Senate Health and Human Services Committee, March 23, 2026

Transcript

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1. 0:09:33

   And then, uh, so we don't have a quorum yet again. The, uh... And then, so we got six bills, seven with the hearing, and, uh, so, uh, we may or may not let people, uh, testify, but we may get you up there and say yay or nay. So, we'll play it by ear.

2. 0:20:50

   All right, we have our quorum of s- of seven, so, uh, we'll get started. And again, we got the sign-up sheets. Um, we're certainly gonna have testimony on the last one for hearing. Uh, hearing only HB 1393. Uh, and we'll try to get as much as we can otherwise. Uh, but, uh, if we get things going, we theoretically only have one hour, but we may have a little bit longer than that. But we, uh... Others are gonna come from, um, uh, public safety, and then they'll have, some will have to leave for, uh, finance.

3. 0:21:25

   So, and house committees, too. So, let's bring the, uh, state senate, uh, health and human services committee to order. And, uh, the, I'm gonna let, uh, Senator Harrell, uh, be, open us up in prayer, if you don't mind.

4. 0:21:40

   Is that okay?

5. 0:21:42

   Yes.

6. 0:21:42

   We've never prayed before.

7. 0:21:43

   Uh, well, there's a first for everything.

8. 0:21:45

   Okay. All right.

9. 0:21:47

   Okay.

10. 0:21:48

    If we could open with a moment of reflection. Um, we're at a tense part of the session, um, and nerves get frayed. Um, but let us take a moment to recognize that, um, everyone here is here representing people from back home, um, to do good work, uh, that the people want.

11. 0:22:19

    And, um, so let's all think about, um, the, the human side of, of, of everyone, um, even when we have disagreements. And, um, take a deep breath and let's do the people's work. Amen.

12. 0:22:39

    Thank you so much. We really appreciate that. Uh, we all certainly need a deep breath at days like today. So, uh, the, we're going to

13. 0:22:54

    start with my favorite Chatham delegation chairman, Representative Ron Stephens, uh, House Bill 382.

14. 0:23:11

    Thank you, miss. There we go. Thank you, Mr. Chairman, members of committee. House Bill, um, 382 is, uh, LC 461487S. And, um, I'm really glad that you brought that in that moment of reflection because this bill really centers on that. Uh, it started out as a pharmacy bill. Uh, it was to talk about technicians and ratios and that kind of stuff. But we started working a couple of years ago to try to get some help, uh, if you will, with our process.

15. 0:23:43

    Um, as you know, we do the, and you did it last week I believe, the, um, uh, our drug update bill where we go through and as the, um, drugs come down and, and are approved by the FDA, uh, we, um, usually agree and assign them to a, a class and, uh, and then they're available for use in the state of Georgia. We can't wait this time. Uh, we've got two drugs, uh, in section two and three. Uh, if you'll notice those, the, in section two talks about lysergic acid.

16. 0:24:18

    Section three talks about psilocybin. Lysergic acid and psilocybin are both class one drugs. Uh, we can thank Emory University for doing some amazing research, um, on PTSD. Uh, and for those, that will be the indication for the, uh, lysergic acid. Psilocybin is used for life-threatening type, um, depression. Both of these, I don't believe that any of us ought to wait until next year bef- until we can get these thing approved to, um, to go to the, um, to the public.

17. 0:24:55

    So, um, if we do this, we've, uh, worked with the Board of Pharmacy for a couple of years to make sure that once the, uh, FDA approves the drugs, they would then be available for use. Um, in addition to that, what the original bill was was on section five it talks about interns and, uh, the tech supervision. Um, it talks about certified techs on line 92 and it talks about, um, the, the pharmacy certified technician on the, on, beginning on line, um, 95.

18. 0:25:35

    And then we come back again to section seven and eight which, uh, again makes available those two drugs that I just talked about so that we can finally for the first time in a couple of decades treat this debilitating disease, post-traumatic stress syndrome and make sure that we have a drug to treat this life-threatening, um, type of depression which, um, will really maybe save some lives. So, Mr. Chairman, that's the bill. I'll, um, open for any questions and hope that we can move this one along.

19. 0:26:09

    Do we have any questions from the committee?

20. 0:26:13

    Uh, Senator Setzler.

21. 0:26:15

    Yeah. Thank you, Mr. Chairman

22. 0:26:17

    Thank you. Um, these, uh, substances in question, what's the, what's the common English ... Are these substances we know about or have been, been used before or have any context in ... I just, I don't recognize the names.

23. 0:26:32

    Lysergic acid you may have known for a long time ago as, as a derivative from LSD. This is, um, a derivative from that. Again, being in that class, it's a Class 1. Psilocybin is known as the, um, psychedelic mushrooms. Uh, we have found a use for that just as we have found for marijuana and the amazing things that we've done with medical marijuana is, uh, is pretty amazing. So again, this will still be highly regulated now that we've got a medical use.

24. 0:27:03

    It will be classed as a Class 2, um, as high as you can get.

25. 0:27:11

    Um, appreciate the author's clarity on that, Mr. Chairman. Uh, also on the, uh, pharmacy supervision piece, um, we're moving to a pharmacist being able to supervise six people. What's the ... What are we moving from to get there? Was it-

26. 0:27:26

    We're having issue ... Well, six people, one of those would be a, a, um, a pharmacy intern and a pharmacy extern could be two of those. The other four are technicians. We at one time had certified technicians and those are those that are certified in everything from, uh, inoculations, um, flu shots, those kinds of things that are also supervised by a pharmacist. We're having issues in find ... There's nothing to prevent you from becoming, um, a certified tech, um, and going through the rigors of that.

27. 0:27:57

    But this is, was requested by the board. We're having issues in getting certified techs.

28. 0:28:03

    So is, uh, if you've got a busy shop, um, you, you obviously can have six non-pharmacists there. Does this allow for four or five non-pharmacists to be present and no pharmacist be physically present? Or does there still-

29. 0:28:20

    No

30. 0:28:20

    ... phar- pharmacists be physically present?

31. 0:28:22

    You have to be physically present and overseeing those and technically it's only four because you have a pharmacy tech and a pharmacy extern that can be two of those six.

32. 0:28:31

    Okay. So, so you could have seven people, up to seven people in a, in a, in a shop as it were.

33. 0:28:37

    Correct.

34. 0:28:37

    But there's never going to be a circumstance where there's not a pharmacist physically present?

35. 0:28:40

    No. Uh, never. It's always in the same location, same ... Physically overseeing them, yes.

36. 0:28:45

    Okay. Okay. Mr. Chair, I mean, I- I've got some concerns about, I have concerns about sh- moving these things to Schedule II to, to study them. I, I disagree with the premise that, uh, what we've done with medical marijuana is, is a positive move. I have a profound disagreement with that. But I think moving from Schedule I to Schedule II so we can, you know, investigate things and look at derivatives, that seems to be an immediate step. So ...

37. 0:29:10

    Yeah. Help me, help me understand that. I mean, we can, we can move it to Schedule I here in the state?

38. 0:29:16

    No. The, um, the FDA does it and, and therein lies part of our problem. The FDA, if it's approved and if it's ready to go far ... From the FDA's point of view, they're ready to package it out and run it. We can't allow it in the State of Georgia until it passes our Drug Update Bill. Um, we move things in and out of prescription. For example, we've moved Sudafed over the years and some of the antihistamines from prescription back and forth. We ... So the problem is, is the delay in getting this drug that should be available to these people right away instead of having to wait until next year whenever we can do the Drug Update Bill.

39. 0:29:54

    It's just not worth it for me and I hope not to you to get these sorely needed drugs to the people that need them.

40. 0:30:01

    So you're saying these drugs now, they're Schedule I. In the interim, in a year from ... You know, in the interim they change them to Schedule II, we'll, we'll be able to ... There'll be, there'll be an automatic trigger to go to Schedule II.

41. 0:30:14

    Yes.

42. 0:30:15

    And, uh, we won't have to wait until the due of the Drug Update.

43. 0:30:17

    For these two drugs alone.

44. 0:30:20

    Okay. Any further questions from the committee?

45. 0:30:30

    All right and, uh, I have the will of the committee. Motion to pass. Motion to pass, uh, Senator Brass, second by Senator Orrock. Any further discussion? All those in favor let's raise our hands here. All those in favor.

46. 0:31:01

    There's six. There's six in ... Come on.

47. 0:31:05

    Second that. Okay. I'm sorry. Let's everybody keep their hand up. Let's make sure we're clear on this. All those in favor. One, two, three, four, five, six.

48. 0:31:17

    Count.

49. 0:31:17

    One, two, three ... This is in favor of this bill.

50. 0:31:22

    Yes.

51. 0:31:22

    All those in favor.

52. 0:31:23

    Okay. Four.

53. 0:31:25

    Four. One, two, three, four, five, six. All those against. One, two, three, four. Four. Six, four. It passes. Okay. Thank you. All righty.

54. 0:31:40

    Mr. Chairman, on behalf of the, um, Vietnam vets and my generation, thank you.

55. 0:31:44

    We appreciate that.

56. 0:31:45

    Thank you.

57. 0:31:45

    Who's, uh, who's carrying your bill, Chairman?

58. 0:31:48

    I was hoping you would.

59. 0:31:49

    Uh, yeah, I'm, I'm sort of full right now. Who, who, uh, who voted for you up here? Um.

60. 0:31:59

    Um.

61. 0:32:00

    You, you can circle back to us. Absolutely. Okay. All right.

62. 0:32:25

    Next up is House Bill 506. Uh, Representative Scott Hilton, you're there. All righty. Uh, and-

63. 0:32:33

    Mr. Chairman, do you have a copy?

64. 0:32:35

    Do we have a copy of that?

65. 0:32:38

    Got it.

66. 0:32:38

    Yeah, sure.

67. 0:32:53

    Thank you, Mr. Chairman. Members of the committee, I'll be reading House Bill 506, LC521090S.

68. 0:33:09

    I've got our oldest son, Trent, is a, uh, has a severe wasp allergy. He, uh, was at band camp this past summer, and he's been seeing an allergist, so the allergy's not too bad, but he's still, he got s- managed to get stung, and they had to take a- an ambulance to, to the local hospital. And- and he was perfectly fine and healthy. What was not fine is afterwards when we got the bill, it would've been cheaper for me to run for governor than to pay my EMS bill. Um, and so that's the impetus of House Bill 506 here, which, uh, has, now has a substitute. Uh, House Bill 506, I believe, has- has already been out of this committee and- and really through the Senate floor.

69. 0:33:45

    It, uh, pr- includes EMS in the Surprise Billing Consumer Protection Act, which was excluded from the original act. But we're now seeking to, uh, include that for the very reason that, that I mentioned to y'all. Um, uh, given the fact that we are ... I know you've got a number of bills on your agenda. This has passed committee already. Um, I will pause, uh, for any questions, but that- that's what the bill does.

70. 0:34:11

    So w- what this is, is a substitute, uh, as you can see, LC521090S. And this basically is the same thing that passed out of here. If you look on line 44, that's 325%, and that was, um, that's been passed out of here through rules and on the floor. Uh, and, uh, so it has gotten, um, I don't know. So we're- we're- we're passing it here.

71. 0:34:39

    Yes, sir. Yeah.

72. 0:34:39

    Again, see what we can do and get that maybe back over to y'all for an agree.

73. 0:34:43

    Yep.

74. 0:34:44

    All right. Um-

75. 0:34:45

    Yes, sir

76. 0:34:45

    ... any further, any questions?

77. 0:34:47

    I have a question.

78. 0:34:48

    Yeah. Yeah. All right. Uh, there we go.

79. 0:34:50

    Um, thank you for bringing the bill forward. Have you thought about a- including vaping in that? I know this is nicotine, but vaping products sometimes have that in there. We-

80. 0:35:00

    Yeah. So- so 506 originally was a smoking cessation bill. Uh, that portion, I believe, has been entirely removed.

81. 0:35:08

    Okay.

82. 0:35:09

    Yeah.

83. 0:35:09

    Okay. Sorry.

84. 0:35:11

    No, you're good. You're good.

85. 0:35:14

    Okay.

86. 0:35:14

    Yeah.

87. 0:35:15

    Any other-

88. 0:35:15

    506 originally was a great bill, but this is nicotine-

89. 0:35:17

    Any other questions at all?

90. 0:35:21

    No other questions? Uh, all right. And, uh, have the will of the committee here. Make a motion to pass. Make a motion to pass. Senator Halbarn second, uh, s- uh, Senator, uh, Harrell. Uh, any further discussion?

91. 0:35:56

    Uh, we're not You're in ... Uh, Ms. Mills, you're in favor of the underlying bill, of the bill that we have for substitute? Okay. Just, um, in- in, uh ...

92. 0:36:09

    In interest of time, if it's okay, we'll just mark that in your favor. This is the underlying surprise bill. We got it. I got thumbs up. Thank you so much. So any further discussion from the committee? All right. Will the committee take any time to entertain a motion?

93. 0:36:26

    We did make a motion. We did make a motion. Yes. We did make a motion.

94. 0:36:28

    Yes.

95. 0:36:28

    Discussion. All those in favor, raise your hand. Okay. All right. That is unanimous. Thank you so much. Appreciate that. Thank you for doing that.

96. 0:36:37

    Uh, Senator Still will be our-

97. 0:36:39

    He's gonna carry it again.

98. 0:36:40

    Yes, sir.

99. 0:36:40

    All right. We got it.

100. 0:37:05

     So we're in posture of House Bill 1138. And, uh, we are ... Representative Camp, the floor is yours, and if you can just take us through that, if you wouldn't mind. Uh, just take us through the substitute. And, um, I think we may have a amendment that is in our folders, but we'll wait for the time, uh, for that. Okay.

101. 0:37:27

     All right. Thank you.

102. 0:37:28

     The floor is yours.

103. 0:37:28

     All right. I've got House Bill 1138, LC461553, S as in Sam. And this bill enables pharmacists to be able to prescribe contraception. Um, the mechanism to do so has been done in 34 other states successfully, so we are not reinventing the wheel. There will be an agreement between the pharmacy board and the Department of Public Health, and they will establish the protocol and the training necessary for pharmacists to be able to do so.

104. 0:38:05

     It certainly does not mandate pharmacists prescribing contraception if they don't wish to do so, but it does enable them to do so if they so choose. Um, it also establishes where individuals who are getting contraception can get up to 12 months at a time, which is important for people who travel, people who are in college, people who might be gig workers that get money in lump sums along the way to make sure they have access to this And that's pretty much the gist of the bill.

105. 0:38:36

     I'm open to any questions.

106. 0:38:40

     Questions from the committee?

107. 0:38:43

     Uh, all right, Senator Setzler.

108. 0:38:47

     Thank you.

109. 0:38:48

     Okay.

110. 0:38:48

     Um, welcome to the committee.

111. 0:38:50

     Thank you.

112. 0:38:51

     Um,

113. 0:38:59

     there's a, there are circumstances in which drugs that, uh, you know, if, if a woman's taking birth control, um, or contraceptives and other drugs interact with that, it can counteract the effect of the birth control.

114. 0:39:15

     Yes, and a pharmacist would know that better than anyone else, and be able to tell them if they were prescribing them antibiotics or other medications, that your contra- oral contraception would not be working during this time to have a backup method.

115. 0:39:28

     Yeah.

116. 0:39:28

     And, and most good pharmacists do tell women that when they come in.

117. 0:39:31

     Yeah. I mean, I, I know, I, I've heard antibiotics, there may be others. So that, that, that came to mind immediately.

118. 0:39:35

     There are, there are others. Antibiotics is just more of a well-known one, but there are other drugs that are contraindicated if someone is on contraception.

119. 0:39:42

     My concern is just, um, just share with the author, and I'd like your thoughts on this, um, you know, parenthetically, is that, um, I mean, I've got a relation- uh, uh, you know, a, a, uh, in this case, a woman would have a relationship with an OBGYN. That tends to be a little bit more, uh, they tend to have one OBGYN, um, or one general practitioner. Um, they may or may not have one pharmacist. Um, even within a pharmacy shop, there may be other phar- a number of pharmacists that kind of rotate through the CVS, the Walgreens near your house, or the, or the local pharmacy.

120. 0:40:17

     Um, but to me, I have a comfort level that if your OBGYN is, is prescribing this or your general practitioner's descri- prescribing this, all the drugs that you're taking are sort of filtered through this one entity, and then once you go to ph- to a pharmacist, it just seems to be sort of branched out that it seems to be able to multiply the potential effect of not knowing what other things are going on medically and, and prescription-wise within a, a patient's life. How would we, uh, uh, are, are we comfortable that we, this, this covers that?

121. 0:40:49

     Well, first and foremost, I can tell you women go to more than just OBGYNs. Um, there's general practitioners, there's dermatologists, there's a whole litany of physicians that women see. And typically a pharmacist is, you don't send your medications to multiple pharmacies typically. You go to one pharmacy. And even though it might not be that same person, when I had my daughter, um, 25 years ago, I think I went through every midwife and every OBGYN in that practice because I was a high-risk pregnancy. So I saw probably 12 different people.

122. 0:41:22

     Now, I know they all understood because they had my chart. Very much the same way with pharmacists. They can look and see what medications you are on at that pharmacy. Um, it's challenging. I don't know anyone who goes to multiple pharmacies because it would be super challenging to do so. Um, but that's not an impossibility. This is a scope of letting people have access. 82 counties in our state do not have an OBGYN. 82. But I can promise you there's a pharmacist in every single one.

123. 0:41:54

     So this is an opportunity for individuals to not have unintended pregnancies, to get pregnant when they desire to get pregnant. So we have the best outcome for them and for their children.

124. 0:42:08

     Yeah. Uh, uh, Mr. Chair, I just, I just share that 'cause that's, that's what I'm wrestling with, is t- to Delois' point, um, the, you know, a- and I, I t- I'm come comfortable with longer prescription times. With the, historically, um, the, the birth control prescriptions were very narrow. They were-

125. 0:42:29

     A month

126. 0:42:29

     ... yeah, or, or 90 days, and then, and n- now we're... So th- this bill moves it, um, I, I think to me, moving that out, once you're under the care of a physician, mo- extending the timeline makes sense to me. I just don't know that, that, that take, making him quasi non, non, well, giving a prescriptive authority to a pharmacist-

127. 0:42:52

     Like PEP and PrEP?

128. 0:42:54

     I, I, I, I just, just, I'm weighing that differently, Mr. Chair. Thank you.

129. 0:42:58

     Understand. Thank you. Um, Senator Kirkpatrick.

130. 0:43:03

     Thank you, Chairman. Um, isn't it true that the OBGYN community is very supportive of this bill?

131. 0:43:11

     Yes. They are in favor of this bill, actually came and spoke in favor of this bill, and MAG has deferred to their judgment on this particular issue, understanding we do have a massive shortage of access of care in this state.

132. 0:43:27

     Any further questions? All right, uh, will the committee, happy to entertain a motion.

133. 0:43:35

     Motion to do pass.

134. 0:43:36

     Motion do pass. All right, second. And we are, any further discussion? All those in favor-

135. 0:43:43

     No, we're not. Mr. Chairman, I'd like to-

136. 0:43:45

     Oh, that's right. I'm sorry. Glad you interrupted me there. All right, um, recognize, uh, Senator Harrell.

137. 0:43:52

     Thank you, Mr. Chairman.

138. 0:43:53

     But your, your number is?

139. 0:43:55

     One, two, one, two, one, two. One.

140. 0:43:58

     Gotcha. Okay.

141. 0:44:00

     Uh, yes, Mr. Chairman, members of the committee, I would like to offer an amendment to this bill. Um, it is in your folder. The LC number is AM600027. Background of this amendment is that for two decades now, we have been fortifying wheat products with folic acid because we discovered that if women have, um, rather large amounts of folic acid in their blood systems when they get pregnant, that, um, it prevents the development of spina bifida, which is a spinal cord, very debilitating spinal cord disability.

142. 0:44:41

     Um, and- Since we've been fortifying wheat flour, um, the rate of spina bifida has decreased. Um, however, we now know that the rate of spina bifida in the Latino population is over twice that of any other population, and that's because, um, Latinos eat more corn than wheat. So what this amendment does is simply requires the fortification of corn flour with folic acid, um, so that we can bring that rate of spina bifida in the Latino-

143. 0:45:17

     Well, that's not working

144. 0:45:18

     ... community down.

145. 0:45:20

     Why don't you, uh, why don't you try-

146. 0:45:22

     Oh, I guess it's not.

147. 0:45:22

     Try mic, try mic, uh ... So I'm just gonna turn that ... Try mic six if you don't mind.

148. 0:45:28

     Sure. Do I need to ... I don't need to start over, do I?

149. 0:45:31

     I think you were speaking loud enough. If anybody, anybody in the-

150. 0:45:34

     Could you hear me?

151. 0:45:35

     Anybody in the room want her to replay that?

152. 0:45:37

     No.

153. 0:45:37

     I don't see any hands. All righty, so we're going. Go with six.

154. 0:45:43

     Right. So, um, yeah, that, that pretty much sums it up. We had an extensive hearing on this issue last year where I brought in about five experts, um, surgeon, doctor, nutritionist, fortificationist. Um, this group has been working for about 10 years to try to get this done. Um, they've worked federally. They've tried to get it done voluntarily. Um, they don't really want to do it state by state, but that's the last tool we have left. And this is an expensive disorder. Um, I had a woman who's a CEO of a hospital who said this no- this bill is a no-brainer.

155. 0:46:16

     We need to do this because much of this care, um, and it's high cost care, is uncompensated for the hospitals.

156. 0:46:24

     Okay. Any questions from the committee on this amendment? All righty. So, uh, we have, we're in the posture of, of, uh, offering this amendment up. And the- got a motion for the amendment. Uh, Senator Harrell m-

157. 0:46:45

     I move. Oh.

158. 0:46:46

     Senator Orrock makes a motion.

159. 0:46:48

     Yeah.

160. 0:46:48

     And, uh, Senator Merritt seconds. And we got a question down here. All right.

161. 0:46:56

     That was a second.

162. 0:46:56

     13 was a second or ... All right. Okay.

163. 0:46:59

     Yes.

164. 0:46:59

     And, uh, any further discussion on this? So all those in favor-

165. 0:47:03

     Mr. Chairman, I had, uh, uh, I- I would just point out, I, I, I'm, I'm highly familiar with this because a ch- a fellow church member of mine, uh, a physician, uh, highly respected, worked for years to get, uh, Congress to adopt, uh, putting folic, uh, acid in our wheat products. And as, as the, as the author said, it, it was a dramatic change. And of course, spina bifida is a lifelong crippling condition with high medical costs.

166. 0:47:34

     Uh, and I would, I'd point out that, uh, snack food, uh, on line 53, is, uh, is except, is, is, uh-

167. 0:47:46

     Sorry.

168. 0:47:46

     Yeah.

169. 0:47:47

     How many states do this now?

170. 0:47:50

     Uh, c- Alabama and California have both passed laws, and it's being considered here and in Oklahoma.

171. 0:47:58

     And it, it does, it does carve out?

172. 0:48:02

     Snack foods.

173. 0:48:03

     Snack foods.

174. 0:48:04

     Yes.

175. 0:48:05

     Right.

176. 0:48:05

     And it carves out, uh, the cottage food industry as well as, um, food service establishments-

177. 0:48:12

     Okay

178. 0:48:12

     ... restaurants who make their own.

179. 0:48:14

     And this was in your bill when it came over or was not?

180. 0:48:18

     It was not. It did not pass through the House. It was subbed out and then it was subbed back to the original form.

181. 0:48:25

     Okay. Is this considered a friendly amendment from your perspective or you think it's-

182. 0:48:28

     I, I do not object.

183. 0:48:29

     Do not object. All right. Even if it kills the underlying bill?

184. 0:48:33

     Now if it kills underlying ... Oh, now, okay. That's a different conversation, Senator.

185. 0:48:36

     It shouldn't.

186. 0:48:37

     Now listen, I mean, that's, uh, you know-

187. 0:48:38

     Well, if it's gonna kill the underlining bill, underlying bill.

188. 0:48:41

     I, I don't know that. I'm just saying that's a possibility. All right. Any further questions from the committee? All those-

189. 0:48:50

     Senator, Senator Watson, if you think it's gonna kill the underlining bill, then I'm gonna-

190. 0:48:53

     Uh, you know this is gonna be the will of the committee on this one.

191. 0:48:55

     Okay.

192. 0:48:55

     So that's where we are. Uh, you got, each member's gonna have to vote their own. So, um, so we've, I think we've finished discussion unless there are questions. Senator Brass has a question.

193. 0:49:08

     So Senator Harrell, can you remind us, you had this bill as a standalone. Where, where did it make it in the process?

194. 0:49:15

     Uh, you moved it through rules.

195. 0:49:17

     Yes.

196. 0:49:17

     And it was-

197. 0:49:18

     Well, the committee did

198. 0:49:19

     ... on the floor. The committee moved it through rules. Um, it was on the floor, um, for a vote on crossover day. And unfortunately, uh, Democratic bills were not being called up, and, um, mine got caught up in that.

199. 0:49:32

     Okay.

200. 0:49:34

     Any further discussion? All right. So the will of the committee here, all those in favor of this amendmen- amendment, uh, raise your hand.

201. 0:49:47

     It is unanimous. All righty. Okay. So then we're going to, uh, this is a substitute 1138, uh, LC 461553S as amended. Did I say that right? I think I did. And, uh, uh, we have a question from Senator Setzler. Okay.

202. 0:50:11

     Thank you, Mr. Chairman. Um, I'm reading the bill summary about key changes in the bill. It says, "Removes provisions," um, um, it's a couple bullets down in our summary.

203. 0:50:21

     Which part are you reading? What one?

204. 0:50:22

     Uh, I'm ask- I'm ask-

205. 0:50:23

     The summary

206. 0:50:23

     ... I'm asking the author. "Removes provisions requiring specific abstinence disclosure language in patient written r- materials." What's the, what, what's the s- what, what's the deal with that?

207. 0:50:36

     Um, in the bill that passed the House, when it was still under the Medical Composite Board, um, we borrowed language from Tennessee that listed, um, basically that abstinence was the only

208. 0:50:51

     100% birth control. And it was determined, speaking with Department of Public Health and the Pharmacy Board, that will very likely be included. Most, I mean, I believe most physicians share that information as well. That was ex- that was not put in the bill because we wanted them to come up with a protocol on what was appropriate and not necessarily tell them they had to say one particular thing word by word.

209. 0:51:15

     Yeah.

210. 0:51:16

     Uh, we'd much rather it be more of a conversation and make sure that it's done. Um, I do have faith in the Department of Public Health and the Pharmacy Board that they'll come up with the correct language for their pharmacists to use.

211. 0:51:28

     Yeah. I, I, I g- I have confidence in our board. I, I, just today, I, I don't know what future boards look like. I mean, the only bulletproof birth control is, as you know.

212. 0:51:38

     That's 100% all the time.

213. 0:51:41

     All right. Any further discussion? I think we're in the posture of voting. Uh, and all those in favor of HB 1138 as, uh, this was a substitute and as amended. All those in favor raise your hand.

214. 0:51:59

     And all those opposed, like sign. It, uh ... All right. This passes. Thank you.

215. 0:52:05

     Thank you.

216. 0:52:05

     And who was carrying that one for you? Representative-

217. 0:52:08

     Senator Kirkpatrick.

218. 0:52:09

     Uh, as she left. Okay. That's great.

219. 0:52:12

     Well, she-

220. 0:52:12

     So she leaves, she gets assigned. No, I'm just joking. You talked to her already?

221. 0:52:15

     We have spoken, yes.

222. 0:52:16

     Okay, great. Thank you so much.

223. 0:52:18

     Thank you.

224. 0:52:18

     Appreciate it.

225. 0:52:54

     All right, Representative Townsend. Here we are. This is the sh- maybe the shortest bill we do all year. So we're at House Bill 970, LC65-0051S. Is that accurate?

226. 0:53:08

     Yes, sir.

227. 0:53:09

     Okay.

228. 0:53:09

     Thank you, Mr. Chair. Thank you, committee. And if I was in rules, that'd be a ding, ding, right? Anyway, sorry.

229. 0:53:15

     You have to take that up with the rules chairman down there.

230. 0:53:18

     Uh, this is a, a simple bill, like you said. Basically, it codifies what Georgia High School is doing now. They're in support of this bill. It requires a physician, a doctor, osteopathic medicine, a PA, or nurse practitioner to conduct the physicals. Also adds a cardiovascular exam, um, for this, uh, for this type physical at the end. It's, uh, basically the cardiac, cardiovascular exam, uh, based on past history, current data from the current, what they're doing, like the blood pressure and things like that.

231. 0:53:49

     Plus, it also is a questionnaire that's given to the parents and kids to fill out. And so, um, and then if there's any catches there, then that's when further examination continues. It also basically extends for the last 12 months, if it occurs after April 1st, just for the entire year after that. Uh, basically it's, it's, it's, it's supported by American College of Cardiology, American Heart Association, and other national organizations. So that's basically the details of the bill.

232. 0:54:19

     I can go more in depth. I remember helping out with these when I was a coach. Uh, we did have some issues in Georgia, have had some issues in Georgia of young men or women having cardiovascular trouble, uh, heart attacks, cardiac arrests in the fall practices and things like that. Hopefully, we can screen and do it, uh, by the right people to help limit that as much as we can. You can never prevent things.

233. 0:54:43

     Mm-hmm.

234. 0:54:43

     But you can. I did see at times when I was, um, whether it was coaching or I was a principal or CEO at a career academy or a superintendent, where, uh, some people may tend to go against policy or whatever else. Uh, if you codify it, they'll be afraid to do that. They'll just go by the law, and that's what they need to do. And w- by, uh, at the end of the day, it's about the kids.

235. 0:55:06

     Yeah, it, let me just, for the record, uh, state that there was a cardiologist here at American College of Cardiology that was in favor of this and felt that this did improve the process and, uh-

236. 0:55:18

     Yes, sir

237. 0:55:19

     ... uh, but he w-

238. 0:55:19

     Dr. Kim

239. 0:55:20

     ... but he was not able to, uh, stick around for this, uh, 5:15 meeting. So, uh, yeah.

240. 0:55:27

     He's a Georgia Tech guy, probably leading cardiologist in sports physiology like this.

241. 0:55:32

     Um, 10. Who is? 10's that senator.

242. 0:55:36

     Thank you, Mr. Chairman. Uh, appreciate the, the, the effort behind this.

243. 0:55:40

     Yes, sir.

244. 0:55:40

     Um, you know, as I talked to, um, a clinician today and some other advocates, I, I'm very comfortable doing physicals before playing sports. Um, I, I am concerned about sort of a shifting standard of care if the, if the, if the sort of standard becomes one of doing physical screens and scans. I know that's not the standard today.

245. 0:56:06

     No, sir.

246. 0:56:06

     You know, my, my concern is, is w- w- when we reference a nationally recognized, um, standard, if that kind of becomes the new standard, what we're really, I mean, w- w- isn't it true we're, we're kind of, that, that standard can kind of shift over years and decades?

247. 0:56:25

     It can, but there's no technology here involved. This is-

248. 0:56:28

     No, sir

249. 0:56:28

     ... this is fine-tuning the history and the physical examination that may prompt that.

250. 0:56:35

     Okay.

251. 0:56:35

     And that's, and that's where you're leaning towards-

252. 0:56:37

     Yeah, that-

253. 0:56:38

     But there are no echoes or EKGs-

254. 0:56:40

     Not at all

255. 0:56:40

     ... or any kind of thing that are required.

256. 0:56:42

     Because the physician you're talking about I spoke to today as well, he's also strongly opposes a requirement to have a scan-

257. 0:56:48

     Yes

258. 0:56:48

     ... sent.

259. 0:56:48

     Correct, yes.

260. 0:56:49

     So, so-

261. 0:56:49

     That's correct

262. 0:56:50

     ... so I, I'm right, I'm right with him on that

263. 0:56:53

     Um, so how do, how are we confident that we don't drift into a scan requirement over time if that becomes prolif- but proliferates and becomes the standard? If someone like me or some- I would never do that based on my past. But if other people come in and go before you, you turn 'em down. You say no, p- period. Unless they're- Well, listen, I- ... data to provide, data to, uh, document, to- But the fact is, is we update all the time- Correct ... and we may need to. I, I, I don't know the answer whether that's 5 years, 10 years, or 100 years. I would imagine in 100 years, the screening probably will be different, but I don't know that.

264. 0:57:27

     But right now, the standard is, is the improved history and physical exam, uh, and that's where we are. Now, may that lead to other testing? It's certainly possible, but it does not, uh, anticipate that. Um, for, so Senator Merritt.

265. 0:57:44

     Yes.

266. 0:57:44

     Thank you.

267. 0:57:44

     Uh, thank you, Mr. Chairman. At the appropriate time, as the mom of a, of a student athlete, I think this is a great bill, and I know what the boys go through, and this is about protecting our kids. So any and every screening we can do with them before they play these sports is great.

268. 0:57:58

     And they-

269. 0:57:58

     At the appropriate time, Mr. Chairman

270. 0:58:00

     ... and they do have screening now. This is-

271. 0:58:02

     They do

272. 0:58:02

     ... tightening up the screening-

273. 0:58:03

     Just how they do

274. 0:58:04

     ... that we're talking about. And at the appropriate time, I will... Let me make sure there are no other questions. Uh, no other questions? All right. Senator-

275. 0:58:10

     Motion to pass.

276. 0:58:11

     Motion to pass. Second, Senator Mangham. Uh, and got discussion. Senator Setzler. And Mr. Chairman, th- this is just a question to you as a physician. I, I just, I, I support the policy that we're talking about. Yes, sir. I- my only concern is the words on the page don't lock this down to the, the kind of physical we're talking about, the stethoscope questions. You know, the, the, the things we're doing now, I'm completely comfortable with. I just, i- if we have, if the standard of care shifts, how do we, how do I know I'm not voting for something that in 9 or 10 or 12 years doesn't become a scan because we're simply saying, "You shall do what the standard of care is," um, which may change?

277. 0:58:53

     That, that's perhaps a question to the chair. How do we lock down to make sure we're, we know really what we're voting on? I'm gonna let the author answer that one, and then I'll circle back.

278. 0:59:05

     I, I guess it's, uh, probably a ledge council question. The way I'm reading it, I, I see it differently, respectively. So, you know, the standard of care may also go the other way around. It may say we need a different history. We may need to back off on this or do this particular exam. Um, I've been doing school physicals, I've done them, you know, 30 years ago, and this is tightening down the history and the physical exam. We considered, a- and I'll go back to the, you know, Italian data that was 25, 30 years ago, that they did, Italy did, uh, EKGs on every school physical.

279. 0:59:41

     Uh, unfortunately, that was... And they sh- their data supposedly showed a reduction in sudden death, prolonged QTc that leads to sudden death, that, you know, that, uh, was at Gathers, I think, is with the, the player out in the West Coast, and, uh, stopped taking his Inderal, and he- Yeah ... died, sudden death, and that's what led to the AED on the sidelines and everywhere. But having said that, that was not reproducible. And the American College of Cardiology is certainly sensitive to, uh, you know, how much you need to do for that, and there's always a w- a balance of what you need to do.

280. 1:00:16

     Uh, but right now, um, uh, I don't think, uh, uh, they're suggesting that by any means. This is just tightening it d- down a little bit and, um, in the history and, and formalizing that from that standpoint. Listen, um- Correct ... I'm, uh, 13 is the rules chair.

281. 1:00:36

     So Mr. Chairman, I'll just add, if, if it ever came to a point to where we didn't feel comfortable with that standard of care, we could come back and change the law.

282. 1:00:47

     Listen, we, we delve into that lots of times, sometimes when we probably shouldn't, but we certainly do, and I would certainly respect that. Yeah, absolutely. Yeah. So, um, uh, Senator Setzler, I'm, uh, uh, there's always a risk that we have. Mr. Chairman, I plan to support the bill. I would just, I would just say that for, for the record, I do in the context of as it's proposed, as the standard of care we're proposing. I strongly oppose a scans requirement, but that's not a requirement, so I support the bill.

283. 1:01:15

     Yes, sir.

284. 1:01:16

     Okay. Thank you. All right. We got, uh, questions here. 13, no question. 15 is, uh, somebody pressed the down there. Maybe by mistake. Maybe by mistake. We're all good. All right. Uh, so let's see. We're in the posture, uh, we have, um, we've had a motion do pass. We've had plenty of discussion, I think, and, uh, all those in favor raise your hand. Uh, I suspect it is unanimous. All righty. Good deal. Thank you.

285. 1:01:46

     All right. Thank you, Chair. Mr. Committee, uh, Senator Hodges will be carrying the bill.

286. 1:01:49

     Thank you for volunteering that, 'cause I'd forgotten. You're good. Appreciate it.

287. 1:01:56

     The banker is carrying the bill for the school physicals. I love that. That's great. Thank you. Sure.

288. 1:02:06

     I bet he's had a lot of school physicals

289. 1:02:41

     back then, way

290. 1:02:44

     back. We are moving along. So, um, House Bill 659, Representative Gerald Green, and I was just asking the question if we were having finance up here, and I see that we must be still having finance, so... No. I'm just here as in like here at the Capitol.

291. 1:03:00

     Okay. We're gonna be-

292. 1:03:01

     Okay. All right

293. 1:03:01

     ... gonna start on time.

294. 1:03:02

     Thank you, Chairman. That's good. Looks like it is gonna start on time. All righty. But we still have a quorum so I'm happy. Uh, Representative Green, the floor is yours.

295. 1:03:12

     Thank you. Thank you, Mr. Chairman, ladies and gentlemen of the committee. House Bill 659 adds optometrists to the list of healthcare practitioners who may have their loan forgiven if they practice in rural areas of Georgia. This bill came out of when I was chairing the House Rural Development Committee, and we saw the need for, uh, these individuals. And currently, that list includes physicians, dentists, physician assistants, and advanced practice, uh, registered nurses.

296. 1:03:48

     And, uh, with our, um, new, um, optometry school in the State of Georgia, this would only fit in just perfectly in that particular way. Um, and hopefully it's going to entice them to practice in underserved rural areas.

297. 1:04:07

     Mm-hmm.

298. 1:04:08

     And I'm not aware of any opposition to this legislation, Mr. Chairman.

299. 1:04:13

     All right. Um-

300. 1:04:15

     Yes.

301. 1:04:15

     Okay. Uh, Al- Alrey, uh, did sign up and he is being minimalist and respecting others, and, uh, we got it. Okay. Thank you. Uh, questions? Uh, Senator Kirkpatrick.

302. 1:04:30

     Yes. Thank you very much. Um, I'm a big fan of these service cancelable loans. My question is, is it just rural areas or is it all underserved areas?

303. 1:04:39

     Just rural areas.

304. 1:04:40

     Just rural areas right now. We found that, uh, in many of our, our rural areas we have no optometrists now at all, and we thought maybe this is one way we can, we can do that. Hopefully we can expand this as we go forward. The only two schools that we have is one in Memphis and one in, um, Birmingham, and we have enough students going there that would make up our first class in the State of Georgia. How many, uh, how many optometry schools are in the, in the US?

305. 1:05:15

     In the, uh, US.

306. 1:05:17

     I do.

307. 1:05:18

     What, Matt? 24. 24 I'm seeing from the audience. Okay. That's good. And so, but the closest here in, to us here in Georgia is Alabama and- Memphis ... and Memphis, Tennessee.

308. 1:05:32

     And Memphis. Yes, sir.

309. 1:05:32

     Okay. Wow, nothing in South Carolina, North Carolina, Florida. Florida. South Florida. Really South Florida. Gotcha. Okay, any questions from the, uh, committee? Uh, the will of the committee, motion do pass. Brass second. Uh, we're gonna do Hodges. Uh, Senator Hodges. And further discussion. Senator Setzler, you me calling you? I'm just joking with you. All right, gotcha. The, uh, the... All those in favor raise your hand.

310. 1:06:04

     All right, it is unanimous. All right. Thank you.

311. 1:06:07

     Thank you.

312. 1:06:07

     And, uh, I will ask who is carrying that for you.

313. 1:06:10

     Senator Brass.

314. 1:06:11

     Senator Brass. Thank you so much. He, uh, uh, got it. Okay.

315. 1:06:15

     Thank y'all so much.

316. 1:06:17

     Okay. Thank you.

317. 1:06:25

     All righty. Next to last, last one we're voting on today, House Bill 1275. So, uh, Representative Newton, I saw him in the audience as he's making his way, and we are on LC 46-1554S. Is that correct?

318. 1:06:44

     That is correct.

319. 1:06:44

     That's correct. Uh, floor is yours.

320. 1:06:47

     Thank you. And thank you members of the committee and chairman, uh, for the opportunity to, to, to bring this bill before you. It's, it's a effort to, uh, to see that Georgia continues to be innovative in a lot of the new medical therapies that are out there. Uh, House Bill 1275 addresses human stem cell therapy. Uh, before I get much further, if you look on... Just, just, just be cautious. On lines 16 and 17, uh, you'll, you'll read this, these are not... These are cells obtained in an ethical manner that doesn't involve human stem cells of, uh, derived from aborted fe- fetuses. Uh, this is an innovative treatment that is being used in sports medicine and in, uh, uh, orthopedic injuries and, and, uh, wound care, especially in some of our diabetic wound care.

321. 1:07:26

     Uh, this is... These are tissues that are derived from donated, um, uh, umbilical cords and placental tissue. Uh, right now these procedures are going on in Georgia right now, where the therapies are being done to try to do the wound healing and, and assist with, um, uh, orthopedic, uh, injury rehabilitation. However, right now these, these have to be re- obtained from out of s- other states like Florida and further, so they have to be packed on dry ice to send here. So this is a perfectly legal process that's going on here now. What we want is for Georgia to allow the processing, uh, uh, to go on here in the state as well.

322. 1:08:02

     That will shorten the, that, that'll im- improve the capability and decrease the, um, the risks that are associated with having to transfer these from out-of-state sources. So that's what the bill does. This allows, uh, uh, producers, uh, and we have someone who may speak of that, to, um, to obtain this. This is usually donated material, um, uh, after birth, uh, placental material, um, uh, uh, umbilical cords, and th- that's where the stem cell therapy will be derived from. Um, once again, on lines 41 and 42 are the, are the legal part that say it, it, that this is not from human, uh, uh, aborted fetuses or, or, uh, embryos.

323. 1:08:41

     So there's minimal manipulation. Obviously you can't completely sterilize this. There's cleaning procedures that go on, but this is a l- a live tissue that's used, and it's shown some inc- incredible innovative, uh, uh, uh- ... results that are, that are very beneficial. And so we did go through, and you can see on line 67 and following, um, we do have some areas where some of this is going on now already, either through the FDA-approved research. So, uh, you can see some of the different organizations that, that do some accrediting or certifying for this.

324. 1:09:13

     Uh, there is on line 95 just a notice that right now these therapies have not been studied enough to be approved by the FDA, and that's the way it is with a lot of, uh, new research. And then at the very end, uh, line 126 and following, um, i- if research for therapeutic, uh, research purposes being c- conducted now at some of our universities in accordance with federal law, that th- that's n- this bill is not meant to affect any of that. So Emory, I know, is doing some research on this, and some others as well. So w- we're just, uh, this is, this is for those who are not in the research fields to be able to, uh, to obtain and produce this material and make it available to the physicians and practitioners who, who understand it, who know some of the, the capabilities, and for us to continue in- innovating in ways that can, uh, improve lives.

325. 1:10:01

     So glad to answer any questions, Mr. Chairman.

326. 1:10:03

     Thank you. Um, can you just point out to me the area where... Is it, is it in line 90, or is it in the, the area, uh, after, uh, line, say, 112 about, uh, testing for hepatitis and other communicable diseases? Um, is it-

327. 1:10:22

     That is part of the, the collection and, and, uh, processing. But, um-

328. 1:10:26

     So 85 through 92

329. 1:10:27

     ... if you, if you don't mind, we can, can I get an assistant up here that's with a pr-

330. 1:10:30

     Yeah

331. 1:10:30

     ... company who does this in Florida right now?

332. 1:10:33

     Yeah.

333. 1:10:33

     Is that all right?

334. 1:10:33

     C- Can... Sure. Yeah, that'd be great. Yeah.

335. 1:10:36

     If you could introduce yourself.

336. 1:10:36

     Come on up and, uh, pull that mic down, introduce yourself. If you just wanna help clarify that. Where is that in here that we're all good?

337. 1:10:43

     Good, good afternoon, everybody. Uh, could you hear me? Was it-

338. 1:10:46

     Yeah.

339. 1:10:46

     Okay. Um-

340. 1:10:48

     Your, your name-

341. 1:10:49

     My name is

342. 1:10:49

     ... your, your name and who you're with

343. 1:10:50

     ... sorry about that. My name is Fadi Alkhatib. Um, I am the director at Point8 Therapeutics. So once we pro- while we process this product, uh, we do additional, we do hepatitis testing. It goes through three different rounds of sterility testing. So the company that collects the umbilical cord, they do the first round. They provide the report over to us. Then we do a second round of sterility testing, and after the extraction process, we do a third round of sterility testing to make sure that-

344. 1:11:14

     Okay

345. 1:11:14

     ... the product is safe for our clients.

346. 1:11:16

     So, so is that, the standards on that come from FDA or-

347. 1:11:21

     It's FDA. Yes, that is correct. Yes.

348. 1:11:22

     FDA.

349. 1:11:22

     Yes.

350. 1:11:22

     Gotcha. Okay. So presumably like they do organ transpla- tran- transplantation, uh, very similar, I would presume.

351. 1:11:31

     It, it's a bit more strict because it's, it's donor tissue that has to be processed in the lab.

352. 1:11:36

     Yours, yours is more strict than donors?

353. 1:11:37

     It, it, it just a tiny bit.

354. 1:11:39

     Okay.

355. 1:11:39

     The reason is-

356. 1:11:40

     All right

357. 1:11:40

     ... um, it has, it has to go through multiple rounds of sterility testing that donor tissue doesn't have to go through.

358. 1:11:45

     Okay. Thank you. And, and you're in Florida?

359. 1:11:48

     Uh, Georgia.

360. 1:11:49

     You're in Georgia.

361. 1:11:49

     Yes. Yes.

362. 1:11:50

     Okay. So you're doing some of this now?

363. 1:11:51

     We, we, we'd like to make it public. That is correct, yes. Available for retail for medical providers to provide to their client, uh, patients.

364. 1:11:58

     Okay. I gotcha. Questions from the committee?

365. 1:12:03

     All right, uh, got Senator Brass first.

366. 1:12:06

     Yes, sir. Uh, it seems this is very similar to what we did last year, the Hope for, um, Georgia Patients Act on SB72 that allowed, um, non-FDA approved type medicines on certain illnesses.

367. 1:12:26

     Mm-hmm.

368. 1:12:27

     It, it seems similar and am I off on that? In fact, I'm a little surprised it's not included in it, but-

369. 1:12:34

     I, you know, I don't remember that. Who...

370. 1:12:36

     It's under the advance directive.

371. 1:12:37

     Yeah. But it sounds similar, maybe a different, uh, different route. Uh, Senator Setzler.

372. 1:12:45

     Mr. Chairman, appreciate the author on this. Um, appreciate the controls we're trying to put in place, and this, obviously, there's so much potential here. I th- I thoroughly appreciate that. M- My only question really is on lines 126 through 130, um, 'cause that, you can see as, as you highlighted above, you know, on line 41 through 42, "Shall not include treatment or research using, you know, th- that came from a embryo or aborted fetus." 126, "Nothing s- code sections shall be construed to regulate, restrict, or prohibit stem cell research or the derivation banking use, um, conducted accordance with federal law, including research overseen by an institutional review board or embryonic stem cell research oversight committee." W- What i- what is...

373. 1:13:27

     I- if it's nothing shall be construed to prevent that, what, uh, the embryonic stem cell research oversight committee, I just, e- educate me on that. I'm just not clear what that all means.

374. 1:13:38

     Um, m- my understanding is that the, there's nothing in this bill meant to preclude anything that's currently legal in Georgia-

375. 1:13:45

     Yeah

376. 1:13:45

     ... through, through whatever process they have through the federal government or federally supported research. So that's not really the goal of this bill to, to either approve or not approve anything along those lines. This is simply to allow material that's being used today to be, uh, also to be ob- not just be obtained from out of state right now and used by Georgia physicians and practitioners, would, would allow the, um, uh, the processing, the, the gathering, the donations, the processing, and then the distribution in the state of Georgia from a Georgia-based, uh, producer.

377. 1:14:19

     Sure. So-

378. 1:14:19

     So we're, we're, we're not, that's just was a statement really that we're, we're not getting into whatever the current reg- federal rules are that govern federally funded research either direction. We're not approving anything that's not been approved before, and we're not restricting anything that hasn't been restricted before in this bill.

379. 1:14:37

     A- and again, Mr.... I have great confidence in Chairman Newton. We have, I just think, think the world of the, the author. I just, this piece, if it's, if this is gonna serve to open, unknowingly open up some things that, I just want, I just want, uh, I just want us to know what we're voting on. And, and that, this, this seemed to have the effect of kind of cracking a door that I didn't really understand. That, that's all. I would, wasn't sure if you're aware of the details of what this means or not, so.

380. 1:15:06

     Senator Kirkpatrick.

381. 1:15:07

     Yeah, I was just gonna say, in looking up Senate Bill 72, which was Senator Brass's bill, he did cover some of this in that bill.

382. 1:15:18

     To allow it to be used or to be manufactured? This bill's about manufacturing in Georgia.

383. 1:15:23

     This has to do with manufacturing and use, if I'm not mistaken, and it was signed by the governor. So we may need to take a quick look at that and make sure that we-

384. 1:15:34

     Why- why don't you do that? Look at, uh... What's the number?

385. 1:15:38

     72.

386. 1:15:38

     House Bill 70... I'm sorry, Senate Bill-

387. 1:15:41

     72

388. 1:15:41

     ... 72 from last year. I'm gonna get, uh, a couple people to testify. Just pull that up on your phone or something like that if you want to. Um, would, would y'all mind letting a couple people testify, please? And, uh, Mike Griffin, Georgia Baptist.

389. 1:16:05

     Thank you, Mr. Thank you, Mr. Chairman. Uh, my name is Mike Griffin. Am I on or off or are you-

390. 1:16:11

     Uh, it's just not... It might want to-

391. 1:16:13

     Testing. Got it. There it is.

392. 1:16:14

     Okay.

393. 1:16:15

     My name is Mike Griffin. I'm Public Affairs Representative of the Georgia Baptist Mission Board, and we have already testified in favor of House Bill, uh, 1275. We really have a lot of respect for Representative Newton and his work in all these different kinds of areas. And we really appreciate one of the basic facts of this regulation that's in the introduction. It says, "So as to ensure that stem cell therapies are used to advance medical treatments and improve patient outcomes in an ethical manner that does not involve stem cell derived from aborted fet- fetuses." Also, in section one, it mentions this, and I don't have the exact LC that you have, but it talks about, "Medical innovation should be fostered while upholding ethical standards that respect the sanctity of human life." So it is a very good piece of l- legislation, and we appreciate, uh, the aspects of this bill very much.

394. 1:17:12

     Thank you.

395. 1:17:12

     So we appreciate your support for it.

396. 1:17:14

     Thank you. We appreciate that. Any questions? All right.

397. 1:17:18

     Thank you.

398. 1:17:18

     Thanks so much. Couple others to testify, I think. Uh...

399. 1:17:23

     Two of us.

400. 1:17:32

     Uh, Lynn Goldman and Brooke Mills. Yeah, you can come up and-

401. 1:17:42

     Oh, okay.

402. 1:17:44

     You can introduce yourself and the floor is yours.

403. 1:17:47

     Good afternoon. I'm Lynn Goldman. I'm the president of the Georgia Fertility Network, and thank you for having me, Chairman and, and the committee. Um, so as I said, I'm the president of the Georgia Fertility Network. We're a coalition of patients, fertility providers, legal experts, and, um, fertility, um, doctors in Georgia that work to protect and expand access to fertility treatment, including IVF. It's our primary mission to educate policymakers and advocates at the state level to ensure patients can continue accessing reproductive technologies.

404. 1:18:21

     House Bill 1275 raises several concerns due to its broad and, in some cases, ambiguous language that could create unintended consequences for fertility care and medical research in Georgia. The bill prohibits the use of stem cells, um, without clearly distinguishing this from standard IVF practices, which could introduce legal uncertainty around routine procedures such as embryo biopsy, embryo disposition, and donation.

405. 1:18:51

     This ambiguity may make providers more risk-averse, potentially limiting access to these important services. Additionally, the bill could conflict with Georgia's recently enacted IVF protections by introducing inconsistent definitions related to embryos, undermining a bipartisan framework designed to safeguard access to care. Beyond fertility treatment, the bill's restrictions on embryonic stem cell use may have a chilling effect on legitimate federally compliant research, potentially discouraging innovation and driving clinical trials and research institutions out of the state of Georgia.

406. 1:19:31

     At the same time, the legislation allows for the use of non-FDA approved stem cell therapies with only consent and disclosure requirements, which could expose patients to unproven treatments and create a parallel market that lacks rigorous oversight. Finally, the bill sources, sources... Ah, excuse me. The bill's sourcing and accreditation requirements could introduce additional compliance burdens, limit access to necessary materials, and increase costs for providers and patients without clear evidence of improved safety.

407. 1:20:04

     Taken together, these issues suggest the bill is not narrowly tailored and warrants further study to avoid unintended impacts on IVF and embryo-related care in Georgia's broader biomedical landscape.

408. 1:20:21

     All right. Thank you. We appreciate that. Any questions?

409. 1:20:26

     Yep.

410. 1:20:26

     Yes.

411. 1:20:27

     Madam, uh, witness, is there any language that you deem would, uh, clarify this particular legislation, 1275, so that would make it acceptable and, uh, compatible with your understanding?

412. 1:20:41

     Um, yes, Senator. We would like the term embryo taken out of this bill.

413. 1:20:46

     The word embryo, um...

414. 1:20:52

     If the point of this bill is solely to use umbilical cord blood, then say it. Just say it in the bill. It doesn't say it anywhere in this bill. There's no need to, to use the term embryo.

415. 1:21:08

     Okay. All right. Thank you.

416. 1:21:09

     Thank you.

417. 1:21:09

     Okay.

418. 1:21:13

     Did she

419. 1:21:16

     ... did she say anybody else?

420. 1:21:18

     Brooke Mills.

421. 1:21:20

     Brooke Mills had signed up, but I don't think she is here.

422. 1:21:24

     Yeah.

423. 1:21:24

     All right. Uh, we had the author. You want to get back up and, uh...

424. 1:21:31

     Hang on here just a s-

425. 1:21:48

     All right. Uh, the, uh... You want to wrap it up?

426. 1:21:52

     Sure. I guess a couple of things. We did look at, uh, Senate Bill 72, which was a very impressive bill. Um, it does describe individualized, uh, investigational treatment on line 67 of that bill, and one of it says a drug or a biological product. I thought biological product sounded like it might be this, but apparently in federal guidelines, biological, a, a biologic is different than what the, the way these are processed.

427. 1:22:17

     Yeah.

428. 1:22:17

     And so they need different... They would need... They're not able to do the, the, the gathering and the, uh, processing it and the deriving of these stem cells under the current Georgia law. So that, that's why this law just allows... Once again, it doesn't, and by this, pr- for this pre- previous testimony I think just prior, um, this doesn't change what is or isn't legal in Georgia, right? This just affects the processing, uh, f- processes that go, that a, that a manufacturer goes about to provide, um, these materials, uh, for stem cell therapy.

429. 1:22:53

     Okay.

430. 1:22:53

     And once again, we do have the, uh, at the end, we have the exemption of whatever federal research is going on. I'm sorry, federal, federally funded research institutional review board, uh, oversight committees on line 129 and 30, 130. Um, but that's-

431. 1:23:09

     Any questions for the author? All right. Do you have the, have a motion here?

432. 1:23:15

     Move to pass.

433. 1:23:16

     Move do pass, uh, from Senator Setzler. Second, Senator Brass.

434. 1:23:21

     Can I ask for a potential amendment-

435. 1:23:24

     Mm-hmm

436. 1:23:24

     ... if it's all right, sir? Um-

437. 1:23:26

     It has to be offered by somebody up here, but, uh-

438. 1:23:28

     Uh, I'll, can I mention it and see if anybody wants to offer it?

439. 1:23:31

     Okay.

440. 1:23:32

     Um, we realized, uh, uh, two small oversights. One is, um, on line 36 and 37, um, we inadvertently, D should be left out.

441. 1:23:45

     Okay. Uh-

442. 1:23:46

     That would

443. 1:23:47

     So-

444. 1:23:47

     So-

445. 1:23:48

     Yeah, the whole line 37 should be removed, and the, and the word or on line 36 should be moved up to line 34. I don't know if ledge council is able to look at that.

446. 1:23:59

     So line 37-

447. 1:24:01

     Is omitted

448. 1:24:01

     ... you're striking that.

449. 1:24:03

     Striking it.

450. 1:24:04

     And the word or is-

451. 1:24:07

     It's, it's-

452. 1:24:07

     ... you're striking that-

453. 1:24:08

     Striking it on 36-

454. 1:24:08

     ... and you're putting an or-

455. 1:24:09

     ... and placing it at, at the end of-

456. 1:24:10

     ... on line 34 after products.

457. 1:24:12

     Right. That's, that's one.

458. 1:24:13

     You got that?

459. 1:24:14

     That, that was an inadvertent thing-

460. 1:24:15

     All right

461. 1:24:15

     ... when we had-

462. 1:24:16

     Yeah. Is there anything else?

463. 1:24:17

     There is one, one group on line 72, the National Marrow Donor Program, said that they don't really certify or accredit any of those, and they requested if they could be left out. So omitting line 72, that would change the-

464. 1:24:31

     So we're striking line 72, and that would change the lettering-

465. 1:24:35

     Obviously change the lettering now-

466. 1:24:36

     ... letters. Yeah. Got that. So 73-

467. 1:24:38

     So those, those two changes would, would allow-

468. 1:24:40

     Okay

469. 1:24:40

     ... this to, uh-

470. 1:24:41

     Ms. Crittenden, is that-

471. 1:24:42

     Yep.

472. 1:24:42

     Do you have that also?

473. 1:24:43

     Yes.

474. 1:24:44

     So that's just gonna change the s- line 73 to A, 74 to B, C, and D on down. So, okay. All right. So-

475. 1:24:54

     Thank you.

476. 1:24:55

     All right, so we have the-

477. 1:24:57

     Got a motion.

478. 1:24:58

     Got a motion. Got a second. Okay. Any further discussion?

479. 1:25:01

     Senator Setzler.

480. 1:25:01

     On the amendment.

481. 1:25:02

     Any further discussion?

482. 1:25:03

     On the amendment.

483. 1:25:04

     We are, we're voting on the amendment. Yes. Thank you. I'm, got it. Keeping me straight up here. Appreciate that. Voting on the amend... All those in favor of the amendment, uh, raise your hand. One, two, three, four. Uh, all right. That was unanimous. And all those, uh, f- so we're on Substitute House Bill 1275 LC461554S as amended. And all those in favor, raise your hand. Again, unanimous.

484. 1:25:35

     And so thank you.

485. 1:25:37

     Sure.

486. 1:25:37

     Bill passes.

487. 1:25:38

     Thank you, sir.

488. 1:25:38

     And who's carrying that for you?

489. 1:25:40

     Chairman Brass.

490. 1:25:41

     Chairman Brass. Dr. Brass.

491. 1:25:43

     It's, it's, it, it-

492. 1:25:43

     He might get an honorary doctorate here again today.

493. 1:25:45

     It is a follow-up on his previous bill.

494. 1:25:47

     Okay.

495. 1:25:47

     Thank you, sir.

496. 1:25:48

     Well, that's true. It is. He's going, he's, um... Got it. Okay. I won't make that joke. I gotcha. Okay.

497. 1:25:54

     Thank you, committee.

498. 1:25:54

     Uh, good.

499. 1:25:55

     Chairman.

500. 1:25:55

     Thank you. Appreciate it. And thank you for those changes. Appreciate it.

501. 1:26:03

     So last bill hearing, a hearing only 1393, House Bill 1393, and, uh, Senator Workhouse, uh, Representative Workhouse, LC 461497S. Is that accurate?

502. 1:26:21

     I don't see an S on mine, but you might.

503. 1:26:28

     You didn't have a substitute in the House?

504. 1:26:29

     Oh, I'm sorry. It was a two-word change. You are correct.

505. 1:26:31

     Okay.

506. 1:26:32

     I've got my original. You are correct.

507. 1:26:33

     Okay. All right.

508. 1:26:34

     Yeah, it was a two-word-

509. 1:26:34

     So in our folder is, uh, LC 461497S. There you go. And, uh, House Bill 1393. And I think we do have some folks to testify. This is gonna be hearing only. And, uh, in the queue we have... You can go ahead and get started. That'd be good.

510. 1:26:54

     Okay. Well, I'm gonna do it as quick as I can. It is a lengthy bill, but it is actually pretty, uh, simple. Came up with the idea, uh, based on two things. I serve on the, on the board of directors of Evans Memorial Hospital in Claxton for about five years, so hear the monthly problems that rural hospitals have. And then this past summer, um, went on a 300-mile, two-day- Nine hospital trek, um, visiting rural hospitals.

511. 1:27:27

     And the idea was that if we could, if some of these rural hospitals could combine on three different areas, on purchasing, staffing, and negotiations. Um, supplies is pretty simple. They could lower costs by buying supplies cheaper, but that's not gonna keep their doors open. Staffing, as, as y'all know, getting, uh, doctors to come to rural hospitals is tough.

512. 1:28:00

     So if, if three hospitals that are 15 miles apart from each other could come up with a contract where they rotate, then that'd be great. The, the biggest part of the bill is for them to be able to negotiate with insurance reimbursements. And, um, I could give you stat after stat of hospitals that... Well, yesterday Evans said about 82% of the patients that come through that hospital are either Medicaid, Medicare, or self-insured, which means, or self-pay, which is no pay.

513. 1:28:37

     And so makes it very, very tough. A, a single change in a insurance reimbursement rate, and we're not asking what all the other hospitals are getting. We're not asking for even a fourth or fifth or sixth of what they get. We're asking for a 10th of what they get. Um, that alone would save the hospitals. I, I'm gonna bring this up because, um, there's a lot of talk in the halls, and I think we've nailed it down. And, and Dr.

514. 1:29:08

     Newton was a big help in committee. Um, there is the issue of antitrust or price collusion when, when groups get together and talk about pricing. And so in 2013, there was FTC versus P- Put- uh, Phoebe Putnam, and,

515. 1:29:31

     and they lost. And so what we did is, is we took what the, there was a Supreme Court ruling, and then there was the Georgia Supreme Court, and they were very close on winning that except for on the state immunity clause. And I'm just gonna read you one sentence, which this bill fixes. "The court held that the state action immunity does not apply because the Georgia legislature did not clearly articulate any intent to allow anti-commed- competitive activity through the hospital authorities law." If we were to pass this bill, that's what you would be doing.

516. 1:30:10

     You'd be articulating what you could and could not do. And so we, and there was four other factors that, um, that we took through that Supreme Court ruling and basically plugged those holes, and that's about as condensed as I can give it to you.

517. 1:30:31

     Okay. Uh, in the House, I think you'd had someone help you, uh, present that. Did you have anybody that in-

518. 1:30:36

     There was an attorney. So we had antitrust attorneys and attorneys from Bradley. They could not be here on short notice. I've got Bill Lee, my hospital CEO here. He, he would like to speak from a hospital's perspective. But no, I am, I am out of intelligent-

519. 1:30:55

     Okay. So-

520. 1:30:56

     ... um, ammunition

521. 1:30:56

     ... can we get, um-

522. 1:30:58

     Told you more than what I know

523. 1:30:59

     ... hospital administrator Bill Lee up. And, uh, you have a question while you're getting up here-

524. 1:31:05

     Okay

525. 1:31:05

     ... uh, Senator Kirkpatrick.

526. 1:31:06

     Yeah, I, uh, you know, I used to be in a independent medical practice, and we would like to have worked with other groups to contract, but it was pretty clearly not legal for us to do that. And so we had to form an entity that w- was more of an umbrella type of a thing. I think we called it an IPA or something like that. And, uh, still there were n- a lot of limits on what we could even talk about and what we could do.

527. 1:31:38

     And so we ended up merging so that we'd all have the same tax ID number, and that was the only way that we could really legally do the type of thing that you're talking about unless the law has changed. So I'm just, uh, not clear on how you can legally do that.

528. 1:31:54

     Well, we're basically intersecting the state doctrine, um, along with the, uh, against the state immunity law, um, and the hospital authority law. Um, and this does restrict, is very restrictive to those that are rural hospitals as defined by law. Um, and it would not allow a larger, like a WellStar or Northside to come in and capture one so that they could get their benefits, um, because there'd be problems with theirs.

529. 1:32:32

     But it, but, um, I've probably already told you more than what I know, so I'm gonna let Bill speak and see if he can't answer it.

530. 1:32:42

     Mr., Mr. Lee, if you don't mind, I know who you are, but the rest of the committee does not. So if you might introduce yourself and give us a little of your history and where you are now.

531. 1:32:50

     Thank you so much, Mr. Chairman. I think that's on. Um, I'm Bill Lee. I'm the CEO of Evans Memorial Hospital in Claxton, Georgia. Been there about six years. Have spent the last 25 to 28 years in healthcare leadership, um, and really feel like that at this point, this is one of the most pivotal points of legislation that could come forth, um, especially under the hospices of the Rural Health Transformation Program. I think at this point we are being tasked to do more with less.

532. 1:33:20

     Um, rural hospitals has many challenges as you read, hear about across the country, not only in Georgia. I think that was the, the background of why the Big Beautiful Bill and the Rural Health Transformation Program came about, and part of it is optimization. And so as we work across rural hospitals, one of the things that we look at is with recruitment. Um, we can't recruit talent because we can't pay for it. The workforce shortage has driven that. If you could combine shared leadership across the board I know that there has been a lot of talk about contracts and negotiation, and I think it's sort of taken a life form of its own in the fact that contract negotiation is really also about supply chain, about group purchasing, things that we could do collaboratively together to save money because you have no scope and scale as a singular rural hospital that's volumes are pale in comparison to a larger health system.

533. 1:34:14

     There is the question about leverage around managed care contract negotiations, and I think, you know, our, uh, antitrust attorney, we had... I think we flushed through that in the subcommittee of the House, talking about h- hospital authorities and the immunity around that. But I think I wanted to remind people that when you look at a population size, and I'll use my own as an example, the population we would have in Evans County that would actually benefit from a, a, a renegotiation with Anthem or others with higher rate, even combined with Candler County, Emanuel County, if you could took all those hospitals and roll them together, they would pale in the cons- comparison to one unit at WellStar.

534. 1:34:54

     And so there's not enough dollars and cents in there as far as that is not like it's going to be a $14 million pickup for any facility in the, in this, um, market. This is about parity. This is about rural hospitals have no leverage, and we have fact that they are paid 20 to 30% less than their like-minded, like, um, hospitals in larger urban areas, and I think that is concerning. So when we're asked as hospital CEOs to continue to pay for staffing, to pay for supplies that cost the same whether you're in Claxton or whether you're in Decatur or whether you're in Metro Atlanta, it's problematic.

535. 1:35:37

     And so I think this is an opportunity for us to use our, our power of partnership, which is what is behind the whole concept of the Rural Health Transformation program, is being innovative, and this is our answer to innovation, and I think it is critical that we have to consider this and not delay another calendar year.

536. 1:35:59

     Senator Kirkpatrick.

537. 1:36:00

     Just a follow-up question.

538. 1:36:02

     Okay.

539. 1:36:03

     Um, thank you for what you do. Um, obviously, the General Assembly's a big fan of rural hospitals. My question, though, is the rural, um, the new program through the federal government, that is a grant program, right? And my understanding is it doesn't have anything to do with changing the law as it relates to antitrust or, uh, consolidation or anything like that. Wouldn't Congress have to act to do that?

540. 1:36:30

     So it i- it is, to answer the first question, it is a grant-driven program, but it, however, part of it is driven based on innovation, optimization, and cost efficiency, for lack of a better word. And so that is some of the drivers that they are asking from a value-based perspective. And so part of those drivers are only gonna be done if you have the opportunity to collaborate and work from scope and service. But to your question, that has nothing to do with contract negotiation except for the fact that it could be advantageous because you could speak for more than one.

541. 1:37:06

     Any, any further questions? If not, we ask more folks to... Senator Setzler.

542. 1:37:11

     Thank you for being here. And, uh, you're already working 60-hour workweek. I'm sure being here just is on top of that, so thanks, thanks for being part. So in plain English, uh, if you've got three small hospitals and, that are maybe 25, 30 miles a- apart-

543. 1:37:25

     Mm-hmm

544. 1:37:25

     ... does this contemplate having maybe a, um, more of an oncology practice in one and, and, and, and more of a s- strength in other technologies in others so that you're able to work as kind of a, kind of a cluster but you're still a distinct hospital? Is that what this is about?

545. 1:37:40

     Th- th- this is part of it because I think that's a great example, and I will take just 30 seconds to expand on that. I know two hospitals that are, say, 30 minutes apart, 25 minutes apart, that one focuses on swing beds and post-acute, and one is more focused on acute and surgical procedures. So if you took those two facilities, how could you really, instead of duplicating, complement each other so that you could work together, share resources, share physicians that could cover those, but actually have patients that would align and, again, use those facilities for a niche or for facilities that would make sense within a market, a geographically desirable market?

546. 1:38:16

     So under our current law, you doing that, that would be unlawful collusion, is what you're saying?

547. 1:38:21

     I'm not saying that at all.

548. 1:38:22

     Okay. So, so what's, what's the-

549. 1:38:24

     Under, under current law-

550. 1:38:25

     But, but, but, but, but-

551. 1:38:26

     You're saying under current law you could do that

552. 1:38:27

     ... under-

553. 1:38:28

     I'm saying the current law, what it, what creates this is that we as a hospital authority can't partner and collaborate outside the jurisdiction of your county as a hospital authority. So that allows you to go across county lines and work with other like hospital authority or not-for-profit rural hospitals.

554. 1:38:44

     So I think the answer to your question was yes.

555. 1:38:45

     So, so the, so the essence of this bill is allow collaboration, which would now be unlawful, is what you're saying, under the current...?

556. 1:38:54

     I'm saying yes. Currently, we cannot legally collaborate because we, because of the way the law is divided.

557. 1:39:00

     Right.

558. 1:39:00

     The only way you'd be able to do that is if one group took over the other, which is what we're trying to prevent so that the authorities maintain their autonomy and-

559. 1:39:13

     Independence is correct

560. 1:39:14

     ... independence.

561. 1:39:14

     Quite rightly.

562. 1:39:15

     So, so does the bill prevent that from happening, the large urban hospital-

563. 1:39:21

     It does.

564. 1:39:22

     It does. I'm sorry.

565. 1:39:24

     So, okay. So would... And, and then they would not have antitrust, so they take over that hospital, then that big hospital would not have-

566. 1:39:34

     Well, A, they wouldn't need it-

567. 1:39:36

     They would-

568. 1:39:36

     ... because they're, they're getting all these benefits. So if-

569. 1:39:39

     You, you're telling me a big hospital doesn't want antitrust legislation?

570. 1:39:43

     I'm saying that they don't need, they don't need, uh-

571. 1:39:46

     Uh

572. 1:39:46

     ... the scale and-

573. 1:39:48

     Okay.

574. 1:39:48

     May we argue?

575. 1:39:48

     I, I don't think, uh, I think you may be the lone person in the room that would think that.

576. 1:39:53

     Well, if, if, if Northside took over- Heaven's Memorial, it wouldn't show up as a blip on a-

577. 1:39:59

     They would enjoy the antitrust. Yeah, they would enjoy the antitrust.

578. 1:40:02

     Well, they, they couldn't under the-

579. 1:40:03

     They are not. All right, let's, uh, let's see. Okay.

580. 1:40:06

     I was just gonna say, but what would happen in that situation is you essentially lose your independence, because then you would be under the control of a Northside hospital, and I think that goes against the tenor of the bill in itself, is to maintain independence, local control.

581. 1:40:19

     But the Norths- or w- not gonna pick on Northside- ... but a larger metropolitan hospital would not-- could buy a hospital-

582. 1:40:29

     Correct

583. 1:40:29

     ... and, um, you would be for sale-

584. 1:40:31

     Correct

585. 1:40:32

     ... with the right price.

586. 1:40:33

     For r-- anything's for sale.

587. 1:40:34

     And, and then they would enjoy that antitrust.

588. 1:40:38

     Well, they would essentially own, they would be the sole owner and operator, so then they could do it, because they wouldn't, it wouldn't be antitrust-

589. 1:40:43

     Same tax ID

590. 1:40:43

     ... because they, same tax ID, the same parent company.

591. 1:40:47

     Gotcha. So let's, let's explore that a little bit further. Any other questions from the committee?

592. 1:40:53

     All right. Leva?

593. 1:40:55

     Uh, Mr. Lee, s- uh, Witness Lee, you indicated you use your own hospital. What type of volume are you looking at, and what type of volume are you wanting to, uh, collaborate with? Can you give me a better idea? I'm, uh, I'm... Well, I'm not going to give you an example. Give you, give me an example of the, the size and the scope that, that-

594. 1:41:20

     So demo- give us the demographic

595. 1:41:21

     ... some general-

596. 1:41:21

     Most, most of s- most of these hospitals that we're describing are 25-bed hospitals. Ours is 49 beds, but we operate 25, so with an average daily census of somewhere 15 to 20. Um, and so, and then outpatient volumes in addition, about 1,000 ER visits a month, um, up to, you know, 2,000 E- E- ER visits a month, depending upon the size and the location. So we're not talking about mammoth volume of patient population, and that's, at the end of the day, you just hit the nail on the head.

597. 1:41:51

     That's why sharing leaders, sharing specialists, sharing individuals is much more cost effective.

598. 1:41:58

     All right. And you want to get that number up to how many beds or how many ER visits so that you can be competitive on the, on the negotiations?

599. 1:42:07

     It's, it's more about just the vo- the current occupancy and volume. So, you know, you would, like, take that to where you're doing 20 to 25, um, patients average daily census versus, uh, 15 to 20. So essentially you're adding patient volume because as a hospital, the way they're structured now, its volume is critical in order to pay the bills.

600. 1:42:29

     Gotcha. Thank you. All right.

601. 1:42:30

     Thank you.

602. 1:42:30

     We appreciate that. Any other questions? And, uh, we got three people that signed up. Uh, actually, I'm sorry, four people. Um, let's go with, uh, Mr. Belafonte.

603. 1:42:55

     We'll let the author just sort of step back for a minute. We'll go through them as fast as we can. Jesse Weatherington after that, Chris Jensen, and if Whitney Gregg's still here, we'll go there. Okay?

604. 1:43:07

     Thank you, Mr. Chairman. Um-

605. 1:43:09

     Could you get a little bit closer?

606. 1:43:10

     Yeah.

607. 1:43:10

     Yeah. Set-- I'll turn the volume up.

608. 1:43:11

     There we go.

609. 1:43:12

     There you go.

610. 1:43:12

     All right. Thank you, Mr. Chairman, members of the committee. Um, I'm Josh Belafonte. I work with Robins Government Relations. And respectfully, I would suggest to you that the bill's scope and the bill's, um, uh, impact is far greater than just rural hospitals, rural public authority hospitals, uh, and, uh, purchasing, staffing, and negotiations. If that's where the bill was limited, I think there would be less concern. But the way that it's set up, it doesn't shield, um, it doesn't focus on, and it's not triggered by a rural public hospital authority.

611. 1:43:49

     In fact, it's not even defined in the bill. Where it kicks in on the rural side is if an operation is in a rural county, 50,000 or less. So some of the large hospitals can do something with a public hospital authority in a rural county, and it would be exempt from antitrust. And that would be quite new, uh, at least after the Supreme Court decision. And part of the reason or how they get there is they effectively say that a public hospital authority is a state actor.

612. 1:44:21

     It is no different from a county government. It is no different from muni- municipality. And that's true for the ones that are restructured as well. Those are the ones that have the 501[c][3]s that do the operating arm of the hospital authority. And so that's how they get to this antitrust limitation is by effectively making them arms of the state. That's actually the phrase in antitrust law, and there was a case out March 5th that dealt with effectively New Jersey Transit, it's Gillette, and says, "If you have your own board and your own corporate entity, you're not an arm of the state." So that was a case dealing with sovereign immunity, but the analysis in sovereign immunity and antitrust on state actor is virtually the same.

613. 1:45:07

     So let me just point out a few things in the bill, 'cause again, if it's just h- allowing two or three independent rural hospital authorities to collaborate, I think that makes a lot of sense. But what the bill does is, I think, opens the door. On page 49-- or excuse me, lines 49 and 50-

614. 1:45:26

     That's me

615. 1:45:31

     ... the express policy of the state, starting at 46, is to encourage hospital authorities or restructured hospital authorities in rural counties in coordinated healthcare planning delivery, including but not limited to mergers, acquisitions, consolidations, and affiliations with other hospitals or healthcare providers. No limitation on rural.

616. 1:45:55

     And so the first part gets you The Rural Hospital Authority, but the second part is what allows a larger hospital system to come into that authority under an affiliation or a consolidation or a merger or an acquisition. You see it again on lines 119 to 124 when it talks about a collaborating entity. This kicks in later in the bill when it says who the Rural Public Hospital Authority can work with and be exempt from antitrust.

617. 1:46:27

     And there, it's any public or not-for-profit hospital authority or restructured hospital authority or nonprofit licensed healthcare entity that partners with. Query why it has to be limited to tax-exempt hospitals, but I'll save that for another day. The next one is, um, and I won't do all of them, but there's a, there's a couple here. I would go to line 225 to 227.

618. 1:46:54

     This is who the immunity extends to. And, and there's basically three different, uh, immunities in here, all for antitrust. But the way it's set up, one's mergers, one's collaboration. The immunity is not just for the Rural Public Hospital Authority. It's for anybody that is under common control, controlled by, with a hospital authority, including a subsidiary affiliate, which could be, again, your larger systems. If you go to lines, the next page or two pages over, 272 to 280, you've got the same thing.

619. 1:47:27

     Joint operating agreements, other collaborative arrangements, other hospital authorities, or other healthcare entities. They would be immune from antitrust in the, if the operation is in the rural county. But remember, the operation only has to be one thing. And once they get there, share information, negotiate together, et cetera. And on lines, there's several places, lines 37 to 45, uh, 200 to 201, in responding to the Phoebe decision, it will become the policy of the State of Georgia to displace health, uh, competition in healthcare.

620. 1:48:08

     And if you look at that, several times it says that, it's not limited to rural areas.

621. 1:48:18

     And so it's hard to-- I, I think that that's an area that could be trimmed in as well. Um, we would suggest to you that if you combine our current CON laws, which allow hospitals to have, and, and not just hospitals, other facilities as well, uh, to have a monopoly that they can protect through CON, and then remove antitrust. Whenever a hospital works with a rural hospital, you've effectively, and in the name of, of the state's desire to displace competition, use the state to block any growth and any, uh, sustainability for new healthcare providers.

622. 1:48:57

     And I would suggest that that's not what I think the intent of the bill is, and I think the bill can be worked in such a way that it would do, um, what is described. Whether that's the scope and be limited to, uh, purchasing, staffing negotiations, or whether that's just dealing with two, uh, rural hospital authorities working together and not with a system or a larger hospital in a suburban or urban area. So that's all I have unless the committee has questions.

623. 1:49:26

     Thank you. Any questions from, from the committee? Um, just, just to, just sort of clarification. Um,

624. 1:49:35

     so the, you know, the question is where, just for, so a large rural s- a large urban system purchases a rural system that has this antitrust, so it creates, it creates a monopoly for both of them?

625. 1:49:53

     Well, if the, if the system affiliates with the rural one, then antitrust would not, the review would not have to go, it would not have to go through antitrust review. And so-

626. 1:50:04

     It would bypass antitrust?

627. 1:50:06

     Yeah. Yes. Oh. It, you know, I mean, this would have to get litigated at some point, but yes, that's the intent.

628. 1:50:13

     Right. That's the intent. I gotcha. Okay. All right. And, um,

629. 1:50:19

     okay.

630. 1:50:27

     It doesn't necessarily have to be a large urban system, but it can be, um, a middle size.

631. 1:50:34

     It could be. And in some areas, you know, some systems have just independent hospitals. They're not hospital authorities. They would not be able to, to do this because it's hospital authority to hospital authority or restructured hospital authority. Um, so think about specialty hospitals or something like that. Most of those are private. But, but yes, a- as I read the bill, because the focus is on where the transaction's happening, not who the parties to the transaction are, or exclusively that question about who they are, that's what allows the larger systems to come in and not just acquire, but affiliate and, and, uh, you know, share, uh, pricing information and so on for those negotiations.

632. 1:51:15

     All right. Senator Setzler.

633. 1:51:17

     Thank you, Mr. Chairman. Um, Mr. Bellafanti, thanks for being here. Uh, I'm on two twenty-five through two twenty-seven, exploring the, your reference to affiliation. Um, affiliate or other entity in which ho- hospital authority has an ownership or membership interest. So essentially, you could have another, uh, entity from out of town, could be a big system that, uh, has any ownership interest. You could have a five percent ownership, a ten percent ownership interest by an outside entity, and they get to k- essentially, by, by virtue of that affiliation, a- achieve the, the antitrust objective they would have.

634. 1:51:55

     That's, that's how I read it, and cer-- and, and at least in that rural county. So whatever they're doing in that rural county, antitrust does not apply

635. 1:52:03

     For laymen who're not living in the antitrust world, just open up for us briefly what the, what advantages that gives, w- would give a, an ent- outside entity that's, that's affiliating this.

636. 1:52:12

     Sure. I think as you heard, staffing. I mean, there's, there's some things that make a lot of sense, right? I mean, if you've got one CT in, you know, two counties and they wanna be able to coordinate how to use it or staff it, that, that's one thing. And so that would be an advantage for the two rural hospitals. But what could a large system gain from it? However many more lives that that hospital treats is leverage on negotiations with insurance. It is leverage for negotiating with physicians in the area. So if there's two systems that are coordinating together, um, for example, non-compete agreements, if it now applies to both, that physician, if they decide to leave, is effectively going to leave that area to get out of their, um, radius.

637. 1:52:57

     And, and those are some things that, that folks have found also increase the cost of care.

638. 1:53:02

     Thank you.

639. 1:53:07

     No other questions. But from, from the, the premise, the premise of the bill is to put two or three hospitals together so that they can work together and purchase an MR scan or do oncology or do, uh, something that they can do together because they would have the scale at that time to do that, the rural hospitals.

640. 1:53:29

     That, that's my understanding from the prior committee and the House floor.

641. 1:53:33

     Okay. Thank you. All right. No more questions. Uh, let me... Uh, thank you-

642. 1:53:38

     Thank you

643. 1:53:38

     ... Mr. Belafonte. Uh, and then the... We had Chris Denson, Jesse Wetherington, and Whitney Griggs. We're...

644. 1:53:52

     Any-

645. 1:53:52

     Which order you want them in.

646. 1:53:54

     E- either whatever we all decide. Y'all can flip a coin there if you want to.

647. 1:53:59

     Reverse alphabetical.

648. 1:54:00

     There, that works. I, listen, with a Watson, I, I get that. Absolutely.

649. 1:54:05

     I feel your pain. Um, uh, thank you, Mr. Chairman, members of the committee. Good evening. My name is Jesse Wetherington. I'm the president and CEO of the Georgia Association Health Plans, which is the commercial group representing the health benefits industry. Um, we share, uh, the concerns, uh, Mr. Belafonte, uh, with House Bill 1393 as written. Um, I do believe, again, this is a well-intentioned piece of legislation, but the way that is presented to you, I do believe contains some pernicious unintended consequences, many of which, uh, were described to you by Mr. Belafonte in a much more eloquent fashion than I would be able to do.

650. 1:54:38

     Um, but we do share those concerns. As health plans, um, we think this could have a negative impact, again, on the affordability of healthcare by bidding up the price of the care that's delivered in rural Georgia. Um, we share the concerns about the potential for large urban systems to be able to come in and sort of abuse, uh, the privilege that they would be given under this bill. And I think, you know, it's basic economics to remind everyone, you know, what the, what the impact of monopolies are. They reduce the quantity and quality of services they provide at a higher price. We think that's the wrong prescription for increasing rural healthcare for Georgians, so we would urge you to, uh, cautious, take, take caution, reject this bill, and definitely read it very closely because while I think there is a good intent behind it, it is a sort of gold-plated 20-page affirmative action for state action immunity, uh, defense for antitrust liability, and we're concerned with that.

651. 1:55:26

     Thank you. Any questions from the committee? Mr., Mr. Denson, Chris Denson.

652. 1:55:32

     Mr. Chairman, I'll waive.

653. 1:55:33

     You'll waive? All righty. Thank you. And Whitney Griggs.

654. 1:55:36

     I'm here.

655. 1:55:36

     There she is. And you know what? I didn't spot her. Goodness gracious. I'm sorry. Uh, thank you, Ms. Griggs.

656. 1:55:43

     I'm-

657. 1:55:44

     Just introduce yourself, please, ma'am.

658. 1:55:47

     I'm Whitney Griggs. I'm the director of health policy at Georgians for a Healthy Future. We're a nonprofit healthcare consumer policy and advocacy organization. And we share, shockingly, some of the same, um, concerns as Mr. Wetherington about, um, creating, um, areas of anti-competition that can, um, drive up consumer prices. Uh, research consistently shows that when hospitals consolidate, that does drive up prices for consumers. And a lot of times in rural areas, the hospitals are already consolidated.

659. 1:56:22

     Um, Phoebe Putney is a great example of that. The case that's being referenced, um, they bought up the kind of sole remaining hospital in the area. Um, and we know that that can lead to, um, decreased negotiating power and ultimately higher costs for the folks who we're also, who we- we're trying to protect with this bill. Also very concerned about the, um, loophole that would allow healthcare systems, large, potentially urban healthcare systems to participate in this antitrust, um-

660. 1:56:57

     Environment

661. 1:56:58

     ... environment. That's a good word.

662. 1:57:00

     Okay.

663. 1:57:00

     Um, and in 2023, North Carolina actually had a bill that tried to do almost the same exact thing, and the FTC blocked them because of the language that said that healthcare systems that had, um, a presence in rural areas could, um, be, participate in this. Um, and then the other piece that I'll just raise awareness on is the reference to the Rural Health Transformation program. A lot of what, uh, has been mentioned today, the staffing, um, participation with providers, that's already allowed under federal antitrust law.

664. 1:57:38

     So this bill wouldn't really address that. We're already allowed to do that. And the value-based care models, um, in the Rural Health Transformation program would not benefit from this. So we're really concerned about the unintended consequences of this bill. If the committee does move forward with this bill, we would request that there's some state oversight. The bill specifically removes state oversight from the, um- Current law and says that the state does not have-- There's no active oversight from the state for these rural hospital authorities.

665. 1:58:13

     The rural-- The Federal Trade Commission has said, "In other states where this collaboration has been allowed, there has to be some sort of state mechanism for oversight." Oftentimes, it's multiple agencies, so the Department of Insurance, the attorney general, their, um, Department of Health. Um, and we would request that the state actually specifically provide a specific oversight body to oversee this to understand, one, the impact on affordability to consumers. Two, is this type of model actually doing what it says that it's going to do?

666. 1:58:45

     And three, um, just intervene in case there's these, you know, potential unintended consequences come to fruition.

667. 1:58:52

     Thank you. Any questions, uh, for the... Nope. Oh, sure. All right. Good. Okay. Um, I think that was it for testimony. Um, um, Mr., uh, Senator, Representative Workhouse, do you wanna come back up and, uh, I mean, um, uh, I hope that we can, um, you know, move forward. I'd, uh, move forward and make some adjustments here, and sounds like there may be little, some gaps in there that may need to be closed with that. I, I, I like the underlying premise of, you know, two or three hospitals, you know, working together, uh, economy of scale and, um, without fear of, of trust.

668. 1:59:32

     So it sounds like the FTC may be, uh, you know, looking from above somewhere. But still, uh, you know, if we can get through this and work through that, uh, sounds, you know, I would like to do that. So if we can-

669. 1:59:45

     We're certainly open to suggestions, but I, I do wanna make one comment that not surprising these folks would show up. Um, just give you an example. We've got Optum right down the road that is almost... You go in their parking lot, it is filled with license plates from people all over the southeast, fully insured, people getting replacements. But you can't get a gallbladder surgery there. Folks that just spoke, they'll reimburse them, you know, six to eight thousand dollars.

670. 2:00:17

     You get that same gallbladder surgery at Evans Memorial, you'll get a reimbursement of six hundred dollars. So of course they don't want this. And-

671. 2:00:29

     And-

672. 2:00:29

     To drive up costs is, to use that excuse is ridiculous. But anyway, I'm open for s- suggestions.

673. 2:00:36

     Yeah. And, and I don't think you would-- You're not throwing Tattnall under the bus 'cause it's certainly been a great-

674. 2:00:41

     Well, I, I love that hospital

675. 2:00:42

     ... great winner, great winner for that hospital.

676. 2:00:44

     Yes.

677. 2:00:44

     And Optum's done a great job. But, you know, you're right. The ACA forbid that to happen anymore, um, and-

678. 2:00:50

     No, I'd, I'd love for any-

679. 2:00:52

     And, and so you-

680. 2:00:52

     I want them all to get rich, not just one.

681. 2:00:54

     Yeah. No, I don't want rich or not. You know, I, I always open up my committee meetings that if we do what's best for the patient, generally, you know, things will fall into place. Uh, and, um, listen, um, antitrust, CON, I mean, the, it, it all restricts, uh-

682. 2:01:11

     I understand

683. 2:01:11

     ... particular competition. So you're, you're exactly right. And I get it. Uh, they've negotiated, Urban Hospital's negotiated better prices, uh, than, than what you may be able to negotiate. Uh, so, um, um, I understand what you're saying. Uh, and, but I will tell you, you know, the Rural Health Transformation, uh, is driving value, is what Mr. Lee said, but, uh, I'd like to say quality. It's driving quality, 'cause when we drive quality, we drive price. And if you do what's best for the patient, that's good.

684. 2:01:42

     Do you, do you know how much we're getting, Rural Health Transformation, per year?

685. 2:01:46

     Well, the total package is fifty billion, but-

686. 2:01:49

     The total package for the US.

687. 2:01:50

     Yeah.

688. 2:01:51

     So Georgia's getting two hundred and eighteen million dollars. Would've got more if we'd done away with CON, but some of the CON bill legislation that we passed last time, we got more. So two hundred and eighteen million every year for five years for Rural Health Transformation. So- Breach. What's that? Breach. No, it's the truth. Uh, the truth shall set you free, right? And then the, uh, directed payment plan, I didn't get how much, but I would like to hear how much, uh, directed payment plan that, you know, some of these hospitals, like Mr.

689. 2:02:22

     Lee, what, how much you got, and how much through the DPP2 will you be getting. So I think we just, sounds like we need to have some good discussion and see if we can, um, tighten this down a little bit and, um, see if we can work together. So, uh-

690. 2:02:37

     My door's always open.

691. 2:02:39

     The-- Works both ways. The, if we are, um, if there's no further business, we'll be happy to, uh, adjourn. And I think that, uh, judiciary starts in this room in seven minutes. Meeting's adjourned. We're m- we're going to meet, our last meeting is gonna be Wednesday. Thank you.