--- title: House Public and Community Health Committee, March 10, 2026 collection: meetings id: 2026-03-10/house-public-and-community-health cite_as: House Public and Community Health Committee, March 10, 2026, video https://vimeo.com/1171123936 (machine transcript by Georgia Commons) canonical_url: https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health md_url: https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health.md text_url: https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health/text source_url: https://vimeo.com/1171123936 date: 2026-03-10 status: machine transcript corpus_version: meetings-2026-10-23-8c15ead0f18d license: Machine transcript and summaries by Georgia Commons from the General Assembly's public video; the video stays on the General Assembly's Vimeo channel; see about.md publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice. up: https://georgiacommons.org/meetings/2026-03-10.md previous: https://georgiacommons.org/meetings/2026-03-10/senate-floor.md next: https://georgiacommons.org/meetings/2026-03-10/senate-retirement.md index: https://georgiacommons.org/meetings/index.md chamber: House body: House Public and Community Health Committee body_url: https://georgiacommons.org/meetings/house-public-and-community-health.md meeting_kind: committee session: 2025-2026 Regular Session start_time: 2026-03-10T14:00:00-04:00 location: 606 CLOB duration_seconds: 8193.0 video_id: 1171123936 video_title: 03.10.26 Public & Community Health agenda_url: https://www.legis.ga.gov/api/document/agendas/house/Juvenile Justice%2FCommittee Agenda 3.10.2026.pdf bills_discussed: - HB 1430 - SB 535 - HB 102 summaries_model: gpt-6.1-sol transcript_turns: 458 transcript_chars: 116078 parts: - https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health.md?start=0 - https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health.md?start=59997 --- # House Public and Community Health Committee, March 10, 2026 House Public and Community Health Committee; March 10, 2026; 2025-2026 Regular Session. Video, on the General Assembly's Vimeo channel: https://vimeo.com/1171123936. Agenda: https://www.legis.ga.gov/api/document/agendas/house/Juvenile Justice%2FCommittee Agenda 3.10.2026.pdf. > 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. ## Summary written by Georgia Commons Written by gpt-6.1-sol from the transcript below. It is not part of the record. Quote the transcript or the video, not the summary. The committee heard three bills and approved one. Members approved [SB 535](https://georgiacommons.org/bills/2025-2026/sb535), which the sponsor described as a change to community service board governance intended to make mental health and disability services more consistent statewide. The committee also held hearings on [HB 1430](https://georgiacommons.org/bills/2025-2026/hb1430), concerning supportive senior housing and Medicaid-funded services, and [HB 102](https://georgiacommons.org/bills/2025-2026/hb102), concerning combined clinical and insurance claims data for measuring healthcare quality. The chair said those two proposals would receive further work over the summer. Neither received a vote. ## Bills discussed (3) Each account was written by gpt-6.1-sol from the stretch of the transcript it names. The bill's number is said in that stretch, unless it was the only bill on a committee's agenda. ### HB 1430. Community Health, Department of; license supportive senior housing communities; provide [HB 1430](https://georgiacommons.org/bills/2025-2026/hb1430) (2025-2026 Regular Session). From [0:39:02](https://vimeo.com/1171123936#t=2342s), turns 1 to 94. The sponsor said [HB 1430](https://georgiacommons.org/bills/2025-2026/hb1430) would create a license category for supportive senior housing and an assisted living Medicaid waiver, offering an alternative to nursing homes. The sponsor said 117,000 Georgians age 65 or older live below the poverty line. A Silver Birch Living witness said eligible residents would be at least 65, qualify for Medicaid and meet nursing facility care criteria, but could receive medication help, meals and other support in apartments. The witness estimated savings of about $95 per resident daily compared with skilled nursing and said Georgia was one of 13 states without assisted living waiver access. Asked about funding, the sponsor said the proposal contained no appropriation and would require a later funding request. Asked about a proposed 50% Medicaid occupancy threshold, the witness said states use different mixes of private-pay and Medicaid residents, including people who become Medicaid-eligible after spending down their resources. Members also asked whether services could come to existing homes. Presenters distinguished this residential proposal from home-based care. The Department of Community Health's chief operating officer said Georgia's existing home and community services waiver does not cover its licensed assisted living category. The chair said this was a hearing only, with further development planned over the summer. No vote occurred. ### SB 535. Mental Health; the re-creation of community service boards; provide [SB 535](https://georgiacommons.org/bills/2025-2026/sb535) (2025-2026 Regular Session). From [1:03:23](https://vimeo.com/1171123936#t=3803s), turns 97 to 237. The sponsor said [SB 535](https://georgiacommons.org/bills/2025-2026/sb535) would reorganize community service board governance to improve consistency statewide. The chair described a state-employed executive director, retirement protections for an existing board employee moving into that role, and board education requirements. The Department of Behavioral Health and Developmental Disabilities commissioner said two boards had required state takeovers after financial failures costing several million dollars, and another was close to that point. Members questioned conflicting instructions from state leadership and local boards, executive director dismissal and loss of local independence. The commissioner said dismissal language was unchanged from the previously approved House version and revisions developed with the community service board association had secured its support. A Georgia Mental Health Policy Partnership witness responded to earlier concerns about investigations, contracting, command and property ownership, saying boards would remain separate legal entities and retain employees and property. The discussion did not establish that the organization raising those concerns had withdrawn them. A NAMI Georgia witness supported accountability while retaining community input. A parent described unavailable local services, a year-long hospitalization and lengthy travel for care, supporting stronger oversight. Other members supported statewide consistency. The committee approved a do-pass motion by voice vote; no numerical count was stated. ### HB 102. Community Health, Department of; Georgia Quality Reporting Project; establish [HB 102](https://georgiacommons.org/bills/2025-2026/hb102) (2025-2026 Regular Session). From [1:28:39](https://vimeo.com/1171123936#t=5319s), turns 244 to 456. A Medical Association of Georgia presenter said [HB 102](https://georgiacommons.org/bills/2025-2026/hb102) would establish the Georgia Quality Reporting Project, combining clinical records and insurance claims through standardized measures of care quality and opioid treatment. The presenter said separate reporting systems obscure outcomes and create duplicate work. McIntosh Clinic's chief executive said 13 clinical staff supported 18 reporting programs covering more than 4,600 assigned patients, spending 52 additional staff hours weekly on quality measures. The witness described delayed reports and insurers assigning patients the clinic had never treated. A Kansas hospital executive said combining data improved follow-up, screening and finances while allowing longer patient visits. A healthcare data researcher supported standardized information sharing. A statement from the Georgia Medical Group Management Association's president described repeated reporting requests, changing measures and declining financial incentives. Members asked about patient privacy, public records and pricing transparency. The association presenter said personal identifiers would be protected from public disclosure and information handled under privacy requirements. The Department of Community Health's chief operating officer raised significant feasibility concerns, saying Georgia's All-Payer Claims Database is de-identified, governed by federal agreements and not designed for the proposed matching. The official distinguished a hospital's internal system from a statewide project. The chair requested further discussions with the department over the summer. No vote occurred. > The transcript runs 116,078 characters. A reader that cannot take it at once can read it in 2 parts: part 1 https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health.md?start=0; part 2 https://georgiacommons.org/meetings/2026-03-10/house-public-and-community-health.md?start=59997. ## Transcript (458 turns) [0:00:00](https://vimeo.com/1171123936#t=0s) Okay. [0:38:28](https://vimeo.com/1171123936#t=2308s) Okay, everybody, let's... Hello, good afternoon. Sorry about the fact that I'm late. I said, "Oh, well, we'll never get a quorum," so I will be starting late, so here everybody is on time. So thank you very minute- much to all my committee members. And I understand why before you might've been late, and we were going so many different places, uh, but I'm glad to see you today. Okay, we are gonna start, uh, with Representative Taylor, uh, House Bill 1430. [0:39:15](https://vimeo.com/1171123936#t=2355s) And, uh, Representative Taylor, you're responsible for introducing your person that's sitting with you or letting her introduce herself. [0:39:26](https://vimeo.com/1171123936#t=2366s) Thank you. Thank you, Madam Chair, members of the committee. Um, I'm very happy today to bring to you for discussion House Bill 1430, LC52 1000. This is a, um, unusual, it's kind of a new thing. We're gonna be having a new licensure category and a standalone assisted living waiver to provide a low-cost community-based alternative to skilled nursing for Medicaid-eligible seniors. There's been identified a problem. Um, we have 117,000 Georgians that are 65 plus, and they're living below the poverty line, seniors who can no longer remain in their homes but do not need full nursing care, and it's not affordable to them. [0:40:09](https://vimeo.com/1171123936#t=2409s) Medicaid supported this group, and it is a possible alternative. Uh, increasing costs of full nursing homes and assisted living has hit everybody as we've got such an aging population. The purpose of this bill is to be supportive of these senior living communities and to look at new opportunities that we could have. The bill provides for the type of residents that would be qualified for this, employment of certification aides and a staff that would be there. Um, it will be developed, and there will be a plan of care for each resident. [0:40:41](https://vimeo.com/1171123936#t=2441s) It'll make financial stability, and those are gonna be part of the requirements for these organizations. And, um, they'll have a waiver request will be submitted. And it's gonna be really looking after our seniors. Too many of them are struggling right now. But the Department of Community Health would be the agency to establish the rules and oversee this implementation. And I have met with the experts, and I've brought one with me that she's gonna introduce herself, and she's gonna share a little bit more information about it. [0:41:11](https://vimeo.com/1171123936#t=2471s) Thank you. Good afternoon, Madam Chair and members of the committee. My name is Harmony Harrington. I'm the Vice President of Government Relations for Silver Birch Living, and we're a leading owner and operator of affordable assisted living communities in Indiana, Ohio, Arizona, and Illinois. Our communities are purpose-built to serve low and moderate income seniors, most of whom qualify for Section 19C Home and Community-Based Services Waivers to access assisted living. Residents who call Silver Birch home typically have about two to three health conditions like diabetes, hypertension, and C- COPD, among others. [0:41:51](https://vimeo.com/1171123936#t=2511s) Thank you for the opportunity today to speak in support of House Bill 1430, which provides both affordable housing and assisted living services for seniors and really rebalances Medicaid spending away from higher cost care. House Bill 1430 creates a new licensure category for supportive senior housing communities, SSHCs. If you want a tongue twister, you can say that three times. Uh, it empowers the Department of Community Health to apply and establish a 1915C HCBS assisted living waiver, and this legislation allows vulnerable seniors to find the right care in the right setting at the right time and at the most affordable cost to the state. [0:42:34](https://vimeo.com/1171123936#t=2554s) Like many states, Georgia is experiencing a rapidly growing senior population, and many older adults want to age with dignity and independence and stay in their community, but they still need some support. Unfortunately, today, low and moderate income seniors are left with choices that don't serve them best and are more expensive for the state Medicaid budget. House Bill 1430 helps address this gap by creating a framework for affordable assisted living through licensed SSHCs, bending the growth of the Medicaid cost curve, and allowing the state to realize substantial cost efficiencies by shifting from higher cost to lower cost settings. [0:43:16](https://vimeo.com/1171123936#t=2596s) Under the structure envisioned in this legislation, residents would qualify based on clear criteria. They must be Georgia residents aged 65 years or older, eligible for Medicaid, and clinically determined to meet nursing facility level of care. In other words, these individuals who are already medically qualified to enter a nursing home today. Many of these seniors do not actually require the intensity of a nursing facility setting. What they need instead is supportive housing with services such as assistance with medications, meals, daily living activities, wellness monitoring, transportation, s- and social support with structured care plans in a residential community environment. [0:44:03](https://vimeo.com/1171123936#t=2643s) SSHCs are designed specifically for residents who require greater levels of support than perhaps home health, but yet do not need institutional nursing home care. We really call ourselves the missing middle. Importantly, federal Medicaid law requires states like Georgia to cover skilled nursing facility care as a mandatory benefit. Because of that requirement, when seniors qualify for nursing facility level of care and they lack affordable options, they often enter nursing homes even if a less institutional setting would better meet their needs, and this dynamic has caused significant cost implications. [0:44:42](https://vimeo.com/1171123936#t=2682s) Nursing facility care often exceeds one hundred thousand dollars per year, while assisted living typically costs substantially less. When Medicaid-eligible seniors are placed in nursing homes simply because no affordable assisting living option exists, the state ends up paying the higher level-- for a higher level of care than is needed. Georgia stands to save approximately ninety-five dollars per day, per person residing in an SSHC versus skilled nursing. [0:45:13](https://vimeo.com/1171123936#t=2713s) Many other states like Tennessee, North Carolina, have already recognized this issue and successfully created Medicaid-supported assisting living options by creating 1915c HCBS waivers. Georgia is only one of thirteen states without an access to assisted living under a waiver. For example, Indiana also serves Medicaid seniors through its HCBS services waiver, and this allows older adults who meet nursing level-- nursing facility level of care to receive services in assisted living settings rather than nursing homes. [0:45:49](https://vimeo.com/1171123936#t=2749s) These programs serve thousands of seniors and demonstrate strong demand for community-based alternatives to institutional care. Serving over eight thousand residents in affordable assisted living a year, the state of Indiana sees five hundred and sixty-five million dollars in savings each year. That's Medicaid savings. Similarly, Ohio has recently expanded it, its efforts to support affordable assisted living through programs that combine Medicaid services with affordable housing financing. [0:46:20](https://vimeo.com/1171123936#t=2780s) And these initiatives are already producing new developments across the state with one billion dollars in private investment underway for twenty-six purpose-built communities going through permanent within one year of legislative policy change. The demand and need for bending the Medicaid cost curve as part of the silver tsunami is great. Additionally, in states that we operate in, we work closely with our skilled nursing partners and trade associations. In many instances, skilled nursing facilities are the greatest referral for seniors to move into affordable assisted living through a waiver. [0:46:57](https://vimeo.com/1171123936#t=2817s) These examples show that when states create the right policy framework, they can expand housing and support services for seniors, attract private investment, and rebalance Medicaid spending away from higher care cost. House Bill 1430 creates a responsible pathway for Georgia to do the same. It allows DCH to license supportive senior housing communities and establish appropriate standards to protect residents and ensure quality services. Georgia has an opportunity to best service residents like Joe, a sixty-eight-year-old disabled retired factory worker, or Marie, a seventy-three-year-old disabled bank teller, and Mary, a seventy-seven-year-old retired housekeeper, each of whom have worked their whole lives, and these are the people whom Medicaid was intended to serve. [0:47:47](https://vimeo.com/1171123936#t=2867s) As Georgia's population ages, we must ensure that our long-term care system includes the full continuum of options that meet seniors where they are, and H- House Bill 1430 helps create that missing middle option between personal care h- homes, home health, and nursing homes, providing appropriate support while preserving independence. We appreciate and thank Representative Taylor and her efforts to strengthen support for seniors in Georgia and her work to find strategic, fiscally prudent solutions for Georgia Medicaid. [0:48:20](https://vimeo.com/1171123936#t=2900s) And for these reasons, we respectfully ask for your support of House Bill 1430. Thank you very much. [0:48:27](https://vimeo.com/1171123936#t=2907s) Okay, we're doing things a little bit differently, and I'm glad there's so many of the members here. We're not gonna vote on this today, but I thought it was important for us to hear it because they're gonna be working on this over the summer. Uh, those of you that haven't been here for a while may not know, and others may not remember, Representative Oliver and I will remember, and Representative Taylor, for years we did not have a designation for assisted living. We only had independent living and nursing homes. [0:49:02](https://vimeo.com/1171123936#t=2942s) So what we had was if somebody could no longer keep up with their medications or maybe drive or a few minor problems, then they would h- their only choice was to go to a nursing home. And we finally, after three years of great discussion about this, came up with the assisted living facility. Those are private pay, uh, and, uh, quite exper- expensive. So really people that would qualify for Medicaid don't have an option if they're in that in between of needing some kind of help. [0:49:40](https://vimeo.com/1171123936#t=2980s) Um, from personal experiences time from a friend who has a sister whose husband is in a-- needed to go into a nursing home, and the sister went from being independent living Into assisted living. This is down below Atlanta. It's not in our high market, but the nursing home is almost $11,000 a month, and the assisted living is 6,000-plus a month. That on in- you know, independent pay. [0:50:12](https://vimeo.com/1171123936#t=3012s) So you can imagine somebody that would qualify for Medicaid, how there's no option. So for that reason, that's why we're hearing it, and it's a chance for you to ask questions. So I'm gonna open up the floor, and we have our first one, Representative Oliver. I thank you, uh, Chairman Taylor. It's a good time to have this discussion. And the weeds and the details, we'll have time over the summer. Yes. Does this bill suggest in, in general that once DCH has decided what the licensure rules shall be, that then it comes back to the General Assembly to appropriate money? [0:50:49](https://vimeo.com/1171123936#t=3049s) This obviously doesn't include an appropriation. Yes, it will, it it will need appropriations. It will need appropriations. So there's not a mandatory payment of what the DCH- Not yet. This is still... They'll have to design it, come up with the regs, rules, how it's gonna be run, the format. This is an outline of what we are expecting, and we will be working over the summer to put it together, and then it will go through an appropriation ask. And again, Madam Chair, this is a, a, a detailed, in-the-weeds discussion, but if I may ask one question. You said this is only for Medicaid recipients, but your flyer here says 50% of residents Medicaid-eligible, so... [0:51:29](https://vimeo.com/1171123936#t=3089s) Correct. Different states set up their waiver programs differently. Um, so in many states that we operate, um, we are purpose-built, so we mainly serve Medicaid residents. [0:51:39](https://vimeo.com/1171123936#t=3099s) What does mainly mean? [0:51:40](https://vimeo.com/1171123936#t=3100s) Um, about 85 to 90%. [0:51:42](https://vimeo.com/1171123936#t=3102s) Okay. [0:51:43](https://vimeo.com/1171123936#t=3103s) Um, so we, that is our mission, and we are purpose-driven in that way. Some states have opened it up so that it could be at a 50% threshold, so that, um, owners and operators could have half private pay and half Medicaid-eligible. Um, so when we were drafting kind of a framework for consideration, we discussed a 50%. [0:52:02](https://vimeo.com/1171123936#t=3122s) And if Sunrise costs $8,000, your facility would cost 3 to 4,000? [0:52:07](https://vimeo.com/1171123936#t=3127s) So $273 a day for skilled and $175 for affordable assisted living. [0:52:14](https://vimeo.com/1171123936#t=3134s) Thank you, Madam Chair. This is a good discussion to have. Thank you. I appreciate everybody's input on this, because it is something being designed now. We're on the ground floor. We need to put what we need in it, so... Uh, Representative Seabaugh. [0:52:28](https://vimeo.com/1171123936#t=3148s) Thank you, Madam Chair. Thank you for, um, this discussion is very appropriate in my life right now. Is there a private... So this is Medicaid, I understand. Is, is, if you have private insurance and have an, uh, a senior living in an apartment independently, and she needs somebody to come in and do these services, is that available? Like, uh, visiting angel nurses or something like that. Is that- [0:52:54](https://vimeo.com/1171123936#t=3174s) There are- [0:52:55](https://vimeo.com/1171123936#t=3175s) ... kind of what this would do for our Medicaid patients? [0:52:57](https://vimeo.com/1171123936#t=3177s) No, this is a residential program, so this particular one is residential. We do have some things, um, where we do have some limited funds where you can have someone come into your house if you qualify for it, but they're very limited. So- Are you asking if we had this kind of program, would they let people come in? [0:53:18](https://vimeo.com/1171123936#t=3198s) Yeah. So- [0:53:19](https://vimeo.com/1171123936#t=3199s) Uh- [0:53:19](https://vimeo.com/1171123936#t=3199s) ... I have a constituent lives in a, in one of these progressive retirement centers where you go from a cottage to a, an apartment to an assisted living to memory care. Assisted living's full, and if you're living independently in your apartment but you need assisted living, there's nothing that I'm aware of right now that c- will come in and, and basically provide assisted living in the apartment that they live in. And assisted living are these things that we're talking about here, which is medication management, bathing- [0:53:53](https://vimeo.com/1171123936#t=3233s) Which is good [0:53:53](https://vimeo.com/1171123936#t=3233s) ... helping get their food, helping them get dressed, those kind of things. [0:53:57](https://vimeo.com/1171123936#t=3237s) But what they're, if I'm wrong, what they're talking about, they are the in-between of that, and they would provide. They don't just provide housing. They would provide all of those, but it would just strictly be to people living. They would provide the assisted- [0:54:13](https://vimeo.com/1171123936#t=3253s) In their facility. [0:54:13](https://vimeo.com/1171123936#t=3253s) Yeah, I think the distinction, um, Representative, that you're speaking about is in a private pay world, um, if I'm a senior who is not Medicaid-eligible, they have home healthcare that they can pay for or use Medicare to help fund to some extent. These are really narrowly tailored to, um, Medicaid-eligible seniors who meet certain criteria, so they get these services provided in our community. [0:54:39](https://vimeo.com/1171123936#t=3279s) Right. Well, it sounds like the same kind of community for a Medicaid population. That, that's, I guess that's what I'm- [0:54:45](https://vimeo.com/1171123936#t=3285s) Right [0:54:45](https://vimeo.com/1171123936#t=3285s) ... trying to get to. But I appreciate the discussion. Thank you. [0:54:48](https://vimeo.com/1171123936#t=3288s) Thank you. That makes me wonder [0:54:52](https://vimeo.com/1171123936#t=3292s) what kind of requirements that these progressive units have. If we've opened them up where they, they're allowed to have the progression, what they do when there's no way for somebody to move. And, you know, if you've signed up and met the requirements to live there for the rest of your life, and you need that extra help, it seems like to me, I think we need to look at that and see what happens. If that's a contractual thing, I don't remember it being added, but it would seem like in those progressive type, I mean, they, you think you're gonna live there for the rest of your life and be able to progress, that if you need a little extra help and you can't, for living independently because there's no assisted living, that they ought to be responsible for finding care. [0:55:41](https://vimeo.com/1171123936#t=3341s) Now, that's just- Mm ... what I think, and I don't want somebody from assisted living to answer that question for me today, but, but I'll be asking it, because, uh, of that. Okay, when they don't take, when they don't take all Medicaid patients- [0:55:58](https://vimeo.com/1171123936#t=3358s) Is this because they thought they couldn't fill them up? I know that when we did the assisted living, the progression, when we first opened them up, there, you know, you open a brand-new one and everybody lives in independent living or assisted living, then there isn't anybody, um, from inside that's gonna fill up your nursing home. So the way the bill was written to and make everybody happy in the nursing homes, they could, when they were brand-new, for so many years they could take a percentage of out, uh, from people from the general public that hadn't started out in their progression. [0:56:41](https://vimeo.com/1171123936#t=3401s) But after five years, everybody had to come from within house. Is that what you're doing or it, uh, with most of them so that you fill them up? The- [0:56:53](https://vimeo.com/1171123936#t=3413s) In s- in some instances you could do a startup ratio like that where you allow for private pay to move in and you have a mixed ratio of private pay versus Medicaid. Um, other states have a critical access rate, where there may be one rate for private pay and a critical access rate to really serve the Medicaid population, um, to incent service to that population. Um, so a lot of states do it, do it differently- [0:57:15](https://vimeo.com/1171123936#t=3435s) Mm-hmm [0:57:15](https://vimeo.com/1171123936#t=3435s) ... depending on demand, and we, um, are looking forward to working with DCH more to kind of drill down into that level of data and need. I will give an example about our newest community that we're opening in Ohio. So this is the first affordable assisted community purposely built to serve the Medicaid population. We are scheduled to open in April 16th. We're working with four different state agencies and the governor to make this happen. Uh, we already have a wait list of 65 seniors who are looking to move in. It's not even fully constructed yet. [0:57:45](https://vimeo.com/1171123936#t=3465s) These are Medicaid-eligible seniors who have no other options right now. So you can see that de- demand in one community in Ohio, very similarly to some of the data we've looked at in Georgia, the demand is there. [0:57:57](https://vimeo.com/1171123936#t=3477s) But you've built that for 120-something people? [0:58:00](https://vimeo.com/1171123936#t=3480s) Correct. So our, our communities, um, have 120 separate apartments or units. [0:58:05](https://vimeo.com/1171123936#t=3485s) So for a while you will be not full. [0:58:08](https://vimeo.com/1171123936#t=3488s) Correct. [0:58:09](https://vimeo.com/1171123936#t=3489s) And maybe that's why some states let- [0:58:12](https://vimeo.com/1171123936#t=3492s) Correct. There are also some owners and operators of assisted living facilities who, um, maybe have individuals who are kinda close to that tipping point for Medicaid eligibility. [0:58:23](https://vimeo.com/1171123936#t=3503s) J- [0:58:23](https://vimeo.com/1171123936#t=3503s) And so, and so, um, they may want to be able to move in private pay individuals as they spend down and then become eligible for Medicaid, those who are hovering and teetering at that poverty level. [0:58:36](https://vimeo.com/1171123936#t=3516s) All right. Yeah. Anybody else? Do we have other... Who... Oh, Representative Richardson. [0:58:44](https://vimeo.com/1171123936#t=3524s) Yes, ma'am. Uh, I think there's already some assisted living through, uh, Medicare under a, a waiver. What would this, would this compete with that? Or is it... How, uh, people that are already- [0:58:59](https://vimeo.com/1171123936#t=3539s) A waiver [0:58:59](https://vimeo.com/1171123936#t=3539s) ... in the business or? [0:59:01](https://vimeo.com/1171123936#t=3541s) I don't, I don't think we have... We don't have a current waiver that does what this does. [0:59:06](https://vimeo.com/1171123936#t=3546s) Not, not for the Medicaid population. [0:59:08](https://vimeo.com/1171123936#t=3548s) Not for the, not for the Medicaid population. They can't... In fact, did that underscore... Who, we have anybody in the audience that works for one of the... That can answer that question? Am I not... Yeah? [0:59:22](https://vimeo.com/1171123936#t=3562s) I'm Joe Hood. I'm the chief operating officer for the [0:59:24](https://vimeo.com/1171123936#t=3564s) Oh, help, I didn't recognize you with the new glasses. [0:59:27](https://vimeo.com/1171123936#t=3567s) Yes. [0:59:28](https://vimeo.com/1171123936#t=3568s) Clark, who is it? Superman, Clark, whatever his name is, you know, or something. I'm sorry, Joe, but- [0:59:34](https://vimeo.com/1171123936#t=3574s) No worries Uh, I had cataract surgery, so I got glasses for a little while. [0:59:39](https://vimeo.com/1171123936#t=3579s) Okay. [0:59:39](https://vimeo.com/1171123936#t=3579s) Um, so we have a waiver today, a home community service waiver- [0:59:44](https://vimeo.com/1171123936#t=3584s) Mm-hmm [0:59:44](https://vimeo.com/1171123936#t=3584s) ... and an individual can choose, uh, if they live in i- in an apartment or in a home setting, and if they're chosen and they w- meet all the requirements that are listed here, they could have services in that setting. We currently do not have a waiver that allows assisted living, uh, the, the state license assisted living category to utilize that because it's largely determined congregate care. Their licensure program would be different in that it is, it is set up as apartments. [1:00:14](https://vimeo.com/1171123936#t=3614s) And so it's largely apartments combined with the services that are currently in HCBS. So you would have two different things that are being proposed here. One is a new state licensure program that would be apartments with the appropriate services for the HCBS, which are likely, uh, higher than what is in assisted living. Assisted living does not require... You, you wouldn't have a skill level of care for assisted living. So if you think about tiers, you're gonna have assisted living here, this apartment is going to be here, and then nursing home is going to be there. [1:00:49](https://vimeo.com/1171123936#t=3649s) So it's, it's in the middle that, that that would be, and it's, it's just a little bit uniquely different than what we have here today. We have different tiers. When they reference to other states, assisted living in many states is synonymous with what they're describing. In Georgia, we have defined at that base level, which if you think about an assisted living community, you might go into it like a nursing home, and they would have a room, and they might have a roommate in assisted living, and it, then they'd have congregate eating and congregate areas, whereas this is a, an apartment complex, much like independent living is set up, but the services would be there to accommodate HCBS. [1:01:26](https://vimeo.com/1171123936#t=3686s) I hope that helps. [1:01:27](https://vimeo.com/1171123936#t=3687s) Yes. All right. So right now we don't have a way that a Medicaid patient can enter our current assisted livings? Okay. They have ta- somebody may have talked to you about it because, uh, they have approached me that maybe some of the assisted livings might have some openings, the re- our as- assisted livings, and why couldn't somebody on Medicaid use those? And so far that hasn't gone anywhere. [1:01:59](https://vimeo.com/1171123936#t=3719s) Somebody telling you different? [1:02:01](https://vimeo.com/1171123936#t=3721s) No. [1:02:02](https://vimeo.com/1171123936#t=3722s) Or- [1:02:02](https://vimeo.com/1171123936#t=3722s) Uh, that, that there's something out there, alternative living services? [1:02:09](https://vimeo.com/1171123936#t=3729s) I don't... We'll have to look into it. It's not- [1:02:11](https://vimeo.com/1171123936#t=3731s) I'm not- [1:02:12](https://vimeo.com/1171123936#t=3732s) Joe knows all about how they work, so anyway, that, I don't know about the altern- alternative living centers. Are there other questions? [1:02:22](https://vimeo.com/1171123936#t=3742s) Okay. Um, hearing none, thank you very much. [1:02:28](https://vimeo.com/1171123936#t=3748s) Thank you very much for hearing this, and I look forward to good discussions out of session. Thank you. [1:02:33](https://vimeo.com/1171123936#t=3753s) Okay. And we appreciate you coming, and let us know when you're having these meetings over the summer. Do they have to be all the way down in Thomasville? [1:02:42](https://vimeo.com/1171123936#t=3762s) No. [1:02:42](https://vimeo.com/1171123936#t=3762s) I'm teasing. I'm te- Thomasville, if you haven't been there, is a wonderful city. Unfortunately, it's just below the net line like so. But it's a great little town who's certainly shown what small communities and their hospital is excellent, and they're really doing new and different things, so it is a great place to visit. Okay. Dr. Kirkpatrick, are, have you, are you in a h- wait, wait, wait, wait. I really need to let another group go. [1:03:12](https://vimeo.com/1171123936#t=3792s) Are you in a hurry to get back to another committee or? [1:03:16](https://vimeo.com/1171123936#t=3796s) Got someone else running my committee that I trust. [1:03:18](https://vimeo.com/1171123936#t=3798s) Oh, come on. Come on. Okay. Come, come forward. This is on House Bill or Senate Bill 535. I will tell the committee, we don't really need to spend a, I- If it's your will, we don't need to spend a lot of time on this. We moved exactly the same bill out. It was my bill. It's on, uh, making some changes to the community service board, and I guess they got worried about who was gonna move it where, and so they dropped it on both sides. [1:03:48](https://vimeo.com/1171123936#t=3828s) And Commissioner, welcome. We don't need to go over it line by line again, but we're glad to have you. All right, Senator, go ahead. [1:03:56](https://vimeo.com/1171123936#t=3836s) Thank you so much. I brought my friend, Commissioner Tanner, over here. You guys may have met him before. This bill is a department bill, and it has to do with the collaborative process between DBHDD, the CSB CEOs, and, um, others. And basically, it's a reorganization of the governance structure of the CSBs. Um, I got here in 2017, and there have been problems with consistency of the CSBs, depending on where you are in the state, for years. [1:04:32](https://vimeo.com/1171123936#t=3872s) And so this is an effort to bring some standardization and consistency to the procedure. I know you've already heard the details, so I won't go through all that unless you want me to. And, uh, Commissioner Tanner is available for questions also. [1:04:48](https://vimeo.com/1171123936#t=3888s) Okay. Uh, just so you remember what we did, we allowed him to hire an executive director that would be a, a state employee. Um, it could come, he could choose somebody within the CSB. Uh, and if it did, there's all sorts of, uh, protection of moving any retirement they had over, uh, as they move to a state employee. That person is on the board of the CSBs. Uh, they're trying to make sure that the CSBs across our state at least have a basic level of everybody, uh, meeting certain basic needs, but then they, if they wanna go above and beyond it, they can do it, and it's basically oversight. [1:05:34](https://vimeo.com/1171123936#t=3934s) So with that, Commissioner, you wanna add anything? [1:05:36](https://vimeo.com/1171123936#t=3936s) The only thing I'll say is we work closely with ACCG. The county commissioners appoint the boards. ACCG has sent a letter to you supporting this legislation. We also work very closely with the CSB Association, who represents the boards and the CEOs of the CSBs. They also voted to support this legislation. Um, I know, uh, Kim Jones is here, and, and I know she signed up to speak, but she represents the organization made up of 130 different, uh, mental health organizations in the state. They also have voted to support this legislation. [1:06:08](https://vimeo.com/1171123936#t=3968s) I think to both Senator Kirkpatrick and r- uh, Chair Lady Cooper's point, um, this is, uh, something in an effort to bring every level of care up to the same standard regardless of the zip code, and it's exactly the same bill as you passed out of this committee two weeks ago in House Bill 1368, and it passed the House last Wednesday with two no votes. So it's the same legislation, no changes. [1:06:32](https://vimeo.com/1171123936#t=3992s) Okay. Questions from the committee. Representative Hilton. [1:06:36](https://vimeo.com/1171123936#t=3996s) Madam Chair, um, there was a woman who testified, uh, two weeks ago. I believe she was with GCDD. I, I don't know if she's in the audience. Uh, do they still have concerns or... I know they expressed concerns at the time in the meeting. [1:06:49](https://vimeo.com/1171123936#t=4009s) Um, I can't speak to th- their concerns specifically. I can tell you there are some folks here that have signed up to speak that can discuss those issues and why they don't believe they should be concerned. [1:07:01](https://vimeo.com/1171123936#t=4021s) There was a question that came up, and I thought it was a good one. I just wanted to revisit it. Um, so the executive director will be hired through your office, and then the board itself will elect a chairperson. How do you... I guess the question was around kind of areas of potential conflict, where you're sort of telling the executive director one thing, the board is telling the chairperson another. How does that get resolved in, in your mind? [1:07:25](https://vimeo.com/1171123936#t=4045s) Yeah. So c- currently, the d- we've had to take over, uh, two CSBs this past calendar year, uh, that failed financially at a cost to the state of several million dollars. We have another one that we're real close for that happening. So the state's the primary funder of most of our CSBs. We've had, uh, we've operated the Gateway CSB. Ashley Allen, who's here today, is the CSB on the coast, um, and she works directly for our agency, and we haven't run into any issues, uh, in that at all. [1:07:57](https://vimeo.com/1171123936#t=4077s) That's why we work very closely with the CSB Association that represents those boards. The legislation we originally drafted versus what's in front of you today is much different because we really had to craft and thread that needle to address those issues. [1:08:11](https://vimeo.com/1171123936#t=4091s) Well, I hope it was nobody from the house that did that to you. [1:08:14](https://vimeo.com/1171123936#t=4094s) It's cancer and getting some of it cut out yesterday, so- [1:08:17](https://vimeo.com/1171123936#t=4097s) Good [1:08:17](https://vimeo.com/1171123936#t=4097s) ... yeah. [1:08:18](https://vimeo.com/1171123936#t=4098s) Good. Good. Okay. [1:08:20](https://vimeo.com/1171123936#t=4100s) That answer your question? [1:08:21](https://vimeo.com/1171123936#t=4101s) Yes, ma'am. [1:08:21](https://vimeo.com/1171123936#t=4101s) Okay. All right. Okay, Representative Oliver. [1:08:26](https://vimeo.com/1171123936#t=4106s) We have a very good and strong and stable CSB in DeKalb County with a lot of DeKalb County cooperation. But I'm very happy to see this bill. I happen to remember the early stages of House Bill 100, and I think that the energy that we've spent over the last decades to try to equalize things without a, um, direct responsibility, without direct power to do so, has been a lot of wasted energy. I feel like this is really gonna benefit a lot of the more rural areas of the state and provide greater cohesiveness and connectivity for the mental health services that we need across the state. [1:09:04](https://vimeo.com/1171123936#t=4144s) So I'm happy to see it come forward. Thank you. [1:09:08](https://vimeo.com/1171123936#t=4148s) Thank you. Okay, Representative Drenner. [1:09:11](https://vimeo.com/1171123936#t=4151s) Thank you, Madam Chair. Uh, Commissioner, I apologize for being late. I, I know a couple of weeks ago I did ask this question about House Bill 1368, and you do know I'm in DeKalb as well. I, and my question was specifically around the execute- the executive director, and how could you terminate an executive director? In this bill, is, has that been addressed in a different way than in the House bill version? [1:09:39](https://vimeo.com/1171123936#t=4179s) No, ma'am. It's the same exact language that passed this committee and the House. It's the same. [1:09:45](https://vimeo.com/1171123936#t=4185s) Okay. [1:09:45](https://vimeo.com/1171123936#t=4185s) Yes, ma'am. [1:09:45](https://vimeo.com/1171123936#t=4185s) Thank you. [1:09:46](https://vimeo.com/1171123936#t=4186s) Yes, ma'am. [1:09:47](https://vimeo.com/1171123936#t=4187s) Okay. Uh, that's all. I know we have people. Um, I- all right, uh, Kim Jones with NAMI, if you... [1:09:58](https://vimeo.com/1171123936#t=4198s) Yes. So I will be brief. Kim Jones, Executive Director of NAMI Georgia. I'm also a member of the Behavioral Health Reform and Innovation Commission that came out in Jul- 2019, and then also co-founder of the Georgia Mental Health Policy Partnership, and I've left that information in your packets. I just wanna say this is something that we've discussed in the Behavioral Health Reform and Innovation Commission Access Committee multiple, multiple times over the several years. It continues to be a problem, um, at the CSB level. I've had another NAMI state past ED, whose son is here, who had three different days trying to get up at 6:30 in the morning, 'cause you had to be in line to be able to be served, and if you didn't get there in time, you had to come back the next day. [1:10:41](https://vimeo.com/1171123936#t=4241s) If you know about mental health, the medication that many of our people are on, um, don't allow you to get up early very easily. So, um, I also just wanted to thank the board, or to say that I do believe how they handled the community part of it with the advisory board at the community level still keeps it grassroots. NAMI is similar. We have a national, a state, and then a local organization, which we have guidelines, business guidelines we have to follow. So I see this as very similarly, and just ask for your support. [1:11:12](https://vimeo.com/1171123936#t=4272s) Thank you. [1:11:14](https://vimeo.com/1171123936#t=4274s) And I think as a member on the floor, and I'm sure we've had so many bills, that one of the things I'd share is, there will be education. 'Cause a lot of this is like our small hospitals, and the boards that were over them, really good people from the community were on the boards, but they didn't know anything about running a hospital or running a CSB. But they wanted to serve the community, they stepped up. And so we had to pass and require that people do continuing education on how to run a hospital. [1:11:45](https://vimeo.com/1171123936#t=4305s) And it really made a difference in our small hospitals. And so there is a continuing education key to this, trying to help the boards help themselves and do better governance, uh, going along. Uh, Roland Bam? Bam? I can't think. [1:12:02](https://vimeo.com/1171123936#t=4322s) Bam, like Bam. [1:12:03](https://vimeo.com/1171123936#t=4323s) Pardon? [1:12:04](https://vimeo.com/1171123936#t=4324s) Like name, Bam. [1:12:05](https://vimeo.com/1171123936#t=4325s) Bam, okay. [1:12:06](https://vimeo.com/1171123936#t=4326s) Yes. [1:12:06](https://vimeo.com/1171123936#t=4326s) Got it. [1:12:08](https://vimeo.com/1171123936#t=4328s) Madam Chair, members of the committee, uh, I'll also try and keep my remarks brief. Uh, I wanted to dive into Representative Hilton's, uh, questions, uh, that were raised at the last hearing concerning this sort of, um, perhaps inconsistency between DBHDD and CSBs. And what I wanted to say is that there were four, uh, issues that, uh, the group had raised, uh, that there would be sort of critical incidents in which maybe DBHDD be c- would be considered investigating itself, uh, that there would be the now comp letters of agreement in which DBHDD would be contracting with itself, uh, issues involving the chain of command, and also issues involving property ownership. [1:12:55](https://vimeo.com/1171123936#t=4375s) And I can understand, um, if you're not sort of fully engaged with the act, uh, that those are relevant concerns. But you need, n- you need, I would suggest, uh, stepping back and realizing that nothing in this bill or in the one that you passed, uh, earlier, uh, results in the CB- CSBs going away. The CSBs continue to remain separate legal entities, state corporations, and they have the rights that those state corporations are provided for in the statute. [1:13:27](https://vimeo.com/1171123936#t=4407s) So they can own property, they can have employees, uh, they can manage their, their system along with the regulations that we're sitting in here. So it, uh, it, it sounds like one, some may argue, a form over substance, but the form is appropriate, necessary, and legal, which is DBHDD still remains DBHDD, CSBs still remain separate legal entities, and then there are relationships among this. Um, perhaps an example that, you know, y'all might be familiar with is the Georgia Housing and Finance Authority, uh, remains a public corporation with its own powers, even though the code assigns a state official, uh, the Commissioner of Community Affairs, as its executive director. [1:14:10](https://vimeo.com/1171123936#t=4450s) And SB th- five thirty-five follows this model. So in short, uh, I believe that SB five thirty-five strengthens top-line accountability, uh, through the executive director role, but it does not collapse CSBs into DBHDD, convert the CSB workforce into state employees, or transfer CSB property to the department. Thank you. [1:14:32](https://vimeo.com/1171123936#t=4472s) Okay [1:14:35](https://vimeo.com/1171123936#t=4475s) Um, did you ask that question last time? I don't think so. I think you muddied the waters. [1:14:42](https://vimeo.com/1171123936#t=4482s) It's a smart question. I bet I did. So you're, you're in support of it? [1:14:45](https://vimeo.com/1171123936#t=4485s) Yes, sir, I guess. [1:14:45](https://vimeo.com/1171123936#t=4485s) I, I was confused 'cause, I mean, you started out talking about how DVHD investigates DV, you know, all those sort of conflict- [1:14:52](https://vimeo.com/1171123936#t=4492s) Yes, sir [1:14:52](https://vimeo.com/1171123936#t=4492s) ... gray areas did not sound good to me. But you're okay with those? [1:14:56](https://vimeo.com/1171123936#t=4496s) Yeah. Those gray areas were the ones that, uh, the, uh, organization that testified had raised as potential problems, uh, with the House bill that you passed that mirrors this. [1:15:09](https://vimeo.com/1171123936#t=4509s) And those issues have been resolved? [1:15:11](https://vimeo.com/1171123936#t=4511s) Well, um, [1:15:14](https://vimeo.com/1171123936#t=4514s) uh- [1:15:14](https://vimeo.com/1171123936#t=4514s) The association [1:15:14](https://vimeo.com/1171123936#t=4514s) The associations voted to be in favor of this bill. The C- C, community service boards. [1:15:21](https://vimeo.com/1171123936#t=4521s) It's the development, um, GDD. [1:15:24](https://vimeo.com/1171123936#t=4524s) And they did? [1:15:25](https://vimeo.com/1171123936#t=4525s) Do send the email. [1:15:27](https://vimeo.com/1171123936#t=4527s) Oh, sorry. GCDD had raised the concerns, and they're appropriate. I was responding to those claims. So my apologies- [1:15:35](https://vimeo.com/1171123936#t=4535s) Right [1:15:36](https://vimeo.com/1171123936#t=4536s) ... for the miscommunication. [1:15:37](https://vimeo.com/1171123936#t=4537s) Who's telling you the answer to that? Could they stand up, and are they somebody with that board? [1:15:42](https://vimeo.com/1171123936#t=4542s) No, they are not. I, but don't believe that GCDD is here. I'm responding to their telling. [1:15:49](https://vimeo.com/1171123936#t=4549s) Okay. Remember the, the little lady that spoke at the end who was concerned about the homes where, um, those with disabilities live in our community? Okay. [1:16:00](https://vimeo.com/1171123936#t=4560s) Thank you, ma'am. [1:16:00](https://vimeo.com/1171123936#t=4560s) So those, those have been resolved are their concerns. Thank you. [1:16:04](https://vimeo.com/1171123936#t=4564s) No. [1:16:05](https://vimeo.com/1171123936#t=4565s) And name, who are you with? [1:16:06](https://vimeo.com/1171123936#t=4566s) Roland Boehm, and I'm also with the Georgia Mental Health Policy Partnership and a past chair of the American Foundation for Suicide Georgia Chapter. [1:16:14](https://vimeo.com/1171123936#t=4574s) Thank you. [1:16:15](https://vimeo.com/1171123936#t=4575s) Thank you. Thank you, Chair. [1:16:16](https://vimeo.com/1171123936#t=4576s) Okay. Okay. Need somebody to s- okay, got it. Okay. Brandi O'Reilly. Brandi O'Reilly. [1:16:29](https://vimeo.com/1171123936#t=4589s) Hi. I'm not here with anybody. I'm just a mom. So I am in favor of this. Um, good afternoon, Chair Lady Cooper, members of the community. Thank you for allowing me to speak today. Um, my name is Brandi O'Reilly. Like I said, I am a mom. My son's name is Gavin, and he lives with my husband and me in Kennesaw. Gavin receives a NOW waiver for community support services, behavioral support. Um, he's been diagnosed with autism, anxiety disorder, OCD, PTSD. [1:17:05](https://vimeo.com/1171123936#t=4625s) Um, in Georgia, we often hear that your zip code shouldn't determine whether you can access critical services. But in our case, it did. My local CSB, um, failed my child. There was a time not too long ago, um, we were desperate for help. Like many families in Georgia, our journey to find the right services for Gavin has not been easy. In 2024, Gavin needs stabilization services to help manage his medications. [1:17:36](https://vimeo.com/1171123936#t=4656s) We also needed respite care, and Gavin needed coordinated services from the community. So I did, um, what the system tells you to do. I reached out to our local community services board, um, for support, but they did not have any services for Gavin. Um, because those supports weren't available in our community, Gavin just became another person that fell through the cracks. When we were looking for a CSB to help, Gavin bounced between emergency rooms, and he actually spent, sorry, an entire year hospitalized away, hours from my house. [1:18:18](https://vimeo.com/1171123936#t=4698s) At one point, he was transferred to a private institution without me, his legal guardian, even being notified. When I was finally able to take my son home, he was bruised, filthy, deeply traumatized, and as a parent, that's something you never forget. Instead of getting help in our community, we had to look outside of it. Um, the state helped me connect with another CSB that was willing to serve Gavin, but it was hours away, and that meant using, um, paying for lodging out of pocket and long drives every day. [1:18:56](https://vimeo.com/1171123936#t=4736s) So I went from Kennesaw to Gainesville, Georgia, um, stayed there until my money ran out, and then drove there every day. I was commuting for hours just to make sure my son could receive the care and support he needed. No family should have to do that to get help for their child. What I want for most families like mine is simple. I want Gavin to feel wanted. I want him to know that when he needs support, there is a safe spla- safe place for him to land, and a place that will not turn him away. [1:19:28](https://vimeo.com/1171123936#t=4768s) As a parent, I will always fight for my son, but the reality is that my husband and I will not always be here to advocate for Gavin. One day, the system will have to speak for him. That's why accountability matters. Community service boards exist to serve people like my son, and when CSBs fail to provide those services, there must be accountability so that families aren't left scrambling, searching, and driving hours just to help. SB 535 is about making sure that people like Gavin are not left behind. [1:20:03](https://vimeo.com/1171123936#t=4803s) This bill would keep CSBs accountable if they fail to serve individuals with intellectual and developmental disabilities. SB 535 makes sure that your zip code does not matter. Families like mine should not have to wonder whether our children would have received help sooner had we lived somewhere else. My son Gavin deserves that. Every person like him deserves that. Um, thank you for your time in considering SB 535. [1:20:31](https://vimeo.com/1171123936#t=4831s) Ms. O'Reilly, thank you for being- [1:20:34](https://vimeo.com/1171123936#t=4834s) Yeah [1:20:34](https://vimeo.com/1171123936#t=4834s) ... a very involved mother and- [1:20:36](https://vimeo.com/1171123936#t=4836s) Mm-hmm [1:20:36](https://vimeo.com/1171123936#t=4836s) ... for advocating for your son. I We've come a long way in the last few da- da- the few years. I will say that the commissioner, Kim, who you heard speak, the advocates for mental health, and it started with Teeka Ralston, who's now deceased, and our current speaker has continued. We are moving to try to e- really improve and give quality care to our patients that are mentally ill. [1:21:07](https://vimeo.com/1171123936#t=4867s) It's a long journey. [1:21:08](https://vimeo.com/1171123936#t=4868s) Mm-hmm. [1:21:09](https://vimeo.com/1171123936#t=4869s) We don't have as many trained people as we need. [1:21:13](https://vimeo.com/1171123936#t=4873s) I have some ideas. [1:21:14](https://vimeo.com/1171123936#t=4874s) Oh, you do? [1:21:15](https://vimeo.com/1171123936#t=4875s) Yeah. [1:21:16](https://vimeo.com/1171123936#t=4876s) I have to get you with the commissioner and our- your legislator from up in where- [1:21:21](https://vimeo.com/1171123936#t=4881s) I'm in Kennesaw. Yeah. [1:21:22](https://vimeo.com/1171123936#t=4882s) Kennesaw? [1:21:22](https://vimeo.com/1171123936#t=4882s) So- [1:21:23](https://vimeo.com/1171123936#t=4883s) Okay [1:21:23](https://vimeo.com/1171123936#t=4883s) ... I have, um, Lisa Campbell and Ed Setzler are my representatives. [1:21:27](https://vimeo.com/1171123936#t=4887s) Okay. I would suggest you talk to Eddie and come talk to me anytime. [1:21:31](https://vimeo.com/1171123936#t=4891s) Okay. [1:21:31](https://vimeo.com/1171123936#t=4891s) We're taking those and sharing them with other people and really trying to make a difference- [1:21:36](https://vimeo.com/1171123936#t=4896s) Mm-hmm [1:21:36](https://vimeo.com/1171123936#t=4896s) ... and appreciate everything you do for your son. And by sharing with us, helping other parents- [1:21:43](https://vimeo.com/1171123936#t=4903s) Mm-hmm [1:21:43](https://vimeo.com/1171123936#t=4903s) ... with children that need help across the state of Georgia. [1:21:46](https://vimeo.com/1171123936#t=4906s) Oh. [1:21:46](https://vimeo.com/1171123936#t=4906s) Thank you very much. [1:21:47](https://vimeo.com/1171123936#t=4907s) Thank you. [1:21:49](https://vimeo.com/1171123936#t=4909s) And one last person, Ashley Allen. Oh, okay. Thank you. That's it. All right. Uh, any other... Oh, hi. Okay. Representative Oliver. [1:22:03](https://vimeo.com/1171123936#t=4923s) Just wanna, uh, request a opportunity to make a motion if the chair is ready. [1:22:09](https://vimeo.com/1171123936#t=4929s) Um, yes, sir. [1:22:10](https://vimeo.com/1171123936#t=4930s) Well, now I've, now's the time, so. [1:22:13](https://vimeo.com/1171123936#t=4933s) I move to due pass of 535. [1:22:15](https://vimeo.com/1171123936#t=4935s) Okay. And Teddy, Teddy sec- uh, Teddy seconds it. Uh, is there any other questions or discussion among my members? Uh, seeing none. Everybody... Okay, do you need it? [1:22:28](https://vimeo.com/1171123936#t=4948s) I, yeah, I'm probably beating a dead horse here. I, I, I, th- the second time hearing this, it's kinda prompted more questions. I, I get that there's bad actors out there, and we've had some really bad situations. I just wanna make sure we're not bringing a sledgehammer to a f- fly, you know? And, and it just seems, uh... I'm, I'm concerned that the CSBs might lose some sense of independence, um, a- and, and what we're doing here with the legislation. [1:22:54](https://vimeo.com/1171123936#t=4974s) Yeah, and that's a good point. That's actually the exact terminology they used, uh, originally when they saw the first draft- [1:23:00](https://vimeo.com/1171123936#t=4980s) Mm [1:23:00](https://vimeo.com/1171123936#t=4980s) ... of the bill. And we met with, they formed an ad hoc committee that met with us, and we really brought the bill down to where everyone felt like it was in a much better place. Um, so that's why the CSB Association agreed to, uh, voted to support the legislation. Uh, governor approached me about three years ago after taking this job and said to me, he said, "We need to find a way to get some additional controls over the CSBs, uh, 'cause we spend a wh- millions and millions of dollars." And you just heard the lady speak. Uh, we hear those stories. [1:23:31](https://vimeo.com/1171123936#t=5011s) I have legislators, county commission chairs come into my office all the time. That, this is our safety net- [1:23:36](https://vimeo.com/1171123936#t=5016s) Mm-hmm [1:23:36](https://vimeo.com/1171123936#t=5016s) ... of the system. [1:23:37](https://vimeo.com/1171123936#t=5017s) Mm-hmm. [1:23:37](https://vimeo.com/1171123936#t=5017s) It cannot fail. [1:23:39](https://vimeo.com/1171123936#t=5019s) Yeah. [1:23:39](https://vimeo.com/1171123936#t=5019s) And right now it has to basically be a bankrupt system before I have the ability to do anything, and this is gonna make a huge difference. Um, it's gonna save a lot of lives in the long run. Um, those of us who've been working on this for the last seven years, I know, uh, Representative Oliver's been in that fight, uh, Kim Jones has been in that, Roland and others. Uh, we've talked about this for seven years, and this is a very carefully crafted piece of legislation. [1:24:03](https://vimeo.com/1171123936#t=5043s) Okay. I wanna thank that mom, too, for, that was... Thank you for sharing. Thank you. [1:24:11](https://vimeo.com/1171123936#t=5051s) Who we got? Oh, Representative Howard. [1:24:13](https://vimeo.com/1171123936#t=5053s) Madam Chairman. Thank you, uh, Commissioner and Senator. I was trying to resist not saying anything, but just to mark him, thank you for this bill. I've had several incidences where we needed this. Uh, we need some consistency across the state, so I think this is gonna, this is gonna help us a lot. [1:24:31](https://vimeo.com/1171123936#t=5071s) Thank you. [1:24:31](https://vimeo.com/1171123936#t=5071s) Thank you. [1:24:32](https://vimeo.com/1171123936#t=5072s) Thanks, Mr. Howard. [1:24:33](https://vimeo.com/1171123936#t=5073s) And I, I think you'll remember that I said one group was on the edge of bankruptcy and didn't have money to meet payroll, and they had just given the person that had been running them 130, I think it was $132,000 a year for life. And then when they talked to him about they couldn't meet budget, they still said, "Well, we need to give her more money." And it's just not about money. Cobb County almost lost ours. Uh, and we're a big county, and you, we usually run things pretty well. [1:25:04](https://vimeo.com/1171123936#t=5104s) And literally, uh, it, it was sort of a forced takeover, um, because, you know, every county wants to run their own stuff or, you know, you never want change. But a very popular doctor, his s- son had been voted in by the board to run it, and he ran it all right into the ground. And we came within just... We all met as representatives, and they finally agreed to go with another CSB that had been trying to help them get out of the hole. [1:25:35](https://vimeo.com/1171123936#t=5135s) So it is a problem, not just small, not just urban, but big ones, too. All of our state have run into major problems, and this is a chance to try to get some consistency and keep them solvent and have them offer, uh, the services they need to offer. We have one area, I will tell you, that the person that runs it, okay here, Commissioner, I can't stand it, that doesn't like the fact and won't take. [1:26:08](https://vimeo.com/1171123936#t=5168s) We won't, uh, it will not take, and the most seriously ill that really need, uh, to be in treatment 24 hours a day for a while, because when you have that kind of patient, you do need to have security, and the person running it doesn't like the fact that you have to have security. So therefore, that area doesn't offer that service to some of our most needy people. And so this would help correct some of that. [1:26:40](https://vimeo.com/1171123936#t=5200s) It's where maybe even personal things were getting in the way of the kind of service that we ordered And so with that, I don't see any more comments. I have a motion, uh, on to due pass and a second on due pass, and I am going to call the thing. So everybody in the favor of the passage of Senate Bill, uh, 535, say aye. [1:27:05](https://vimeo.com/1171123936#t=5225s) Aye. [1:27:05](https://vimeo.com/1171123936#t=5225s) Anyone opposed, no. So the ayes have it. Thank you very much. And Commissioner, thank you for coming and for the bill. And thank you, Senator Kirkpatrick, for coming. I'm not-- I have taken your other bill off the thing. I understand that somebody wants to add another word or two or something in the amendment. [1:27:25](https://vimeo.com/1171123936#t=5245s) I'm ready to present it if you all wanna call it off the table. [1:27:29](https://vimeo.com/1171123936#t=5249s) Yeah. [1:27:29](https://vimeo.com/1171123936#t=5249s) Or I can come back another day. [1:27:31](https://vimeo.com/1171123936#t=5251s) I do. We have s- we have another group and I will come back another day and see us. [1:27:35](https://vimeo.com/1171123936#t=5255s) Okay. [1:27:35](https://vimeo.com/1171123936#t=5255s) Thank you very much for coming. Okay. Um, I'm the sponsor of the next bill. Here again, this is one I think you just need to hear that's gonna be worked on over the service, uh, call Brent Walker, who is, uh, with MAG, the Medical Association of Georgia, and he can introduce his person. One of the things is we keep trying to work on quality care. And one of the problems when we started collecting data all over the country, the feds gave people a choice of what kind of system they wanted to use for collecting data. [1:28:11](https://vimeo.com/1171123936#t=5291s) So there are all multiple systems. And the systems don't talk to each other. And even the ones that collect what the insurance company pay, they don't really tell us what was ordered and what the clinical status was. And we now, as things go, have a way of putting those together. Uh, and this is what th- they would present and what we might be working on over the summer for House Bill one zero two. So Brent, Brent, introduce yourself even more. [1:28:46](https://vimeo.com/1171123936#t=5326s) Thank you, Madam Chair. I appreciate the introduction. My name is Brent Walker. I'm General Counsel for the Medical Association of Georgia, uh, and also the Director of Government Relations for the Medical Association. And, uh, today I have the enviable, enviable job of acting as your MC for the hearing on House Bill one zero two. Um, we have four people here to testify about what the nature of the issue is here within the state of Georgia currently, and a couple of guests that are gonna join us via Zoom to talk about what the solutions look like in other states, and hopefully they are still there. [1:29:20](https://vimeo.com/1171123936#t=5360s) Um, but House Bill one zero two is legislation that would establish the Georgia Quality Reporting Project. Georgia collects an enormous amount of healthcare data. I mean, we collect claims data through the All Payer Claims Database. We collect quality reports from the payers. We collect program-specific measures across Medicaid and other lines of business. But too often these data streams live in separate silos. The claims data tells us what was billed and paid for, and the clinical data tells us what actually happened in the exam room. [1:29:54](https://vimeo.com/1171123936#t=5394s) HB one zero two is about bringing those two worlds together, combining clinical data and claims data in a standardized, nationally recognized way to calculate quality measures and opioid treatment metrics at the state level. If we truly want to paint a picture of-- an accurate picture of healthcare in the state of Georgia, especially within Medicaid, we must move beyond fragmented reporting and towards integrated outcome-focused quality measurements. This bill is not about creating new burdens for our healthcare workforce or our institutions. [1:30:25](https://vimeo.com/1171123936#t=5425s) The intent is to leverage standardized electronic clinical quality measures and combine them with claims data in a way that improves accuracy, transparency, and accountability. We can't improve what we can't measure clearly, and we can't measure clearly if we are only looking at half the picture. With that, I have Mike Gable with us from Thomasville, which, uh, had quite a few compliments earlier. Uh, he's gonna help us understand the administrative burdens, uh, that are faced by practices here within the state. [1:30:57](https://vimeo.com/1171123936#t=5457s) Uh, Mr. Gable is the CEO of McIntosh Clinic in Thomasville, and hopefully he will help us understand how these reporting requirements affect physician-owned practices on the ground, including staffing time, attribution challenges, and the delayed feedback loops that we're experiencing that have direct impacts on our patients on a daily basis. Mr. Gable. [1:31:17](https://vimeo.com/1171123936#t=5477s) Um, Madam Chair and members of the Public and Community Health Committee, thank you for the opportunity to be-- appear before you today. My name is Mike Gable, and I serve as the Chief Executive Officer of McIntosh Clinic, a physician-owned multi-specialty practice in Thomasville that has cared for families across Thomas County and surrounding Southwest Georgia communities since nineteen ninety-three. Because we deliver a high volume of primary care and participate in multiple quality and value-based programs, my team deals with the day-to-day reality of quality data collection, chart abstraction, documentation chasing, and measure work that often happens after the patient visit ends. [1:31:50](https://vimeo.com/1171123936#t=5510s) I'm here to share what that administrative burden looks like and how it pulls staff time o- staff time and resources away from patient care. McIntosh Clinic's Internal Medicine Department currently has thirteen clinical staff members. That staff supports our physicians' efforts to meet quality goals across eighteen programs and more than forty-six hundred attributed patients. The problem they face is the lack of standardization across programs. From measures included in each payer scorecard, the various ways patient attribution is tracked, and the way the payers want quality reported. [1:32:21](https://vimeo.com/1171123936#t=5541s) The payers often do not finalize and deliver their measures lists and target thresholds until well into the new measurement year, sometimes as late as May. And even after we have done the work, reporting updates on those measures can lag another two to three months on quality measures and three to six months for financial reporting. In essence, we are trying to improve performance without timely feedback or confirmation that the patients and services are being credited to us accurately. Attribution methods are another sore spot for practices, with some payers attributing patients to our physicians when there is no existing relationship, instead of using historical claims data to see where those patients are receiving their care. [1:32:55](https://vimeo.com/1171123936#t=5575s) We have one payer that has attributed a group of patients in suburban Atlanta to one of our physicians in Thomasville. We have never seen these patients, yet we are still held responsible for their compliance with those measures. Many payers will not remove these patients even when we document that there is no relationship. We even have some payers that hold us responsible for the performance of all patients we see in our clinic, regardless of their insurance type. We have payers that measure our quality based on claims data, which can run up to 12 weeks behind, some that will take information in the form of an Excel spreadsheet, some that want the pertinent document uploaded to their secure portals, and even one that wants us to duplicate the same information via a tablet. [1:33:33](https://vimeo.com/1171123936#t=5613s) Even though we work to get them this information conveyed to the various payers, we often have no information back to determine if the payer has processed it correctly or not. The lack of standardization and timeliness leads to a loss in patient-facing time due to our annual training of staff on new and revised measures, chasing down documents from other providers such as specialists, labeling documents correctly so that the measure is counted as compliant, reviewing lists of non-compliant patients that are actually excluded due to other factors, and duplicating work completed because the payer has yet to update our compliance rates. [1:34:05](https://vimeo.com/1171123936#t=5645s) All this work manifests itself weekly when all 13 of my primary care clinical staff members use the four hours after lunch on Friday to get caught up on their outstanding quality measures, a total of 52 staff hours a week outside of the daily work that is required. Time spent on these measures is time that could be better spent getting our patients the care they need by completing prior authorizations, responding to patient issues, or preparing patient visits for the following week. Thank you. [1:34:30](https://vimeo.com/1171123936#t=5670s) Okay. But first, can you put that in h- in understandable terms for us? [1:34:35](https://vimeo.com/1171123936#t=5675s) Sure. [1:34:36](https://vimeo.com/1171123936#t=5676s) Can you walk us through a patient and what these entities that are asking for this, give us an example of what they need for you to t- what quality measures they need for you to tell them, and what they're looking for- [1:34:52](https://vimeo.com/1171123936#t=5692s) Yeah [1:34:52](https://vimeo.com/1171123936#t=5692s) ... and where does it go, and what do they do with it? [1:34:55](https://vimeo.com/1171123936#t=5695s) Well, I couldn't, I can't tell you what they do with it. That is probably part of the problem. [1:34:59](https://vimeo.com/1171123936#t=5699s) They pay you, don't they? [1:35:00](https://vimeo.com/1171123936#t=5700s) I'm sorry? They do, yeah. [1:35:01](https://vimeo.com/1171123936#t=5701s) Don't they write you? [1:35:01](https://vimeo.com/1171123936#t=5701s) So they, at the end of the year, we end up with a percentage that, that, uh, can affect a payout based on our quality measures. Um, take a diabetic, for example. Uh, you've got an eye exam, you've got an A1C. So the eye exam has to be scanned into the system and, and uploaded to their system. The A1C goes through claims data. So- [1:35:21](https://vimeo.com/1171123936#t=5721s) The A1C is what? [1:35:22](https://vimeo.com/1171123936#t=5722s) Is their, uh, measure of their glycohemoglobin in their blood. It's, it's a measure of how bad their diabetic, diabetes is. [1:35:30](https://vimeo.com/1171123936#t=5730s) It's a blood test. [1:35:31](https://vimeo.com/1171123936#t=5731s) It's a blood test. [1:35:31](https://vimeo.com/1171123936#t=5731s) And that goes somewhere else. [1:35:33](https://vimeo.com/1171123936#t=5733s) Yeah, so, so... Well, and, yeah, and it goes through claims data. So at the following month, I may know, I may get it back that Ms. Johnson has had her A1C done, but they haven't checked off the eye exam yet. So then I've got a new report, and I've got to sit down again and go, "Hey, Gina, Ms. Johnson hasn't had her eye exam yet." And she goes, "Yes, she did. It's right here." So we d- we're duplicating a lot of work d- trying to track down whether something has been completed or not. And diabetes is just an easy one. I mean, we have, there's congestive heart failure measures, there's obesity measures. There's all sorts of them, depending on the payer. [1:36:05](https://vimeo.com/1171123936#t=5765s) Okay. All right. Questions from the committee. [1:36:10](https://vimeo.com/1171123936#t=5770s) Okay. What? Oh, somebody's ready on... Oh, A- Azar, is that one of ours? Who's this? No. Uh, Gilliard, uh, that, is ready. Can we finish- [1:36:23](https://vimeo.com/1171123936#t=5783s) Austin Gilliard [1:36:23](https://vimeo.com/1171123936#t=5783s) ... this? They're ready to go. Can he hold for a minute? Can he hold? [1:36:28](https://vimeo.com/1171123936#t=5788s) Yes. [1:36:30](https://vimeo.com/1171123936#t=5790s) Okay. Thank you. Okay, questions from the committee. Okay. Well, that was easy. [1:36:38](https://vimeo.com/1171123936#t=5798s) That was easy. [1:36:39](https://vimeo.com/1171123936#t=5799s) So- [1:36:39](https://vimeo.com/1171123936#t=5799s) You nailed it [1:36:40](https://vimeo.com/1171123936#t=5800s) ... okay, I think it, I, I, I come with a medical wor- background- [1:36:45](https://vimeo.com/1171123936#t=5805s) Mm-hmm [1:36:46](https://vimeo.com/1171123936#t=5806s) ... and it's confusing about, I think it's... Okay, I think it's one of the things that doctors complain about most is all of this double reporting and all, when it takes time away from patients. [1:37:03](https://vimeo.com/1171123936#t=5823s) Yes, ma'am. [1:37:04](https://vimeo.com/1171123936#t=5824s) Like that. A- and if you're getting all this data, correct, and you don't get it back, you really, if you're waiting for the eye exam to come back or you're wai- can't really tell if what you're doing on the patient is working. [1:37:21](https://vimeo.com/1171123936#t=5841s) Correct. Espe- especially if they're gonna hold us to some sort of- [1:37:24](https://vimeo.com/1171123936#t=5844s) Accountability [1:37:24](https://vimeo.com/1171123936#t=5844s) ... an a- accountability, especially from a, an 85% or a 90%. You know, they set thresholds depending on where they want us to end the year and kind of rank us based on that- [1:37:34](https://vimeo.com/1171123936#t=5854s) Uh [1:37:34](https://vimeo.com/1171123936#t=5854s) ... versus, versus other practices, and that can absolutely affect a primary care practice who's trying to, you know, see patients. We see anywhere between 20 and 30 a day, depending on my physician, and then we ask them, "Hey, click these boxes." You know, and that's a frustration with every EMR, with every physician, and every specialty. But, you know, to be able to spend that time with the patients to where maybe we don't have to see as many patients in a day, these programs do pay. But it does create a lot of extra work. [1:38:03](https://vimeo.com/1171123936#t=5883s) Okay. And we're talking about the programs, we're really talking about the evil insurance- [1:38:08](https://vimeo.com/1171123936#t=5888s) Yes [1:38:08](https://vimeo.com/1171123936#t=5888s) ... empire. Sorry. [1:38:10](https://vimeo.com/1171123936#t=5890s) They- [1:38:11](https://vimeo.com/1171123936#t=5891s) We're being funny. [1:38:12](https://vimeo.com/1171123936#t=5892s) Yes. I can, I can't argue with you. [1:38:14](https://vimeo.com/1171123936#t=5894s) But when they're making millions and millions of dollars above what normal playing the stock market makes and everything, one does wonder. [1:38:21](https://vimeo.com/1171123936#t=5901s) It does. Well, especially when they pay us to have to do some of this stuff. I mean, it, it, they net out way ahead of where the physician taking care of your grandmother nets out. [1:38:30](https://vimeo.com/1171123936#t=5910s) Or the cost. [1:38:30](https://vimeo.com/1171123936#t=5910s) Yeah. [1:38:32](https://vimeo.com/1171123936#t=5912s) Okay. Thank you very much, Reed. Are you ready to go with Mr. Gillion? [1:38:36](https://vimeo.com/1171123936#t=5916s) We can. [1:38:37](https://vimeo.com/1171123936#t=5917s) Okay, or- [1:38:38](https://vimeo.com/1171123936#t=5918s) Happy to be here. Um, Mr. Gilliard, uh, is from another state. It's important to hear, you know, um, what is possible when clinical and claims data are properly integrated. Um, so Austin Gilliard is the CEO of Clay County Medical S- Center, I'll let him give a further introduction, uh, to hopefully discuss the rural healthcare implications and the importance of meaningful, usable quality measurements. [1:39:03](https://vimeo.com/1171123936#t=5943s) Yep. Perfect. Um, Madam Chair, can you hear me virtually? How do we get it back up? Okay. Uh, we can hear you, but n- uh, right now... Oh, here we go. Wait a minute. Media service is catching up. Sorry. Hopefully, we'll be able to see you. Fabulous. There you are. Okay. Okay. Well, perfect. Well- And how are you? Thank you so much for, for having me and inviting me to this. It's so refreshing to actually h- hear, um, you speak about all the different healthcare topics, um, currently going on in an educated manner. [1:39:37](https://vimeo.com/1171123936#t=5977s) It's beautiful. Sometimes we don't have that in the state of Kansas, so thank you for that. Um, my name's Austin Gillard. I'm the CEO of Clay County Medical Center in Clay Center, Kansas, a small community, rural community, of 4,500 residents. Um, here at Clay County Medical Center, we do operate a critical access hospital and five rural health clinics. Um, and in total, we've got 15 primary care providers that serve around 20,000 lives in North Central Kansas. And just hearing a little bit about the testimonies already spoken about, I think our biggest struggle, um, as in Georgia, as in Kansas, around the entire United States, is how do we get all this clinical data and mesh it with what's going on with the claims data so we can take care of the patient as a whole person instead of just at the time of service, whether it be in the clinic setting, in the lab, in the radiology department, or in the emergency room. [1:40:31](https://vimeo.com/1171123936#t=6031s) Um, and so I want to talk a little bit about today what we've been able to do here in the state of Kansas at our hospital, um, and just talk about how we've been able to combine the clinical data with the claims data to improve the quality of care being provided to the patients. But also, it's led to our financial stability in the state of Kansas, where over 80% of the hospitals operate in the red currently within the state. Um, so I'm gonna share my screen real quick and just go through a few slides. [1:41:09](https://vimeo.com/1171123936#t=6069s) All right. Uh, madam, are you able to see my screen? Not yet. What's... [1:41:20](https://vimeo.com/1171123936#t=6080s) Okay. Is that us? [1:41:24](https://vimeo.com/1171123936#t=6084s) Okay, here we go. [1:41:29](https://vimeo.com/1171123936#t=6089s) Now we've got you started. Okay. Fabulous. Mm-hmm. Um, so again, like I said, Clay County Medical Center. Um, again, about us. Critical access hospital, five rural health clinics, 15 primary care providers. Um, we've got over 30 specialists that come to visit us, 20,000 lives in North Central Kansas, and we employ about 350 team members. Um, but what, what I want to talk about and what you, um, just from previous conversations hearing you speak, um, is how do we get the clinical data and the claims data to actually talk? [1:42:01](https://vimeo.com/1171123936#t=6121s) And when we're talking about clinical data, we'll talk-- we're talking about data from the various EMRs, whether it be, um, the doctor's office, the hospital, the dentist, the optometrist. Um, and the source of this data, of course, is usually from medical providers. And the great thing about clinical data is it's real time because that physician or that APP saw that patient that day. Um, but one of the problems we find is the data's often siloed, meaning it's at that hospital, it's at that clinic, and the systems do not talk. [1:42:34](https://vimeo.com/1171123936#t=6154s) I think we're all very familiar with that. On the claims data side, um, it's administrative. It's the, um, as you might have pointed out, the insurance companies. Um, and they use this data for utilization of the patient, what's being done, billing codes. And often, the claims data is delayed. I mean, we've got payers in the state of Kansas that don't even pay us within 90 days. Um, and that kind of develops an issue. Um, and these all consist of CPT codes, pharmacy, and just various costs from the claims data. [1:43:10](https://vimeo.com/1171123936#t=6190s) Now, the neat thing is, and this graphic's kind of a mesh of everything, but what we've been able to do here at our facility is combine the claims data with the clinical data to make sure the patient is taken care of in the most appropriate fashion. And so I want to dive into the various metrics that we've been able to work on. Our unique patient lives here that we serve at Clay County Medical Center, um, is a little over 11,000. But what we really try to focus on with these patients is are they getting their annual wellness visit? [1:43:45](https://vimeo.com/1171123936#t=6225s) And that's a hard one to track. Um, are they getting their breast cancer screening appropriately, colorectal cancer screening, cervical cancer screening, if needed? And another big one is with the utilization of the emergency department is, are those patients having a follow-up visit after that emergency room department? And then, of course, we can check immunization status and 15 other metrics here at the medical facility. And the neat thing with these 11,000 patients is we've not only been able to increase quality for these patients when we're talking about payers and quality metrics, um, but we're also able to give them a better life. [1:44:23](https://vimeo.com/1171123936#t=6263s) Um, they're getting in for their annual wellness exams. Um, if they-- if they're on several medications, they're getting in every three to six months with a provider, and with this data, we're able to see if they actually filled those scripts, because it's not uncommon in our rural, um, rural settings that people don't have the finances to go fill that heart medication or that diabetes medication. And so with this data, we're able to track if they actually filled that script and have that conversation with them at the time of their appointment. Um, and it's also led to a lot of ancillary services such as mammographies or colonoscopies, additional lab and therapies when we're able to track the claims data with the clinical data. [1:45:04](https://vimeo.com/1171123936#t=6304s) Um, and this is just some financial performance at the very bottom of our, our facility. These are audited numbers. Um- From our audit firm. Um, in 2025, we had a net income of 1.3 million, 2024, 1.26, and in 2023, 1.1 million. And I contribute this a lot to us focusing on quality and getting these patients in, um, in a timely manner. But again, none of this would've been possible without combining the clinical data with the claims data. [1:45:35](https://vimeo.com/1171123936#t=6335s) So... [1:45:37](https://vimeo.com/1171123936#t=6337s) Okay. Am I-- Okay, let's see. Is this like if you can combine these two, it would be like we have the PDMP where a doctor can go out and check and see if a patient is getting other narcotics from some other physician, and how often they're getting them, and look at that. So by combining the two, you can look and see if a patient did their follow-up after an emergency room, you would know it. You could look, and you could see it. Or you would know that you had ordered a, uh, a breast exam, and they actually went to get it or they didn't get it. [1:46:14](https://vimeo.com/1171123936#t=6374s) So you would have a... Is, is that what happens? You would have all of those together so you could really see if they went to the specialist they needed to go to and what the report is and all. Is that what you can do if that information is combined from the two without having to call the specialist and say, "What was-- What did you find?" If the patient remembers to tell them. Okay. Is that correct? [1:46:40](https://vimeo.com/1171123936#t=6400s) That's correct. So yeah, now we're able to take the claims data on what, what claims went out on that patient because every patient has their unique social or however we decide to scrub the data. Um, and we get to match that with the clinical data on what happened with that patient. So it's, it's the full three-sixty look at what's going on with this patient and their care, which is really, really unique. [1:47:05](https://vimeo.com/1171123936#t=6425s) Okay. And I didn't understand about the money. I mean, I'm concerned about patient care. [1:47:09](https://vimeo.com/1171123936#t=6429s) Mm-hmm. [1:47:10](https://vimeo.com/1171123936#t=6430s) Were you saying that you, you actually made more money and the patient got better care? [1:47:17](https://vimeo.com/1171123936#t=6437s) That's correct. So the higher quality that we've been able to provide here at Clay County Medical Center for our patients, the financial success has also followed us, which has been really neat to see. [1:47:29](https://vimeo.com/1171123936#t=6449s) Okay. Which would've kept you functioning, your clinic or a small hospital functioning, correct? [1:47:35](https://vimeo.com/1171123936#t=6455s) That's correct. [1:47:36](https://vimeo.com/1171123936#t=6456s) Using the-- By having less cost of duplicate test and all, if you have this kind of information, and then you can talk to the patient and see what you need to do to make sure they're doing what they're supposed to do. [1:47:51](https://vimeo.com/1171123936#t=6471s) Correct. And what also has kind of been an offshoot of this, as we've become more financially solvent, um, it's also allowed us not to have our physicians see those twenty, twenty-five or thirty patients a day. We're focusing on quality care, so our, our physicians might see max fifteen to sixteen a day. So they're actually able to spend more time with the patient versus trying to get through so many patients to stay, to stay s- financially viable. [1:48:20](https://vimeo.com/1171123936#t=6500s) That's certainly a positive. Questions? Okay, Representative Au. And Representative Au is going to ask you a question, and she is an anesthesiologist. [1:48:28](https://vimeo.com/1171123936#t=6508s) So it wasn't really a question, but, uh, just to make this point that when we moved to EMR across the country, part of the goal was to be able to capture more of this usable information. Often it is used for billing and to identify the, the billing codes, as we talked about. But since we're capturing it to be able to streamline it and not waste a lot of, uh, practitioner time having to reenter it in order to prove our quality metrics are being met is, I think, quite efficient since we're already using the EMR we're talking about. [1:48:57](https://vimeo.com/1171123936#t=6537s) Okay. All right. Other questions from the committee? Uh, thank you very much. Uh, thank you for treating patients in Kansas? Was it- [1:49:07](https://vimeo.com/1171123936#t=6547s) Kansas. [1:49:09](https://vimeo.com/1171123936#t=6549s) You have quite a few, um, in the family practice area. You better not let me see the list. I might be visiting and seeing if some of them can come to rural Georgia. I'm not beyond trying to steal physicians- ... to treat our patients, so. But thank you very much for what you do, those patients that are out there with you. So thank you. [1:49:29](https://vimeo.com/1171123936#t=6569s) Thank you. [1:49:30](https://vimeo.com/1171123936#t=6570s) Pardon? Oh, what is that? I mean, it's... Okay. All right. We'll go on to the next person, and thank you again. We'll let you get back to work. Thank you. Uh, go ahead, Brent. [1:49:40](https://vimeo.com/1171123936#t=6580s) Thank you, Austin. We really appreciate your input there. Um, we also had, uh, John Demore lined up. Is he available on the Zoom? [1:49:48](https://vimeo.com/1171123936#t=6588s) Okay. [1:49:49](https://vimeo.com/1171123936#t=6589s) Hello. Can you hear me on the audio? [1:49:51](https://vimeo.com/1171123936#t=6591s) Yes, we d- can, and we can also see you. [1:49:54](https://vimeo.com/1171123936#t=6594s) Great. [1:49:54](https://vimeo.com/1171123936#t=6594s) Thank you. [1:49:56](https://vimeo.com/1171123936#t=6596s) Well, um, uh, chair, members of the committee, I just want to say thank you for the opportunity to speak on quality and quality measurement. It's a topic that's essential for the future healthcare and for public health improvement. Um, I, I just want to r- you know, first start by saying the, the earlier speakers, I agree, um, very much with their perspectives. Um, my name's John Demore. I've spent my career working at the intersection of healthcare quality and data sharing. I'm part-time faculty at Boston University, where I teach graduate informatics students, uh, around many of these topics, around da- data sharing and how quality measure works. [1:50:30](https://vimeo.com/1171123936#t=6630s) And I've also worked with many companies in the healthcare industry, um, around interoperability. I'm actually in Las Vegas today at the annual HIMSS Conference, um, where a lot of these software vendors get together. It's the biggest conference for health IT annually in the United States. In 2021, uh, I led an, uh, the research study that was called Clinical Data Sharing Improves Quality Measurement and Patient Safety. The paper outlines clear evidence demonstrating that the quality of care we measure, and therefore the quality of care that we can improve, depends fundamentally on the data that health systems are able and willing to share. [1:51:06](https://vimeo.com/1171123936#t=6666s) You know, why does this, you know, really matter for it? Well, we kind of know and we've heard from the earlier speakers, the process of quality measurement's not simple. Um, there's, you know, uh- ... pretty significant costs that are incurred by doctors, by hospitals that are participating in these programs. It's essential. Um, quality measures have multiple parts, inclusion and exclusion criteria, and they draw across a range of clinical data. You know, we heard about claims data, but also the types of clinical data can be varied from problems and diagnoses, laboratory results, medications, immunization history, procedure history, and vital signs. [1:51:41](https://vimeo.com/1171123936#t=6701s) Um, and all those are different for different types of measures. You're looking at controlling blood pressure, you're very interested, or, uh, you're very interested in the blood pressure vital signs, uh, for things. If you're looking at comprehensive diabetes care, you'd be very interested in the laboratory results for glucose control or HbA1c, um, or also procedures. Uh, things like, um, having your eyes checked out a- annual visits on an annual basis, and also being able to get, uh, pr- purple and nephropathies checked. Um, the process for quality measurement's pretty expensive, uh, for all parties that are involved, but a lot of what it boils downt- down to right now is that you need to have the accurate information and the complete information on patients to be able to do this well, um, for things. [1:52:21](https://vimeo.com/1171123936#t=6741s) So today, you know, patients routinely receive care from multiple providers across hospitals, clinics, specialists, labs, and increasingly telehealth. Um, when these data remain siloed, quality results become incomplete or misleading. That was really part of the study that we showed, which is when you take the data from one institution and calculate the quality versus taking the data on the same patients and integrating it across the spectrum, um, across a using a health information exchange, uh, you actually get different quality measures. [1:52:51](https://vimeo.com/1171123936#t=6771s) So information sharing is just really essential, uh, to this. Providers who care for complex patients can actually, um, appear worse, um, simply because their data's fragmented. Um, you know, as you get more comorbidities, you're gonna have more specialist visits, you're gonna have care at more disparate settings. And public health leaders, you know, can't see the full picture of community, uh, needs, particularly in rural high-risk areas, unless you really have good quality measurement, which really relies on the sharing of that information. So across multiple studies and real world implementations, data sharing through modern standards like health information exchanges, uh, national networks that are also integrated in electronic health records, um, there's been a lot of federal regulation around this, um, but have been shown to improve the accuracy of quality measurement. [1:53:35](https://vimeo.com/1171123936#t=6815s) And so part of what we showed is that some measures could actually be a double-digit improvement, identify care gaps earlier, uh, increase patient safety, and also support more equitable, uh, measurement program. In my own research, we found enabling access to clinical data from outside facilities allowed quality measurement to reflect the actual patient care, um, uh, rather than, uh, something where it's just an artifact of how well, um, as one of the, uh, committee members mentioned around how well you have to double document that data in your electronic health record. So things that, uh, legislators can do around this is to, you know, continue to strengthen statewide interoperability, uh, ensuring that doctors and hospitals, health systems can participate in trust- trusted data exchange networks to respond to and share that information. [1:54:19](https://vimeo.com/1171123936#t=6859s) Um, you know, it's a largely re- unreimbursed process. Um, you can't bill as a physician for data sharing. Um, but it's really essential to those hours that Austin talked about at the end of week because you can't do quality measurement right without that. Support standards-based exchange, um, and also try to reuse and align to a lot of the federal programs, um, so that the measures that you're using are, um, the, the same between different providers, Medicaid and private plans and Medicare Advantage. Um, you know, the more you have different providers doing different programs for different payers, uh, you can get different, um, you add more complexity and burden to the system for it. [1:54:55](https://vimeo.com/1171123936#t=6895s) And, you know, in closing, I'll just say quality measurement's only meaningful, um, if it ac- if it accurately represents patient care. Uh, I'm really impassioned. I'm, uh, I'm really excited to hear the, um, the thoughtful, um, process that the committee, you know, has around this. And, you know, when data's shared, you know, securely, consistently in standardized formats, patients receive better care and, you know, they get more fairer evaluations, and that does, uh, you know, apply to the reimbursement that goes to doctors and to health systems. So, um, I, I urge, I urge you to continue to advance policies to make that clinical data sharing, uh, the foundation, uh, for quality measurement. [1:55:29](https://vimeo.com/1171123936#t=6929s) I'm happy to answer any questions. [1:55:32](https://vimeo.com/1171123936#t=6932s) I think I have one. Representative Cannon. [1:55:36](https://vimeo.com/1171123936#t=6936s) I think it's more to the bill, but it's about line 64 through 66, if that is... [1:55:44](https://vimeo.com/1171123936#t=6944s) Mm-hmm. What is it? Line... [1:55:47](https://vimeo.com/1171123936#t=6947s) 64 through 66. [1:55:49](https://vimeo.com/1171123936#t=6949s) Okay. [1:55:49](https://vimeo.com/1171123936#t=6949s) I just was curious if that was covered in what he was discussing just about personal [1:55:56](https://vimeo.com/1171123936#t=6956s) identifiers and public records. [1:56:00](https://vimeo.com/1171123936#t=6960s) Okay. [1:56:01](https://vimeo.com/1171123936#t=6961s) What does line 64 through 66 mean? [1:56:04](https://vimeo.com/1171123936#t=6964s) Do you have a co- copy of the bill? [1:56:06](https://vimeo.com/1171123936#t=6966s) I don't have it in front of me, but I believe- [1:56:07](https://vimeo.com/1171123936#t=6967s) Oh, here [1:56:08](https://vimeo.com/1171123936#t=6968s) ... what- [1:56:12](https://vimeo.com/1171123936#t=6972s) Thank you. I think... Does anybody have a question for the presenter? We'll let you go back to your work. Thank you very much for talking to us. And, uh, to finish that up, what you're saying is, uh, that the doctors, like, if you take, um, all insurance plans, you'd like maybe three insurance companies in your area, and you take Medicaid, and Medicaid has different CMOs, CMOs, that you would, could be using different ways that you have to send that data to all of them. [1:56:50](https://vimeo.com/1171123936#t=7010s) Yes. Absolutely. [1:56:51](https://vimeo.com/1171123936#t=7011s) Okay. [1:56:51](https://vimeo.com/1171123936#t=7011s) It, it, it's an incredible burden, um, uh, for the system. [1:56:54](https://vimeo.com/1171123936#t=7014s) Okay. So one of the things we keep hearing, and I keep hearing and see doctors write about, is the burnout. And one of the things that they say is leading to the burnout and them wanting to retire early is this paperwork. Is, is that what you found or you hear in Boston from- [1:57:13](https://vimeo.com/1171123936#t=7033s) Well, I- [1:57:14](https://vimeo.com/1171123936#t=7034s) ... from physicians up there? [1:57:16](https://vimeo.com/1171123936#t=7036s) I, I think I've worked with a lot of health information exchanges, Boston, but also New York, uh, Kansas, uh, Indiana, California. I think that that's a very common refrain. [1:57:25](https://vimeo.com/1171123936#t=7045s) I bet, 'cause I'm hearing it over and over, and reading it in medical journals and all about that that just is sort of what pushes them over. You know, they want to see patients. They want to do that work and, and improve patient, but when they finally just sort of had it with the paperwork, okay. [1:57:44](https://vimeo.com/1171123936#t=7064s) Uh, I would say that most doctors, you know, didn't sign up to be medical secretaries, didn't sign up to do a lot of this paperwork process. They want to care for patients. They want to do the right thing. They want to deliver high-quality care. Um, but we've put a lot of programs in place that are, that are hard, um, and that make data chasing, um, too much a piece of the puzzle. [1:58:02](https://vimeo.com/1171123936#t=7082s) Thank you very much for that. So thank you, and we'll let you get back to work, or you can stay with us, whatever you want to do. Uh, that's all the questions I have for you. Okay. Back to Representative Cannon for your question on line 64. That's where you were, 64. [1:58:20](https://vimeo.com/1171123936#t=7100s) So in, in the conceptualization of this bill, you know, which is really at this point- [1:58:24](https://vimeo.com/1171123936#t=7104s) Yes [1:58:24](https://vimeo.com/1171123936#t=7104s) ... getting the conversation moving forward, wh- when you run this information and get all these different networks talking to each other, we have to be cognizant of protecting personally identifiable information and HIPAA protections. And so what happens when the information goes into these types of networks is it's de-identified. You know, there are unique patient identifiers, but you don't have personally identifiable information or numbers associated with the patient. It helps you collect the quality. Um, with this bill, uh, essentially setting up a, a silo under the state of Georgia, uh, that merges with some of the claims payer data, et cetera, um, that direct personal identifiers is again to protect private information, uh, and HIPAA compliance so that an open records request wouldn't result in thousands of patient records being inadvertently disclosed with identifiable information associated with them. [1:59:18](https://vimeo.com/1171123936#t=7158s) Representative Cannon, did that answer your question? [1:59:20](https://vimeo.com/1171123936#t=7160s) I think it does, and so I think you further go on to say line 67 that, but the other information does have to be HIPAA compliant. [1:59:31](https://vimeo.com/1171123936#t=7171s) That's right. [1:59:32](https://vimeo.com/1171123936#t=7172s) So, um, can you just, just, just explain it one more time, that there is information that is subject to HIPAA that is X, and then there is this information that becomes de-identified? [1:59:52](https://vimeo.com/1171123936#t=7192s) Yeah. Well, because it, it may not be information that is necessarily subject to HIPAA. Sometimes it's coming from the insurers and different aspects, and when it's merged together, you know, the way that, uh, my nerdier colleagues can work, you can do wonderful things with computers, including matching things up and identifying people and things like that. So this is really a broad coverage issue because we want to protect private information. You know, nobody wants their health information to be disclosed publicly necessarily, so that's a privacy issue because we won't necessarily al- it, it'll be e- electronic medical records, electronic health records. [2:00:28](https://vimeo.com/1171123936#t=7228s) It's insurance payer data that goes into the mix here. It's claims payment data. It's all these things, these different silos of information that need to talk to each other in an effort to create greater efficiencies for the delivery of healthcare. So that is the risk that we're trying to address here in, in those lines is that you got to have HIPAA coverage, and as a lawyer, you always try to be as, as, uh, broadly drafted as possible to cover any eventuality. So any other type of private personal identifiers should be scrubbed from the data. [2:01:00](https://vimeo.com/1171123936#t=7260s) Thank you. Just one follow-up. So, okay, so line 65 and 66, I went to see what Article 4 of 1850 is, and, um, I'm unclear. What is it saying that these direct personal identifiers are not subject to? [2:01:22](https://vimeo.com/1171123936#t=7282s) I believe that is the code section dealing with open records requests that, uh, that are sent to the state. So if I was to send... Oh, gosh, I don't even know. There's so many different ways we can do an open records request. We just don't want to risk this data being disclosed unintentionally is, is the issue. Yes. Thank you. [2:01:43](https://vimeo.com/1171123936#t=7303s) But if there was an open records request, that it would identify that which is not shielded under what the statute would be, but it wouldn't disclose like 64-year-old woman with a history of congestive heart failure. Like identifier, date of birth, Social Security number, hospital room number, those are, those are personally identifiable, um, pieces of information attached to a patient that are usually stripped out when we have to disclose broader pieces of data, like would be shared with, um, for quality measures. [2:02:18](https://vimeo.com/1171123936#t=7338s) Okay. So the, the, the direct personal identifiers though would not be subject to what within open records? We're still in... It's too general. Does no one understand what I'm saying? I'm saying, um, I understand that there are personally identifiable information, and there is information that can be shielded for an individual. What are we saying here happens with the direct personal identifiers? [2:02:55](https://vimeo.com/1171123936#t=7375s) That they would not be publicly disclosed. [2:02:58](https://vimeo.com/1171123936#t=7378s) So if- [2:02:59](https://vimeo.com/1171123936#t=7379s) Thank you [2:03:00](https://vimeo.com/1171123936#t=7380s) ... if you were re- records requesting, say for a public health research, right, and looking, uh, how many people have a certain diagnosis in the state of Georgia, you'd be able to determine how many patients had that diagnosis currently within the state if the system is fully functioning, but you couldn't pair that to figure out who those people are explicitly. Does that make sense? [2:03:18](https://vimeo.com/1171123936#t=7398s) Yeah. [2:03:18](https://vimeo.com/1171123936#t=7398s) So if it was maybe HIV or some sort of unflattering condition outside of that or, you know, cancer diagnosis or whatever, people may not want to share that information. But it is important from a public health perspective that we're able to track that more closely across the state. [2:03:33](https://vimeo.com/1171123936#t=7413s) Thank you [2:03:36](https://vimeo.com/1171123936#t=7416s) Other questions from the committee? No. So the object is over the sum- summer to work on this bill or- [2:03:44](https://vimeo.com/1171123936#t=7424s) Madam Chair, I, I did have one other speaker- [2:03:47](https://vimeo.com/1171123936#t=7427s) Oh [2:03:47](https://vimeo.com/1171123936#t=7427s) ... who had a sudden medical emergency- [2:03:49](https://vimeo.com/1171123936#t=7429s) Mm [2:03:49](https://vimeo.com/1171123936#t=7429s) ... and was una- unable to join us. Um, based on the questions that I've heard, it might be beneficial. She has a statement- [2:03:54](https://vimeo.com/1171123936#t=7434s) Okay [2:03:54](https://vimeo.com/1171123936#t=7434s) ... she had prepared, uh, and gave me permission to read it into the record for you. And it may help if, if you would indulge. [2:04:01](https://vimeo.com/1171123936#t=7441s) No, I will. After what she went through today. She was over getting lunch, and she had an allergic reaction and ended up in the hospital to be cared for. [2:04:10](https://vimeo.com/1171123936#t=7450s) We are generating claims and quality data. [2:04:13](https://vimeo.com/1171123936#t=7453s) That's, that's not quite. So I'm glad to know she's- [2:04:16](https://vimeo.com/1171123936#t=7456s) Yeah [2:04:16](https://vimeo.com/1171123936#t=7456s) ... uh, she is doing okay. Is she still in the hospital or did they release her? [2:04:20](https://vimeo.com/1171123936#t=7460s) I understand. Um- [2:04:20](https://vimeo.com/1171123936#t=7460s) Okay. [2:04:21](https://vimeo.com/1171123936#t=7461s) Well, I don't think we violated HIPAA here today, but I will read her statement that she's given permission for me to read. Um, hmm. [2:04:29](https://vimeo.com/1171123936#t=7469s) If you did, I did. And then do we have legislative immunity? Where is Senator Oliver when we need her? So our, our former senator, now Representative Oliver, so. [2:04:40](https://vimeo.com/1171123936#t=7480s) Well, Madam Chair, with your permission. [2:04:41](https://vimeo.com/1171123936#t=7481s) Okay, go ahead. [2:04:42](https://vimeo.com/1171123936#t=7482s) Um, pretend I'm better looking, uh, and I am Kelly Ladd. So, uh, Kelly Ladd is the president, the current president of the Georgia Medical Group Management Association. Uh, bet you didn't know you were in for a dramatic reading this afternoon. Uh, thank you for the opportunity to speak today. My name is Kelly Ladd, and I'm the president of the Georgia Group Medi- the Georgia Medical Group Management Association. I am here to share what quality reporting looks like from the perspective of medical practices across Georgia, and why the state should take a closer look at whether our current approach is producing meaningful insight into quality or simply expanding administrative burden. [2:05:19](https://vimeo.com/1171123936#t=7519s) Let me start with a basic point. Georgia and the federal government invest billions in healthcare, yet we still do not have a clear and consistent picture of what quali- quantifies quality as it pertains to the investment. From where I sit, we often measure process. We measure boxes checked, portals updated, and documents uploaded. However, too often, we do not measure the true outcomes of whether or not patients are actually getting healthier. There seems to be a disconnect between the perceived processes and the reality of what practices face in obtaining and reporting data. [2:05:52](https://vimeo.com/1171123936#t=7552s) I want to describe the actual and realistic demands and processes required inside a medical practice tied to HEDIS and HCC reporting, especially when linked to incentive programs and additional reimbursement opportunities, as these demands have become overwhelming and costly. In a typical practice, it is not unusual to have two full-time employees whose primary job is to report metrics to multiple insurance carriers. Reporting these metrics requires significant time and knowledge because each carrier has its own portal, reporting format, and deadlines. [2:06:24](https://vimeo.com/1171123936#t=7584s) The carriers also require we attach or upload documentation and medical records per each visit we are required to report at the time of reporting. However, this never seems to be enough for the carriers, and we are often faced with having to resend the same information and/or additional information during annual audits or validation reviews. It is not uncommon for these requests to involve hundreds of patients at one time with very strict time deadlines. It is extremely time-consuming and constant. In addition to the extra workload, the added cost to the practice has also become unsustainable. [2:06:57](https://vimeo.com/1171123936#t=7617s) Approximately 10 years ago, carriers encouraged practices to voluntarily participate in these programs by providing a per-patient stipend to offset the cost of the reporting. Those incentives have d- decreased significantly to the point where my formal- former internal medicine practice of over 14 providers decided to stop voluntarily participating in the program and had to eliminate those staff positions dedicated to the reporting. Physicians want patients to be well and have good outcomes. [2:07:27](https://vimeo.com/1171123936#t=7647s) They want to be compliant with coding and reporting. They do improve over time, especially when someone tells them exactly what codes they need to use. But this also highlights the concern. When quality programs turn into teaching the code, they can start to feel like the overall process of improving care is less important than the compliance for payment. We are literally fighting to remain as independent businesses trying to keep our doors open. In addition to an already complicated and onerous process, the metrics change every year. This not only creates new costs, but also adds new work. [2:07:58](https://vimeo.com/1171123936#t=7678s) This requires practices to retool workflows, retain staff, retrain staff, and learn new requirements before any real improvement work can even begin. So what does this look like day to day? It looks like checking boxes, cross-checking portals and internal reports, sending information back and forth, chasing down documentation details, and preparing for audits. This is a lot of work. It is a lot of expense. However, the real cost is that it pulls time and attention away from what every practice wants more of, which is face-to-face time with patients and better care coordination. [2:08:31](https://vimeo.com/1171123936#t=7711s) I want to be clear, practices are not opposed to accountability, transparency, or quality improvement. We support measuring outcomes. Our healthcare goals are patient-oriented as we want to prevent common chronic illnesses and mitigate disease progression as much as possible. The question is, are we getting a clearer and more trustworthy picture of quality, or are we paying for an administrative machine that measures activity instead of results? If we cannot answer that confidently, then we need to change the approach. Please understand that in today's physician practice, we don't have big profit margins. [2:09:04](https://vimeo.com/1171123936#t=7744s) If we want better outcomes, we need to move beyond endless box checking and build a smarter approach. We need an approach that creates real insight for policymakers, real improvements for patients, and more time for clinicians to provide care. Thank you for the opportunity to speak today. And while I am not Kelly, I am happy to answer any questions. [2:09:27](https://vimeo.com/1171123936#t=7767s) Okay. [2:09:27](https://vimeo.com/1171123936#t=7767s) None? [2:09:28](https://vimeo.com/1171123936#t=7768s) Okay, we got... [2:09:30](https://vimeo.com/1171123936#t=7770s) Well. [2:09:31](https://vimeo.com/1171123936#t=7771s) Okay. Just a second. Who we got? Oh, uh, Representative Hilton. [2:09:36](https://vimeo.com/1171123936#t=7776s) Thank you, Chair. Excellent reading, Kelley. [2:09:39](https://vimeo.com/1171123936#t=7779s) Thank you. [2:09:40](https://vimeo.com/1171123936#t=7780s) Um, I like this, what this is trying to do, because, yeah, as I talk to folks in the medical field, I mean, it just, it's data entry and, you know, so much time on that as opposed to taking care of the, the patient. So from the patient perspective, this sounds great. I, I would just add, as you study this over the summer, I, I hope that all this yields to more transparency in pricing. I, I'll tell you, as a patient, when we walk in, we've got no idea what-- You know, we just go get what we're told to do. And so if there's a way that all this data can yield, you know, here's what the final costs are, you know what I mean? [2:10:16](https://vimeo.com/1171123936#t=7816s) The, uh, yeah, basic services. Yeah. [2:10:19](https://vimeo.com/1171123936#t=7819s) Notice if Mr. Joe to stay here with us. Joe, do you have comments you'd like to make on this? Okay. [2:10:26](https://vimeo.com/1171123936#t=7826s) Yes, ma'am. [2:10:27](https://vimeo.com/1171123936#t=7827s) Okay. [2:10:28](https://vimeo.com/1171123936#t=7828s) So I'm Joe Hood. I'm the Chief Operating Officer for Department of Community Health. And first, I want to say I certainly appreciate the goals and objectives that are outlined in the bill, so I don't want to, to take away from what you're trying to achieve, and certainly understand that. The department would have concerns with how this is outlined to accomplish that in conjunction with the All-Payers Database. Just as a reminder, some of you may know, the All-Payers Database is a Medicaid-funded database that includes the data that is housed at this, at the Department of Community Health. [2:11:00](https://vimeo.com/1171123936#t=7860s) In particular, we went to great lengths to work with SSA and our Medicaid entity in order to form that. And in doing so, we have agreements that we would not have personal identifier information, particularly SSA information, contained in that database after it's created. So the methodology that is proposed there and what the discussion on personal identifiers is really not applicable because it's not present. It's my understanding that there's not the ability to do matching with outside-- After you've already done that, and you've already established that, and you've created the All-Payers Database, this is de-identified so that you're only looking at claims data. [2:11:41](https://vimeo.com/1171123936#t=7901s) You have to remember, the All-Payers Database has a specific purpose, at least the one that we have here, and that is to do comparisons between claims, claim services for the public and others. It's never intended, at least the way that we formatted it and have it approved with SSA, with CMS, and with our partners, to accomplish what you've outlined here. So for example, when you looked at the Clay County example, I presume that he's talking about his system approach, and he has access to that entire dataset on both sides, and he's facilitated that. [2:12:14](https://vimeo.com/1171123936#t=7934s) There's not a statewide example that I'm aware of that would allow you to do this at the enterprise level that you're proposing, particularly in Georgia, where we are an SSA determinant state, meaning SSA determines Medicaid eligibility. And once we've had that determination and put it into our system, we no longer have access to use that for data matching. So that's very relevant in what you're trying to accomplish. And I don't certainly agree with everything that's been stated and quality objectives, and we're facing many of these with electronic medical records as we look to do rural health projects throughout the, the state right now as we implement, and certainly understanding of that. [2:12:53](https://vimeo.com/1171123936#t=7973s) But I just want to point out those are tremendous challenges. It took us over two years, if I recall correctly, to get to the place where we could move forward with it, with the All-Payers Database and accomplish what we have today. So just, I just want to point that out that, that that is a challenge, and it's a significant challenge, and one we have not really been able to overcome for our state health benefit plan data to merge to do that. We had that goal just for our own data that we have at the department. We really haven't got to that place. [2:13:24](https://vimeo.com/1171123936#t=8004s) So it's, it's a very challenging environment given that you've, you-- it's not a state-owned dataset, as it were, because of the Medicaid funding and the way that that is, has SSA and Medicaid data coming in. [2:13:39](https://vimeo.com/1171123936#t=8019s) Have we agreed to, to do our system differently, like, than they did in Kansas or where he was from? I mean- [2:13:47](https://vimeo.com/1171123936#t=8027s) I, I suspect, Madam Chair, that he's speaking about just his system subset and not the state of Kansas. Like when he described that he had clinics and, and hospital. So if we were to take a system and they have control of all their data quality and claims, they could do that themselves internally perhaps. But when you rise up to an enterprise level and you talk about the whole entirety of the state, that, that is-- that dataset is, is problematic, and that's where we ran into challenges with All-Payers. [2:14:18](https://vimeo.com/1171123936#t=8058s) Okay. Well, then I certainly think over the summer, they need to talk to you. [2:14:24](https://vimeo.com/1171123936#t=8064s) Yes. Yes, ma'am. [2:14:25](https://vimeo.com/1171123936#t=8065s) If-- I mean, you may be able to tell them just the same thing that you told me, but, uh, or you're telling us, but I don't- [2:14:33](https://vimeo.com/1171123936#t=8073s) Uh, yes, certainly. I understand. Thank you so much. [2:14:35](https://vimeo.com/1171123936#t=8075s) Or if they can tell you that it's working somewhere else or why it's working, or do we ask for a change in the way we do stuff going forward, you know, with-- I don't know. [2:14:45](https://vimeo.com/1171123936#t=8085s) I just don't know that that can be done with All-Payers Database. [2:14:48](https://vimeo.com/1171123936#t=8088s) Okay. [2:14:48](https://vimeo.com/1171123936#t=8088s) I mean, there's certainly other means and to accomplish that perhaps, but that-- it's, it's challenging. [2:14:54](https://vimeo.com/1171123936#t=8094s) Okay. Brent, you had- [2:14:56](https://vimeo.com/1171123936#t=8096s) I, I think that's a great point. It demonstrates sort of the need to have these ongoing conversations. Um, just sort of as a conclusion, I mean, the modern currency of healthcare is data. We have reams and reams and reams of data. All these remote technologies are reporting, the systems are reporting, images, everything, um, and it's going to get more intense. We're gonna collect more and more data as innovation and things like AI and healthcare come online. And as we move forward, we need to carefully consider how we handle this data, right? [2:15:29](https://vimeo.com/1171123936#t=8129s) How do we make the system more efficient to generate better outcomes for our patients, more efficient payment systems, and just a better all, overall healthcare, state of healthcare within the Georgia, right? Um, so that's what we need to consider and look at. And there are, there are significant challenges. Uh, you know, I almost fall asleep when you really start digging into de-identifiers and databases and things like that. It's not the most thrilling thing, but it can have the most profound impact for every single Georgian in this state. So, Madam Chair, I thank you for having the hearing on this, and I look forward to moving the conversation forward. [2:16:02](https://vimeo.com/1171123936#t=8162s) Thank you very much for presenting and for you coming all the way from Thomasville, uh, to tell us about your system. And with that, I will say that we adjourn and thank everybody that stayed here. And Brandy, I have a question for you. And Joe, you can help me ask-- you probably know too, [2:16:32](https://vimeo.com/1171123936#t=8192s) so...