State measures will have huge impact on health care

The Albany Herald

ATLANTA -- State Rep. David Knight had a triumphant look Friday when talking about his quest for more oversight and restrictions on the PBM industry.

Pharmacy Benefit Managers are basically corporate middlemen between health insurers or large employers and drugmakers in handling pharmaceutical benefits. The Georgia General Assembly approved a group of bills to rein in how PBMs operate.

“I think these bills probably are the most comprehensive PBM reform legislation in the nation,’’ said Knight, a Griffin Republican. He has arguably been the biggest legislative critic of these entities, and he led the push for the new measures.

The restrictions included closing current loopholes on laws prohibiting PBMs from steering patients to certain pharmacies. They create new oversight over government health care contractors, and provide more transparency on prescription pricing.

The atmosphere at the Capitol in Atlanta on Friday was a vivid contrast to such concluding days in past General Assembly sessions. The typical circus-like gathering of lobbyists, relatives of lawmaker and visitors clogging the halls gave way this year to mostly empty corridors.

COVID-19 fundamentally changed the logistics of the legislative session, causing a hiatus that stretched into months. Yet over the last two weeks, after lawmakers finally reconvened, they produced several important bills involving health care and a budget that had milder cuts to vital programs than had been feared.

For at least five years, proposals to curb surprise medical billing have run into intractable deadlocks in the Legislature. Not so this year.

House Bill 888, which passed both chambers, addresses surprise billing that occurs after elective surgery or emergency care, when the facility itself is in the patient’s insurance network but the ER physician, anesthesiologist, radiologist or pathologist is not. In such cases, the patient gets a separate, unexpected bill from that out-of-network doctor, a bill that can reach into the thousands of dollars.

The legislation won’t apply to people covered by large, self-insured employers.

Another bill, sponsored by Rep. Mark Newton, R-Augusta, who’s a physician, establishes a rating system that patients could use to determine which physician specialty groups in their insurer’s network serve a specific hospital.

Newton’s bill applies to anesthesiologists, pathologists, radiologists and emergency room physicians – doctors often responsible for the most cases of surprise billing.

SENIOR CARE: Legislation to impose new oversight and staffing requirements on senior care facilities passed overwhelmingly. The House unanimously signed off on the Senate’s version of the bill, which added requirements for handling COVID-19 to the bill’s reforms of the senior care industry.

“I am so proud of Georgia’s House and Senate for making the necessary changes to ensure the safety of our seniors who choose to live in assisted living facilities,” said Rep. Sharon Cooper, R-Marietta, the lead sponsor of the bill.

MATERNAL MORTALITY: Georgia will get more financial resources to lower its high rate of maternal mortality. That’s defined as the death of a woman while she is pregnant or within one year after the end of her pregnancy, from any cause related to or aggravated by the pregnancy or its management.

House Bill 1114 authorizes the state to apply for a federal waiver that would allow Georgia to offer Medicaid coverage to eligible women up to six months after they give birth. The current Georgia Medicaid program permits coverage only up to two months.
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LIABILITY PROTECTION: The General Assembly passed legislation aimed at shielding businesses and health care providers from lawsuits filed by people who have contracted coronavirus since March. The bill would shield companies from legal liability unless they show “gross negligence, willful and wanton misconduct, reckless infliction of harm, or intentional infliction of harm.”
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