Gold Dome Report - Legislative Preview
2018 Legislative Session Preview
2018 will mark the final Legislative Session for Governor Nathan Deal. This occasion will likely impact next week's convening of the Georgia General Assembly in two significant ways: 1) it will be Governor Deal's final opportunity to further or finalize budgetary and legislative priorities that will affect both the State and his legacy and 2) the race to replace him will factor into nearly every decision and every issue before the legislature.
Outlined below are a few of the key issues the GHCA Government Affairs Team is focused on leading into the 2018 session.
Georgia's economic outlook continues to enjoy healthy growth in comparison to 2016 figures. As November 2017 ended, the year-to-date numbers showed a 2.7% growth from a year ago for an increase of $238.6 million. As always, we expect some of that surplus to be devoted to mandatory commitments such as growth in pension responsibilities and yet another increase in the state's health benefit plan.
Another factor worth noting in any discussion of the State's budget is the continuous growth of the State of Georgia. Georgia is currently the country's 8th most populous state and 2017 estimates indicated that Georgia was the 6th fastest growing state in the country. While that growth will lead to numerous benefits, ranging from an increased workforce and greater tax collections, the increased population will surely factor into many facets of the appropriations process, ranging from intrastate and transportation to education and healthcare.
This summer provided GHCA membership with some optimism for the session ahead. In August 2017, a Medicaid reimbursement increase was included in DCH's budget recommendation for the first time in recent memory. The August recommendation called for a 3% inflationary increase to the 2012 cost report. This $12 million state investment would lead to over $37 million new dollars into the system. While we are excited about this rare appearance in DCH's recommendation, we know that much more work lies ahead to secure adequate funding for Georgia's skilled nursing care providers.
House Rural Development Council Recommendations: Certificate of Need
Legislators have expressed interest in altering Georgia's Certificate of Need program many times over the last ten years, ranging from a blanket repeal of the program to releasing equipment thresholds. Apart from the 2008 legislation that relaxed CON in anticipation of Cancer Treatment Center of America's arrival in Georgia, little has been done to drastically alter the current program.
However, 2018 may very well provide for a more thorough and animated discussion regarding CON. After months of study, the Georgia House of Representatives' “House Rural Development Council” issued its findings in a December report. In their final report, the Council recommended the following for discussion in the 2018 Session:
- Codify “micro” hospitals:
- Define a limited-bed, 24/7 or extended hour, stabilizing “micro-hospital” in state law.
- Allow the certificate of need and bed licenses of a closing facility in a contiguous county to be purchased together.
- Allow the micro-hospital to be moved and/or rebuilt anywhere in the original county.
- Create a two-tier system in CON to:
- Protect and keep CON rules for service areas under 85,000 population; and
- Allow large institutions to provide care if the institution is engaged in a mandatory partnership with a regional critical access or safety net hospital to perform all prep and/or follow-up treatment.
A full copy of the report can be found here.
House Rural Development Council Recommendations: Requirement of Telehealth Capability
One issue that received a very small, but significant, mention in the Council's report was a recommendation that the State “require nursing homes to have the ability to do telehealth.” This issue was part of a broader, “best practices” discussion designed to increase all providers' usage of the technologies available to them. As of now, no legislation has been formally dropped and GHCA continues to engage with stakeholders regarding the intended outcomes of this portion of the Council's policy recommendations.
A full copy of the report can be found here.
GHCA fully expects legislation calling for enhanced background checks for employees of all long term care facilities, including skilled nursing centers, to be introduced.
Following years of both creating and tweaking elder abuse statutes and various registries, DCH informed GHCA in the Fall of 2017 that the agency had been asked by various members of the advocacy community to create a process to enhance and modernize background check procedures for employees in long term care settings.
Make no mistake, early drafts of this legislation provided cause for concern. As written, the legislation is both broad and burdensome in scope (who is to be checked and how) and, as importantly, provides no mechanism to fund these new procedures.
However, thanks to the positive relationship GHCA and its members have with both DCH and the Governor's Office, we have had multiple meetings to discusss draft copies of the legislation. GHCA attorneys are currently addressing proposed changes that will improve the legislation for providers while still achieving the intended goals of its authors.
GHCA will always support methods and procedures designed to further ensure the safety of our residents and employees. However, we are obviously sensitive to both increased regulation and unfunded mandates in a time where so much of both have occurred at the federal level.
Expect much more discussion on this issue in the weeks ahead.
Preventing Excessive Regulation
Following the tragic events in Hollywood, FL, much of the nation's attention turned to emergency preparedness and alternate power supply issues within skilled nursing centers. This high-profile incident became even more heightened and sensitive due to the subsequent political battle revolving around the Florida Governor's Executive Order mandating stricter generator and fuel requirements for every ALF and SNF in Florida. While a judge eventually struck down this executive order, a heated legislative battle still awaits the Florida legislature.
In Georgia, GHCA has received multiple assurances that a similar mandate or executive order will NOT be coming out of this Administration. However, this does not preclude any of Georgia's 236 legislators from dropping a bill that could move this issue towards debate. Your GHCA governmental affairs team will continue to monitor any discussions regarding this issue.
Cameras in Nursing Home Rooms
As witnessed in the Florida incident referenced above, tragedy in a very public setting can sometimes create increased scrutiny and debate in the public policy arena. Recent press on the state and national levels has led to the discussion of the potential to create legislation pushing for greater availability of video cameras in private rooms in nursing centers. GHCA is proactively preparing for the potential of such legislation in the 2018 session.
Improving the Legal Climate for Georgia's Long Term Care Providers
GHCA is always sensitive to the fact that Georgia providers are under constant attack by plaintiff's attorneys from both inside and outside the State. Based upon input from GHCA members, the government affairs team and GHCA attorneys are always seeking creative opportunities to address any facets of this complex issue, whether it be arbitration, excessive damages, or the rising cost of insurance.
Partnering with like-minded organizations like the Georgia Chamber and their “Georgians for Lawsuit Reform” initiative, GHCA continues to engage on this issue whenever and wherever possible.
While no significant tort reform bills have been dropped to date, you can fully expect the House and Senate Judiciary Committees to be in full swing once session begins.