Wednesday was a big day under the Gold Dome — a big budget day, to be exact. After tying up the loose ends on the Amended FY23 Budget on Monday, House appropriators rolled out their take on the FY24 spending plan in meetings on Legislative Day 30. Highlights include maintenance of the $2,000 cost of living adjustments for state employees and public school teachers and a boost to $4,000 for public safety employees. The House also provided substantial increases to fund mental health initiatives in the Department of Behavioral Health and Developmental Disabilities, honoring the legacy of the late speaker David Ralston in supporting mental health care expansion in Georgia. All the details on the spending plan and a link to the full budget tracking sheet is in this #GoldDomeReport.

Although committee work continued on Wednesday, neither chamber took up legislation. The floors liven back up on Thursday when the House takes up the FY24 Budget and the Senate acts on three House bills before heading into the weekend.

In this Report:

• FY24 Budget Clears House Appropriations Committee

• Committee Reports

• New Legislation

• What’s Next

FY24 Budget Clears House Appropriations Committee

In a series of early morning subcommittee meetings, the House Appropriations Committee unveiled its priorities for the FY24 State Budget on Wednesday. The spending plan, which includes several deviations from Governor Kemp’s proposed budget, is expected to be voted on by the entire House on Thursday. Notable differences in the House version of the budget include the following, and the full tracking sheet is available here.

Department of Behavioral Health and Developmental Disabilities

• Adult Developmental Disabilities Services

  • $8,056,825 for 375 additional slots for the New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP) for individuals with intellectual and developmental disabilities and provide administrative workload support (Governor Kemp requested funding for 250 additional slots).

  • Language directing the Department to begin implementation of the 2022-2023 provider rate study pending approval by Centers for Medicare and Medicaid Services (CMS).

• Adult Mental Health Services

  • $2,251,420 for additional program and administrative support to manage the national '988' hotline.

  • $4,558,493 to convert a crisis stabilization unit at Highland Rivers to a 32-bed and 16 temporary observation chair behavioral health crisis center.

  • $1,902,500 for the Georgia Housing Voucher program to support the requirements of the Department of Justice (DOJ) Settlement Agreement.

  • $2,774,013 for the Georgia Mental Health Consumer Network for peer services.

  • $2,735,431 to increase salaries for state psychiatric hospital staff to address agency recruitment and retention

  • $8,066,106 to support private psychiatric contract beds.

  • $825,000 to coordinate outreach to address homelessness in the Atlanta area.

  • $277,519 to create a crisis response team at View Point Health.

• Child and Adolescent Mental Health Services

  • $600,000 in one-time gap funding for Georgia psychiatric residential treatment facilities receiving less than $500 per patient per day while under current cost report reimbursement methodology.

  • $1,000,000 for the Multi-Agency Treatment for Children (MATCH) teams to support collaboration across state agencies to meet the treatment needs of children.

  • Language directing the Department to utilize funds in the Adult Mental Health program for mobile crisis for children and family response.

Department of Community Health

• Health Care Access and Improvement

  • $3,000,000 reduction to Rural Hospital Stabilization Grants in anticipation of the new hospital-directed payment program.

  • $750,000 for three federally qualified health center start-up grants for primary care in Union County, behavioral health expansion at Christ Community Health Services of Augusta, and a school-based health center in Emanuel County. 

  • $250,000 for charity clinics statewide.

  • $500,000 for Mercy Care Atlanta to support increased patient volume.

  • $409,000 to support existing and new housing with the Area Health Education Centers (AHEC).

  • $1,237,910 for Colquitt Regional Medical Center for medical education training equipment and clinical space.

  • $425,000 for St. Francis Hospital to support graduate medical education facility expansion.

  • $1,097,538 for Archbold Medical Center for infrastructure support for new residency programs.

• Healthcare Facility Regulation

  • $250,000 to implement and regulate the new licensure category for adult residential mental health programs as established by HB 1069 (2022 Session)

• Medicaid – Aged Blind and Disabled

  • $1,390,850 for a 5% increase to emergency medical services (EMS) reimbursement rates.

  • $650,651 for a 2% rate increase for home and community-based service providers.

  • $5,255,948 for a 5% rate increase for Georgia Pediatric Program (GAPP) providers.

  • $308,666 to increase the dispensing fee to $11.50 for low-volume pharmacies that fill under 65,000 prescriptions per year.

  • $2,195,707 to increase reimbursement rates for speech-language pathology, audiology, physical therapy, and occupational therapy providers.

  • Language directing the Department to submit a State Plan Amendment to adjust psychiatric residential treatment facility (PRTF) rates up to 75% of Medicare Inpatient Facility Rates, contingent upon CMS approval and agreement by facilities to follow DCH-defined payment policies that prioritize Georgia’s youth for placement.

• Medicaid – Aged Blind and Disabled

  • $1,401,214 for adult coverage of dental services.

  • $442,464 for a 5% increase to emergency medical services (EMS) reimbursement rates.

  • $871,029 to reimburse for family psychological and therapy services.

  • $584,061 to remove the five-year waiting period for pregnant women and children who are lawful permanent residents.

  • $312,630 to increase the dispensing fee to $11.50 for low-volume pharmacies that fill under 65,000 prescriptions per year.

  • $5,037,452 to increase reimbursement rates for speech-language pathology, audiology, physical therapy, and occupational therapy providers.

  • $18,718,846 to increase select primary care and OB/GYN codes to 2021 Medicare levels.

  • Language directing the Department to require Medicaid managed care organizations to reimburse at no less than 100% of the state Medicaid program Durable Medical Equipment fee schedule for the same service or item of durable medical equipment, complex rehab technology, prosthetics, orthotics, and supplies. This shall also apply to managed care contractor subcontractors and third-party administrators.

• Georgia Board of Health Care Workforce: Graduate Medical Education

  • $648,507 for six child and adolescent psychiatry fellows at the Medical College of Georgia.

  • $150,000 for a Maternal Fetal Medicine fellowship at the Medical College of Georgia.

•  Georgia Board of Health Care Workforce: Morehouse School of Medicine Grant

  • $240,000 to support the start-up of a new rural OB/GYN graduate medical education program to address maternity care deserts in rural Georgia.

  • $1,500,000 to support the increase of the Morehouse School of Medicine class size and expand rural clinical training.

•  Georgia Board of Health Care Workforce: Undergraduate Medical Education

  • $636,341 for Georgia medical student capitation payments to the Philadelphia College of Osteopathic Medicine (PCOM).

Department of Education

• Agricultural Education

  • $171,000 for 18 new extended day/year programs.

  • $288,000 for three young farmer positions in Barrow, Lowndes, and Hall counties.

• Central Office

  • $3,000,000 for Plasma Games statewide rollout and evaluate usage and effectiveness after one year.

  • Language authorizing the Department to establish a pilot program consisting of a representative sample of schools and school systems to study whether the use of advanced technologies capable of reliably detecting children at potential risk of harming themselves or others based on their internet use patterns is effective at reducing rates of youth suicide and violence; provided, however, that such study is limited to internet use on school-issued devices.

• Nutrition

  • $6,333,713 for the cost of breakfast and lunch for reduced-paying students.

• Quality Basic Education Program

  • $8,750,869 to provide a salary supplement of $1,000 to all custodians.

• Technology/Career Education

  • $711,000 for construction industry certification. 

  • $1,000,000 for a construction-ready pre-apprenticeship program.

Department of Public Health

• Adolescent and Adult Health Promotion

  • $363,675 for the Sickle Cell Foundation of Georgia.

  • $500,000 for pregnancy and parenting grant programs.

  • $50,000 for the Georgia Council of Lupus Education and Awareness to support research, data collection, awareness, and education.

• Infant and Child Essential Health Treatment Services

  • $1,689,000 for a pilot to provide home visiting in at-risk and underserved rural communities during pregnancy and early childhood to improve birth outcomes, reduce preterm deliveries, and decrease infant and maternal mortality.

  • $402,421 to increase reimbursement rates for speech-language pathology, audiology, physical therapy, and occupational therapy providers in the Babies Can't Wait program. 

Committee Reports

House Health Committee

Chairman Lee Hawkins (R-Gainesville) called the House Health Committee to order to have an informational meeting.

Liz Coates, executive director of Good News Clinic, was joined by Becky Ryles to give the committee an explanation of the Good News Clinic and how they provide wraparound services to patients based on the social determinants of health. They serve uninsured patients in Hall County who live 150% under the federal poverty limit. Services include primary care, dentistry (1,000 appointments /month), counseling services (200 /appointments), and a pharmacy with 3,500 average unique individuals every year on a $2.6 million budget, the highest it has ever been. Considering 3,500 do not have insurance, they would not have access to care but us. Good News Clinics keep people out of the emergency rooms. For every 100 patients visiting their clinics, their visit saves patients $50,000 in emergency room visits. In 2018, this would have equated to over $2 million. Today that would be $5 million in savings for emergency departments. This is primarily on chronic, persistent issues such as diabetes. Blake Fullenwider was recognized because their health system is their largest partner. The clinic is hoping to triple its capacity. They take in 700-900 new patients every year.

Hawkins noted that the community stepped forward to help by donating money, time, and skills. Representative Mark Newton (R-Augusta) asked if their clinics were able to receive 340B pricing. All their patients qualify and their budget for medications they have to purchase is about $100,000 in their budget. They also review a charitable pharmacy organization and review based on their formulary prescriptions for free. Newton asked about special procedures and eligibility for Medicaid. The Clinic works with local navigators to enroll when they can. 340B is specific for HRSA-funded entities. Mr. Jiles, a board member, came forward to describe how the Clinic stepped up during COVID with vaccinations. Hawkins asked for the number of free clinics like Good News Clinic in the state and FQHCs. Ms. Ryals noted there are 98 free and charitable clinics in the state with 229 FQHCs.

Caylee Noggle, commissioner for the Georgia Department of Community Health (DCH), came to present the Directed Payment Program (DPP), which is a specified financing tool by CMS. This allows federal dollars to be drawn down subject to annual re-approval. There is a robust effort that DCH will have to go through each year. The DPP makes the waterfall, the reshuffle, possible. DCH submitted a quality plan to CMS. DCH created five programs and shared those with CMS. Physician DPP includes physicians affiliated with a governmental teaching hospital. Their achievement of certain metrics includes 14 affiliated hospitals equaling $120 million (roughly 70% is federally funded). The state share is through intergovernmental transfers from the 12 hospitals themselves. The public hospital DPP increases reimbursement rates to Medicare equivalent, equaling $235 million funded by hospitals. Private DPP is almost identical to the last one. 42 private hospitals are eligible. They cannot enter into intergovernmental agreements. So, the provider/bed tax is what helps fund that. Georgia Strong is focused on the workforce — 20% of funds will be reinvested into workforce efforts. There is a lot of flexibility for hospitals to do this. DCH will have reports and reviews on this one to report to CMS. This is the largest at $700 million. This raises Medicaid rates plus 200%. This is a combination of public and private. Georgia Aide has at-risk dollars, including Grady and Augusta. Similarly, raising the Medicaid rate to the average commercial rate valued at $345 million. Again, funding state share through intergovernmental transfer. These programs equal $900 million. At the end of this year, DCH will true up these numbers. This will create the waterfall effect on DSH. Traditionally allocations have been made based on the proportion of Medicaid services provided. Grady is the single largest provider; however, because we are raising their rates, they become ineligible for this program because they are meeting their hospital-specific limit. This $105 million will waterfall to other hospitals, and DCH is changing how they prioritize hospitals. They hope, pending CMS approval, to help rural and urban hospitals. The overall outcome is that Medicaid uncompensated care will be cut in half for the state and eliminated for the 61 rural hospitals. The entire program is roughly $1.6 billion. About 58 hospitals will benefit from $15,000-$1 million. CMS has approved all five programs, and DCH is waiting on methodology approval.

Newton asked about the 14 public hospitals that will be funded by intergovernmental transfers. Noggle mentioned they would be funded based on whatever they want to use in their budgets. He followed up by asking if private hospital bed tax is the same. Noggle acknowledged those increase slightly to draw more down federal money.

Representative Billy Mitchell (D-Stone Mountain) asked if any resources are set aside for the Medicaid unwinding and healthcare delivery in Atlanta with the recent closure. Noggle noted that the department had a plan for a while to help with members and redeterminations. To answer the second part of the question, Noggle mentioned the surrounding hospitals which have opened up extra beds and explained they are working to ensure people are not coming to emergency rooms for primary care. Representative Chas Cannon asked about re-approval and how he should help his district hospitals. Noggle explained that DCH is prepping hospitals to explain funds can be used however hospitals want. They need to do so wisely because DCH will have to show CMS these quality metrics. Some hospitals, like Augusta, do not receive 10% of their funds until they meet certain metrics.

Grant Thomas, director of Health Strategy and Coordination, first provided a brief history of the office. He highlighted the reinsurance program with premiums reduced by 24% equals $1,000 per year for consumers. The premiums have gone down more in rural counties. The Georgia Access model is a state-based exchange, which Commissioner King will manage. There was an investment in this to promote marketing and outreach. This has resulted in a 25% of increase since last year and doubled the national average. The target date for implementation is in 2023. The Georgia Pathways Program provides a new coverage option who make too much but do not qualify for purchase on the marketplace. 376,000 Georgians will have the opportunity to use this if they meet 80 hours of community engagement.

OHSC initiatives include the all-payer claims database and contract improvements. Per HB 1013, there are two studies to be completed (transport and SHBP formulary prescription list). Lastly, there are data projects. The all-payer claims database is the centralized data repository for public and private data for claims the state can use to conduct cases and leverage data to understand costs to consumers. There are several entities involved, OHSC oversees and drives the direction of this database. Georgia Data Analytics Center will house the data. Another initiative was to review contracts and look at supports that include the social determinants of health to issue closed-loop referrals.

OHSC has been studying the transports of 1013 patients. They have expanded to review agreements in other states. The unified drug list study has explained the rebate piece is a big part because CMOs might not have the information. There are financial considerations. The downside to the list is that there is more autonomy currently, but the OHSC report considers these.

Hawkins asked about the claims database, including Medicaid. Thomas noted that the project has multiple phases, resulting in two data banks, which the chairman alluded to. Newton asked about transparency and pricing. Thomas explained the list prices and what they are doing is complementary to what the federal government does to give OHSC a better understanding of the data. Newton asked about the preferred drug list and explained that a longer-acting drug might be more expensive, but the medical expense might go down. Is that calculated in? Secondly, prior authorization can be a phone call, or there can be other requirements. Newton wondered if that was also calculated in. Thomas answered these drug recommendations are just a first step.

New Legislation

The following legislation of interest has been introduced. Since the General Assembly is beyond Crossover Day, new legislation requiring action in both chambers is not eligible to achieve final passage by both chambers during this legislative session, but it will be available for consideration during the 2024 Legislative Session.

What’s Next

The General Assembly will reconvene for Legislative Day 31, on Thursday, March 9, at 10:00 a.m.

The House is expected to consider the following measures on Legislative Day 31:

• HB 19 - General appropriations; State Fiscal Year July 1, 2023 - June 30, 2024 (Substitute)(App-Burns-159th)

The Senate is expected to consider the following measures on Legislative Day 31:

• HB 55 - Banking and finance; provide for definitions; provisions (B&FI-18th) Williamson-112th

• HR 157 - Property; conveyance of certain state owned property; authorize (Substitute) (SI&P-15th) Greene-154th

• HR 158 - Property; granting of nonexclusive easements; authorize (Substitute) (SI&P-15th) Greene-154th