Senate Health and Human Services Committee, March 25, 2026

Transcript

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1. 0:18:39

   Good afternoon. Good evening, it is. Welcome to the State Senate Health and Human Services, and we got our screen going. So, um, uh, Senator Robertson, uh, majority whip, would you mind opening us up in a prayer? You're on number eight, nine?

2. 0:18:57

   Yeah.

3. 0:18:57

   Nine.

4. 0:18:58

   Yes, sir. It looks like a room that could use a prayer. Be happy to do that.

5. 0:19:04

   Dear Heavenly Father, we come before you today, Lord God, as your humble servant. We ask, Lord God, that you open our hearts and our minds and remind us, Lord God, that we're here to be compassionate and caring, that this is not about us but about those we serve. I ask during this committee, Lord God, that you keep us focused and that you keep us compassionate to those who present and to the members of this committee. We ask all these things in the name of your Son, our Lord and Savior, Jesus Christ. Amen.

6. 0:19:34

   Thank you, Mr. Whip. Um, we're certainly happy to be here. This is our last meeting, and therefore our l- chairman of judiciary, who has owned Health and Human Services, been a pleasure having you. This is your last Health and Human Services meeting.

7. 0:19:51

   Right.

8. 0:19:51

   Thank you for, thank you for being here.

9. 0:19:54

   It is. It is.

10. 0:19:59

    So the, the author of HB 1296, uh, Representative Monaghan, is we're gonna work on that all session. He asked that, uh, we continue to work on that, so we're gonna take that off the agenda. And because of the late hour, uh, I'm gonna go ahead and let's do HB 1393. Uh, we have a substitute, and we have some folks, just a couple folks that are going to testify. We're gonna keep it, everything brief tonight. Uh, and then w- we'll have, we'll probably do next is we'll bring back, uh, HB 350 off the table, and we'll have someone quickly testify there.

11. 0:20:37

    And I think we're, hopefully we'll not have anyone else testify except maybe the, obviously the authors. So we're here. Uh, so, uh, if I could get, um, um, Mr. Belafonte, if you don't mind coming, uh, coming up. Uh, so HB 1393, as, as we discussed in the hearing only last week, if you'll note that, uh, that bill, uh, it's gonna be threading, uh, the needle on this, of whether we can get it done, uh, Representative Workhiser's bill done where it passes muster when it comes to, uh, antitrust activity.

12. 0:21:17

    And that's, that's just a fact. I've heard that from everyone, uh, all over the building, and I do mean all over the building. And the aspect of that is that I think that, uh, Mr. Belafonte's been working with the folks who originally wrote the bill and has got it to a good place, and it still may not pass muster when it comes to antitrust. I, I will tell you the Federal Trade Commission, uh, is also very attuned to this particular bill and this particular topic.

13. 0:21:47

    And, um, and there may still be some more, uh, uh, tweaks as we go along, uh, some minor tweaks, uh, that we may hear about tonight, and then w- uh, we may even have some changes in that. Uh, I will tell you, uh, specifically that this bill we added on, uh, you'll see that we added on doing away with certificate of need, with the exception of skilled nursing facilities. But l- let me be very clear, the message is that the bill that is in House Health right now, uh, Senator Cowsert's bill, is a cancer, doing away with, uh, CON for cancer.

14. 0:22:29

    And how anybody cannot move or, uh, vote on a bill to make it easier for patients to get cancer treatment is just, um, I find that hard to believe. And let me just tell you what I say, I've said over the years being Chair of Health and Human Services, is that if we all do what's best for patients, then, then everything else will pretty much fall into place. So with that, Mr. Belafonte, if you wouldn't mind, uh, taking us through the changes and, uh, and then we're gonna have a little testimony, and then we'll go from there.

15. 0:23:03

    Thank you.

16. 0:23:04

    Thank you, Dr. Watson. Um, Josh Belafonte with Robin's firm on this. I have focused on what is in the sub LC 521109S. Is that correct? Okay. Uh, uh, part three, which is what I talked about on Monday, the antitrust side, I believe part one is the repeal of certificate of need. It takes up a lot of space 'cause it's in a lot of areas of the code, not just 31 as well. Uh, and it would be, as you say, repealed for everyone but skilled nursing facilities.

17. 0:23:34

    Um, and then part two, I'd actually, that would be there as well. And then so part three, if I can go there, uh, the antitrust, uh, 'cause there would, there are significant changes in terms of text, in terms of structure. Um, but it, what it really tried to do... And, and look, you- you're gonna have three lawyers give you an opinion. You'll get at least nine probably-

18. 0:23:55

    And that's on page 47-

19. 0:23:57

    So-

20. 0:23:57

    ... part 31178.

21. 0:23:58

    Yeah.

22. 0:23:58

    Is that correct?

23. 0:23:59

    Yes. And so I fully expect par- particularly in anything involving, um, healthcare or antitrust to get plenty of opinions one way or the other. And, and nothing is really clear on this because the Supreme Court has decided recently and changed some of the state action doctrine, uh, in a March 5th decision called Gillette. Uh, so some of this we just don't know. Uh, but the structure is section 31 is in your existing Hospital Authorities Act. That starts on page 47, and it just adds the definition of rural hospital authority will be a hospital authority for purposes of Article 4.

24. 0:24:36

    So we're not changing anything in the existing law on Article 4 The Section 32 is the provision now where there is antitrust, uh, immunity that the Supreme Court said was insufficient given the breadth of the code on this issue. And it makes clear that a hospital, a rural hospital authority that exercises power as set forth in the new article, Article 4A, which is just about rural hospital authorities, that they have the immunity too. So you didn't want a situation where you grant a new immunity in one section, and you don't change the old one, and somebody would say that the old one doesn't apply.

25. 0:25:13

    Just really trying to keep Article 4 as it is. Um, that gets you to, uh, Section 33, which is the really the new part of it. Um, going through the structure of this one as opposed to the other is really, um, 31-7-100 takes all the findings and policies that were scattered in the other one, puts them in one code section. Um, there are-- Most of the findings and policies from the original version that passed the House are there. There are some new ones to reflect, um, what, uh, is the, the healthcare market today.

26. 0:25:47

    The section, uh, code section 31-7-101 starts on line twelve fifty-seven. It is the new section of definitions, and the key one here is, um, rural hospital authority. There are several things that a hospital authority to qualify for the immunity needs to have. It's not enough just to be a hospital authority hospital in a rural county, 'cause I think we can all agree that there would be a difference between an independent rural hospital authority or one in a small group, and one that is part of a large system, uh, whether based, uh, in Georgia, whether based somewhere else, or whether only in Georgia.

27. 0:26:25

    And so as this bill defines rural hospital authority that would have the new, uh, powers, it has to be located-- it has to be a rural hospital authority, whether restructured or otherwise, and, uh, restructured is when you have the operating five oh one C there. It has to, uh, be located in a rural county or operates only in a rural county, affiliated with no more than two other hospitals, so you limit it to three to have the exemption from immunity-- Uh, or excuse me, the, the immunity from antitrust, and, uh, not be affiliated with a non-rural hospital or suburban or urban hospital.

28. 0:27:02

    So if you had a rural hospital authority that is part of a large system, and that large system has a hospital anywhere in a urban or suburban area, that's not a rural hospital authority for purposes of the antitrust immunity. And again, it was, it was from listening to the testimony, and if the purpose of the bill is truly, and it, it makes a lot of sense if it's this, to have the small hospitals be able to coordinate so that, you know, if one has the urologist but one has the scan, they can talk to each other and share resources.

29. 0:27:32

    And if that antitrust is the problem, then limit it to that, that issue, not a larger or more broad one. Um, section one oh two, or excuse me, code section thirty-one seven one oh two grants this additional authority, uh, to the rural hospital a-authorities. It's, it's already largely in the other, but, but, um, and this has got very similar if not the same language from the other two, although all of it continues to limit it to rural hospital authority and rural hospital authority, uh, not the larger systems.

30. 0:28:05

    One oh three is, um, the actual provision of the immunity, uh, while, uh, that is from the other one as well, and, um, tries to carry that over as opposed to, again, doing it in several different places. Um, one oh four, starting on, uh, line thirteen forty-nine, is the, uh, who gets the immunity. That's a provision from the other one, uh, from the as passed, uh, version as well. And, uh, also makes clear either both, I believe here and in another one, that this bill, while speaking of state actors and instrumentalities of the state and so on, is not, uh, granting sovereign immunity to public hospital authorities.

31. 0:28:50

    They're not going to be treated as, uh, you know, a, the Department of Community Health or something of that nature or a county itself, uh, but still having the immunity across, uh, from antitrust. So thirty-one seven one oh five is, um, deciding again l-what the limits of the authority are on, and this is really trying to, um, say you're getting this immunity from antitrust, but again, not sovereign immunity, uh, not if you're in a large group of hospitals, et cetera.

32. 0:29:21

    So it's trying to be very clear about where the immunity is going to be, because when you grant this state actor immunity, you're declaring these entities, uh, parts of the state, and the phrasing that the Supreme Court said is you have to say that you are displacing, uh, competition in a particular location. And so the idea is if you're going to do that to allow this kind of cooperation, that can be as narrow as possible. Um, section, code section thirty-one seven one oh six is a process because, uh, it was thought that not every rural hospital authority that could qualify for this necessarily wanted it.

33. 0:30:01

    Um, there are things that if you are deemed a state actor, and if, if it goes all the way to the county level, you could be liable for things like constitutional violations. Um, if you're a government, you have to comply with equal protection. You have to comply with the First Amendment. And so this is, is limiting, uh, how and where that would be, uh, and trying to be consistent with the other and give the hospitals a chance to say whether they want to do this or not. Uh, and effectively it follows a notice procedure somewhat similar to, uh, other, uh, provisions we have.

34. 0:30:33

    This starts at line fourteen oh five. A hospital that chooses they want to avail themselves of the immunity would provide notice to the attorney general. The governor, the chairs of the judiciary and health committees of the legislatures, uh, the lieutenant governor, and the speaker of the house. The AG would have 180 days to determine if the hospital qualifies, if they meet that definition of Rural Hospital Authority. They would, uh, they have the ability to request documents, and if the documents are not provided, the request is denied.

35. 0:31:03

    And it would, um, also, uh, any person within thirty-five miles that is a, a, a healthcare provider can provide information to the attorney general and say, "We don't think this person meets it." The attorney general gets to decide that. No particular hearing, it's just they have additional information. Anyone can then, uh, whether-- If the attorney general denies it, the applicant or the Rural Hospital Authority can challenge that in court pursuant to a, a fairly limited procedure.

36. 0:31:35

    The-- If you were in that thirty-five-mile radius and a healthcare provider, you had to provide opposition to the attorney general in order to get to court. That's fairly standard what we do in administrative things. And if you were not one of those, then you could challenge it later. Um, and then you have to annually tell the attorney general and DCH that you still qualify, 'cause there's going to be, uh, transactions that happen over the course of the year, uh, that's there. And with that, I think that's what, uh, covers the sections of the bill.

37. 0:32:07

    Thank you so much. So, uh, the first part of the bill, as, uh, Mr. Belafonte noted, was the, uh, certificate of need. So you're establishing an antitrust, uh, in, uh, immunity in the, in a three hospital-- up to three hospital system there. And, um, that was where a certificate of need would add on a significant monopoly for that particular aspect of that. So, uh, I'd like to go with a, a little bit of testimony before we do questions and voting, so, uh, we can get, um...

38. 0:32:41

    Uh, let's see here. Um, I can't read your writing. Hold on.

39. 0:32:56

    One with on Zoom, Ms. Geddes. Uh, is that you, Ms. Geddes? Did I pronounce that correctly?

40. 0:33:02

    Yes, you did.

41. 0:33:03

    Okay, thank you so much. Uh, you're now, uh, front and center for us. Thank you. And-

42. 0:33:10

    Um, th- th- thank you, uh, Chair Watson and, and members of the committee. I'm, I'm happy to be here this evening. Uh, my name is Eiley Geddes. Uh, I am an assistant professor of economics at the University of Georgia, where my research focuses on competition in healthcare markets. Uh, I'm here today in my personal capacity as a researcher and expert in health economics, uh, to share what the economics literature tells us about the impact of certificate of need regulations in rural communities. Um, I wanna be clear up front that I'm not speaking on behalf of the, the University of Georgia.

43. 0:33:43

    Uh, so let me start today by describing what certificate of need laws do, uh, and the reasons that they were enacted.

44. 0:33:51

    Ms., Ms. Geddes-

45. 0:33:51

    Certificate of need law-

46. 0:33:52

    I, I j-- I, I do wanna be clear, we are-- W-we do wanna hear from you, but, uh, it is late. I know you're-- it's seven twenty, so if we can, uh, be real brief, that would be much appreciated. Thank you so much.

47. 0:34:05

    Okay. Um, I, I will try to be brief. Um, okay. So these regulations require healthcare providers to get state approval before they open new facilities, they add beds, or they add equipment. Uh, the idea here was that the state would act as a gatekeeper, uh, to prevent wasteful duplication of service, uh, and to provide some financial benefits from existing healthcare providers, particularly in underserved areas, uh, to make sure that they remain financially viable. And so I'll tell you a little bit about, uh, the empirical literature on these two potential benefits.

48. 0:34:37

    So the initial claimed benefit of certificate of need regulations is that they reduce wasteful expenditures. Uh, it was a major policy concern at the time these regulations were enacted, uh, that there would be duplicate provision of costly medical equipment, and that the presence of such equipment would lead healthcare providers to induce demand for medical services, uh, leading to increased healthcare spending. So the classic argument was Roomer's law, that a hospital bed built is a hospital bed filled. I think it's important to note here that this argument was developed at a time when there was few other healthcare utilization management systems in place, and where payments were largely made on a cost pl- cost plus basis, so providers had little incentive to control costs.

49. 0:35:22

    Payment policy has since shifted, and today we have a lot of other tools through which we can manage costs. The empirical research on this particular benefit, uh, finds little evidence to support the claim that certificate of need regulations lower costs in practice. Uh, instead, certificate of need regulations can often result in higher expenses for patients because they reduce competition. A meta-analysis conducted by Mitchell in twenty twenty-four finds that the majority of studies on certificate of need laws find either no association with spending or increases in spending.

50. 0:35:56

    So it does not appear that certificate of need laws have achieved this first goal of containing costs. So this brings me to the second claimed benefit of these regulations, that they provide a financial benefit to existing providers in underserved areas, which could be used to cross-subsidize unprofitable services. It's crucial to understand here that there's a large trade-off associated with this financial benefit the state provides incumbent providers. The additional profitability that incumbent providers receive from certificate of need laws is the result of restrictions on entry by new competitors, and represents the result of decreased competition in healthcare markets.

51. 0:36:36

    A large body of work in health economics shows that competition in healthcare markets, just like other markets, promotes lower prices and higher quality for consumers and encourages innovation. Critics, including the Federal Trade Commission and Department of Justice, have long argued that certificate of need laws function primarily as barriers to entry that protect incumbent providers from competition rather than serving patients. The empirical literature here suggests that certificate of need states tend to have less capacity, and in some cases, worse access than non-certificate of need states.

52. 0:37:11

    A twenty twenty-five review of the economics literature by Kortemanche and Garruccio found that states with certificate of need laws tend to have fewer hospitals, fewer hospital beds per patient, and less access to imaging services relative to states without such laws. Furthermore, contrary to claims that such laws protect hospitals with high indigent care burdens, as part of an evaluation of Illinois certificate of lead-- need laws, the Lewin Group found that safety net hospitals in certificate of need states had lower margins than in non-certificate of need states.

53. 0:37:46

    There's additionally a structural concern. The review process itself can be captured by existing providers who both have the incentive and resources to challenge competitors' applications, regardless of whether those competitors would actually serve patients well. This aspect of certificate of need regulations amplifies the anti-competitive nature of the laws. In closing, certificate of need laws in Georgia and elsewhere were enacted with genuine policy goals in mind, controlling costs and protecting providers in underserved communities.

54. 0:38:18

    The evidence suggests that the first goal has largely not been achieved. The second involves a real trade-off. Financial protection for incumbent providers comes at the cost of competition, and competition is one of the most reliable mechanisms we have for improving quality and controlling costs in healthcare markets. I hope this committee will weigh these trade-offs carefully as you consider the future of certificate of need regulation in Georgia. I'm happy to answer any questions.

55. 0:38:47

    I'm gonna hold on questions, but thank you very much. Uh, appreciate you, um, uh, bringing that to us. Uh, I, I think it just sort of drives point in a very logical, uh, manner, unpolitical, uh, apolitical, and I really appreciate your, your thoughts on this. Uh, and hopefully we can have you back in the future when we have a little bit more time. Uh, and, uh, lastly, go Dogs. All right. Thanks so much.

56. 0:39:10

    Go Dogs, and I'd be happy to come back anytime.

57. 0:39:14

    Thank you.

58. 0:39:17

    Next, we have, um, we have actually, uh, one more on Zoom, Jim Manley. Um, is that you, Jim, right there?

59. 0:39:27

    Yes. Thank you, Chair Watson.

60. 0:39:32

    The floor is-

61. 0:39:32

    Can you all hear me?

62. 0:39:33

    Yes, we can hear you well. So, uh, if you can be brief like Ms. Geddes, she did a great job. Just brevity is your, is your friend. Thank you.

63. 0:39:41

    Y-yes, yes, sir. I, I think I can actually be even briefer because, uh, Ms. Geddes did a wonderful job, uh, summarizing the empirical research, and so I'll just highlight some of our experience on the legal side of things. I, I'm Jim Manley. I'm the director of, of state policy for Pacific Legal Foundation. PLF is a nonprofit law firm that represents, uh, individuals when their constitutional rights are violated. We do so free of charge. We've litigated more than twenty-four hundred cases, uh, including eighteen wins in the U.S. Supreme Court, uh, and including several cases in, in Georgia.

64. 0:40:15

    Um, part of this work involves PLF representing healthcare entrepreneurs who want to provide needed services to their communities but are unable to do so because of government restrictions like certificate of need laws. Uh, these are regulations that are not related to public health or safety. They're simply aimed at protecting existing healthcare providers from competition. Uh, our client, Katie Chubb, is a midwife in Augusta who tried to open a birth center and was stopped by, uh, com-- hospitals that didn't want the competition.

65. 0:40:46

    Uh, several years ago, uh, in a different role, I represented two doctors, uh, who simply wanted to let other doctors use their surgery center while my clients were busy, uh, at other parts of their practice, and they were vetoed by the hospital across the street with the help of Georgia's CON laws. And in that case, the Georgia Supreme Court said it was up to the legislature to repeal Georgia's CON laws, and, and I hope that is the step that this committee takes tonight to move one step closer to that. Um, the CON process, as I said, has nothing to do with health or safety.

66. 0:41:17

    It allows competitors to veto new services. And then even worse, it allows those competitors to challenge approvals if, uh, the Department of Community Health decides to issue the CON anyways. And so just one illustration of that, uh, every week DCH publishes, publishes a CON tracking report that lists all the pending CON applications. The list that was published just last week includes a CON application that was approved in July of twenty twenty, and it was challenged by a rival hospital and remains on appeal now almost six years later.

67. 0:41:51

    That is the pace of change under the certificate of need system. And a-a-as Professor Geddes explained, decades of research show that CON laws lead to decreases in access to care, higher healthcare costs, and lower quality of care, and I just wanna highlight the impact that has on rural care, because I know that's an important issue in Georgia. Um, a two thousand twenty-four study concluded that rural areas saw the biggest increases in access to care and no associated harm to rural hospitals in states that repealed their CON laws.

68. 0:42:24

    Rural healthcare benefits from repealing CON, and that's part of the reason that the Senate committee in two thousand twenty-three in Georgia recommended that the General Assembly, uh, fully repeal its, its CON laws, the, uh, two thousand twenty-three CON study committee. And we know looking at other states what the, what repeal looks like. Pacific Legal Foundation helps on these issues across the country. Uh, in 2021, Montana repealed its CON laws, and since then, research has shown that services that were previously covered by CON have grown by 12 and a half percent in just the last five years.

69. 0:43:00

    All right, Mr. Manley, I'm, I'm, you know, for interest of time and, and we got everybody here, and I just don't want people to go... I, listen, I, I, I get it. Both of y'all are saying, uh, higher prices, lower quality, uh, without the competition. And, and you have driven it home, and I can give examples in my community, uh, and I think everybody can give those across the state. Um, thank you so much for being here, and I'd love to have you, uh, back again in the future. You're, uh-

70. 0:43:29

    Yeah

71. 0:43:29

    ... certainly-

72. 0:43:30

    Thank you. It's my pleasure.

73. 0:43:31

    Much appreciated. Thank you. Um, the Chris Denson, I hope, um... Chris, do you mind, um, f- for time of brevity, uh, I think you're in support, and-

74. 0:43:46

    Read this, uh, CON provision, and I look forward to reading the, uh, revised version of the, uh-

75. 0:43:51

    Thank you

76. 0:43:51

    ... hospital authority.

77. 0:43:52

    Uh, so Chris Denson's with?

78. 0:43:54

    Chris Denson, Georgia Public Policy Foundation, Georgia Policy Impact.

79. 0:43:58

    Thank you.

80. 0:43:58

    Thanks, sir.

81. 0:43:59

    And then, um, Jesse Weatherington, did you, did you have anything further to offer from our hearing on Monday?

82. 0:44:08

    Yes, please.

83. 0:44:09

    Jesse Weatherington is with the insurance, um... I don't know. What's the, what is the name of your group?

84. 0:44:16

    Uh, Georgia Association of Health Plans, Mr. Chairman.

85. 0:44:18

    There you go.

86. 0:44:20

    Um, thanks to the work of Mr. Belafonte, uh, many of the antitrust concerns we had about the underlying House Bill 1393 seem to have been mitigated. Um, and coupling that with a full-bore certificate of need repeal, uh, we think the benefits of that would more than outweigh any harms. Uh, I would urge the committee to support the substitute. This would be one of the most impactful votes you take as a senator to help improve the health and welfare of the State of Georgia.

87. 0:44:41

    Thank you. Uh, w- we have, um, Anna Adams. Unless she wanted to waive for, uh, I think, uh, Michelle Madison wanted to also speak. I think she had worked with Mr. Belafonte, and they're certainly welcome.

88. 0:44:57

    Thank you, Mr. Chairman.

89. 0:44:58

    Thank you.

90. 0:44:58

    Um, I separately, Anna Adams with the Georgia Hospital Association. We appreciate the work that has gone into the underlying portion of House Bill 1393. Um, I know that we had some questions from some of our members about how that would work, particularly with relation to how those hospitals would partner, and so thank you for that. In addition to that, we do have opposition to the complete repeal of certificate of need, sans nursing homes. Um, we were happy to work with you on previous legislative efforts that have gone through this process, but this one is a little bit further than what our membership is comfortable with.

91. 0:45:32

    Thank you. I, I, I understand that.

92. 0:45:34

    Thank you.

93. 0:45:34

    And you... We started this out with probably wouldn't be here if the House Health had not, you know, heard and voted on the cancer one. So really appreciate-

94. 0:45:47

    Understand. Thank you.

95. 0:45:47

    Thank you so much. And then, um, and I think Michelle Madison didn't sign up, but wanted to speak, and I think, um, and we're happy to have you. We really appreciate you, uh, working and fine-tuning the, um, the rural hospital, 'cause that's why we're here today, is to try to fine-tune this and thread the needle and get that done. Thank you for being here.

96. 0:46:10

    Well, thank you for having me. My name is Michelle Madison. I'm with the Bradley Law Firm. And we did work on the original bill, the antitrust counsel that we have. I'm a healthcare attorney, not antitrust counsel. But the antitrust counsel did work on this bill. And originally, just, and I'll be brief, the focus was really focused on the rural hospitals. I work with about 30 of those rural hospitals in our state, and the concept was to try to make sure that our state law had the right language for the state action doctrine when those hospital authorities can collaborate together in rural areas to cut cost.

97. 0:46:42

    And one of the reasons that we were so focused on it was the Supreme Court decision that came down and said Georgia law needs to have these provisions in it, which is why the original bill had those provisions from the Supreme Court decision of 2013. But the other reason was because the Rural Transformation Fund is happening in our state, and we do wanna make sure that as we move towards a total cost of care, which means that the rural hospitals are gonna get paid one price in 2029 if they all elect to go in for the care they deliver to Medicaid, Medicare, and other third-party payers.

98. 0:47:12

    And when that happens, in order to stay economically viable, we've gotta reduce the cost. And so today, if a rural hospital has imaging, and I shared this with the House committee, has imaging at one hospital and a surgeon at the other, and we don't wanna duplicate those costs, being able to tell patients, "Go to this facility 20 miles away for imaging. Go to this facility for surgery," we can't do that today. We can't quid pro quo it.

99. 0:47:33

    And, and it's real important when it comes to the, uh, Rural Health Transformation. I just got the number on that. I think that's 218 million. I think we talked about that before-

100. 0:47:42

     It is

101. 0:47:42

     ... every year for five years, so over a billion dollars. And-

102. 0:47:45

     It's significant

103. 0:47:46

     ... to be able to coordinate that, and I think is important for rural hospitals, and I think, I think that's good. We are, we are talking about the Georgia Strong DPP and Georgia, uh, Strong number two, and we talked about eligible hospitals, but we're talking about major numbers. 586 million, 2025. 746, 2023. 865. So those are, that's Georgia Strong, and then the eligible hospitals, uh, also and the teaching hospitals, 1.9 billion, uh, for, uh, our DPP too.

104. 0:48:19

     So anyway.

105. 0:48:19

     Yeah, there's a, there is a focus on making sure that hospitals who have residency programs will have funding because we have a shortage of workforce in our state and a shortage of physicians.

106. 0:48:29

     Yeah.

107. 0:48:29

     So promoting the residencies i- is going to be important. At the same time, we have a shortage of nurses and physicians across our entire state, but especially in the rural area, to be able to recruit those specialists. And so I did- Talk with Mr. Belafonte about the revisions that were coming into the substitute bill, and the concerns that I have are related to some of the restrictions. I think this provision related to the antitrust and, and I think Anna spoke to where the hospitals are on the CON side. But on the antitrust side, some of the language limits it to two rural hospitals being able to work together.

108. 0:49:02

     Today, I think two rural hospitals could work together without violating the FTC. We can't do quid pro quo, but it's really a collaboration of providers to come together for group purchasing and to be able to recruit, and to get specialists from some of the actual metro areas to come to the rural areas and provide care. They're not gonna do that on a full-time basis, 'cause we might have 6,000 people in our community, not 400,000 people. And so part of the law that's drafted in this, um, bill that came as the substitute talks about we can only partner with rural physician practices, and that's gonna cut out the cardiologists and the urologists and the GI guys that we do need to come in to partner with us in the rural areas.

109. 0:49:41

     So I am requesting that there be some reconsideration and that we don't pass the substitute bill, because I think that the substitute bill, while I appreciate Mr. Belafonte's efforts, has some concerns related to the limitation of just two hospital authorities working together, limiting it to rural physicians only. And then the administrative process, that if they do want to use the state action doctrine, we have to go to the state and say, "Hey, we wanna use the state action doctrine. Here's all the filings." It's like going through a CON to use the state action doctrine. So the administrative expense there for these rural hospitals will be extreme.

110. 0:50:14

     So I'm requesting that we, um, not move forward with the substitute bill. And obviously, the first 48 pages of the CON, I let Anna handle that part. But I appreciate-

111. 0:50:25

     I got you

112. 0:50:25

     ... I appreciate all the communication and the opportunity.

113. 0:50:27

     And you're, you're with a law firm. You're not with GHA, wanna be clear.

114. 0:50:31

     I am not with GHA.

115. 0:50:32

     Yeah, I gotcha. And, um, and y- your law firm is-

116. 0:50:35

     Bradley Arant

117. 0:50:36

     ... Bradley Arant, and here in Georgia.

118. 0:50:37

     Alabama, Tennessee, North Carolina, DC.

119. 0:50:41

     Okay, great. I got you. That's big. Okay, thank you so much.

120. 0:50:44

     Thank you.

121. 0:50:44

     Appreciate it.

122. 0:50:44

     Thanks for having me.

123. 0:50:45

     Um, so I think that's where we are. Um, the-- Mr. Belafonte, do you mind coming back up and, uh, just-

124. 0:50:53

     Yeah, of course

125. 0:50:54

     ... just, just to answer a couple questions, and then, 'cause we have members that need to leave, and we're gonna vote, uh, in about 10 minutes or less.

126. 0:51:07

     Thank you. Do-- would you mind addressing what she had said about the-

127. 0:51:12

     Sure. Yeah, and I think, you know, certainly, um, a lot of this stuff could be fixed pretty quick. The, the one about-- I'll just go through a few of 'em. The, the process on applying for the status is limited to 180 days with the attorney general, and then potential judicial review after that. It could be shortened on potential judicial review, uh, but I think there's a, also a trade-off, because on the CON side, you heard, uh, that's there, and it would be shorter than a CON, because you have a 180-day at the agency level-

128. 0:51:44

     Mm-hmm

129. 0:51:44

     ... uh, for that to happen without a hearing and then another one. Um, on the physicians' practices being in a rural area, it's a good point that if the specialists aren't there, it can be expanded. That's a language, uh, piece. I think it was narrowed in order to prevent, um, a backdoor, again, for kinda larger systems to enter through a physician group, uh, that they affiliate with, and you could still do that and have the specialists available or allow it only in specialist, uh, areas for that. Um, the, um-- and again, I think the, the idea that, uh-- I didn't hear anything that couldn't be changed-

130. 0:52:20

     I got it

131. 0:52:20

     ... uh, in terms of language.

132. 0:52:22

     Okay. So as we move forward, things can, things can be, uh, changed.

133. 0:52:26

     Yeah.

134. 0:52:26

     The, um-- and, and nobody's against-- you certainly don't wanna bar sub-specialists coming into rural areas too.

135. 0:52:33

     Correct.

136. 0:52:33

     By no means. Um-

137. 0:52:35

     Uh, Chairman, actually on, on that point, I'm, I'm very sorry, but I just wanna make clear, 'cause I didn't, I didn't discuss it before. A lot of the literature that you see, and this was talked about on Monday, is when you, um, combine non-compete agreements, particularly with physicians, uh, and they're applied in rural areas, it, it has a significant anti-competitive effect and it makes it harder to recruit. Because if the urologist knows they have to sign a non-compete, uh, and they're gonna be out of that county and probably the next one after that. And so there is a provision in here that if the Rural Hospital Authority chooses to take advantage of, um, the immunity, they cannot enter into non-compete agreements with healthcare providers.

138. 0:53:14

     That will keep them coming, uh, uh, faster, we believe.

139. 0:53:18

     Okay. Uh, question, Vice Chair. We're gonna be quick. We're gonna do-

140. 0:53:21

     This is just, um, I may need you to dumb this down a little bit about how we can get immunity from a federal antitrust law.

141. 0:53:30

     So the, the federal antitrust law does not apply to states. So for example, uh, state psychiatric hospitals and things of that nature, antitrust doesn't apply.

142. 0:53:39

     So, so you're a, you're an organ of the state.

143. 0:53:41

     Correct.

144. 0:53:42

     Okay.

145. 0:53:42

     Correct.

146. 0:53:42

     That's the answer.

147. 0:53:43

     Yep.

148. 0:53:43

     Next. Anybody else with a question? Uh, Senator Brass.

149. 0:53:48

     Well, Mr. Chairman, if, if should this become law and any part of this bill gets struck down, is there a severability clause in here?

150. 0:53:57

     Uh, goodness gracious. I tell you what, that's-- you're speaking like, uh, the guy sitting right beside you there.

151. 0:54:03

     Oh.

152. 0:54:03

     Severability there. Uh, um, Mr. Belafonte?

153. 0:54:07

     There's a, there's a, uh, an severability in every bill the general assembly passes, whether express or implied.

154. 0:54:13

     Okay. Great. Um, that's a good question. From, from a non-lawyer, that's a good question. Maybe not from a, a doctor today.

155. 0:54:20

     From a doctor, that's right.

156. 0:54:20

     That's right. All right.

157. 0:54:22

     Dr. Brass.

158. 0:54:23

     Um-

159. 0:54:23

     Mr. Chairman

160. 0:54:24

     ... Senator Setzler.

161. 0:54:25

     Thank you, Mr. Chairman. Um, this question about, uh, line 1389, 1390, about these, uh, physician practices that, that again may come in periodically, if we were to change that to not apply any physician practice that is affiliated, and we change that, that is owned in part or whole by a hospital or hospital group, that would keep out

162. 0:54:45

     I think your concern was preventing hospital, hospitals in, in urban or suburban areas from,

163. 0:54:56

     from, from finding ways to kind of-

164. 0:54:58

     Trying to get the, trying to get the specialists in there.

165. 0:55:01

     Yeah.

166. 0:55:01

     Right. Where's-- What line are you talking about?

167. 0:55:02

     13A and 139. If you said, if you prohibited n- non, um, um-

168. 0:55:07

     What number?

169. 0:55:09

     1380

170. 0:55:09

     ... uh, 1389, 1390. Um, nothing in this article sh- shall be construed as applying to a physician practice that you use the term affiliated with. I mean, I would think affiliated with is if you're an independent practice that's affiliated with a, with a suburban hospital that now wants to go serve in a rural area, you'd be prohibited by this. If you said, "Owned in part or whole by," then, then if you're owned by a hospital, um, that would seem to be the nexus of the hospital you're trying to prevent.

171. 0:55:38

     Let me, let me clarify here. Is that, I mean, applying to any physician practice affiliated with any hospital or group of hospitals that's not a rural hospital authority. So an independent group, uh, independent group of specialists. I mean, because a lot of, m- most specialists are now independent partly because of the ASC CON. Th- they wouldn't be prohibited from coming.

172. 0:56:00

     They, they would not. Um, but I, I think, um, you could, you could tighten the word affiliated because someone could argue that includes clinically integrated networks where you-

173. 0:56:11

     Gotcha

174. 0:56:11

     ... you share billing structures. So it could be employed by or part of a group, uh, something of that nature.

175. 0:56:17

     I gotcha. Do you have some- a recommendation there? You wanna think about it for a second?

176. 0:56:23

     I can, I can certainly do that. And if, um, but if there's going to be to address some of the things that I think Ms. Madison raised-

177. 0:56:29

     Mm-hmm

178. 0:56:29

     ... if there's an opportunity to continue working on the bill-

179. 0:56:32

     I, I think that's important to do.

180. 0:56:33

     Okay.

181. 0:56:33

     All right. Um, any other questions? Senator Orrock? The light's not working here in this committee.

182. 0:56:40

     Yeah.

183. 0:56:40

     Sorry. Okay. You're in one.

184. 0:56:42

     I think you told me that-

185. 0:56:43

     All right

186. 0:56:44

     ... that already. Thank you.

187. 0:56:44

     Got a question-

188. 0:56:45

     Yeah

189. 0:56:45

     ... not a statement.

190. 0:56:46

     First of all, I've, I've, I apologize, but four of us came in late because we were in finance committee. Uh, so, uh, uh, M- Mr. Belafonte, I don't, I, I, I don't even know who you're representing. Um-

191. 0:56:58

     I'm-

192. 0:56:58

     That's the mo-

193. 0:56:59

     Yeah

194. 0:56:59

     ... that's my number one question.

195. 0:57:00

     I, I've been asked to, to give a legal analysis of the bill, and so I'm doing it through my law firm. Um, and so I'm not here on behalf of any client that I lobby for in the healthcare space or any other lobby client.

196. 0:57:13

     I see. Thank you. Uh, uh, i- in the remarks that have been made tonight from the, the UGA professor, et cetera, um, it, it's, it's true, isn't it, that federal law requires hospitals, nonprofit hospitals, to, uh, take patients that present and not screen out. Is that right?

197. 0:57:33

     Federal law requires all hospitals, regardless of their tax status-

198. 0:57:36

     Uh-huh, uh-huh

199. 0:57:36

     ... to do that.

200. 0:57:36

     To do that. And, and so that is a reality that, uh, uh, hospitals are charged with following that law, following that federal requirement.

201. 0:57:47

     Yes.

202. 0:57:48

     So, um,

203. 0:57:52

     uh, i- if, if a s- surgical center comes in to do certain procedures, they call it cherry picking, uh, that, you know, that are, that are procedures that are, uh, profitable t- to deliver. Uh, and that's what they del- that's what they sell. That's how they compete with the community hospital that takes everybody and has a large mi- uh, uh, and that they take the mix of the people that can pay over to the surgical center and leave a, a, a large group of uninsured and under-insured people at the hospital.

204. 0:58:26

     And that is, is, is a fundamental reality of hospitals failing financially because they, the, the model doesn't work. How do you, so how do you, how do you true that up when they have, the hospitals have a requirement that they have to meet that a surgical center doesn't?

205. 0:58:43

     Sure. And, and, you know, again, community-- all hospitals, community-

206. 0:58:48

     Uh-huh

207. 0:58:48

     ... uh, otherwise have-

208. 0:58:49

     Does that

209. 0:58:49

     ... have that requirement. So yes. Um, I think what, in, in having gone through a bunch of CON debates since, I guess, 2007, the response to that you typically hear is that the surgery center's doing it for a far less price, and because the charges are less, the reimbursement is less, um, the hospitals are cross-subsidizing. They are charging more to make up for that, uh, other one there. Uh, the surgery centers-

210. 0:59:17

     Make up for what?

211. 0:59:18

     To make up for the patients that come in that are self-pay or no pay or, or have less. So that's why they're charging the insurance, uh, companies har- more than a surgery center was. They're also charging Medicaid, uh, more and Medicare more. So that's where it's recognized in terms of the, uh, what's called cherry picking, uh, that you hear a lot about. Um, and no surgery center that I'm aware of-- well, no private surgery center, uh, is tax-exempt.

212. 0:59:48

     And so that's another piece that, that is there. And those taxes then go to pay to help things like Medicare, Medicaid, et cetera. I'm, I'm offering what, what is kind of there in the literature and what's there on-

213. 0:59:59

     Yeah. Okay

214. 0:59:59

     ... on, um-

215. 1:00:00

     Very-

216. 1:00:00

     ... years of debates on it, but-

217. 1:00:01

     All right. Um-

218. 1:00:02

     Yeah. It was

219. 1:00:03

     Thank you, Mr. Belafonte. I'm ready to entertain a motion. Make motion due pass by, um, the governor's floor leader who needs to head back up to, uh, his daughter's cheer practice. Got to pick her up at cheer practice. I got you. Got a second by Senator Setzler. Uh, any further discussion? You can ask a question. Yes, ma'am.

220. 1:00:28

     Oh, I, I, I thought we were just saying that this bill needed more work and some more time. I thought I understood that.

221. 1:00:35

     And we, and I have, I have, as the sponsor of this substitute, have-- I am firm on that, that if we need to continue to work on this, we will work on it. And we have been, you know, with, uh, uh, with Ms. Madison and so forth. We will. Absolutely. Thank you.

222. 1:00:54

     Does that mean you bring it back?

223. 1:00:57

     There is no back.

224. 1:00:59

     So we'll either do it, uh, other places, or we'll swap it out, or we'll, uh, we'll see what happens over in the House, and there are a lot of variables in there. Got a thumbs up. All right. All those in favor, raise your hand. Two, three, four, five, six, seven, eight. That's eight. All those against? Two, three, four, five. Eight to five, the motion carries. Thank you. And drive carefully, young man.

225. 1:01:35

     All right, so, uh, I have a grandmother that wants to testify on the next bill. She does not look like a grandmother, but, uh, we're gonna do- we're gonna take off the table House Bill 350. Uh, that was by, uh, Representative Cameron. He's, uh, back there. He's raised his hand. Representative Cameron, you can come sit right here. And if you don't mind, uh, Ms. Patterson, this is Jill Patterson, is a, uh, wanted to give us a little quick test- testify, if you don't mind being brief, but-

226. 1:02:04

     Absolutely. I'm happy to

227. 1:02:05

     ... I mean, I understand you drove up here just for this, and I really appreciate you coming, and thank you.

228. 1:02:10

     Totally understand. Thank you so much for giving me this opportunity, and thank you for staying and hearing me out. This is going to be very, very brief. My name is Jill Patterson. I am 50 years old. I've lived here in Georgia since I was 18 months old. I'm a mom of five astonishingly fascinating young adults, two of which choose to call me their mom, and three of which are mine by the grace of genetics. All five are, are impressive humans who are wildly different from each other, but together they formed a tight bond. They are among the best of their generation, and I could not be more proud of them.

229. 1:02:43

     I feel confident in saying that everyone in this room is either the parent of, the uncle or aunt to, or knows a young person that they know and care for as their own child. My family could be your family. On March 17th, 2020, just as the world was going into lockdown, a gentleman came to my door. He was unexpected, and we were trying to maintain social distance. We sat down with our coffee table between us. He asked me if I knew about a case from late 2018, early 2019 in Troup County, where a newborn baby had been found dead in a watermelon-printed cooler on the side of the road.

230. 1:03:24

     I was horrified, but I didn't know about this case. He explained that he was the detective in charge of the case, and that the newborn's DNA had been linked to my family's. Within three minutes, I learned that I had a granddaughter and she was dead.

231. 1:03:40

     I remember asking him if he had seen her. I remember the expression of remorse and the gentleness in his voice when he told me that he had, and that she was beautiful with a head full of hair. I burst into tears. His face was cl- full of compassion as he came to stand next to me and put his hand on my shoulder. Over the next 72 hours, we discovered that my son's highgirl- high school girlfriend had hid a pregnancy, given birth in her parents' home in Troup County, and wrapped that healthy baby in a pair of sweatpants, zipped her into that damn cooler, and abandoned her on the side of the road.

232. 1:04:21

     I have flashes of faces from that spring. The stunned faces of my children, who were in their late teens and early 20s at this time, at the realization that someone that they knew and that they loved was capable of being completely heartless. The solemn expressions and the kind eyes of the Troup County officers and detectives, who at least on one occasion legitimately held me up when I was absolutely woozy with shock. My husband, in tears in the backyard on the phone with his mom.

233. 1:04:53

     My 19-year-old son, who'd always said he couldn't wait to be a dad, curled up on his bedroom floor, face contorted and keening with a pain that I will never fathom. I will never forget that sound. I remember catching my own face in the rear view mirror as I tried to gather myself to drive my boy home after picking up his daughter, the small box cradled in his arms as if it were a baby, and not just her ashes.

234. 1:05:28

     Since then, nothing has been the same. We struggle every year on December 28th, the day that Eliza Jane Warner was born. We struggle every March 17th, the day we found out about her existence. We struggle with the whys, with the what-ifs, and the why-didn't-shes. I still stumble every time someone asks me if I'm a grandmother, because saying no feels cruel to a baby who is loved and who will always be loved, but sharing this story can be cruel to people who are not prepared.

235. 1:06:01

     There are no simple answers for my family, just the cold, harsh reality of what happened to our Eliza Jane. But there is a simple answer before you, ladies and gentlemen. I am here today, and I waited here today to speak with you and plead with you to approve the safe haven baby boxes outlined in House Bill 350. I will never know if having this life-saving device available would have saved our Eliza Jane, but there is a fact that over 75 babies that were born healthy and alive are here today because other states have approved similar bills.

236. 1:06:41

     Please vote yes for Eliza Jane and for HB 350. Thank you again.

237. 1:06:48

     Thank you, Ms. Patterson. We really appreciate you staying. Thank you so much.

238. 1:06:54

     All right, uh, we're- so we'll do House Bill 350, which is off the table. Uh, Representative Cameron, um, we, we had pledged to you that we would bring her off the table, and, uh, we have some amendments, and what we're gonna do, I think, is the best thing to do is, um- Uh, we heard testimony on this, uh, Monday, and, uh, so, uh, what we'll do is, if I remember correctly... Gosh, hang on just a second. Let's do at ease.

239. 1:07:29

     I'd like to make a motion HB350 off the table.

240. 1:07:34

     Second.

241. 1:07:35

     So-

242. 1:07:36

     All right. Can you repeat that in the mic? Do you wanna-

243. 1:07:39

     Sure. I'd, I'd like to make a motion that we bring HB350 off the table.

244. 1:07:43

     All right. S- second motion. All those in favor of that motion, say I.

245. 1:07:49

     I.

246. 1:07:49

     Opposed, like sign. Thank you. All right. So we're off the, uh, off the table, and, um, so, so we need a motion to due pass House Bill 350, uh-

247. 1:08:02

     So moved

248. 1:08:02

     ... LC56-0268. Uh, and so moved, uh-

249. 1:08:07

     Strickland

250. 1:08:08

     ... Strickland.

251. 1:08:08

     Second.

252. 1:08:09

     Second, w- Brass and, uh, Chairman Brass. Uh, so, uh, all those in... Well, well, not before we do that, let's do the amendments. All right. I'm glad I got some experienced guys around here to help me out, so that's good. All right. So-

253. 1:08:27

     Thanks

254. 1:08:27

     ... I got the order. It should be in your, um, in your packet. Let's... We got AM, uh, 560063, AM560072, AM560069, AM560068, AM560067. All right, so-

255. 1:08:52

     And 70.

256. 1:08:52

     And 70. All right. There we go.

257. 1:09:00

     All right. So, uh, legislative council is familiar, so if, if it's okay, um, I'ma just have the author of the amendment... Uh, so we get... Let's count those out. One, two, three, four, five, six.

258. 1:09:16

     Yes.

259. 1:09:17

     All righty. So if... I'ma just have the author, uh, present it, and then we're gonna vote it up or down and, um-

260. 1:09:26

     Okay. I'd like to start, Mr. Chair, if it's okay with you, with 0072, and this is a basically financial issue, and there are two different parts. The first part does not add the, uh, boxes and all the other language about ambulances and so on to the responsibility financially for defects before they take custody of the child.

261. 1:09:52

     Yeah.

262. 1:09:52

     And then the second part of that just confirms what you told us, Representative Cameron, before, that no state funds will be expended for the boxes.

263. 1:10:03

     And he's, he's, uh... For the audience back there, I think they can see. Uh, for the million of people that are watching us online, then, uh, we can say if we saw you nod. Okay. All right. So, uh, any questions on that committee, uh, from the committee? No questions, so, uh, we are, uh... Accept a motion.

264. 1:10:24

     Yeah.

265. 1:10:24

     Motion to-

266. 1:10:25

     So moved

267. 1:10:25

     ... So moved AM560072. Second?

268. 1:10:30

     Second.

269. 1:10:30

     Second, Senator Ch- Chairman Hufstetler. Uh, any further discussion?

270. 1:10:37

     Okay. If there's no objection, there's no objection to the amendment, then... No objection to the amendment, then it is adopted. Okay.

271. 1:10:47

     You want me to do the next one?

272. 1:10:48

     Uh, 0063.

273. 1:10:50

     63.

274. 1:10:51

     Okay.

275. 1:10:51

     Now, this one is, um, basically these boxes are unsecured, and they're in a, um, secured environment like a hospital or a fire station or whatever. And so I feel fairly strongly, and I think some other members of the committee also do, that because the boxes are not locked in any way and that anyone can put anything in the box, that could apply to some criminal activity or some even terroristic activity.

276. 1:11:23

     And so for that reason, I m- am trying to amend this to make sure there's a security camera on the outside box.

277. 1:11:31

     Okay. All right. So, uh, any questions to the author? Um, Chairman Strickland.

278. 1:11:40

     To the author, is that, uh... Are you supportive of that amendment?

279. 1:11:44

     I think I understand. We had a nice discussion about that as far as, uh, if someone were to do some terroristic thing, you wanna be able to, uh, have some kind of a record of that.

280. 1:11:55

     As in, like, explosive device-

281. 1:11:56

     Yes, sir

282. 1:11:57

     ... or something like that?

283. 1:11:57

     Yes, Mr. Chair.

284. 1:11:58

     Right.

285. 1:11:58

     So looking at line 81 of the bill, you don't see a conflict there? If we add that amendment, then the line we have about this being located in an area that's conspicuous and visible to employees, that-

286. 1:12:11

     Mm-hmm

287. 1:12:11

     ... you don't see any conflict there, right?

288. 1:12:14

     No, sir.

289. 1:12:15

     Okay.

290. 1:12:15

     Okay.

291. 1:12:16

     And you're, you're okay with this?

292. 1:12:18

     Yeah.

293. 1:12:18

     Yeah.

294. 1:12:18

     That's what we do.

295. 1:12:20

     Um, so-

296. 1:12:23

     So-

297. 1:12:23

     Did we get a motion?

298. 1:12:24

     Yeah, so, yeah. So I would move that we, um, adopt 0063 amendment.

299. 1:12:31

     0063. I have a second, uh, Chairman Hufstetler. And, uh, is there any objection?

300. 1:12:40

     No objection, and, uh, the amendment's adopted. And, uh, so I think the next... Who's, who's author of 0069 and 68?

301. 1:12:52

     Senator Setzler has all the next four.

302. 1:12:54

     Got all the next four. S- Senator Setzler, you have the mic.

303. 1:12:58

     Thank you, Mr. Chairman. Um, I told the author of the bill, I, I, um, I know there's... T- the big policy move here is about the baby box, but I also think this is an opportunity for us. A number of members are more comfortable with the existing safe haven laws, expanding it smartly in a measured way.

304. 1:13:15

     Yes, sir.

305. 1:13:16

     Um, you know, with the program that you're initiating, there will be a couple communities that do this.

306. 1:13:22

     But most of the state's not gonna have baby boxes

307. 1:13:24

     ... so we think about the existing Safe Haven law. Um, what this amendment, 0069, simply does is right now the law cuts off the immunity from prosecution for the mom handing over a baby in this context to 30 days or younger. Um, while I might like to- it to be more, I've proposed in this amendment extending that to 45 days. So if a baby is 40 days old, 42 days old, they still- the mother could still hand the child over safely and have the protection of the law.

308. 1:13:55

     Motion.

309. 1:13:56

     Motion, second. M- T- Discussion. The authors-

310. 1:14:01

     Um, that, that's very reasonable.

311. 1:14:02

     Uh, that... Very reasonable. Okay. Uh, is there any objection at all?

312. 1:14:07

     No.

313. 1:14:09

     No objections.

314. 1:14:12

     I- I fully-

315. 1:14:12

     Then I guess for the, for the record, none. I gotta... Thank you. Thank you, Senator Orrock. Uh, so the amendment's adopted. Uh, sure, be- which one you wanna do next?

316. 1:14:23

     0067 if I could please.

317. 1:14:25

     Okay. The floor is yours.

318. 1:14:27

     Thank you, Senator Orrock. Um, right now the law st- uh, stipulates that a, um, a mother could hand a child over, again, not in the context of the ba- baby box. This is just the, the warm handoff from a human being to another human being. Could be in a hospital or a birthing center or county board of health. Um, I'm proposing in, in this amendment to extend that to ambulatory surgery center or urgent care facility. Many of our communities have those. I have coordinated with the r- the ambulatory surgery center f- folks who support this, and I appreciate their support.

319. 1:14:59

     This just provides folks in communities that may not have a hospital-

320. 1:15:04

     Okay

321. 1:15:04

     ... but they do have an ASC or urgent care facility.

322. 1:15:05

     Got it. Um-

323. 1:15:07

     Or urgent care.

324. 1:15:08

     Ur- and urgent care. Motion.

325. 1:15:10

     Move.

326. 1:15:11

     Motion.

327. 1:15:13

     Second.

328. 1:15:14

     Second. And, uh, any further discussion? And is the author... He's nod his head, you're okay with that-

329. 1:15:22

     Yeah

330. 1:15:22

     ... ex- expanding that? And, uh, any- is there any objection? No objection, so the amendment, AM 560067 is adopted. All right, do you wanna do-

331. 1:15:34

     0068, Mr. Chair

332. 1:15:35

     ... 0068.

333. 1:15:36

     Um, currently the law, uh, specifies again for handing off, a warm handoff of the child to another human being, a, um, police station or fire station. Um, often in the communities there's law enforcement officers, there may be a police car, there may be a firetruck. Um, a- again, I talked to Senator for the 29th, if, if a law enforcement officer's present they wanna hand it off to a cop, very often the police officer m- may just call an ambulance and have the child evac'd. It gives the ability, other than a fire station or a precinct, to be able to hand a child off safely to a responsible adult.

334. 1:16:10

     Same that would be handling it in a facility, but just away from the facility. That's, that's all this does.

335. 1:16:14

     Got it. Motion.

336. 1:16:15

     Move.

337. 1:16:16

     Motion. Anybody wanna second this one? Second. Chuck Hufstetler. And Chairman Hufstetler, any further discussion? This was sort of brought up the other day, and we're talking about police officers, and I had a little reservation 'cause I was going like, well, police officers, healthcare, but, uh, I got quickly reminded that they're gonna hold the baby and call the ambulance or whatever.

338. 1:16:39

     Real-

339. 1:16:39

     Gotcha

340. 1:16:39

     ... real point, yeah.

341. 1:16:40

     Uh, and wouldn't have to worry about a car seat or anything like that. So anyway, uh, so you're in agreement with this. And is there any objection? No objection, and then the, that amendment, AM 560068 is adopted. And lastly, AM 560070.

342. 1:16:56

     Yes, sir, Mr. Chairman. Um, one of the most, uh, as we understood the testimony, and I appreciate the author and the people that spoke to this, biggest problem with a lot of the moms is sort of this, this sense of dread of facing people. Um, what this includes is if there's somebody that assisted the mother or acts, again, specifically at the direction of the mother, to help convey the child, they're not gonna be prosecuted. This... If someone was, again, at the direction of the mother helping convey the baby, uh, they have the same immunity the mother would have.

343. 1:17:25

     Like a Good Samaritan kind of thing.

344. 1:17:27

     Yeah, yeah.

345. 1:17:27

     So my grandparent or-

346. 1:17:29

     Or mom or sister

347. 1:17:30

     ... somebody assisting. Um, did... Or was it-

348. 1:17:34

     I think we may have another one afterward from-

349. 1:17:35

     Okay. And-

350. 1:17:36

     Move.

351. 1:17:36

     Motion. Second. Second. And, uh, we are... Any further discussion, you're good with that?

352. 1:17:44

     Sure.

353. 1:17:45

     And all those... Uh, uh, actually, there's... Any objection? No objection. AM 560070 is adopted. And we may have one more amendment. He's working on it right now.

354. 1:17:58

     Yes, he's...

355. 1:17:58

     Um, so let's, let's be at ease just for a second and, uh, can I recognize you on number nine?

356. 1:18:08

     Number nine. Mr. Chairman, if there's no objection, I'd request that we amend the motion, amend the legislation and name the legislation after the child that was, uh, lost in Troup County.

357. 1:18:22

     I agree. Yeah.

358. 1:18:23

     Where would you spell that? I, I... We'd check the leg office.

359. 1:18:28

     Do they have a spelling on it?

360. 1:18:30

     Yes, we just wanna make sure we get the correct spelling of the child's name.

361. 1:18:34

     All right. Um, th- that's a good motion. And, uh-

362. 1:18:40

     And that was seconded by Senator Brass.

363. 1:18:43

     Seconded by Senator Brass. Sure.

364. 1:18:48

     Um, we, we're gonna get the... Let me-

365. 1:18:52

     Yes, uh, Chairman Crow is getting us the correct spelling of the name. Excellent. And we can review on that.

366. 1:19:21

     Okay.

367. 1:19:31

     Because of the way this, this legislation is currently done, by adding the baby's name into it, we would be actually placing the baby's name in code, so the baby's name would be in Georgia law. And if there's no objection from the family, then that's what my motion would be.

368. 1:19:55

     Yeah. Thank you. Thank you, uh, thank you, Senator Strickland. Yep. Ledge Council has the-

369. 1:20:04

     Mr. Chairman-

370. 1:20:05

     We got the correct spelling and, and all that. And, um, Senator, Chairman Strickland, you wanna comment on that, please?

371. 1:20:12

     Yes, I just, I wanted to clarify, we name bills after people, but that's just the act itself a lot of times-

372. 1:20:17

     Right

373. 1:20:17

     ... that we do. This bill, actually, the current law, I guess, was enacted in 2002. It's called the Safe Place for Newborns Act of 2002. It's in the code, as you see on the first page of the bill, so it's a lot different, a bigger move, frankly, to actually name the whole act after the child. So, so to make sure if that's what we wanted to do, we state that for Leg Council.

374. 1:20:37

     Okay.

375. 1:20:37

     Yes.

376. 1:20:38

     Stand by my second.

377. 1:20:40

     All right. Can-

378. 1:20:40

     Yeah

379. 1:20:40

     ... got a second. Any, um, any further discussion? We're all, we're all clear. Um, I presume there's no objection. No objection, you know, it is as amended. Thank you. All righty. Um, now I think we are going to vote on, uh, HB 350. Um,

380. 1:21:07

     get the... Can you show me the bill?

381. 1:21:18

     So HB 350, LC 56-0268, as amended here in our committee. Uh, and we have a motion to do pass.

382. 1:21:35

     Have it seconded.

383. 1:21:36

     Second.

384. 1:21:36

     Second.

385. 1:21:37

     All right. All those in favor, uh, let's raise our hands. How about that? All those in favor raise your hands, and, uh, all those in favor. All those opposed, like sign. Okay, thank you. All right. Um, so, thank you. Uh, and who, who was carrying that?

386. 1:21:54

     Senator Strickland.

387. 1:21:55

     Senator Strickland, that's right.

388. 1:21:56

     And, and Mr. Chairman, may I make one point?

389. 1:21:58

     Sure.

390. 1:21:59

     Thank you for all the, uh, input and, and back and forth I've gotten from several members of the committee in the past week. I really appreciate your input, and thank you for your help.

391. 1:22:09

     Thank you, Representative Cameron.

392. 1:22:21

     All righty. Um,

393. 1:22:26

     uh, Chair Lady, um, Tillery, you're up. Thank you. You, Chair Lady Tillery, you still look, uh, fresh and, and, uh, goodness gracious, and here we are, it's, uh-

394. 1:22:38

     Yeah

395. 1:22:39

     ... 8:09 and you're looking, uh, goodness. Did you, you go home and take a shower and you get dressed again?

396. 1:22:45

     No. Thank-

397. 1:22:47

     Yeah

398. 1:22:47

     ... Mr. Chairman. Um, committee, I appreciate this. Um, I bring you House Bill 291. You've heard this before. You've seen it before. It concerns our community health workers. It simply establishes the foundation and ability to develop a structure for those who provide healthcare assistance in our local communities. Um, you've heard this before. It was passed out last year. Um, it's a good bill. It identifies who and what a community health worker is. It outlines who can and who cannot.

399. 1:23:18

     Um, again, it's the bill you've heard before. It's a vehicle really to build a program, and, um, it's gonna bring the healthcare resources to our rural and underserved area. It aligns very strongly with the Department of Public Health's current strategic plan to increase our skilled public workforce to help meet our state's needs. It's gonna standardize who and what a community health worker is. We already have several hospitals, Grady and Emory use them already, our FQHCs do. This is gonna be a good way to help give that guiding hand that we need.

400. 1:23:51

     It's gonna be providing a certification for these workers, it's gonna en- uh, enhance our workforce, but it's another way for healthcare resources in our rural and underserved areas to help.

401. 1:24:01

     Thank you. Thank you-

402. 1:24:02

     That's it

403. 1:24:02

     ... Chair Lady Tillery. Uh, would you mind just going through the education that they have to have or-

404. 1:24:07

     It's gonna be established in the program. Um, I will tell you from last year there have been two changes. One, because it was a 2025 bill, we've updated it a year to make that, and because there had been some concerned, um, about checking out and getting certification, we've included a background check that includes, uh, um, fingerprints.

405. 1:24:26

     Fingerprint-

406. 1:24:27

     Yeah

407. 1:24:27

     ... FBI check.

408. 1:24:28

     Yes, that's right.

409. 1:24:29

     Gotcha.

410. 1:24:29

     But, uh-

411. 1:24:29

     So if you have someone in your home, ought to be-

412. 1:24:31

     Yeah

413. 1:24:31

     ... ought to be-

414. 1:24:32

     That's exactly right

415. 1:24:32

     ... background.

416. 1:24:33

     That was in consultation with Department of Community Health and members of the committee, so I appreciated that.

417. 1:24:38

     Okay. Thank you.

418. 1:24:39

     And I am working off of, let's make sure we get it, it's LC 57-0257S.

419. 1:24:47

     No, we're on LC 60-0349S.

420. 1:24:51

     I think they get a new one every year.

421. 1:24:53

     Oh, this is a new one. I just got it several weeks ago, and s- it was supposed to have been delivered to your office.

422. 1:25:00

     Okay.

423. 1:25:01

     I think this is the most recent one.

424. 1:25:03

     Yeah, that's-

425. 1:25:03

     Maybe not. Let me, let me make sure, 'cause I've got several versions of it.

426. 1:25:08

     This is the one we've got right here.

427. 1:25:10

     Okay.

428. 1:25:10

     Is it, it says 6-

429. 1:25:13

     6-0. I, I have this one too. Let's just make sure it includes everything that this one does. The only changes were the, um, fingerprint.

430. 1:25:26

     Okay.

431. 1:25:39

     Okay.

432. 1:25:45

     Is that the right date? Yes. Yes, it's the right one. You, you have the right one. You have the website, the updated dates on it.

433. 1:25:53

     What was that?

434. 1:25:54

     Yes, that's the correct one.

435. 1:25:55

     We got that.

436. 1:25:56

     Yeah.

437. 1:25:56

     We have the right one, LC600349S.

438. 1:26:00

     That's correct.

439. 1:26:00

     Okay, great. Um, and we were at... Have we, we made a motion yet?

440. 1:26:08

     Yeah, thank you.

441. 1:26:09

     Had made a motion. Motion by Senator Halpern. Um, any second? Second by Senator Harrell. And, uh, any further discussion? All those in favor say aye. All those opposed, like, sign. Thank you, it passes unanimously. And, uh, who was carrying that for you?

442. 1:26:32

     Um, Senator Anavitarte.

443. 1:26:34

     Anavitarte.

444. 1:26:35

     Yeah.

445. 1:26:35

     Okay, great.

446. 1:26:36

     Thank you.

447. 1:26:36

     The leader. All righty, so thank you, Chair Lady Taylor. Um, House Bill 334, Representative Crawford. Stage is yours. We... And this has changed a little bit, right?

448. 1:26:59

     It has.

449. 1:26:59

     Yeah.

450. 1:26:59

     And thank you, Chairman, it has changed slightly, and I can go through some of the changes.

451. 1:27:03

     Just, if you don't mind, briefly, I think it's not, uh, too complicated.

452. 1:27:06

     Yes, thank you. Um, I'm looking at LC number 521115S.

453. 1:27:12

     Gotcha.

454. 1:27:13

     All right. The bill now contains a provision that helps people that are children that are impacted by RSV, better known as respiratory syncytial virus, and RSV is a leading cause of hospitalization amongst infants in the US. There are multiple, uh, stages which the last le- worst stage can lead to lung infections. And what this first portion would do is require learning centers and family child centers, if a child has RSV, to properly give that information to parents so that parents will be aware of any children in that childcare facility with RSV.

455. 1:27:54

     So the parents will now have an opportunity to protect their children with that information. The second portion of this bill goes, um, in section two, starting at line 20, addresses sickle cell disease. Uh, sickle cell disease is an inherited blood disorder that impacts multiple people in our state, approximately 15,000, and research shows that there's someone in every county in this state impacted by sickle cell. It is when the blood creates a sickle or a crescent shaped red blood cell, making it hard for blood to flow throughout the body, that can negatively impact organs and reduce life expectancy.

456. 1:28:37

     What I'm asking in section two is for the Department of Community Health to conduct an annual review of the medications and treatments available for people inta- impacted by sickle cell, so that we can have more input as medications and treatments evolve. The Department of Community Health has already heard this legislation. They support the legislation, um, after hearing it, and that's really the bulk of the bill.

457. 1:29:02

     Thank you so much. I'll-

458. 1:29:04

     Yeah

459. 1:29:05

     ... have a question.

460. 1:29:06

     Well, it's really a comment. I just wanted to give a shout-out to Senator Harbison. He chaired the study committee on sickle cell disease and has worked on this tirelessly the whole time he's been here.

461. 1:29:17

     Mm.

462. 1:29:17

     So I just wanted to be sure that we recognize that.

463. 1:29:20

     Thank you.

464. 1:29:22

     Any further questions to have a motion? Was that a motion?

465. 1:29:27

     Motion, and, and, uh, uh, um, I, I move do pass.

466. 1:29:31

     Right. Thanks, Senator Orrock.

467. 1:29:32

     Mm-hmm.

468. 1:29:33

     All right. Second. Senator Merritt, uh, second. And, uh, any further discussion?

469. 1:29:39

     I, I, I just want to make a comment. I did have an, uh, uh, um, a, uh, niece, uh, uh, uh, and it, uh, uh, on her first birthday was hospitalized, because you can, that can kill. That, that, that's... I mean, I really applaud both aspects of your bill.

470. 1:29:54

     Okay.

471. 1:29:55

     Uh.

472. 1:29:55

     Thank you.

473. 1:29:55

     Thank you.

474. 1:29:56

     Thank you.

475. 1:29:56

     Any, um... All those in favor say aye. Aye. All those opposed, same sign. Passes unanimously. Thank you.

476. 1:30:05

     Thank you. Thank you, Chair.

477. 1:30:06

     And who was gonna carry that for you?

478. 1:30:08

     I, I, I have a few requests of people who may be interested in carrying it out.

479. 1:30:12

     Oh, okay.

480. 1:30:12

     Uh-

481. 1:30:13

     Harbison

482. 1:30:15

     ... uh, Harbison, or even Senator Kirkpatrick-

483. 1:30:17

     And-

484. 1:30:17

     ... would you be-

485. 1:30:19

     Senator Harbison-

486. 1:30:20

     Harbison or Senator Kirkpatrick would be-

487. 1:30:21

     Senator Harbison would be great, really. Yeah. I think that'd be great.

488. 1:30:24

     Yeah. Um-

489. 1:30:25

     Okay.

490. 1:30:26

     Senator Harbison.

491. 1:30:27

     That- Harbison.

492. 1:30:29

     Yeah. Thank you

493. 1:30:30

     The data- Harbison would probably- But- It'd probably get passed pretty easily, I think, if Senator Harbison

494. 1:30:36

     Yes.

495. 1:30:37

     I don't know. I mean, I know the rules chairman is here, but, uh, you know, yeah.

496. 1:30:44

     Okay. All right. Okay. Thank you. If you could just get the information to him, and, uh, the little details, that'd be great.

497. 1:30:50

     Will do.

498. 1:30:51

     Yeah, yeah. Let him know.

499. 1:30:54

     Will do. Thank you all very much.

500. 1:30:56

     Thank you.

501. 1:30:56

     Thank you.

502. 1:30:56

     Thank you, Representative. Appreciate it. All right-

503. 1:30:58

     Thank you

504. 1:30:59

     ... so we're at, uh, 657, Representative Hagan. Yes, and, um, all right. And let's make sure we get the LC. I got-

505. 1:31:10

     Yeah

506. 1:31:10

     ... LC600359S.

507. 1:31:15

     Yes, sir, Mr. Chairman, that's the one I have here.

508. 1:31:17

     Okay.

509. 1:31:18

     And I'll be as brief as possible, but if you want me to go into more detail, just let me know.

510. 1:31:22

     No, don't worry.

511. 1:31:22

     So Georgia is a national leader when it comes to supporting our neighbors in recovery, and in fact, Georgia now has the most recovery community organizations of any state in the country. Um, we were second to Texas last year, but we surpassed them, uh, in the past year. So, um, this bill is necessary to protect the integrity of these life-saving programs. Um, the, the sub incorporates SB440, so I will be happy to just go over the f- the four pages that are this original language quickly, and then pass that off to you.

512. 1:31:59

     Yes, ma'am.

513. 1:32:00

     Okay, that's fine.

514. 1:32:00

     Okay. So what this bill does is it defines certified peer specialists and the different types of certified- peer specialists, and it also states that a, a DBHDD-approved certified training body would need to train those peer specialists. It sets out, um, recovery community organizations' basic operating requirements. And we want these RCOs to retain their unique character.

515. 1:32:35

     They're, they're all different, and that's important so that they can be as relevant and welcoming and supportive to the people in their particular communities, but we also wanna make sure that they're providing consistent care and support. So that, that is w- w- why the request for this legislation was made by the RCOs. Um, and the bill then says that DBHDD shall designate a statewide RCO to coordinate a network for all of these different RCOs, subject to appropriations.

516. 1:33:08

     So that's a, that, that is the bulk of-

517. 1:33:12

     That's the-

518. 1:33:12

     ... that original portion of the bill.

519. 1:33:14

     Great. Any, do you have anything else to add?

520. 1:33:17

     I do not.

521. 1:33:18

     Okay.

522. 1:33:18

     I guess I need to talk about 440 briefly.

523. 1:33:21

     Yes. Okay.

524. 1:33:23

     Um, yeah. So the first part of the bill, you've seen before, and we passed it already. It was Senate Bill 440, which is a Department of Public Health Agency cleanup bill. We passed it, you know, a long time ago. It went over to the House. They amended it, and, um, I got word from the governor's office that the governor's office is opposed to amending an agency bill. And so, uh, this bill is back to, um, m- as riding along with your bill.

525. 1:33:58

     And I'm happy for it to do that.

526. 1:33:59

     All right.

527. 1:33:59

     Yes, ma'am.

528. 1:34:00

     Any questions? Do I have a motion? So moved. So moved. Setzler, Senator Setzler, Ro- uh, Senator Robertson, the whip. And no further discussion. All those in favor, say aye. Aye. All those opposed, like sign. Passes unanimously. Thank you.

529. 1:34:19

     Thank you.

530. 1:34:19

     Um, Representative Hagan, who was carrying that? It would probably be likely or somebody over here.

531. 1:34:24

     Senator Brass-

532. 1:34:25

     Oh, Senator-

533. 1:34:26

     ... was o- was originally gonna carry it simply because-

534. 1:34:28

     Okay

535. 1:34:28

     ... he's got one of the largest RCOs in his committee.

536. 1:34:30

     I, um, I think that's a good person, e- especially at the end of the year here.

537. 1:34:33

     Yes. I, I thought it might be as well.

538. 1:34:35

     Great. And-

539. 1:34:35

     Thank you

540. 1:34:36

     ... agency bill, he's sort of sensitive to those agency bills. Gotcha. Okay.

541. 1:34:40

     Thank you.

542. 1:34:41

     Thank you so much. Appreciate it. Thank you for bearing with us with time-wise.

543. 1:34:53

     All right. W- we're down to the last bill. Uh, so 'cause the, uh, we've done the other two at the bottom, and one was canceled, and the last one actually is, uh, Representative Kelly's, and he was not able to make it, uh, tonight. This basically, uh, expands the national organizations for guidelines and recommendations. You can see there, uh, in the summary and analysis. But, uh, big story is that, uh, for colon cancer screening, colorectal screening is, obviously colonoscopy is the gold standard.

544. 1:35:25

     It has dropped down to age, uh, 45, uh, maybe two or three years ago, and because of the increased incidents of colon cancer at younger ages, so it dropped from 50 to 45. And, um, they're now, the, the gold standard's been colonoscopy. The next one has been Cologuard, uh, and there's still some people who, uh, don't wanna do the colonoscopy and don't wanna do that i- in full knowledge that it saves lives, and there's g- good data and obviously good experience.

545. 1:35:56

     There's a blood test now that is available that has a sensitivity and specifi- specificity that, uh, m- is, is certainly not as good as a colonoscopy or Cologuard, but it's really pretty close. It does meet the criteria, and it's a New England Journal medicine article, uh, that we reviewed, uh, and, uh, it has good numbers. So the sensitivity, specificity is in the 80s and 90s and, uh, and is good. So that's why I agreed to present the bill, uh, and have the bill on our committee.

546. 1:36:26

     So, uh, any questions on that? Uh, Chairman Hufstetler. Yeah, thank you, Mr. Chairman. I just wanna say, when you get a house lawyer to present a bill that's only 19 lines long, then I think we should vote for it. That is, you know, there's something to be said about that. Yes. Yes.

547. 1:36:43

     Yes, and just one comment about that. Uh, this is, this bill is not to say that people with, that are high risk for colon cancer, they're likely gonna need a colonoscopy, so I don't think the bill, uh, would-

548. 1:36:57

     Right. So this, this references the, the several different societies, uh, especially United States Preventative Task Force, which is really the, the one that we go to, and usually is, uh, is what's looked to. So sh- she's absolutely correct. High-risk individuals, those who've had polyps before, those who have family history, first-degree relative with, uh, colon cancer and so forth, not eligible to have anything else but colonoscopy, including this blood test.

549. 1:37:24

     Now they're both column.

550. 1:37:26

     The colonoscopies? I mean, they're- They're, they're, yeah, they're- They are. They are, yes. They're absolutely-

551. 1:37:33

     At the appropriate time

552. 1:37:33

     ... the guy to your left is, uh, does the anesthesia that makes 'em much more tolerable. That's right. That's right. Absolutely. They feel nothing when they're around, uh, uh, Chairman Hufstetler.

553. 1:37:45

     Make a motion.

554. 1:37:46

     Uh, uh, we're making the motion-

555. 1:37:48

     Yeah

556. 1:37:48

     ... of do pass, and second by anybody you wanna pick. All those in favor, say aye. All those opposed, like sign. Passes unanimously. That's our last meeting. Thank you for being here. It is 8:24. Thank you to everybody for hanging, hanging around. I really appreciate that. Thank you.