MAG caps banner session with passage of 'Name Tag Bill'

Posted over 10 years ago by Jill Nielsen

FYI:

The Medical Association of Georgia (MAG) enjoyed another banner state legislative session in 2015, according to MAG Council on Legislation (COL) Chair Michael E. Greene, M.D. And when it comes to landmark legislation, he reports that lawmakers passed H.B. 416 – which is also known as the "Patient Consumer and Awareness Act" and the "Name Tag Bill."

"With the exception of optometrists and chiropractors and dentists who don't practice in hospitals or nursing homes or assisted living facilities, this bill would require every licensed health care practitioner in the state to wear an ID on lab coats or similar distinguishing clothing or uniforms that states their name and license or educational degree," says Dr. Greene. "This has been one of MAG's legislative priorities for the last two years."

Dr. Greene also notes that lawmakers passed a FY 2016 budget that includes some $23 million in additional funds to increase the reimbursement rate for select Medicaid primary care and OB-GYN codes. And he explains that legislators also approved $199,000 to maintain the Prescription Drug Monitoring Program in the state in FY 2016.

MAG Executive Director Donald J. Palmisano Jr. applauds Dr. Greene and the rest of the COL, and he adds that, "I would like to also thank MAG Government Relations Director Marcus Downs and his team for their tireless efforts, and I would like to congratulate them on a job well done and another excellent legislative session."

Downs says that, "We really focused on building and maintaining our relationships with our allied stakeholders."

He is also thanking Georgians for a Healthy Future for the key role it helped to pass the aforementioned name tag bill. He says, "This consumer advocates' group stepped up in a very big way."

Downs notes that the group also played a pivotal role in supporting the "Insurance Omnibus Bill (S.B. 158). According to Downs, "They provided some strong and effective testimony when it came to discussing the flaws associated with today's health insurance networks from a patient-consumer perspective."

Downs also gives credit to the registered dieticians in the state who supported MAG in its efforts to pass H.B. 416. He explains that, "This was the focus of their day at the capitol event in 2015, and they helped legislators understand that this bill affected the full spectrum of health care providers."

Downs says that allied medical societies in the state also made key contributions during this year's legislative session. He believes that, "Because we were unified, we were especially effective in securing additional funds for Medicaid primary care and OB-GYN physicians in the state."

And he says that the Council on Alcohol and Drugs was a strong ally when it came to MAG's efforts to ensure that the Georgia PDMP continues to be adequately-funded.

Finally, Downs says that, "It goes without saying that we simply couldn't accomplish what we do without our member physicians – especially the members of our Board of Directors – and MAG staff. He concludes that, "MAG's Board demonstrated great leadership in dealing with some incredibly complex and politically-charged bills."

MAG tracked about 140 bills during this year's legislative session. Gov. Nathan Deal will now determine the fate of the bills that passed.

Contact Downs at 678.303.9280 or mdowns@mag.org with any questions related to the 2015 state legislative session.

While some of the legislation is still subject to a final administrative review, the following summary addresses the key bills that were related to MAG's legislative priorities in 2015...

MAG Priority: Preserving Physician Autonomy

H.B. 416 by Rep. Carl Rogers (R-Gainesville) would require licensed health care practitioners in the state to wear an ID on their "lab coats or similar distinguishing clothing or uniforms" that states their name and license or educational degree. The only exceptions would be optometrists and chiropractors and dentists who don't practice in hospitals or nursing homes or assisted living facilities. This has been one of MAG's legislative priorities for the last two years as voted on by MAG's Board of Directors. A number of other groups also supported the bill, including speech language pathologists, audiologists, respiratory therapists, marriage and family therapists, ophthalmic technicians, and APRNs. MAG position: Supported. Outcome: Passed.

H.B. 350 by Rep. Tom Taylor (R-Dunwoody) would have given dental hygienists the authority to administer local anesthesia under the direct supervision of a dentist under rules and regulations that would be established by the Georgia Board of Dentistry. MAG position: Neutral. Outcome: Did not pass.

H.B. 564 by Rep. Rick Jasperse (R-Jasper) would have required physicians to complete and document five hours of continuing education every two years to prescribe controlled substances. MAG position: Opposed. Outcome: Did not pass.

S.B. 115 by Sen. Chuck Hufstetler (R-Rome) would have allowed PAs to prescribe a 30-day supply of Schedule II drugs under a physician protocol. MAG was the only organization to oppose the bill in its original form. Consistent with the wishes of MAG's Board of Directors, MAG played a key role in scaling-back the scope of this legislation. The amendments that MAG proposed would have limited a PA's prescribing authority to hydrocodone combination products, which is the same level of authority they had before the U.S. Food & Drug Administration reclassified these drugs from Schedule III to Schedule II in 2014." Outcome: Did not pass.

H.B. 179 by Rep. Sharon Cooper (R-Marietta) would have allowed certified nurse anesthetists to work at pain management clinics under a physician protocol. Rep. Tom Weldon (R-Ringgold) introduced a similar bill (H.B. 212). MAG position: Neutral. Outcome: Did not pass.

H.B. 482 by Rep. Wendell Willard (R-Sandy Springs) would have changed the definition of destination cancer hospitals from a certificate of need requirements (CON) standpoint to mean in-patient hospital. The measure would have also eliminated requirements for destination cancer hospitals to 1) be 50 beds or less and 2) have 65 percent of out-of-state patients for two consecutive years. MAG policy calls for the organization to support efforts to repeal the state's CON law. However, MAG did convene a task force that studied CON issues in 2014, and MAG's 2014 House of Delegates (HOD) called for the organization to continue to study the issue and to provide a report at the HOD meeting in 2015. Outcome: Did not pass.

H.B. 498 by Rep. Lee Hawkins (R-Gainesville) would have added the word "diagnose" to the scope of practice code for licensed professional counselors in the state. The existing statute uses the term "diagnostic impressions." The change would have had to take place to allow the counselors to continue to receive reimbursements from agencies and insurance companies when the codes from DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) are fully implemented. The change was made for licensed clinical social workers and marriage and family therapists in the last several years. MAG position: Opposed. Outcome: Did not pass.

H.B. 395 by Rep. Joyce Chandler (R-Grayson) would have added "psychological testing" to the definition of "practicing psychology" in the state. Under this bill, psychological testing would have been defined as the "use of assessment instruments that measure mental abilities, personality characteristics, or neuropsychological functioning in order to diagnose, evaluate, classify, render opinions regarding, or treat mental and nervous disorders and illnesses, including, but not limited to, organic brain disorders and brain damage." MAG position: Neutral. Outcome: Did not pass.

MAG Priority: Third Party Payer/Insurance

H.B. 354 by Rep. Barry Fleming (R-Harlem) would have required State Health Benefit Plan (SHBP) insurers to include certain trauma centers in their network, including every Level I trauma center in their service area. The measure would have also established a panel to resolve rate and contract disputes between SHBP insurers and hospitals. MAG position: Supported. Outcome: Did not pass.

H.B. 409 by Rep. Darlene Taylor (R-Thomasville) would prohibit health insurers from limiting or excluding coverage for burn treatments that use cadaver or non-human xenographic skin tissue. MAG position: Supported. Outcome: Passed.

S.B. 158 by Sen. Dean Burke, M.D. (R-Bainbridge) would have addressed rental networks, all-products clauses, and other key issues. The bill would have required contracts to remain intact during the course of the first year or on the anniversary of its renewal – whichever is longer. It would have also required health insurers to maintain sufficient networks so patients know which physicians are in a particular network. And S.B. 158 would have shored up a requirement for insurers to maintain a provider list that is accessible to the public. MAG's Board of Directors voted to support this measure. The bill evolved into S.R. 561, which is a "study bill" – which means that a group of legislators will develop a report for the General Assembly's consideration in 2016. The Georgia Association of Health Plans opposed S.B. 158. MAG position: Supported. Outcome: Did not pass.

H.B. 429 by Rep. Ron Stephens (R-Savannah) would require health insurers to cover autism spectrum disorders (ASD) and applied behavioral analysis (ABA) therapy for their insured patients who are under the age of six. To qualify for the coverage, the insured would have to get a licensed physician or a licensed psychologist to verify that there is an "ongoing medical necessity." Insurers would not be able to limit the number of treatments, though they could cap the ABA therapy coverage at $30,000 per year. MAG Position: Supported. Outcome: Passed.

MAG Priority: Tort Reform

H.B. 407 by Rep. Ronnie Mabra (D-Fayetteville) would have required a "non-terminal" patient who receives a Schedule II or III drug prescription for chronic pain for 90 consecutive days to receive opioid education and pro-active addiction counseling every three months during the course of their treatment. This would have been provided by independent and licensed third party professional counselors with costs capped at $100 per session. MAG position: Opposed. Outcome: Did not pass.

For the second year, Sen. Brandon Beach (R-Alpharetta) introduced the "Patient Compensation Act" (S.B. 86) – a measure that would replace the state's medical malpractice system with an "administrative compensation" system. MAG opposed the bill in 2014 following a lengthy and comprehensive analysis. The measure did not receive a committee hearing in 2015. Outcome: Did not pass.

MAG Priority: Increasing Access to Care

H.B. 504 by Rep. Sharon Cooper (R-Marietta) would extend the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis. Pharmacists would be required to complete a 20-hour education requirement, including 12 hours that would be recognized by the CDC and eight hours of self study; the pharmacist or nurse who administers the vaccine would have to take a complete case history and determine whether the patient had a physical examination within the year; the pharmacist or nurse wouldn't be able to administer a vaccine to a patient who has a condition for which such vaccine is contraindicated; the pharmacist or nurse would have to provide the patient with a Georgia Department of Public Health (DPH) form that stresses the need to see their primary care physician on a regular basis; and the pharmacist or nurse would have to provide the patient with a wallet-sized card containing information from DPH about the vaccine. MAG's Board Directors voted to support this kind of measure given strict limits and notification requirements. MAG worked with Rep. Cooper to ensure that appropriate sanctions are in place for any violations. MAG position: Supported. Outcome: Passed.

H.B. 505 by Rep. Sharon Cooper (R-Marietta) would change the definition of the term "physical therapy" under the Georgia Physical Therapy Act to include "examining, evaluating, and testing patients; alleviating impairments; reducing the risk of injury, impairment, activity limitations; dry needling for preventative and therapeutic purposes; instructive, consultative, educational, and other advisory services." This legislation would allow physical therapists to examine and evaluate a patient without a prior consultation with a physician. They would have 21 days or eight visits before they would have to refer a patient to a physician, and they would also have unlimited access to patients when it came to health promotion, wellness, fitness or maintenance services under this measure. The bill was amended to require physical therapists to notify patients that their health insurers may not be required to pay for treatments that are related to their diagnosis. H.B. 505 would also expand the Georgia Board of Physical Therapy's authority to regulate the practice of physical therapy by interpreting and enforcing the law and by issuing advisory opinions. MAG position: Neutral. Outcome: Passed.

H.B. 1 by Rep. Allen Peake (R-Macon) would allow Georgians who obtain a physician's "recommendation" to possess cannabidiol oil. The bill would cap the amount of tetrahydrocannabinol (THC) that can be included in the oil cannot at five percent for patients who are 19 years old and older and at three percent for patients who are 18 years old and younger. In 2014, the bill was limited to patients who have cancer, glaucoma and seizures. In 2015, it was modified to include amyotrophic lateral sclerosis, Crohn's disease, Mitochondrial disease, Parkinson's disease, and Sickle Cell disease. "Certified" patients (and their caregivers) who possess the oil in its approved form would be immune from prosecution; the physician's recommendation would serve as the certification. H.B. 1 would also create a Georgia Commission on Medical Cannabis Regulation that would 1) study the effects of legalizing medical cannabis and 2) regulate the medical cannabis program in the state, including licensure, distribution, security, and production quality. MAG's Board of Directors had voted to, "Continue to support the use of marijuana in strictly controlled medical research programs for patients who have cancer or glaucoma or who suffer from seizures as a result of refractory epilepsy; support the standardization (i.e., concentration and dose) of cannabinoids; support the availability of cannabinoids for compassionate use in intractable cases; support measures that will hold physicians harmless for recommending the use of cannabinoids; and continue to oppose the recreational use of any drug or substance." MAG ended up assuming a neutral position on this bill because it wasn't limited to research and because of the additional diseases that were included. MAG position: Neutral. Outcome: Passed.

S.B. 185 by Sen. Lindsey Tippins (R-Marietta) would have required the Board of Regents of the University System of Georgia to design, develop, implement, and administer a cannabidiol products research program. The bill would have permitted volunteers who are 18 years old or younger and who meet certain residency requirements and who have medication-resistant epilepsies to possess cannabidiol products in the context of the clinical trials. S.B. 185 was consistent with a policy that was established by MAG's Board of Directors. MAG position: Supported. Outcome: Did not pass.

H.B. 47 by Rep. Sharon Cooper (R-Marietta) would allow pharmacists to refill topical ophthalmic products for up to 70 percent of the predicted days of use without receiving a new prescription or the approval of the patient's physician. MAG and the Georgia Society of Ophthalmology (GSO) worked to ensure that the measure wasn't modified in any ways that undermined patient safety. MAG position: Supported. Outcome: Provisions were included in S.B. 194, which passed.

H.B. 195 by Rep. Cooper would regulate the labels that go on interchangeable biological products. Under this bill, a pharmacist who substitutes an interchangeable biological product for a prescribed biological product when they dispense a prescribed medication would have to affix a label with the name of the interchangeable biological product – as well as a note indicating that the substitution had occurred – unless the physician notes "brand necessary" on the prescription. The measure also includes an exemption for drugs that are dispensed at inpatient hospitals and drugs that require a specific dosing schedule that cannot be substituted as defined by the Georgia Board of Pharmacy. MAG supported this bill once it was modified to include MAG's suggested amendment to require pharmacists to notify prescribers of any substitutions by way of "facsimile, telephone, electronic transmission, or other prevailing mean" within 48 hours. MAG position: Supported. Outcome: Passed.

S.B. 109 by Sen. Nan Orrock (D-Atlanta) would revise the state's Physician Order for Life Sustaining Treatment (POLST) law – which addresses a patient's end-of-life care – by adding a "do not resuscitate order" or DNR option. In Georgia, a POLST "shall be voluntarily executed by either a patient who has decision-making capacity and a physician who knows and has provided treatment to the patient or the patient's authorized person and a physician who knows and has provided treatment to the patient." MAG established a POLST policy in 2007 – something it reaffirmed in 2012. MAG also established a policy on end-of-life issues in 2011. MAG position: Supported. Outcome: Passed.

H.B. 429 by Rep. Ron Stephens (R-Savannah) would block health insurers from restricting coverage for prescribed treatments and drugs and devices for insured patients who have been diagnosed with a terminal condition. This would include "any disease, illness, or health condition that a physician has diagnosed as expected to result in death in 24 months or less." MAG position: Supported. Outcome: Passed.

H.B. 436 by Rep. Valerie Clark (R- Lawrenceville) would require physicians and health care providers to offer to test pregnant women who are in their third trimester for HIV and syphilis. This would cover, "Every physician and health care provider who assumes responsibility for the prenatal care of a pregnant woman during the third trimester of gestation." Under H.B. 436, the provider would have to offer to conduct the tests at the time of first examination during the third trimester – and there wouldn't be any penalties or sanctions for failing to do so. The bill was amended to include the provisions of a bill (S.B 114) that would add "community service boards" to the list of exemptions for the the number of APRN's that are allowed to be supervised by a physician. MAG position: Neutral. Outcome: Passed.

S.B. 126 by Sen. Chuck Hufstetler (R-Rome) would have allowed additional medical professionals to prescribe auto-injectable epinephrine "to an authorized entity and for other emergency purposes." Georgia's current law – Code Section 20-2-776.2 – limits this authority to physicians, PAs and APRNs. MAG position: Neutral. Outcome: Did not pass.

H.B. 463 by Rep. Ben Harbin (R-Evans) would have permanently extended a $1,000 tax credit for "medical core clerkship" preceptors for "community based" nurse practitioners and physician assistants. MAG position: Supported. Outcome: Did not pass.

State Budget

Lawmakers passed a 2016 FY budget (H.B. 76) that included some $23 million in additional funds to increase the reimbursement rate for select Medicaid primary care and OB-GYN codes. This included $17.1 million for primary care physicians (i.e., 90 percent of the 2014 Medicare fee schedule for the applicable codes) and $5.9 million for OB/GYN physicians (90 percent of the 2014 Medicare fee schedule for the applicable codes).

Legislators also approved $199,000 to maintain the Prescription Drug Monitoring Program in the state in FY 2016. MAG position: Supported. Outcome: Passed.