you these additions to your original bill? [0:22:27] They did. Uh, the original bill only had the, the two class one drugs that are about to be released to the public- [0:22:35] Right [0:22:35] ... for some amazing use, and the rest of these were added by the Board of Pharmacy. [0:22:39] Right. Which will help our pharmas- [0:22:40] Yes, sir [0:22:41] ... pharmacists throughout this state. [0:22:42] Yes, sir. [0:22:43] Great. I like that. Any questions from any members? Seeing none, do I hear a motion? So moved. Second? Second. All those in favor, say aye. Aye. All those opposed, say nay. Congratulations. Uh, you have a due pass on 382. That's LC461487S. [0:23:07] Thank you, Mr. Chairman and members of committee. [0:23:11] Okay. Um, is Representative Clark here? [0:23:17] Yes, sir. [0:23:17] I'm sorry. Oh, sorry about that. Let's go ahead and hear 1332. I didn't see you come in, I apologize. [0:23:26] Okay. Jim can go over there. [0:23:29] Oh, okay. You can do it there. What's... Is that your mic? Oh, okay. [0:23:38] Thank, thank chairman and colleagues. I have, uh, House Bill 1332, LC461453, and it's called the, uh, Georgia Buy American Medicine Act. And it just simply prioritizes, if we get state funds to hospitals, clinics, and all that, that they would prioritize American pharmaceutical, American medicine over foreign, uh, medicine. Um, and I'll say, you know, about 90, 92% of medicine we use here is produced over in, like, China, India, and all that. [0:24:14] Um, and I mean, I know, and I'm looking more of from a, you know, as a, well, now former Green Beret, but, like, you know, on national security, like, medicine matters, and if we went to war tomorrow with, say, China, which hopefully we don't, since we rely on them, you know, 90% of our medicine comes from overseas and mainly from China, what that could do to us. Um, and even there was one plant, a, um, amoxicillin plant that was gonna be shut down, last one in the United States, and if it had not been bought and we went to war tomorrow, amoxicillin is one of the most widely used drugs in the world. [0:24:50] That means possibly, I mean millions could lose their lives here in America. Um, and I think, and we see it from the federal, even in the Biden administration, the Trump administration now talking about the need to secure our own medicine, and what this would do is just prioritize here in Georgia buying it American-made. Um, and what it does is, um, [0:25:13] it, uh, you know, unless it's substantially higher, means greater than 20%, um, you know, there's caveats where they can go buy from overseas. Um, you know, any healthcare provider p- um, says any, uh, healthcare, healthcare provider, uh, may procure a pharmaceutical drug that's not manufactured in the United States if a American-manufactured pharmaceutical is not reasonably available, uh, procurement of an American manufacturing pharmaceutical would jeopardize patient safety or clinical outcomes. Um, and there's a list of, of other ones m- given that caveat, if they need to go and buy from overseas, but that, they would just prioritize, um, American pharmaceuticals. [0:25:50] Um, 'cause I, I mean, I think each state has a part to, a part to play in national security. [0:25:54] Right. [0:25:55] Um, and it's big, and we need to start looking towards the future. We see with what's happened in, in Iran and others. Um, we live in uncertain times, and I think we need to start taking those steps, which we are. Um, and then also we have, um, um, AbbVie is investing $380 million in North Chicago to expand pharmaceutical, uh, manufacturing here in the United States. So, and multiple other, uh, companies are investing now to start building right here in America. So I think we need to bring that balance back in. That's why I'm carrying this bill. [0:26:24] All right. [0:26:25] I'm glad to take any questions. [0:26:27] Are there any questions? Representative Gisler. [0:26:33] Hey, um, uh, thank you, Mr. Chairman. Um, I guess my, my concern with this is that, that section D that starts at, uh, or paragraph D in section 3 that starts at line 56, it seems to take away any teeth away from the bills. Uh, h- how is this enforced, and, and do we think it's going to be effective with those exceptions in there? [0:26:55] Yeah, so I, I mean, if it's life and death and, and, and the other list of stuff, like, if they need to get it, then go buy it overseas, you know, 'cause it's not like we can switch entirely to American medicine. [0:27:05] Right. Right. [0:27:05] Um, but it has, you see on line 65, 66 about, you know, keeping the documents, uh, for three years. So, you know, if they put the reasons of, "Hey, I can't buy it here. You know, I'm buying it over there. Here's why," um, you have that. And then also if you go to the, uh, page four, the last page, um, talking about failure to comply with this code section may result in corrective action plans or for r- repeated- [0:27:29] Okay [0:27:29] ... or willful violation, suspension or termination of eligibility to receive state funds. So it has teeth, but then it comes back to us in the end, which I think is good, 'cause, you know, if you look at if s- some hospital's buying from overseas and they have good reason, but somebody's saying they don't, us as a general assembly, we are the ones in the end, right, who are budgeting, pass the budget, um, to decide if there needs to be, you know, corrective, um, things. [0:27:55] So- [0:27:55] So it puts some teeth, but I don't wanna put too much teeth. I think that there's a mixture of highlighting what's going on on the world stage- [0:28:01] Mm-hmm [0:28:01] ... um, 'cause sometimes you, you don't need to put too much teeth, I think, a little bit, 'cause... But it's waking people up, and investors also. I think we lead here in Georgia. It's waking up investors to say, "Hey, look, you invest here in America, you know, we'll prioritize American-made medicine via ma- manufactured here." So I think there's a mixture. Like, you don't wanna go too hard, but you wanna also highlight. It's that balance. And I, I mean, I think it's a good balance, but I'm open-minded- [0:28:26] Yeah [0:28:26] ... to putting more teeth into it. [0:28:27] Well, I appreciate that. I, I did have a concern about is it going to cause unnecessary shortages, but given those, those exceptions- [0:28:36] Exactly [0:28:36] ... it doesn't, so okay. [0:28:37] I mean, same way- [0:28:37] Thank you [0:28:37] ... we passed last year unanimously on the drone thing, you know- [0:28:40] Yeah [0:28:40] ... it had flexibility. I gotta look at anything we do. You know, you need to have that balance also. It's not just bring the hammer down also- [0:28:47] Yeah, yeah, sure [0:28:47] ... 'cause you're not trying to hurt an industry. You're not trying to hurt our state, you know, our patients, our hospitals, our clinics. [0:28:52] Yeah. That makes sense. Thank you. [0:28:54] Yep. [0:28:56] Any more questions? Any more questions? You got one? Chairman Newton. [0:29:02] I, I appreciate the, the bill and the, and the goal of the bill and the fact that it's not exactly punitive, but it appears to be, um, it's mainly a reporting. It's, it's almost like the old saying that what you really wanna manage, you first have to measure it, and it seems like a good point to measure. I was interested on line 49 and then again on 61. Uh, I'm sorry, 63 and 64. The, um, it looks like substantially higher, that greater than 20% difference is not a- ... [0:29:33] is not enough by itself, even though a lot of hospitals would argue significantly hi- um, s- of, um, substantially higher is enough in it of itself. It looks like it has to be, "And would significantly limit patient access or care," in 60, Line 64. What's the reason? W- what... Could we just end it at substantially higher? [0:29:57] Oh, instead of the 20%? [0:29:58] Well, no, the 20% would apply under the definition of substantially higher in Line 49. It would apply on Line 63. Um, it's just the and. Um, I don't know if we define significantly limit patient access or care. I, I'm, um, that little phrase at the end of it, uh, seems harder to define. [0:30:24] Oh, on saying, "And would significantly limit-" [0:30:25] Instead of... Yeah, just leave off. It's starting, you know, starting with the word and, and would significantly limit patient access or care. I think that just the fact that it's substantially higher, um, would, would be enough to, um, to document. That's the reason you're not preferring the, an American manufactured one if available. [0:30:47] Yeah. Yeah, I mean, we can remove that part. Um- [0:30:50] I mean- [0:30:50] I mean, it's just keeping it broad enough to where they have, you know, the ways to be able to say, "Hey, this is why we could not." Um, but we still track, um, everything going on. But I mean, I'm open to it. [0:31:04] I, I will tell you just, just Mr. Chairman, if you don't mind, the... I can tell you the, the, the things that we have run out of in hospitals, I mean, I just heard yesterday about two milligram morphines are, are hard to come by, so we're trying to make sure people could start using the four milligram per CC version without overdosing the patients. So I mean, these d- these things that... We were out of saline bags at one point. S- it was soon after a lot of them were made in Puerto Rico. I think it was a, in a recent year. So I do think the goal of having more sources in America is a, is a laudable goal. [0:31:35] Um, but, but we also don't wanna... Like I say, a 20% increase for some of our hospitals across rural Georgia in particular would be the last nail for them. Thank you. [0:31:48] All right. [0:31:54] Representative Lamb. [0:31:58] Thank you, Mr. Chair. Uh, Representative Clark, and you and I have spoken about this bill too, to my seat mate. Could you just, um, in, in your words explain what you mean in Line 50 by preference? Because I, I very much appreciate, as I told the author last week, the, the goals behind the bill. I think like all of us, we just wanna make sure that it's workable. So in Line 50, when it says, "Any healthcare provider receiving state funds shall give preference," to me, preference is not actually a very strong mandate, which I think can be important. [0:32:28] And so I'm just curious, when you think of things like generic versus non-generic, or they're, they don't cost exactly the same, but they're not exactly the same drug, but they could be used for similar conditions, could you just explain a little bit about what you mean when you say preference in that line? [0:32:47] Um. [0:32:51] Which line were you- [0:32:52] Line 50. [0:32:56] Oh. I mean, I mean, I think from taken on this line, it's just the preference is reference to this subsection B of this co-section that says, "Shall only apply to the expenditure of state funds." I mean, it's tech- I think that's what that line's meaning unless I'm missing it. It, it's just saying the preference, reference in this line has to do with the state funds and shall not apply to federal funds or any funds. I'm not sure. [0:33:21] So just to, just a quick follow-up. [0:33:23] Yeah. [0:33:23] As I'm reading it, preference does not mean you must absolutely purchase American manufactured pharmaceuticals provided such pharmaceuticals are reasonably available. Because this language leaves room. This is a friendly question. [0:33:36] Yeah. [0:33:36] This language leaves room for considerations that not, that there may be conditions for which there are different drugs that could treat them, uh, in a similar way, but are not exactly the same drugs. And so the flexibility in the word preference allows for such judgment to be made. Is that correct? [0:33:54] Yeah. W- what are you thinking about sliding in there to tighten it? I mean, I mean, are you wanting to tighten it? [0:33:59] Uh, no. I, I'm, this is how I read it. I f- [0:34:03] Yeah [0:34:03] ... I like that word, and I'm just making sure that you as the author, your intention is there. Because I think it is important to leave that flexibility in there. I, I certainly myself, uh, do not wanna, quote, "Tighten it," further. I like the word preference. [0:34:15] Yeah. [0:34:15] But I just wanna make sure that that- [0:34:16] Yeah [0:34:16] ... accords with your intention. [0:34:17] Yeah. I'm, I'm fine with it. [0:34:18] You like it? [0:34:19] Yeah. [0:34:19] Okay. [0:34:20] I mean, 'cause I'm not trying to bring the hammer down. [0:34:21] You might, right, right. [0:34:22] I mean, a big thing is, I mean, I believe we do need to pass this is, and I'd like to today. But it's really just highlighting what's happened on the world stage, and we need to have that balance of, you know, medicine, water supply, food supply, grids, infrastructure. We need to be able to control that, you know, and be able to close our gates, um, if we go to war, which I hate war, but it's always there. Um, it's kind of putting our community and our nation first. Yeah. Thank you. [0:34:47] Thank you. [0:34:48] Representative Davis. [0:34:50] Thank you, Mr. Chair. Is it not true that the hospitals can override that part as far as preference? So there is some give and take in that. It's not a mandate, right? [0:35:05] Yeah. I mean, I... Yeah, they have a lot of leeway in all that. [0:35:08] Okay. [0:35:09] And that's why we didn't put all these other teeth in to where technically the funding comes down from us. We control it, so, like, we can step into, you know, if somebody's trying to, you know, mess with the funding. [0:35:18] Well, I want to thank you for the bill, because, uh, I worked in hospitals where we came up short. And it would be a lot easier if we can get it right here at home, and rather than have to have it shipped in. [0:35:32] 'Cause even 50% of, like, the shortages and supply issues are happening overseas in China and India and all that. So the more we can bring it back here and have that mixture, which I know- [0:35:42] It's a global economy type trade and all that, I'm all about it. But then being able to close our gates, can we keep our people safe and, and alive? [0:35:49] Mm-hmm. Okay. I see no more questions. Any more questions? Okay. Do I hear a motion? Do pass. [0:35:59] Second. [0:36:00] Uh, Rep- uh, Chairman Newton, you had an amendment you wanted to address on this. Is that right or am I wrong? [0:36:09] Yes, sir. [0:36:10] Okay. Can you tell us the lines and the words? [0:36:13] Sorry. [0:36:19] That's okay. It's all right. [0:36:23] The, the, the, that was to, uh- ... uh, on line 63, deleting after the word, putting a period after the word "higher"- [0:36:32] Mm-hmm [0:36:33] ... and then just delete, "And would significantly limit patient access or care." [0:36:41] So eliminating line 64. [0:36:44] Eliminate line 64, and then the word "and"- [0:36:46] "And" [0:36:46] ... on line 63. [0:36:47] Okay. [0:36:50] I'll make that motion. [0:36:51] Anyone, does everyone have that? You got a question? [0:36:55] I, I was gonna suggest maybe a different way to handle it is, uh, or- [0:36:58] Uh, which, which, which mic are you? Three or four? [0:37:00] Uh, number four. [0:37:01] Four, okay. [0:37:02] Yeah. [0:37:02] Go ahead. [0:37:03] I was just gonna suggest instead of eliminating everything after the "and" on line 63, we just add "or" and make line 64 sub bullet five, 'cause, you know, significantly limiting patient access or care seems like a significant carve-out, too. [0:37:19] We've already dealt in line 58 with an American manufactured phar- pharmaceutical that's not reasonably available, uh, or would jeopard- and then in line 59, would jeopardize safety or clinical outcome. Um- [0:37:31] Yeah, that's fair [0:37:32] ... or is fine. I mean- [0:37:33] It, it, it's a little more, I guess, permissive, but I mean, either way. [0:37:36] Yeah, I would, uh, I'd be fine with just the change. [0:37:38] But we can keep the or just so you use more, uh- [0:37:40] Let me just, let me just- [0:37:41] ... words [0:37:42] ... can I amend my amendment? [0:37:43] Yes, yeah. Amending, yes. [0:37:45] Forget about what I s- the, the- ... just change the word and to or. [0:37:48] Okay. [0:37:50] Perfect. [0:37:51] And then keep line 64? [0:37:53] Correct. [0:37:53] Correct. That's what I thought. Okay. Yeah. Ev- everyone have that? Mm-hmm. We're good? Mm-hmm. We're good? Okay. All right, um, on the amendment, all those in favor say aye. [0:38:07] Aye. [0:38:07] All those against say nay. Okay, going back to the main body of the bill. Uh, all those in favor say aye. [0:38:14] Aye. [0:38:15] Those against say nay. Okay, we, you have do pass on House Bill 1332 LC46 1453 as amended. All right, congratulations. [0:38:29] Thank you. [0:38:30] All right. Up next, how about Chairman Dr. Newton? [0:38:37] Thank you, Mr. Chairman. Uh, members of the committee, I'm, I'm bringing before you, uh, House Bill 1309 LC46 1488S, committee sub. Uh, this is a bill that basically clears up an ambiguity in the f- federal, in the Georgia Code right now. We have, um, physicians and other providers who prescribe medicines. We have pharmacists who dispense medication. We do in limited situations right now allow Georgia physicians to actually dispense certain medications, in particular non-controlled substances, in their offices. [0:39:07] This is particularly important in some of our rural areas, um, uh, some of which don't have a pharmacy. It's becoming more important to some of our primary care specialties as they're measured on the compliance of the patient, not just what the doctor or the provider did, uh, but, but whether the patient actually picked up their, you know, got their medicine from the pharmacy. They're getting their quality measured on this. So because of that, some primary care practices more and more are looking at, uh, at least for particular medicines, for diabetes, for high blood pressure and other things, to actually dispense the medicines in the office, explain the same thing a pharmacist would. [0:39:40] And so currently in code, we do allow a physician to do that in an office. More and more of our patients are getting a, at least a portion of their care through, um, advanced practice practitioners that are non-physicians, and this bill will just clear up that ambiguity by allowing, um, uh, allowing those in that the advanced nurse, advanced nurse practitioners or physician assistants to also be able to do the same thing that's allowed for physicians in offices as long as it's been delegated by a physician on their, either their protocol or their supervisory agreement. [0:40:14] And so that's, that's what the bill does. It, it just allows the limited dispensing from medical offices, but it allows it to be done by physicians as it is now, and also advanced nurse practitioners and, um, physician assistants. [0:40:30] Okay. We got a question from Representative Lim. Is it you? Douglas? [0:40:37] No, no. [0:40:37] I got a blinking light up here. Okay. [0:40:39] Mic is still on, yeah. [0:40:40] Still on. [0:40:40] Oh, oh, okay, sorry. All right. [0:40:42] You want me to say something, Mr. Chairman? [0:40:45] Hello. Are there any questions? Uh, there is an amendment on the table. Well, n- not in your folder, but I have a suggested amendment. [0:40:56] Glad to hear it. [0:40:57] And that would be, uh, on line 105, you strike, "To delegate the authority," on 106. So it'll read, "Nothing in this paragraph shall construe to allow a physician to dispense Schedule 2 drugs." And the reasoning for this is years and years ago, before a lot of y'all were here, we had a battle with the pill mills, and had a problem with Schedule 2 drugs coming out of physicians' offices. We don't wanna circle back to that. [0:41:29] Y- I think that's a, an excellent reminder for those that, uh, the, the, the programs don't do it now, but, but just to make sure that no one did come in. [0:41:37] Right. [0:41:37] And of course, if the physician's not allowed to dispense it, then n- then they can't delegate that authority to anyone else by definition to a PA or a nurse practitioner. [0:41:46] Right. [0:41:46] So it covers the entire- [0:41:47] Right, right [0:41:48] ... waterfront. [0:41:49] Right, right. ... covers the whole lot [0:41:50] So I consider that a friendly amendment. Thank you [0:41:52] That's a friendly amendment. Okay. Does everybody have the amendment? Yes. Okay, thank you. I'll call... Okay, first, all those in favor of the bill. I shouldn't do that. [0:42:02] Make a motion. [0:42:02] Huh? You have to call a motion. [0:42:04] To pass. [0:42:04] Yeah. Oh, oh, yes. Excuse me. To pass. Well, make a motion. Yeah, make a motion for the bill. So moved. Second? Second. Okay. Now, I've explained the amendment. Do I hear a motion on the amendment? So moved. [0:42:16] Approved. [0:42:17] All those in favor, say aye. Aye. [0:42:19] Aye. [0:42:19] All those against, say nay. Back to the main body of the move- of the bill. All those in favor, say aye. Aye. [0:42:26] Aye. [0:42:26] All those against, say nay. Congratulations. [0:42:29] Thank you. [0:42:29] You have your bill. [0:42:31] Thank you, Committee and Chairman. [0:42:31] House Bill 1309, LC461488S, as amended. [0:42:39] Thank you, sir. [0:42:39] Thank you. Okay. Let's move up to, uh, House Bill 1393. Representative Werkheiser. [0:42:54] Want the mic? [0:42:54] Yes, sir. [0:43:07] Thank you. [0:43:11] Sit back, please. [0:43:12] Very good. Yes. Thank you, Chairman Hawkins and members of the committee. Um, [0:43:20] I've got House Bill 1393. I think the initial alliteration of LC461443. Pretty lengthy bill, and since I'm not an attorney or a hospital authority bec- uh, expert, since there's many of those in this room, I'm gonna leave all that to them and just give an overview of how this bill came about. Um, believe myself and Noel Williams are the only two people in legislature that sits on hospital boards, so we get to hear on a monthly basis the concerns that, uh, rural hospitals have. [0:44:01] And so this idea has come about as a accumulation of, um, being in those meetings. And then also with, um, Hometown Health, I was invited on a grueling 300-mile, two-day, nine-hospital tour and got to ask CEOs all over South Georgia what their concerns were. [0:44:26] And ov- just in a two-sentence overview what the bill does, it allows, um, hospitals, rural hospitals, and it's very specifically limited to them. And, um, throw this out at the beginning. There were some concerns about, um, antitrust and price collusion. We believe those have been addressed in the bill, and we've even had, um, for those of you in the hospital world knows who Bradley is, the accountant that, firm that represents probably half the hospitals in Georgia. [0:45:02] Their antitrust folks worked on this. And there is a state doctrine that gives provision. Now, and I've got a list of states, um, Alabama, Tennessee. There's about four other states that do something similar. But this simply would allow multiple, either two or three, whatever the number is, specifically to define rural hospitals to collaborate on contracts, whether it be purchasing, staffing. [0:45:33] And the, I guess the problem that's giving some people heartburn is negotiating on insurance contracts, because that's probably the different, the, the most, um... The thing that's hurting our rural hospitals the most because of their payer mix. I've got two hospitals 15 miles apart that I live in between. Um, if you saw the reimbursement rates on a, uh, very simple, you know, say a, a gallbladder surgery. [0:46:08] I guess it's not simple if it's being done on you. Um, but something that's very apple to apple, the, the, the reimbursement rate is literally 10 to 15 times different. And so that's what this bill is trying to address. And so I was gonna make mine very short because I know we've got some folks that traveled all over the state, and I'd like for you to hear from them, if that's okay. [0:46:34] Absolutely. Um, hold, hold. You have a question. [0:46:39] Okay. [0:46:41] Representative Douglas. [0:46:43] Thank you, Mr. Chair. Um, uh, love the bill. I didn't know it was any, just a fun fact, I didn't know there was rural hospitals left out there- ... since there has been so many closing. You have one, you say, 15 miles apart? [0:46:55] Yeah. There's, there's actually, um, probably close to 30 or 50 odd. There, there's quite a few, but some of them are down to three days', uh, cash on hand. And so, um, for those of you in the business world know that's, that's tough. And so, um, but there is... And they're, you know, they're about every 30 or 40 miles, is what. [0:47:22] Thank, thank you. [0:47:22] And they're struggling. [0:47:24] Thank you. [0:47:26] Senator Newton. [0:47:27] Um, thank you. Y- well, that was kind of my question, is this, this is only rurals associating with another rural. So if one is, and I see in line 150 w- we've got rural county defined. Um, really two questions on that. This, these are only hospital authorities or f- or facilities that are in a rural county, is that right? [0:47:50] Yeah, because there was great concern that We, you know, there's, it's known as the Big Four, the, um, Sheila, Piedmont, uh, Emory- [0:48:01] Northside [0:48:01] ... Northside. Um, so that this bill would not allow them to come in and take over, integrate. This would li- lit- just literally be other rural hospitals collaborating with, you know, uh, Evans Memorial with a Jeff Davis. So two, two or three small hospitals being able to work together. [0:48:27] Thank you. I, I appreciate the, that effort and I think it's a, a very sh- important. A, line 151 that talks about any future such census, if a county ... Some of these counties, if they're successful, they're gonna, their, their hospital's gonna be strong, they're gonna be able to attract new businesses, their, if their population in 2030 goes over 50,000, are they gonna be the victim of their own, um, success? I know it's a pipe dream maybe, but, um- [0:48:54] That's a great question [0:48:55] ... is, is the goal, is the goal about the future censuses just to be ones that could be added or would they lose this ability as soon as in 2031 when ... I know, I know for example, Camden County in 2020 was 50,152 people in it. So it, it escaped a lot of Georgia's, uh, um, rural county, uh, efforts. I don't know how many other counties are close, but, um, in four or five years they might be. [0:49:23] Right, and that's a great question and I think I can point you to an example of that. Um, the hospital about an hour away from me, Douglas, was struggling. They were at 30,000 less than 10 years ago. They're above 50,000 and doing much better. I think once you get above that threshold you don't n- you probably wouldn't need the help that this bill is trying to provide. But I'll let some of my hospitals answer that. I've already told you more than what I know. [0:49:52] Thank, thank you. Yeah, we, if we could stick with the 2020 one that we do know- [0:49:56] Yeah [0:49:56] ... um, that might be one way, but thank you. Thank you for this one. [0:49:59] So you're Forrest Gump-ing your way through this one? [0:50:01] Absolutely [0:50:02] All right. [0:50:03] Um- [0:50:03] Representative Davis. [0:50:06] Um, thank you Chairman. My question is, how do we reassure people that this will protect them against monopolies in price setting? [0:50:16] Well, it, it is addressed in the bill, um, because those are currently against the law. But it w- it would allow them, and I'll let some of the lawyers speak to that because there, we do have, um, it's called state doctrine. And so there's already enough laws on the bills that would prevent that from happening. [0:50:38] Follow-up please. [0:50:39] Yes. [0:50:40] You also spoke of, uh, staff sharing. Uh, is it that, uh, say that as a nurse I can be shared between two hospitals, like you say you have two hospitals you live between, uh, if they can't use me in one hospital, do they send me to the other? [0:50:57] Well, of course a nurse, like any contracts they're two-sided. They would have to agree to that. And there's already the whole industry of travel nursing where they could go. But there might be situations where, um, and I guess it would be a hybrid of a travel nurse type situation where a hospital, um, let's say if they're doing PRN, they don't need, um, they might not need you the minimum four shifts a month. But you would, you would agree to work at, you know, I've got ... [0:51:28] I mean, just in my situation I, I represent four counties and I guess the furthest you'd have to drive from one to the other would be an hour, but there are hospitals that are 30 minutes apart from each other. [0:51:40] Thank you. [0:51:41] Okay. Um, let me just say now ... Oh, you got another question. Chairman Newton. [0:51:49] Sorry. Thank you. [0:51:50] No, that's all. [0:51:50] Just curious on the, on the, and maybe you said it and I missed it. On line t- 208 and following, talking about immune from liability under federal antitrust. Is that, is, is that something we can do? I mean, I, I've, I would see how that's the intent of what we're trying to do, but do we actually control whether or not the feds consider this a antitrust violation or not? Can we make this- [0:52:17] I'm, I'm gonna let you ask a lawyer that question. [0:52:19] All right. Thank you. [0:52:19] I, I'm, I'm ... Legislative counsel. Can, Vince, can you answer that? [0:52:25] Sure. [0:52:26] Yeah. [0:52:26] And can we do it on PBMs while we're at it? [0:52:28] Yeah. [0:52:29] So as long as we're ignoring federal law. [0:52:31] Thought we were gonna outlaw those. [0:52:32] Yeah, true. [0:52:42] Well, I guess I'd just say this is somewhat of an open question. Um, but yeah, just simply because we declare ourselves immune, that doesn't, that in itself doesn't accomplish our goal, the goal of the legislation. But I mean, I, and I guess a lot of attorneys are here to speak about this issue too, but there is a, a, uh, US Supreme Court authority for this doctrine on which this bill is proceeding under. Now how it would ultimately be determined is up in the air at this point. Um, there was a, a, uh, US Supreme Court case dealing with, uh, Georgia authorities, um, I think around- [0:53:10] 2013 [0:53:10] ... 20, yeah, 2013. [0:53:12] FCC versus, uh, Phoebe Putney. [0:53:15] Right. And in that case the court decided that the doctrine was not applicable. But this legislation as drafted it appears to be somewhat in response to that Supreme Court decision, the language and everything else about it. So, um, at this point, I mean, I would say it's, you know, it's impossible to know exactly how it would play out in the courts, but it is based on a, a, you know, current, uh, precedent of the US Supreme Court. [0:53:38] Well, thank you. Um, to the author. Oh, we, we have another question so go, go ahead Gisler. Representative Gisler. [0:53:45] Thank you Mr. Chairman. Um, I'm just curious, and it may be it's in here and I'm just not seeing it, but i- is this restricted to nonprofit hospitals only or are for-profit hospitals already, or also available to them? [0:53:55] I believe it's nonpro- nonprofit. [0:53:57] Nonprofit only. Okay. Thank you. [0:54:00] Representative Lim. [0:54:02] Yeah, I had a question on line two thirty-six. For purposes of federal and state antitrust law, including the application of the State Action Doctrine, et cetera, hospital authorities operating in rural counties shall be deemed political subdivisions of the state. I understand, um, Chairman, you're not an attorney, but my question is, it seems to me that this is saying that rural hospital authorities are not-- are essentially immune from federal and state antitrust law regardless of the specific responsibilities or powers that we're adding in here, meaning the immunity we're carving out is not relative to lines four forty-seven, um, all of the additional powers we're adding on. [0:54:48] And I just wanna know if that's the intention of the bill, because even without adding all those other things, that essentially means that for any purposes, rural hospital authorities are not subject to federal or state antitrust law. Is that the intention? [0:55:02] I don't know if we... Again, to Dr. Newton's point, I don't know that we can say, state that they're immune, but, uh, but the intention is that, that they're not participating in price collusion, um, in anti- in violating antitrust laws. [0:55:20] Okay. Uh, to the author, as we discussed this morning, um, and with leg counsel and others, this bill legally has some troubling areas. I like the bill. I like the intent. But at this point, until we work those out, this will have to be a hearing only today. [0:55:42] I understand, and I meant to bring that up at the beginning and- [0:55:45] That's okay [0:55:45] ... to ask for that, and I'm sorry. I- [0:55:46] No, no, it's okay. It's okay. [0:55:48] Mm-hmm. [0:55:48] But I want those who came to speak to this bill to speak to this bill, because when we do hearing onlys, that sets you up that if we can get over some hurdles within the bill, then this bill can come back, of course, not this year, because this is our last meeting before crossover. [0:56:04] Yeah. [0:56:05] But it can come back as a rider, a substitute, or beginning of next session and be ready to go. [0:56:12] Thank you. [0:56:12] But until we- [0:56:14] Sunny [0:56:14] ... do these things, I cannot hand the chairman of rules a bill that, uh, has this kind of possible problems. Okay? All right. Michelle Madison, I think you're here to speak to the bill. [0:56:35] Thank you. Hello. Thank you, Mr. Chairman. Thank you, everyone. Um, so I am the attorney, but not the antitrust attorney. I'm the attorney, and I work with about 20 or more of your rural hospitals in the state, and we actually have 62 total still in our state. So the definition of rural county is in the statutes, about 50,000 or less. And to your point, it can change. We've had some hospitals that have been considered rural county hospitals, and their population grew over 50,000. The purpose of this bill really originated from the rural hospitals are in a unique position. [0:57:07] Some of these hospitals are critical access hospitals, which means they have 25 beds. They're lucky if they can get a surgeon at one of those hospitals, and then some other hospitals might be lucky if they can get a CT or advanced imaging. For those hospitals that are within 15 miles of each other or 25 or 35 miles of each other, it's difficult to duplicate those services and stay viable. So the purpose of this bill was really to take a concept that's already in other states and that we really already had in Georgia, which is the State Action Doctrine. So the narrowness of this bill is really related to hospital authorities that are in rural counties that are non-profits, and hospital authorities are created by county or city resolutions. [0:57:48] Sometimes it's both. Sometimes it's both the city and the county that pass a resolution to create the hospital authority. So they're created by statute. And then there are some that are called restructured hospital authorities, which means we took the leased assets, we took the assets of the hospital authority and leased it to a non-profit tax-exempt organization specifically to be able to operate that hospital in that rural community to meet the needs of the community. So this bill is narrowed down to both of those, and the purpose was really to say, "Okay, if I have a surgeon at one hospital and another hospital has imaging, the FTC today would say, 'I can't tell one of my hospitals, "Send all your surgery patients here and send all your imaging here.'" That would be an FTC issue, right? [0:58:30] But the concept of State Action Doctrine is you're created under statute, you operate under the state, and the purpose of all of these statements that are in this bill, and I agree, it's an attorney's wordy bill, totally agree, um, but all of that language is designed to say that our state policy is to make sure that we're using these assets and using assets in rural areas to meet the healthcare needs of that community. It's a hard area when we have individuals who have to drive 60 miles to get to a larger facility. [0:59:01] These facilities are necessary, essential providers in each one of these counties. And so if they can work together, they can stay viable, right? That's the purpose, is for the state to say that we are here to support public policy initiatives directed at access to care. There are other states that do have State Action Doctrine. It is not a total, "FTC, don't come in. We've got total immunity. Go away," to legislative counsel's point. The FTC still has governance authority. We did have State Action Doctrine in Georgia. We do have it today. [0:59:32] It was challenged in 2013 in the FTC versus Phoebe Putney case. [0:59:37] Mm-hmm. [0:59:37] And what the Supreme Court said in that case was there are parts of the Georgia bill that talk about pieces of the State Action Doctrine, which gives us that ability to have immunity for these rural providers to work together to ensure access to care, but it doesn't meet every element that they were looking for. And so in that Supreme Court decision, they said in Georgia's bill, they really, or in Georgia's laws, they are missing this, this, and this. So what our antitrust counsel did at Bradley was they put this, this, and this into the bill that's in front of all of you. [1:00:07] So all that language is to address that Supreme Court decision. It does not give carte blanche immunity to, to everything. The FTC can still look at arrangements. It's not intended to engage in some kind of negotiation that would violate FTC governance related to price fixing or negotiating rates. And I will tell you, to Representative Werkheiser's position and statement earlier, the rate difference between the rural providers and the metro providers is dramatic. And so the intent of this isn't to go to the, to the managed care companies in our state and say, "Oh, well, we deserve this huge increase." It's really, "How do we stay viable? [1:00:43] How do we deliver access to care? And how do we work together to make that happen?" So it's cost-effective care. The other thing that I want to make sure you all are aware of is- Our state got $218 million, as I'm sure you're all aware, from the federal government for the next five years focused on rural transformation programs, because the focus is to make sure that our network of rural hospitals, which is huge. If you look out at Georgia, you can see this massive area, and the State Office of Rural Health has this fantastic map of Georgia that shows you where all our critical access hospitals are and where our rural counties are. [1:01:16] But this money is supposed to be dedicated to making sure that we can develop the right delivery of care models in those areas. One of the things the state is dedicating $54 million to is a program called the AHEAD program. Good, bad, who knows yet? We haven't implemented it yet. But it's $54 million that focuses on what's called an accountable care organization model where you get a bundled payment. So if someone's gonna pay you a bundled payment for a Medicare or a Medicaid or some kinda payer, you've gotta make sure you can reduce your cost to stay viable. [1:01:48] If you can't collaborate with the hospital down the road so you're not duplicating services and making sure access to service is there, you're not gonna be viable when that program launches. So the pro- the reason why we brought this forward this year was, number one, that program's been initiated, right? We have it for the next five years. Number two, you have amazing rural hospitals that in some counties are the largest employers who are delivering unbelievable care in your community, and we saw that during COVID in the enhanced levels of care they can deliver. [1:02:18] But the cost of healthcare for them is the same as it is in a metro area. If I buy a CT in Bainbridge, I'm buying the same CT in Atlanta. That cost is the same. So we have to figure out how do you use resources and allocate them so we can ensure access to care. So in doing that we said, "Well, what can hospital authorities do?" And that's where we focused on that state action doctrine. Let's correct the Georgia State Action Doctrine so these hospital authorities that are in small rural areas who have populations of 10 or 20,000 people can actually work together to deliver care at a lower cost. [1:02:51] And there's a lot in here on what they can do, and all of that is related to the state action doctrine. And so it's based upon other states, based on the Supreme Court hearing, and based on what we have in Georgia. Does that make sense? [1:03:02] Mm-hmm. [1:03:03] Very. [1:03:03] Very much. [1:03:04] I thought it was very well delivered. I- I'm impressed. I'm sure the opposition would like to have you. Okay. You got some questions. [1:03:14] Yes, sir. [1:03:15] Uh, Representative Lim. [1:03:16] Yeah. So I, I appreciate this and, and given what Chairman said, you know, I think we all want to make sure we do everything we can to get this to a passable state, whenever that should be. So I, I wanna go back to lines 236, where this is about the state action doctrine, where it says, "For purposes of federal and state antitrust law, hospital authorities operating in rural areas shall be deemed political subdivisions of this state." That to me seems quite broad. As I stated before, that is not relative to any specific powers, and it reminds me, because I had a bill on it, that we do already have something similar with respect to merger of hospital authorities, which is Section 31-7-72.1. [1:03:57] Mm-hmm. [1:03:57] And that specifically states that, if I can pull it up, that hospital authorities are acting pursuant to state policy and shall be immune from antitrust liability when they're exercising the powers specifically granted to them- [1:04:10] Mm-hmm [1:04:11] ... in that particular code section, i.e. mergers. [1:04:13] Sure. [1:04:13] This one seems broad, and again, unmoored from the specific powers added later on in the bill. Is that intentional? [1:04:21] So unfortunately, the antitrust guys added it, but I asked the same question when they added it. I'm like, "Guys." And so on this language, they said this was specifically in relation in response to that Supreme Court decision to make sure, because the state antitrust and the state action doctrine needed to ensure that we cross-reference back to the subdivisions of the state. And I believe this section is all within, um, the additional section just for the Rural Hospital Authority. So it's intended to be narrow for that section in that article. [1:04:48] Gotcha. And again, we'll do this later- [1:04:50] Sure [1:04:50] ... but I think what might be helpful there is specifically to reference- [1:04:54] Sure [1:04:54] ... those powers because otherwise it just says that even if they're not exercising the powers you're intending to add, that they will be considered state actors, which I'm not sure the state itself wants to do. [1:05:03] We appreciate that. Thank you. [1:05:07] Chairman Newton. [1:05:08] Thank you. And thank you for your explanation that, that using the Supreme Court as a, uh, their de- decision as a template on how to correctly write one that will meet the scrutiny. I don't know how much has changed since 2013, but hopefully enough people are still there. Uh, on line one, uh, 469, it did mention you can participate in a clinically integrated network, an A- ACO, an accountable care organization or other delivery system. Then on f- and then on, um, line 463, you did specifically say we can discuss reimbursement rates and try to- [1:05:37] Mm-hmm [1:05:37] ... try to, um, get that. That seems like that's an important tool that's- [1:05:41] Sure [1:05:41] ... that, that it be available because it is hard to work on one-tenth of what some other hospitals have negotiated. It, that, that is part of the goal though, correct, is to allow this? [1:05:52] Yeah, it's, yes, sir. And so there's two parts to that. One is a clinically integrated network means that you are using patient-centered protocols to bring the providers together to deliver care at a reduced cost with improved outcomes. So the goal on a clinically integrated network is kind of value-based care. So someone's gonna pay you a million dollars for all your Medicaid patients, and then you're going to integrate your doctors and your post-acute care and your hospitals together to deliver care at a lower cost so you can keep some viable part of that. In order to get there, we have to negotiate risk share agreements with the managed care companies. [1:06:26] And I'll tell you, that has been difficult to get those risk share agreements, because you gotta collect quality data, everyone has to agree on the quality data, and then you actually have to pay based on those quality outcomes. So that's a challenge for everybody. But it is a matter of negotiating, and it means the payers and the providers have to come together to make that happen. We have not been successful in making that happen yet in Georgia across the board for all the rural hospitals. So I think this power gives us the ability to work on clinically integrated networks, which part of that is the pricing and how do you get quality payments, not just fee for service payments. [1:06:59] I gotcha. Uh, just a quick follow-up. The, um, the, some of our large systems, I know WellStar and Piedmont, both in the Augusta area. I know we're not rural in the Augusta area on, on, on this, although some of our nearby counties are and have- divisions. Does this exclude those, you big- you called them the big four, uh, if they have invested in a, in a, a McDuffie County Hospital, a cou- a county of 21,000 people, that do- this doesn't exclude them from participating in this if they were, you know, to, to say McDuffie County wanted to get with, uh, Wilkes County and maybe, I know we're Elberton, Elbert County. [1:07:36] It- this doesn't preclude just i- if the owner of the smaller hospital happens to be a multi-hospital owner, does it, or does it? [1:07:44] This is actually focused on rural hospital authorities and restructures. So depending upon how they restructured it- [1:07:50] Okay [1:07:50] ... I'm trying to remember McDuffie, if they did a lease of assets with somebody on the hospital authority board being on the board of the governing body, that's considered restructured, and so they would still be included in this. [1:07:59] They would be eligible. [1:08:00] Mm-hmm. [1:08:00] 'Cause it's- [1:08:01] And I can't imagine they would be needing their help. [1:08:03] Oh, that's a good point. [1:08:04] Yeah. [1:08:05] Good point. They already have it here. Yeah. [1:08:09] Uh, Senator Representative Davis. [1:08:12] Thank you. Um, you said that 54 million would be going to the AHEAD program, and I just Googled AHEAD, and it said Achieving Healthcare Efficiency Through Accountable Design- [1:08:25] Mm-hmm [1:08:25] ... model. And it pointed out that I guess six states are enacting this, and they have Maryland, Connecticut, Hawaii, uh, Vermont, Rhode Island, and New York. [1:08:36] Mm-hmm. [1:08:36] And it said that up to two m- new states can join. Are we one of the two? [1:08:43] I'm gonna ask you to ask Department of Community Health, but that's the rumor, um, that we are looking to be one of the ne- next two states. [1:08:50] Well, I, I, um, I guess what I'm looking at is, is there a possibility we could not be one of the two by not taking this action? [1:09:00] This action won't impact the Rural Transformation Fund. This is more to help the rural hospitals be ready when that Rural Transformation Fund happens. [1:09:07] Oh. [1:09:07] The Department of Community Health is receiving those dollars, and their budget, the only reason I know about the 54 million is their budget was proposed to CMS and approved maybe two weeks ago, and that's the amount that's allocated for it, and that's a program they're launching. This allows the rural hospitals to be able to coordinate and collaborate together so we can reduce costs when that program does get launched. But to your point, today there's an implementation plan under that AHEAD project. It's considered a Centers for Medicare and Medicaid Innovation project, which is trying to think outside the box, how do you deliver care? [1:09:37] Mm-hmm. [1:09:38] And Maryland is the first state to actually have a performance year. This is the first year, so they've been in two months, so we're kinda watching to see what happens. [1:09:46] Well, thank you. [1:09:47] Mm-hmm. [1:09:49] Any more questions? Seeing none. Thank you very much. [1:09:53] Thank you. [1:09:54] Very informative- [1:09:54] Thanks for your time [1:09:55] ... very impressive, Michelle. [1:09:56] Thank you. [1:09:56] Uh, Robin Ralph, Miller County Hospital. [1:10:00] Sir, I'd like to yield my time. [1:10:03] Oh, okay. [1:10:05] I think Miss, Miss Madison- [1:10:06] Wow [1:10:06] ... expressed it really well. [1:10:08] Pretty well, pretty good, huh? [1:10:10] Very well. [1:10:10] Uh, yeah. Bill Lee, Evans Memorial. [1:10:20] Thank you. Thank you, Mr. Chairman. I'm in committee. I'm Bill Lee. I'm the CEO at Evans Memorial Hospital in Claxton, Georgia. I'm sure you affiliate that with cheese, with, uh, fruitcake and with chicken. But, um, there is healthcare there delivered. So I do wanna just add a couple of things. Um, and I wanna start by saying that um, I'm honored that Representative Werkheiser is presenting this. He actually serves on the board at Evans Memorial with me. Um, and I'm excited to be here because I honestly say in my 30 years of healthcare, this is one of the most impactful bills that could be approved. [1:10:57] Um, I think rural healthcare is fragile right now. I've been here as the CEO for six years, and I haven't seen anything like it over the last two years in which with the cost of workforce, the cost of supplies, the cost of drugs, I know Dr. Newton referenced that, some of the bills that were here, all of these things have been a perfect storm. And so when we look out across the state and we look at other rural hospitals that could work together, I think this is critical. [1:11:28] Um, and the real reason I wanna speak is that I'm very concerned about the deferment of this, because I think as we're rolling out the Rural Health Transformation program, part of that is to be rolled out this year. I think we are poised and we're positioned to make great strides in transforming rural health. But without this and some of the ideas that we have created with sharing leaders, sharing staff, sharing supply, um, uh, vendor opportunities, um, things that we couldn't leverage without partnership and collaboration, I think at the end of the day, that is what the PHRAT health program is based on, is collaboration. [1:12:12] And without this bill moving out of committee and moving along the way in this journey, then we are still gonna be held in a very constricted way with ideas that we may have that could ultimately save money, um, and reduce cost and increase revenue. Um, and I do wanna just make sure I point out for those that may be the naysayers around that we're gonna use this to leverage increased reimbursement from payers. If you look at my portfolio at Evans Memorial, 81% of my reimbursement is based on governmental payers. [1:12:49] So 19% then is from other commercial payers. And of that 19% population, when you think about the geographic area I pull, I would pull about one wing of a WellStar Kennestone Hospital. So at the end of the day, what I would pull is never gonna get us rich. It's never gonna be looked at collusion, because it's really not gonna be impactful, and I have to say that. Because at the end of the day, I can run numbers six ways to Sunday, and it is not going to be impactful when you're looking at the Anthem, the Uniteds of the world. [1:13:22] And so at the end of the day, I stress that we really need to take action because it, it, because we are poised to stabilize our rural hospitals, but this is a key step in many of us working collaboratively together to make a difference. Thank you. [1:13:41] Oh, you've got a couple questions. Chairman Newton. [1:13:44] Uh, thank you, Mr. Chairman, and thank you for coming to represent, uh, really a lot of those other 62 hospit- 61 other hospitals that were referenced. I, I think y'all have made a great case of the, the l- the legal question I raised a few minutes ago. I think the attention that has been, um, given it as evidence from the legal evaluation, which sounded pretty thorough, and alleged counsel's work and your description of the, um... Well, the timeliness. The Rural Transformation grants are coming out, to be able to request these and to work on accountable care organizations, and getting good value, and getting paid for it. [1:14:19] I, I don't know. I know this is officially a, um, or at least might still stay a hearing only, but Mr. Chairman, at, if there's an appropriate time, I'd like to motion we do pass, and keep this moving, and be eligible. [1:14:34] Is that a yes? [1:14:37] Ignore me if you a- if you agree. [1:14:43] So I can tell my wife agrees. [1:14:45] Can I second? [1:14:46] Compromising. [1:14:49] He's... [1:14:52] Is that [1:14:56] right? [1:14:56] We could do a cool max extension. [1:14:58] Representative Gisler. [1:14:59] Thank you, Mr. Chairman. I have a question for the witness. Um, just, i- is it fair to say that legislation like this is really necessary because the state has refused to expand Medicaid, and that leaves rural health systems needing to cover the bill or provide services for more uninsured of the population? [1:15:22] I don't, I don't think that is, uh, ap- appropriate based on looking at opportunities to control cost and be more efficient and optimize our spend- [1:15:38] Okay [1:15:38] ... as recreating, whether it be service line, recreating staffing, recreating recruitment for providers. Um, I'm certainly not gonna say that doesn't, uh, help the situation. [1:15:50] Mm. [1:15:50] But I definitely think that all of these other factors are much more, um, pressing to be able to address. [1:15:57] Okay. Thank you. [1:15:58] Thank you. [1:15:59] Mr. Chairman, if I can make a motion to, uh, include- [1:16:01] Amend the bill to expand Medicaid, that means. [1:16:04] It's out of order. Good try, Dan. [1:16:07] Thank you. [1:16:07] Well, Billy's not here, so yeah. [1:16:10] Where is Billy Mitchell? [1:16:11] I just wrote it up. I didn't say anything. [1:16:13] Okay. All right. I see n- no other questions. Thank you very much. I appreciate it. [1:16:20] Thank you. [1:16:27] Nick. [1:16:27] Well. [1:16:27] Oh, well the slide's not on. Do you have another question? [1:16:30] I, no, I just asked it that, um, since we had gotten such an- such excellent answers on the legality of it and the, that con- con- it comports with a previous Supreme Court decision, and alleged counsel, along with others, had worked on it, they seemed to answer, at least in my mind, a lot of the, the legal questions that were there. And if it w- if there was an appropriate time, I, I would love to move to do pass in a- in anticipation of rural Rural Transformation money being available from the federal government and to, and, and what Evans Hospital has mentioned. [1:17:01] So if there, if there was an appropriate time, Mr. Chairman, I'd love to make that motion. [1:17:04] We'll take that under advisement- [1:17:05] Thank you, sir [1:17:06] ... for now. How's that? Okay. Uh, thank you very much. Uh, up next to speak, Jesse Wethington. Good luck. [1:17:15] Uh-oh. [1:17:18] Say something. Say us something now. [1:17:20] Can, can someone get the lights? [1:17:22] Here he is. [1:17:26] Uh, thank you, Mr. Chairman, members of the committee. Uh, I'm Jesse Wethington. I'm here as president of the Georgia Association of Health Plans. Um, and we did have some concerns with this bill as written. I won't rehash comments that have already been made. Uh, Representative Lim, your, your concerns kind of, kind of lined up exactly where ours were. About 80% of this bill does seem to be, you know, like a gold-plated affirmative defense for a state action doctrine challenge. Um, I think we can certainly support some of the intentions and goals. Uh, I think it's a well-intentioned and well-meaning course of legislation, but it's kind of the means of getting there, uh, that our members had some concern about, so we wanted to share those with the committee. [1:18:00] But it does get to the sort of antitrust issue and the broad nature about how some of these additional, uh, hospital authorities or reconstituted hospital authorities would be able to use some of these, um, powers or carve-outs or exemptions from antitrust enforcement. [1:18:13] Attorney's dream, is that what you're saying? [1:18:15] I'm not an attorney myself- ... but I think you could probably keep a few busy, uh, with this one. Yes, sir. [1:18:20] Chairman Newton. [1:18:21] Oh, I'm sorry. That, that, that- [1:18:23] Oh, there's leftover? [1:18:24] Yeah. [1:18:24] Okay. Any questions or comments? [1:18:27] No, I'm good. [1:18:28] I see none. Thank you. [1:18:29] Thank you, Craig. [1:18:34] That's 1098. Um, after conferring with legislative counsel, there's a possibility this thing could squeak through. So instead of a hearing, I'll take a motion, Chairman Newton. [1:18:52] I move, uh, do pass on House Bill 1393, LC 46, 1443. [1:18:59] Second. [1:18:59] Second. [1:19:00] Ooh. Good second. Uh, we, you got a question now? [1:19:05] Can we- [1:19:06] Oh [1:19:06] ... we wanted to do a- [1:19:06] Oh, oh, oh, okay. I'm sorry. Go ahead. I didn't see you. Go ahead. [1:19:09] Yeah, the, uh, I would just, uh, given what, um, Mr. Wethington just said, I would motion to amend lines 236 to 238. And I want to point out that at the very least, lines 80 through 85 already includes the language that I'm talking about, meaning that whatever, uh- [1:19:32] To the whatever extent that the exercise of these powers would make, uh, these authorities essentially state actors, line 80 says, "When exercising its powers under this article." [1:19:44] Right. [1:19:45] It's just that lines 2, 233 to 238 don't include that. And to the extent that that would not only get us- [1:19:54] It's- [1:19:54] ... closer to passing this, but would also make this, no pun intended, immune from any challenges, at least in that way, I would propose that we amend lines 236 to 238 to say- [1:20:05] Mm-hmm [1:20:05] ... "For purposes of federal and state antitrust law, when exercising its powers pursuant to this article, hospital authorities operating in Sevier County shall be deemed political subdivisions of the state." So- [1:20:16] When exercising powers is the additional wording? [1:20:19] Correct. [1:20:19] Mm-hmm. [1:20:20] Yeah, the same language as in line 80 to 81. [1:20:25] Uh. [1:20:26] Okay. [1:20:27] Sounds har- [1:20:28] Would you like to speak to that, Ms. Madison? [1:20:30] So, and as I mentioned to you all, I'm the healthcare attorney, not the antitrust, but I do... Um, if you will look back at 80 and 81 where you're referencing when exercising its powers under this article- [1:20:41] Great. Yeah [1:20:42] ... it's... Yes, it's also referenced in other sections as well, on 96 and 97. So it seems like I can... It... This purpose of this is for purposes of this article. Um, so I can understand the addition. I would say, just to be on the safe side, that we should confirm with antitrust counsel, but we- you're p- talking about putting it in on 36 to 37, just restricting it back down to that article? [1:21:09] Correct. [1:21:10] Yeah. I think that makes sense. [1:21:16] Well, it sounds like- [1:21:16] It sounds like it's- [1:21:18] You good? [1:21:19] Yes. [1:21:20] Yeah. Okay. [1:21:20] Yeah. [1:21:21] Okay. [1:21:21] It seems there's an agreement there. And, and, and as she stated, it's already in other parts of the bill, but I think- [1:21:25] Yeah. Are you saying you're okay with adding it? [1:21:26] I'm okay, not being an antitrust counsel, 'cause it's already in two other sections- [1:21:29] Mm-hmm. [1:21:29] But now we'll confirm with them. [1:21:30] I, I agree. I agree. [1:21:31] But yes. [1:21:31] You just would add it to the end of line 238? [1:21:33] Correct. Yeah. [1:21:34] Yeah. [1:21:34] Before the semicolon- [1:21:35] Right. [1:21:35] Yeah [1:21:35] ... when acting, yeah, the same- [1:21:37] To get the bill moving, I think that's fine [1:21:38] ... when exercising its, its powers under the- [1:21:40] Oh, okay. [1:21:40] I like that. [1:21:42] All right. W- we've already heard a motion on the bill, so now we- we're taking up the amendment. Um, and let's get the amendment clear now. We- we're striking 233 to exactly where? [1:21:56] No. No. [1:21:57] We just- [1:21:57] No, we just add the word- [1:21:57] No, we're not. We're just adding. [1:21:59] 237. [1:22:01] Right. [1:22:01] We're looking at the language on line 80 that begins, "When exercising its powers under this article"- [1:22:07] Right [1:22:07] ... if I remember correctly, and you're adding those same words to the end of line 238. [1:22:12] Correct. [1:22:12] Oh, okay. [1:22:13] Is that right? [1:22:13] After the term state. [1:22:15] After- [1:22:15] Oh, okay. So we're keeping the 233 to 238 and adding line 80 again. Okay. That's fine. [1:22:21] I, I, that's... I second his, his amendment. [1:22:25] Thank you. Thank you, Doctor. [1:22:25] If you're okay with the way I stated it. [1:22:27] Yes. Thank you, Doctor. [1:22:30] You good, Ben? [1:22:30] Yeah. [1:22:31] All right. All those in favor of the amendment, say aye. [1:22:34] Aye. [1:22:34] All those against, say nay. Moving to the main portion of the bill, all those in favor of the bill, say, as amended, say aye, yay. [1:22:44] Yes. [1:22:44] Aye. [1:22:45] All those against, say nay. Congratulations. [1:22:49] Thank you, sir. [1:22:49] Who... Oh, but Representative Werkheiser, you have House Bill 1393 HC461443 as amended. Congratulations. [1:23:02] Thank you. And I promise you, I didn't ask my CEO to do that, but you can see that's why we love him so much. [1:23:10] Well, thank you. Good job. We're gonna stand at ease for a few minutes till we get Representative Chairman Taylor, I mean, uh, Trey Kelley back here. We gotta get him out of committee. [1:23:20] I just accidentally... [1:23:26] Thank you. Thank you. [1:25:06] Had to have that done in a room. [1:25:10] It wasn't a new placement, it was a- [1:25:38] Hey, good to see you [1:25:39] ... Michael [1:26:32] Okay, uh, if the members in the hall can hear me, come on back in. If not, we have a quorum as we are, so we'll go ahead and recognize, uh, Representative Kelly with HB 298. [1:26:47] Thank you. Thank you, Mr. Chairman. Committee members, I come before you today with a substitute to House Bill 298. I'm working today off LC461415S, and we've, uh, we've had language similar to this sitting around for a couple years now, and it's taken, uh, a lot of time and a lot of effort, uh, working with interested parties, uh, to come together to accomplish, uh, I think, a goal that we can all agree on, and that's just helping continue to make our state a great place, uh, for our patients as well as for our healthcare workers. [1:27:28] Uh, the goal of this bill, Mr. Chairman, uh, is simply to, uh, uh, help, uh, just solidify and, uh, codify some of the best practices that are already existing as it relates to our medical facilities, uh, and our nurses, uh, and our nurse, um, personnel as a whole by creating a, uh, nurse staffing committee, uh, and just helping facilitate through the best practices we've seen implemented around, uh, the state, uh, a conversation between those on the frontline, uh, of our healthcare and those who are making very important decisions at the executive level as where, well, Mr. [1:28:12] Chairman. I know there's gonna be some individuals who, uh, are, uh, maybe gonna speak, uh, to the measure today. I think this is important to help us recruit and retain nurses in our community, and I appreciate certainly the Georgia, um, Nurses Association for their collaboration on this. But I also want to thank, uh, all the various, uh, groups that represent our, uh, facilities, our hospitals, uh, for being such, uh, good partners working through this process as well, Mr. [1:28:44] Chairman. I've tried to, uh, as, uh, before I walked in, it, it, uh, you know, and, and as we work through this year, this year, we have gotten an agreement that everyone is, uh, uh, supportive of, of this legislation as it sit here, sits here today. [1:29:02] Okay. Well, we have s- uh, Tim Davis would like to speak to the bill. Georgia Nursing Association. [1:29:15] Thank you, Chair. My name is Tim Davis. I'm the Senior Director of Government Affairs for the Georgia Nurses Association. Uh, grateful to, um, not only the Chair but the committee for hearing this bill. Um, you all have already passed it twice prior. Um, and so we're just looking for a third favorable consideration from the committee on this shared governance bill that, um, uh, will give nurses a seat at the table, um, when we discuss things relating to staffing of both nurses and ancillary staff in the, in the health system. [1:29:47] Happy to take any questions. Would ask for your favorable consideration. [1:29:50] And that is a, a, a good point that I, I missed over, Mr. Chairman. Is not only has this committee considered legislation similar to this prior, we have passed it on the rules, just didn't quite make it across the finish line. [1:30:01] Okay. Thank you very much. I see no questions. [1:30:13] Mr. Chairman, as we were making some final tweaks, uh, if the committee offers a do pass recommendation, which I certainly hope we will, I will have a very short amendment that I'm prepared to offer that will just strike a handful of words. [1:30:29] Thank you. Very timely. Okay. Do I hear a motion? [1:30:33] I'll move. [1:30:34] Second? [1:30:35] Second. [1:30:36] All right. Let's hear the amendment. [1:30:38] Thank you, Mr. Chairman. Uh, I would offer as an amendment on line 35, make this in the form of a motion. After the word available, I would insert a period, and then I would strike the rest of that sentence. So you would just strike, "To meet the level of patient care needed for the hospital's patient care units." [1:31:00] How about, "Such plan shall include a process"? We'll keep that? [1:31:04] Keep that. Yes, sir, Mr. Chairman. [1:31:05] Got it. Okay. All right. Does everybody have that? [1:31:07] We're just shortening the sentence, saving some space in, uh, the Georgia Code Annotated. [1:31:13] Right. Any questions, comments, or anything else? [1:31:18] That's it. I'd love a second. [1:31:20] Oh, okay. Go ahead. [1:31:23] Just curious. Why do you wanna, why do you wanna strike that? Because the level in the ER or ICU is much different than a step-down unit, which is much different than maybe a floor u- unit. You, you, you don't wanna require them to have to, uh, have a written plan for each of those different areas, or are they supposed to try to get an average for all the rooms in the hospital and- [1:31:47] Talking through this, uh, we felt like we could still accomplish that goal, and it was just some requests of the parties that have been working together on this. [1:31:56] You're such a team player. Thank you. [1:31:58] I try to bring people together, uh, where I can, Dr. Newton. [1:32:01] Thank you. [1:32:05] Yep, wonder who did that. Are there any more questions? I see no other questions. Okay, all those ... [1:32:13] Second. [1:32:14] We got a second? Yes. Yeah. On amendment. On the amendment. Okay. All those in favor of the amendment say aye. [1:32:20] Aye. [1:32:21] All those opposed say nay. Back to the main body of the bill. All those in favor of the bill say, as amended, say yay. [1:32:28] Yay. [1:32:29] All those against say nay. All right. Congratulations. You have a due pass on HB298 LC461415S as amended. [1:32:42] Thank you, Mr. Chairman. [1:32:43] Thank you. I want to thank the committee. We actually finished a lot sooner than I thought we would. I thought we'd be at 4:00. I know everybody's got other committees. [1:32:51] You're awful. [1:32:51] And we're losing everybody right now. Thank you. Thank you, Vance. [1:32:55] Thank you. [1:32:55] Consider it. [1:32:56] You got it. [1:32:57] You know why it's so fun, [1:33:43] don't you?