2019 Legislative Summary – Andy Toledo, MD, Legislative Committee Chair
The best way I know to describe the 2019 General Assembly is “roller coaster.” The OBGyn Society was successful once again in obtaining approval for several budgetary items. However, as has been widely reported in local and national news, the “Heartbeat bill” gained final passage by the General Assembly, a bill the OBGyn Society strongly opposed.
The OBGyn Society successfully advocated for several specific budget items that were not included in the Governor’s budget recommendation.
- Full state funding for every existing OBGyn resident position in Georgia – a total of 54 slots at a cost of $828,042. The OBGyn Society has been previously successful in obtaining funding for some of the slots, but this year we asked the General Assembly to fund all of them – and they agreed with our request.
- $200,000 for nurse abstractors for the Georgia Maternal Mortality Review Committee to improve capacity for review of maternal death records.
- $1,047,540 for a maternal telepsychiatry program. This program was championed by Healthy Mother’s Healthy Babies Coalition of Georgia and supported by GOGS, Emory University, March of Dimes, and the Department of Public Health.
Thank you to Skin Edge from Georgialink Public Affairs for his assistance with obtaining support for these critically-needed funding items to advance the quality of women’s healthcare.
Other Budgetary Items to note:
- $500,000 for Morehouse School of Medicine to establish a Maternal Mortality Prevention Research Center of Excellence.
- $500,000 for funds to county health departments for feminine hygiene products for low-income clients.
The Fetal Heartbeat Bill – HB 481
As I mentioned earlier, House Bill 481, sponsored by Representative Ed Setzler (R-Acworth), known as the “Fetal Heart Bill” or the “Heartbeat bill” passed the General Assembly this session with Governor Kemp’s support. Georgia is the 5th state to pass such a bill after North Dakota, Kentucky, Iowa, and Mississippi have done so earlier this year. So far, no court has agreed that these bills are constitutional, and the US Supreme Court has yet to hear a case. The bill prohibits abortions after detection of fetal heart tones. Supporters of the bill say this can be as early as 6 weeks gestation. The bill includes several exceptions: if the pregnancy threatens the life of the woman (emotional or mental conditions that serve as a threat to the woman’s health are not considered exceptions), if the physician determines the pregnancy is “medically futile,” or if the woman was a victim of rape or incest and files a police report alleging her claim.
The OBGyn Society took an early position in opposition to the bill due to increased opportunities for physician criminalization, the scientific inaccuracies that support the goal of the bill and the overall infringement on a physician’s ability to practice the full scope of medicine under the law. The Society testified in opposition to the bill in the House and Senate committee hearings, and lobbied against the bill. I’d like to thank the other physician associations who opposed the legislation: Medical Association of Georgia, Georgia Academy of Family Physicians and American Academy of Pediatrics Georgia Chapter. In addition, I would like to thank our members who reached out to their Representatives and/or Senators to register your concerns with the bill. You are the women’s healthcare experts and your input on matters concerning women’s health policy is vitally important to our profession.
For OBGyn physicians in Georgia, there is no impact of this bill in the near term. Without a court challenge, the bill does not go into effect until January 1, 2020. However, a lawsuit will be filed by the American Civil Liberties Union, which will very likely delay the bill becoming law – or potentially stop it from ever becoming law. As of the writing of this article, Governor Kemp has not signed HB 481.
Other bills approved by the General Assembly:
HB 345 by Representative Sharon Cooper (R-Marietta) to prohibit shackling of pregnant inmates. GOGS supported this legislation.
HR 589 by Representative Mark Newton (R-Augusta) to establish the House Study Committee on Maternal Mortality. GOGS supported this legislation through committee testimony and worked with Representative Newton to require two representatives from the Maternal Mortality Review Committee serve as members of this study committee.
HB 321 by Representative Jodi Lott (R-Evans) to reauthorize the Hospital Provider Payment Agreement. This legislation extends the sunset for a funding mechanism that funds the Georgia Medicaid program until June 30, 2025. Without this mechanism in place, the Georgia Medicaid budget would likely face steep cuts in reimbursements to hospitals and healthcare providers.
HB 187 by Representative Katie Dempsey (R-Rome) creates a pilot program within the State Health Benefit Plan (state employees and teachers) to treat and manage obesity.
HB 324 by Representative Micah Gravely (R-Douglasville) to allow for the production, manufacturing and dispensing of low THC oil.
SB 106 by Senator Blake Tillery (R-Vidalia) to authorize Governor Kemp and the Department of Community Health to apply for Medicaid waivers to extend Medicaid coverage to individuals up to 100% of the federal poverty limit.
SB 115 by Senator Renee Unterman (R-Buford) to create a Georgia physician license category for physicians in other states to utilize telemedicine for patients in Georgia.
SB 267 by Senator Lester Jackson (D-Savannah) proposes to license “Certified Community Midwives” in the care of women in prenatal care and delivery of the baby, which would could occur in an out of hospital setting. GOGS is in opposition to this legislation, which cannot be considered until the 2020 legislative session.
SB 279 by Senator Jen Jordan (D-Atlanta) would prohibit pelvic examinations on an anesthetized patient without the patients informed consent. GOGS is monitoring this legislation.
HB 717 by Representative Karen Mathiak (R-Griffin) would establish licensure for “Certified Professional Midwives.” This legislation is very similar to SB 267 and GOGS opposes it as well.
It was certainly a trying session, but we are fortunate to continue being successful in advocating for state support for women’s health. We have a lot more work that needs to be done between now and 2020. Please continue to build relationships with your elected officials and always support GynPAC when you renew your membership each year.
We had a solid turn out for legislative day in February with over 40 OBGyn physicians and residents despite it being scheduled during CREOG. Please plan to join us next year at the Capitol on March 5th, 2020!
2018 Legislative Update
$2M for maternal mortality, funding for residents, perinatal levels of care
By Andrew A. Toledo, MD
Reproductive Biology Associates, Atlanta, GA
The 2018 General Assembly adjourned, Sine Die, just after midnight on Friday, March 30. The Georgia OBGyn Society (GOGS) had a very successful session. The top two priorities, funding for the prevention of maternal mortality and funding for OBGyn residency slots, were achieved. Our success this session would not have been realized without the expert attention of Skin Edge and partners at the Department of Public Health (DPH), March of Dimes and Patient-Centered Physician Coalition.
In addition, the Society would like to thank the following people for their support during the session:
- Representative Terry England, Chairman, House Appropriations
- Representative Butch Parrish, Chairman, House Health Subcommittee of Appropriations
- Speaker Pro-Tem Jan Jones
- Representative Sharon Cooper, Chairman, House Health and Human Services Committee
- Representative Deborah Silcox
- Senator Jack Hill, Chairman, Senate Appropriations
- Senator Dean Burke, Vice-Chair, Appropriations
- Senator Renee Unterman, Vice-Chair, Appropriations
- Senate President Pro-Tem Butch Miller
- Senator Bill Cowsert, Senate Majority Leader
- Senator Chuck Hufstetler
- House and Senate Budget Staff
I would also like to thank Dr. Jane Ellis and Dr. Cindy Mercer for taking time out of their days to come to the Capitol to lend their voices on specific issues, as well as everyone who attended Primary Care Legislative Day at the Capitol.
Below is a brief summary of the measures GOGS supported this year:
Maternal Mortality Prevention Funding
The FY 2019 state budget includes $2 million, directed to DPH, for maternal mortality prevention. GOGS advocated for this funding during the session, supported by DPH and March of Dimes. GOGS is working closely with DPH in planning for the implementation of the funding, which will be used to implement AIM hemorrhage and hypertension quality improvement bundles.
Funding for OBGyn Resident Positions
The General Assembly appropriated $306,600, continued funding from the FY 2018 budget, for 20 OBGyn residency positions at 5 training programs (4 positions at each program). The OBGyn Society requested $459,900. This is the same amount of funding that was received in the FY 2018 budget. GOGS will request additional funding in the FY 2020 budget next year.
Group Prenatal Care Funding
The FY 2019 state budget includes $500,000 in state funds for reimbursement for group prenatal care. This funding is in the Department of Community Health (DCH) Low-Income Medicaid budget. GOGS supported this request, which was led by the March of Dimes. GOGS will monitor the implementation of this reimbursement.
Increased Reimbursement for Delivery in Rural Counties
Also in the DCH Low-income Medicaid budget is the inclusion of a $250 increase in reimbursement for newborn deliveries that occur in counties with fewer than 35,000 people. GOGS has been successful in previous years in obtaining support for this increase in the state budget.
Levels of Perinatal Care Hospital Designation
HB 909, sponsored by Representative Deborah Silcox (R-Sandy Springs), gained final passage by the Senate on March 14 and was sent to the governor. The OBGyn Society supported HB 909 that establishes a voluntary program for hospitals to designate a level of neonatal and/or maternal care. Currently, hospitals can self-designate their levels of care. GOGS is working closely with the Regional Perinatal Center medical directors and DPH on the implementation of the bill.
“The Health Act”
SB 357, sponsored by Senator Dean Burke (R-Bainbridge), gained final passage on Sine Die. SB 357 encompasses recommendations that were released by the Health Reform Task Force led by Lt. Governor Casey Cagle that convened in 2017. The measure establishes the Health Coordination and Innovation Council and creates the position of state director of health policy. SB 357 also establishes an advisory board to assist the council in developing recommendations. SB 357 directs the Maternal Mortality Review Committee to submit a report to the council annually. GOGS will be closely monitoring the implementation of SB 357 to ensure improving the quality of women’s health in Georgia is a priority.
Rural Health System Innovation Center
HB 769 by Representative Rick Jasperse (R-Jasper), establishes the Rural Health System Innovation Center within the State Office of Rural Health. The purpose of this center is to study and recommend new approaches for financing and delivering healthcare in rural settings in Georgia. The center will be located within an academic health center, which will be determined by DCH after issuing a request for proposals.
Joint Study Commission on Low THC Medical Oil Access
HB 65, sponsored by retiring Representative Allen Peake (R-Macon), establishes a House and Senate Study Commission to evaluate low THC medical oil and its potential to improve health outcomes in Georgia. On Sine Die, language was added to include “post-traumatic stress disorder” and “intractable pain” as conditions for which low THC medical oil can be prescribed after certain conditions are met.
Measures that were not given passage:
- Expansion of scope of practice for advanced practice registered nurses
- Medicaid expansion
- Surprise billing
- Step Therapy
- Licensure for genetic counselors
- Perinatal hospice (never introduced)
Once again, it’s an honor and a privilege to serve as your GOGS legislative chair. Please do not hesitate to contact me for any issues/questions you may have regarding legislative topics.