The early 2018 legislative session in Georgia has been an active one for rural healthcare policy analysts and stakeholders, as state lawmakers consider a variety of ways to improve rural healthcare and stem the tide of rural hospital closures — of which Georgia has had the third-most nationally (6) since 2010.

The Republican-controlled legislature likely will go another regular session without taking any action on expanding Medicaid or pursuing a Medicaid waiver. However, various task forces and study committees have produced a handful of alternate approaches to addressing the state’s rural health crisis.

HB 769 

House Bill 769 is the product of the House Rural Development Council, which met 18 times in 2017 to explore legislative solutions to rural problems.

Among its numerous proposals, the bill seeks to amend the state’s health planning statute to facilitate the creation of “micro-hospitals” – small (2-to-7-bed) freestanding emergency care units that are equipped to stabilize patients for transport to a larger facility. The scaled-down model, open 24/7, would serve as an alternative to traditional hospitals in rural counties where a hospital has already closed, and where a neighboring county contains a hospital interested in reviving the closed facility as a micro-hospital.

Such a “micro-hospital” is possible under current law, but might require a lengthy “certificate of need” review process. HB 769 exempts the micro-hospital from CON review.

HB 769 would also create a Rural Center for Health Care Innovation and Sustainability, to be housed at one of the state’s colleges, with the purpose of ensuring the viability and financial soundness of local hospitals.  The Center would be responsible for developing a curriculum of best practices in rural health care and subsequently training executive leadership and boards of rural hospitals on various complex aspects of hospital management. In addition to its educational function, the Center would serve as a central hub for rural health data and conduct analytics in support of health care planning initiatives.  To fund this program, $75,000 has been added to the proposed midyear budget.

Like other proposals in the General Assembly, HB 769 also contains a provision raising the rural hospital tax credit from 90 percent of the donation to 100 percent. 

Another section of the bill would allow pharmacists outside of Georgia to authorize prescriptions and refills from in-state providers. Telepharmacy technology would enable hospitals to operate 24-hour in-house pharmacies, even without a pharmacist on staff. 

HB 769 also provides for the Georgia Board for Physician Workforce to establish a grant program incentivizing physicians to practice in medically underserved areas of the state.

As of February 26, HB 769 has passed the House and is under consideration in the Senate.

SB 357 

Senate Bill 357, also known as the HEALTH Act, aims to eliminate barriers to care by streamlining the functions of Georgia’s healthcare system. Just as HB 769 emerged from meetings of the Rural Development Council, SB 357 is largely the creation of the Health Care Reform Task Force led by Lt. Gov. Casey Cagle and comprising seven state senators. The Task Force met several times in 2017 and released a report that mirrors elements of SB 357.

The bill would create two new organizations, the Health Coordination and Innovation Council and the Health System Innovation Center. Jointly, these programs would bring together experts from academia and the public and private sectors to create a central forum for vetting ideas and reviewing policies to improve statewide health care.

The bill prioritizes addressing the plight around healthcare in rural communities.  Among the Health System Innovation Center’s primary functions, as set forth in the bill, would be to:

-       Focus on access improvement to affordable health care in rural Georgia;

-       Evaluate and make recommendations for the fiscal stabilization of rural health care delivery systems and ensure their design is appropriate for the community served by such systems;

-       Provide technical assistance and expertise to address immediate needs of rural communities;

The bill passed the Senate on February 7 and is now being considered in the House.

SB 351 

On February 21, the  Senate Health and Human Services Committee passed a scaled-down version of SB 399, which had sought to expand the authority of nurse practitioners in rural Georgia.  The version that cleared the committee, SB 351, does not address rural concerns but increases the number of advanced-practice nurses (APRNs) a physician may supervise at one time from four to eight and permits doctors to delegate the ordering of radiographic images.

The original proposed legislation arose from a state senate study committee’s recent assessment of unmet medical needs in Georgia and the state’s limitations on the practice authority of advanced-practice nurses (APRNs). Current law makes Georgia one of the nation’s most restrictive states for APRNs, requiring they have physician oversight to prescribe medication or order tests like MRIs and CT scans.

In its report, the senate committee recommended granting broader authority to APRNs practicing in rural counties. The committee’s evaluation of barriers to health care access cited statistics that nine rural Georgia counties have no physicians, 63 have no Pediatric physicians, 79 have no OB/GYN physicians, and 22 have no APRNs. The bill’s sponsors had aimed to address these shortages and the resulting gaps in care by granting full scope of practice to APRNs working in rural areas, thus drawing more of them to practice in underserved communities.

The physician-led Medical Association of Georgia “opposed the bill vehemently,” citing patient safety concerns.

SB 352 

In a move with significant healthcare implications not limited to rural healthcare, the Georgia Senate voted unanimously on February 7 to pass SB 352, a measure that confronts the opioid crisis by advancing research and education and also targets fraudulent healthcare billing and payment practices.

The bill creates an Executive Director of Substance Abuse, Addiction and Related Disorders, who will lead a 15-member Commission on Substance Abuse and Recovery to include commissioners of public health, community health and human services, as well as law enforcement officials and appointed representatives. The Commission will develop education plans and create a block grant program, coordinate overdose-related data, consult with other state agencies, give direction on a possible Medicaid waiver for opioid abuse and broaden access to support services related to prevention, treatment and recovery.

Significantly, and somewhat unrelated to opioid crisis, the bill also introduces a new prohibition on patient brokering, building on the federal Anti-Kickback Statute. Many states have codified similar so-called “mini” anti-kickback statutes, but Georgia to this point has not. SB 352 would change that, making certain financial arrangements in healthcare punishable by up to 20 years imprisonment and fines of up to $500,000 per violation.

Finally, the bill takes aim at certain billing practices in the drug-testing space. Specifically, the bill criminalizes “excessive, high-tech, or fraudulent drug testing in the treatment of the elderly, the disabled, or any individual affected by pain, substance abuse, addiction, or any related disorder.” The massive profits associated with certain drug tests have recently come under scrutiny nationwide.

SB 402

SB 402, also known as the “Achieving Connectivity Everywhere (ACE) Act,” offers a host of solutions aimed at expanding access to broadband Internet in rural Georgia. This goal aligns with the needs of rural healthcare providers, who increasingly depend on high-speed Internet for a variety of purposes, including telemedicine.