| 1 | 1 | | 23 LC 33 9274 |
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| 2 | 2 | | H. B. 62 |
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| 3 | 3 | | - 1 - |
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| 4 | 4 | | House Bill 62 |
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| 5 | 5 | | By: Representatives Park of the 107 |
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| 6 | 6 | | th |
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| 7 | 7 | | , Beverly of the 143 |
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| 8 | 8 | | rd |
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| 9 | 9 | | , Oliver of the 82 |
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| 10 | 10 | | nd |
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| 11 | 11 | | , Mughal of the |
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| 12 | 12 | | 105 |
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| 13 | 13 | | th |
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| 14 | 14 | | , Clark of the 108 |
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| 15 | 15 | | th |
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| 16 | 16 | | , and others |
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| 17 | 17 | | A BILL TO BE ENTITLED |
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| 18 | 18 | | AN ACT |
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| 19 | 19 | | To amend Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public |
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| 20 | 20 | | 1 |
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| 21 | 21 | | assistance, so as to enact the "Georgia Health and Economic Livelihood Partnership (HELP)2 |
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| 22 | 22 | | Act"; to provide for legislative findings and intent; to provide for definitions; to provide for3 |
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| 23 | 23 | | eligibility for coverage of health services; to provide for a third-party administrator; to4 |
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| 24 | 24 | | provide for copayments; to provide for premiums; to provide for reforms to the state5 |
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| 25 | 25 | | Medicaid program; to provide for healthcare services payment schedules; to provide for6 |
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| 26 | 26 | | reduction in funding under certain conditions; to provide for an oversight committee; to7 |
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| 27 | 27 | | provide for reports; to provide for rules and regulations; to amend Chapter 2 of Title 34 of8 |
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| 28 | 28 | | the Official Code of Georgia Annotated, relating to the Department of Labor, so as to provide9 |
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| 29 | 29 | | for a workforce development initiative; to provide for notice; to provide for a short title; to10 |
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| 30 | 30 | | provide for related matters; to repeal conflicting laws; and for other purposes.11 |
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| 31 | 31 | | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12 |
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| 32 | 32 | | SECTION 1.13 |
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| 33 | 33 | | This Act shall be known and may be cited as the "Georgia Health and Economic Livelihood14 |
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| 34 | 34 | | Partnership (HELP) Act."15 23 LC 33 9274 |
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| 35 | 35 | | H. B. 62 |
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| 36 | 36 | | - 2 - |
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| 37 | 37 | | SECTION 2. |
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| 38 | 38 | | 16 |
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| 39 | 39 | | Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,17 |
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| 40 | 40 | | is amended by adding a new article to read as follows:18 |
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| 41 | 41 | | "ARTICLE 10 |
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| 42 | 42 | | 19 |
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| 43 | 43 | | 49-4-200.20 |
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| 44 | 44 | | (a) The General Assembly finds that:21 |
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| 45 | 45 | | (1) Improving the delivery of healthcare services to Georgians requires state government,22 |
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| 46 | 46 | | healthcare providers, patient advocates, and other parties interested in high-quality,23 |
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| 47 | 47 | | affordable healthcare to collaborate in order to:24 |
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| 48 | 48 | | (A) Increase the availability of high-quality healthcare to Georgians;25 |
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| 49 | 49 | | (B) Provide greater value for the tax dollars spent on the state Medicaid program;26 |
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| 50 | 50 | | (C) Reduce healthcare costs;27 |
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| 51 | 51 | | (D) Provide incentives that encourage Georgians to take greater responsibility for their28 |
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| 52 | 52 | | personal health;29 |
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| 53 | 53 | | (E) Boost Georgia's economy by reducing the costs of uncompensated care; and30 |
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| 54 | 54 | | (F) Reduce or minimize the shifting of payment for unreimbursed healthcare costs to31 |
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| 55 | 55 | | patients with health insurance;32 |
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| 56 | 56 | | (2) Providing greater value for the dollars spent on the state Medicaid program requires33 |
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| 57 | 57 | | considering options for delivering services in a more efficient and cost-effective manner,34 |
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| 58 | 58 | | including, but not limited to:35 |
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| 59 | 59 | | (A) Offering incentives to encourage healthcare providers to achieve measurable36 |
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| 60 | 60 | | performance outcomes;37 |
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| 61 | 61 | | (B) Improving the coordination of care among healthcare providers who participate in38 |
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| 62 | 62 | | the state Medicaid program;39 |
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| 63 | 63 | | (C) Reducing preventable hospital readmissions; and40 23 LC 33 9274 |
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| 64 | 64 | | H. B. 62 |
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| 65 | 65 | | - 3 - |
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| 66 | 66 | | (D) Exploring methods of Medicaid payment that promote quality of care and41 |
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| 67 | 67 | | efficiencies;42 |
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| 68 | 68 | | (3) Assessing workforce readiness and providing necessary job training or skill43 |
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| 69 | 69 | | development for individuals who need assistance with healthcare costs could help those44 |
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| 70 | 70 | | individuals obtain employment that has healthcare coverage benefits or that would allow45 |
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| 71 | 71 | | them to purchase their own health insurance coverage;46 |
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| 72 | 72 | | (4) It is important to implement additional fraud, waste, and abuse safeguards to protect47 |
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| 73 | 73 | | and preserve the integrity of the Medicaid program and the unemployment insurance48 |
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| 74 | 74 | | program for individuals who qualify for the programs; and49 |
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| 75 | 75 | | (5) State policymakers have an interest in testing the effectiveness of wellness incentives50 |
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| 76 | 76 | | in order to collect and analyze information about the correlation between wellness51 |
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| 77 | 77 | | incentives and health status.52 |
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| 78 | 78 | | (b) The intent of this article is:53 |
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| 79 | 79 | | (1) To modify and enhance Georgia's healthcare delivery system to provide access to54 |
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| 80 | 80 | | high-quality, affordable healthcare for all Georgia citizens;55 |
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| 81 | 81 | | (2) To provide low-income Georgians with opportunities to improve their readiness for56 |
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| 82 | 82 | | work or to obtain higher paying jobs; and57 |
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| 83 | 83 | | (3) To provide for the establishment of a program through a collaborative effort and58 |
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| 84 | 84 | | maximization of the use of existing resources by the Department of Community Health59 |
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| 85 | 85 | | and the Department of Labor to:60 |
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| 86 | 86 | | (A) Provide coverage of healthcare services for low-income Georgians;61 |
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| 87 | 87 | | (B) Improve the readiness of program participants to enter the workforce or obtain62 |
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| 88 | 88 | | better paying jobs; and63 |
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| 89 | 89 | | (C) Reduce the dependence of Georgians on public assistance programs.64 |
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| 90 | 90 | | 49-4-201.65 |
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| 91 | 91 | | As used in this article, the term:66 23 LC 33 9274 |
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| 92 | 92 | | H. B. 62 |
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| 93 | 93 | | - 4 - |
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| 94 | 94 | | (1) 'Department' means the Department of Community Health.67 |
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| 95 | 95 | | (2) 'HELP Act' or 'act' means the Georgia Health and Economic Livelihood Partnership68 |
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| 96 | 96 | | Act provided for in this article and Code Section 34-2-17.69 |
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| 97 | 97 | | (3) 'Member' means an individual enrolled in the state Medicaid program pursuant to70 |
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| 98 | 98 | | Article 7 of this chapter or receiving Medicaid-funded services pursuant to Code Section71 |
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| 99 | 99 | | 49-4-202.72 |
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| 100 | 100 | | (4) 'Oversight committee' means the oversight committee established pursuant to Code73 |
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| 101 | 101 | | Section 49-4-209.74 |
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| 102 | 102 | | (5) 'Program participant' or 'participant' means an individual enrolled in the HELP Act75 |
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| 103 | 103 | | program established pursuant to this article and Code Section 34-2-17.76 |
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| 104 | 104 | | 49-4-202.77 |
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| 105 | 105 | | (a) An individual is eligible for coverage of healthcare services provided pursuant to this78 |
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| 106 | 106 | | article if the individual meets the requirements of 42 U.S.C. Section79 |
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| 107 | 107 | | 1396a(a)(10)(A)(i)(VIII).80 |
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| 108 | 108 | | (b) Subject to appropriations, a segregated account shall be established by the department81 |
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| 109 | 109 | | for the payment of costs, including benefits and administrative costs, of providing82 |
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| 110 | 110 | | healthcare services to individuals who are eligible for coverage pursuant to subsection (a)83 |
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| 111 | 111 | | of this Code section.84 |
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| 112 | 112 | | (c) It is the intent of the General Assembly that the federal medical assistance percentage85 |
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| 113 | 113 | | received pursuant to 42 U.S.C. Section 1396d(y) be deposited in the segregated account86 |
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| 114 | 114 | | established pursuant to subsection (b) of this Code section.87 |
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| 115 | 115 | | 49-4-203.88 |
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| 116 | 116 | | (a) The department shall contract with one or more third-party administrators to assist in89 |
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| 117 | 117 | | administering the delivery of healthcare services to members eligible under Code Section90 |
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| 118 | 118 | | 49-4-202, including, but not limited to:91 23 LC 33 9274 |
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| 119 | 119 | | H. B. 62 |
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| 120 | 120 | | - 5 - |
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| 121 | 121 | | (1) Establishing networks of healthcare providers;92 |
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| 122 | 122 | | (2) Paying claims submitted by healthcare providers;93 |
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| 123 | 123 | | (3) Collecting the premiums provided for in Code Section 49-4-205;94 |
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| 124 | 124 | | (4) Coordinating care;95 |
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| 125 | 125 | | (5) Helping to administer the program; and96 |
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| 126 | 126 | | (6) Helping to administer the Medicaid program reforms as specified in Code Section97 |
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| 127 | 127 | | 49-4-206.98 |
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| 128 | 128 | | (b) The department shall determine the basic healthcare services to be provided through99 |
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| 129 | 129 | | the arrangement with a third-party administrator.100 |
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| 130 | 130 | | (c)(1) The department may exempt certain individuals who are eligible for101 |
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| 131 | 131 | | Medicaid-funded services pursuant to Code Section 49-4-202 from receiving healthcare102 |
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| 132 | 132 | | services through the arrangement with a third-party administrator if the individuals would103 |
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| 133 | 133 | | be served more appropriately through the medical assistance program established104 |
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| 134 | 134 | | pursuant to Article 7 of this chapter, because the individuals:105 |
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| 135 | 135 | | (A) Have exceptional healthcare needs, including, but not limited to, medical, mental106 |
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| 136 | 136 | | health, or developmental conditions;107 |
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| 137 | 137 | | (B) Live in a geographical area for which the third-party administrator has been unable108 |
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| 138 | 138 | | to make arrangements with sufficient healthcare providers to offer services to the109 |
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| 139 | 139 | | individuals;110 |
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| 140 | 140 | | (C) Need continuity of care that would not be available or cost-effective through the111 |
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| 141 | 141 | | arrangement with the third-party administrator; or112 |
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| 142 | 142 | | (D) Are otherwise exempt under federal law.113 |
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| 143 | 143 | | (2) The department shall:114 |
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| 144 | 144 | | (A) Adopt rules establishing criteria for determining whether a member is exempt from115 |
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| 145 | 145 | | receiving healthcare services through an arrangement with a third-party administrator;116 |
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| 146 | 146 | | and117 23 LC 33 9274 |
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| 147 | 147 | | H. B. 62 |
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| 148 | 148 | | - 6 - |
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| 149 | 149 | | (B) Provide coverage for exempted individuals through the state Medicaid program118 |
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| 150 | 150 | | established in Article 7 of this chapter.119 |
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| 151 | 151 | | (d) For members participating in the arrangement with the third-party administrator, the120 |
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| 152 | 152 | | department shall directly cover any service required under federal or state law that is not121 |
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| 153 | 153 | | available through the arrangement with the third-party administrator.122 |
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| 154 | 154 | | (e) The department shall:123 |
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| 155 | 155 | | (1) Seek federal authorization from the United States Department of Health and Human124 |
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| 156 | 156 | | Services through a waiver authorized by 42 U.S.C. Section 1315 and other waivers or125 |
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| 157 | 157 | | through other means, as may be necessary, to implement all of the provisions of this126 |
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| 158 | 158 | | article and Code Section 34-2-17; and127 |
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| 159 | 159 | | (2) Implement access to the healthcare services in accordance with the requirements128 |
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| 160 | 160 | | necessary to receive the federal medical assistance percentage provided for by 42 U.S.C.129 |
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| 161 | 161 | | Section 1396d(y).130 |
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| 162 | 162 | | (f) The department may provide Medicaid-funded services to members eligible pursuant131 |
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| 163 | 163 | | to Code Section 49-4-202 only upon federal approval of any necessary waivers.132 |
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| 164 | 164 | | 49-4-204.133 |
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| 165 | 165 | | (a) A program participant shall make copayments to healthcare providers for healthcare134 |
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| 166 | 166 | | services received pursuant to this article.135 |
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| 167 | 167 | | (b) Except as provided in subsection (c) of this Code section, the department shall adopt136 |
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| 168 | 168 | | a copayment schedule that reflects the maximum copayment amount allowed under federal137 |
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| 169 | 169 | | law. The total amount of copayments collected pursuant to this Code section shall be138 |
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| 170 | 170 | | capped at the maximum amount allowed by federal law and regulations.139 |
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| 171 | 171 | | (c) The department shall not require a copayment for:140 |
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| 172 | 172 | | (1) Preventive healthcare services;141 |
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| 173 | 173 | | (2) Generic pharmaceutical drugs;142 23 LC 33 9274 |
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| 174 | 174 | | H. B. 62 |
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| 175 | 175 | | - 7 - |
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| 176 | 176 | | (3) Immunizations provided according to a schedule established by the department that143 |
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| 177 | 177 | | reflects guidelines issued by the federal Centers for Disease Control and Prevention; or144 |
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| 178 | 178 | | (4) Medically necessary health screenings ordered by a healthcare provider.145 |
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| 179 | 179 | | (d) Each healthcare provider participating in the third-party arrangement shall report the146 |
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| 180 | 180 | | following information annually to the oversight committee:147 |
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| 181 | 181 | | (1) The total amount of copayments that the provider was unable to collect from148 |
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| 182 | 182 | | participants; and149 |
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| 183 | 183 | | (2) The efforts the healthcare provider made to collect the copayments.150 |
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| 184 | 184 | | 49-4-205.151 |
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| 185 | 185 | | (a)(1) A program participant shall pay an annual premium, billed monthly, equal to 2152 |
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| 186 | 186 | | percent of the participant's income as determined in accordance with 42 U.S.C. Section153 |
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| 187 | 187 | | 1396a(e)(14).154 |
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| 188 | 188 | | (2) Premiums paid pursuant to this Code section shall be deposited in the general fund.155 |
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| 189 | 189 | | (b) Within 30 days of a participant's failure to make a required payment, the third-party156 |
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| 190 | 190 | | administrator shall notify the participant and the department that payment is overdue and157 |
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| 191 | 191 | | that all overdue premiums must be paid within 90 days of the date the notification was sent.158 |
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| 192 | 192 | | (c) If a participant with an income of 100 percent of the federal poverty level or less fails159 |
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| 193 | 193 | | to make payment for overdue premiums, the department shall provide notice to the160 |
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| 194 | 194 | | Department of Revenue of the participant's failure to pay. The Department of Revenue161 |
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| 195 | 195 | | may collect the amount due for nonpayment by assessing the amount against the162 |
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| 196 | 196 | | participant's annual income tax in accordance with Title 48.163 |
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| 197 | 197 | | (d) If a participant with an income of more than 100 percent but not more than 138 percent164 |
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| 198 | 198 | | of the federal poverty level fails to make the overdue payments within 90 days of the date165 |
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| 199 | 199 | | the notification was sent, the department shall:166 |
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| 200 | 200 | | (1) Follow the procedure established in subsection (c) of this Code section for collection167 |
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| 201 | 201 | | of the unpaid premiums; and168 23 LC 33 9274 |
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| 202 | 202 | | H. B. 62 |
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| 203 | 203 | | - 8 - |
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| 204 | 204 | | (2) Consider the failure to pay to be a voluntary disenrollment from the program. The169 |
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| 205 | 205 | | department may reenroll a participant in the program upon payment of the total amount170 |
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| 206 | 206 | | of overdue payments.171 |
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| 207 | 207 | | (e) If a participant who has failed to pay the premiums does not indicate that the172 |
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| 208 | 208 | | participant no longer wishes to participate in the program, the department may reenroll the173 |
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| 209 | 209 | | person in the program when the Department of Revenue receives the unpaid premium from174 |
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| 210 | 210 | | the participant.175 |
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| 211 | 211 | | (f) Participants who meet one of the following criteria are not subject to the voluntary176 |
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| 212 | 212 | | disenrollment provisions of this Code section:177 |
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| 213 | 213 | | (1) Discharge from United States military service within the previous 12 months;178 |
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| 214 | 214 | | (2) Enrollment for credit in any unit of the University System of Georgia, any unit of the179 |
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| 215 | 215 | | Technical College System of Georgia, or any other accredited college within Georgia180 |
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| 216 | 216 | | offering at least an associate degree;181 |
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| 217 | 217 | | (3) Participation in a workforce program or activity established under Code Section182 |
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| 218 | 218 | | 34-2-17; or183 |
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| 219 | 219 | | (4) Participation in any of the following healthy behavior plans developed by a184 |
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| 220 | 220 | | healthcare provider or third-party administrator or approved by the department:185 |
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| 221 | 221 | | (A) A Medicaid health home;186 |
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| 222 | 222 | | (B) A patient-centered medical home;187 |
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| 223 | 223 | | (C) A cardiovascular disease, obesity, or diabetes prevention program;188 |
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| 224 | 224 | | (D) A program restricting the participant to obtaining primary care services from a189 |
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| 225 | 225 | | designated provider and obtaining prescriptions from a designated pharmacy;190 |
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| 226 | 226 | | (E) A Medicaid primary care case management program established by the department;191 |
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| 227 | 227 | | (F) A tobacco use prevention or cessation program;192 |
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| 228 | 228 | | (G) A Medicaid waiver program providing coverage for family planning services;193 |
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| 229 | 229 | | (H) A substance abuse treatment program; or194 23 LC 33 9274 |
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| 230 | 230 | | H. B. 62 |
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| 231 | 231 | | - 9 - |
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| 232 | 232 | | (I) A care coordination or health improvement plan administered by the third-party195 |
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| 233 | 233 | | administrator.196 |
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| 234 | 234 | | 49-4-206.197 |
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| 235 | 235 | | (a) To ensure that the state Medicaid program is administered efficiently and effectively,198 |
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| 236 | 236 | | the department shall strengthen existing programs that manage the way members obtain199 |
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| 237 | 237 | | approval for medical services and shall establish additional programs designed to reduce200 |
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| 238 | 238 | | costs and improve medical outcomes. The efforts may include but are not limited to:201 |
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| 239 | 239 | | (1) Establishing by rule requirements designed to strengthen the relationship between202 |
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| 240 | 240 | | physicians and members enrolled in existing primary care case management programs;203 |
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| 241 | 241 | | (2) Strengthening data sharing arrangements with providers to reduce inappropriate use204 |
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| 242 | 242 | | of emergency room services and overuse of other services;205 |
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| 243 | 243 | | (3) Expanding to additional members any existing programs in which case managers and206 |
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| 244 | 244 | | providers work with members with high-risk medical conditions to provide preventive207 |
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| 245 | 245 | | care and advice and to make referrals for medical services;208 |
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| 246 | 246 | | (4) Establishing, within existing funds, one or more pilot programs to improve the health209 |
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| 247 | 247 | | of members, including, but not limited to, efforts to increase pain management, decrease210 |
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| 248 | 248 | | emergency department overuse, and prevent drug or alcohol addiction or abuse;211 |
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| 249 | 249 | | (5) Reviewing existing primary care case management programs to evaluate and improve212 |
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| 250 | 250 | | their effectiveness;213 |
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| 251 | 251 | | (6) Reducing fraud, waste, and abuse in the state Medicaid program before, during, and214 |
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| 252 | 252 | | after enrollment by enhancing technology system support to provide knowledge-based215 |
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| 253 | 253 | | authentication for verifying the identity and financial status of individuals seeking216 |
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| 254 | 254 | | benefits, including the use of public records to confirm identity and flag changes in217 |
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| 255 | 255 | | demographics; and218 |
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| 256 | 256 | | (7) Engaging members with chronic or other medical or behavioral health conditions in219 |
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| 257 | 257 | | coordinated care models that more closely monitor and manage a member's health to220 23 LC 33 9274 |
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| 258 | 258 | | H. B. 62 |
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| 259 | 259 | | - 10 - |
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| 260 | 260 | | reduce costs or improve medical outcomes. Such coordinated care models may include221 |
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| 261 | 261 | | but are not limited to:222 |
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| 262 | 262 | | (A) Patient-centered medical homes;223 |
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| 263 | 263 | | (B) Accountable care organizations;224 |
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| 264 | 264 | | (C) Managed care organizations as defined in 42 C.F.R. 438.2;225 |
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| 265 | 265 | | (D) Health improvement programs;226 |
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| 266 | 266 | | (E) Health homes for behavioral health or other chronic conditions; and227 |
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| 267 | 267 | | (F) Changes to current service delivery methods.228 |
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| 268 | 268 | | (b) The department may ask a third-party administrator under contract with the department229 |
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| 269 | 269 | | to assist in efforts undertaken pursuant to subsection (a) of this Code section when the230 |
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| 270 | 270 | | activity can appropriately be handled by the third-party administrator.231 |
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| 271 | 271 | | (c) A care coordination entity used to deliver Medicaid services shall meet all state232 |
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| 272 | 272 | | standards for operation, including, but not limited to, solvency, consumer protection,233 |
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| 273 | 273 | | nondiscrimination, network adequacy, care model design, and fraud and abuse standards.234 |
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| 274 | 274 | | 49-4-207.235 |
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| 275 | 275 | | (a) The department and the Department of Corrections shall reimburse healthcare services236 |
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| 276 | 276 | | for individuals identified in subsection (b) of this Code section at the rates adopted by the237 |
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| 277 | 277 | | department for the state Medicaid program under Article 7 of this chapter, if the healthcare238 |
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| 278 | 278 | | services are not otherwise covered by Medicaid, Medicare, a health insurer, or another239 |
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| 279 | 279 | | private or governmental program that pays for healthcare costs.240 |
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| 280 | 280 | | (b) This Code section shall apply to individuals:241 |
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| 281 | 281 | | (1) In the custody of the Department of Corrections; or242 |
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| 282 | 282 | | (2) Who are residents, by commitment or otherwise, of a state operated hospital, mental243 |
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| 283 | 283 | | healthcare facility, or chemical dependency center.244 23 LC 33 9274 |
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| 284 | 284 | | H. B. 62 |
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| 285 | 285 | | - 11 - |
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| 286 | 286 | | 49-4-208.245 |
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| 287 | 287 | | If the federal medical assistance percentage for medical services provided to individuals246 |
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| 288 | 288 | | eligible for Medicaid-funded services pursuant to Code Section 49-4-202 is set below the247 |
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| 289 | 289 | | levels established in 42 U.S.C. Section 1396d(y)(1) on the effective date of this article, the248 |
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| 290 | 290 | | continuation of coverage under this article is contingent on:249 |
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| 291 | 291 | | (1) The appropriation of additional state general funds or other action by the legislature;250 |
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| 292 | 292 | | (2) The ability of the department to increase premiums assessed under Code Section251 |
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| 293 | 293 | | 49-4-205 to pay the difference; or252 |
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| 294 | 294 | | (3) A combination of legislative action and premium increases as necessary to provide253 |
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| 295 | 295 | | for the increased state match obligation.254 |
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| 296 | 296 | | 49-4-209.255 |
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| 297 | 297 | | (a) There is established an oversight committee on the HELP Act composed of members256 |
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| 298 | 298 | | of the General Assembly and of other Georgia citizens.257 |
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| 299 | 299 | | (b) The oversight committee shall consist of nine voting members appointed no later than258 |
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| 300 | 300 | | January 1, 2024, as follows:259 |
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| 301 | 301 | | (1) Two senators, one appointed by the President of the Senate and one appointed by the260 |
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| 302 | 302 | | Senate Minority Leader;261 |
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| 303 | 303 | | (2) Two representatives, one appointed by the Speaker of the House and one appointed262 |
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| 304 | 304 | | by the House Minority Leader; and263 |
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| 305 | 305 | | (3) Five individuals appointed by the Governor as follows:264 |
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| 306 | 306 | | (A) One representative of a hospital;265 |
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| 307 | 307 | | (B) One representative of a critical access hospital;266 |
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| 308 | 308 | | (C) One primary care physician;267 |
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| 309 | 309 | | (D) One representative of the state auditor's office; and268 |
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| 310 | 310 | | (E) One member of the general public or a staff member of the Governor's office.269 23 LC 33 9274 |
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| 311 | 311 | | H. B. 62 |
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| 312 | 312 | | - 12 - |
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| 313 | 313 | | (c) The state Medicaid director or the director's designee, the Commissioner of Labor or270 |
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| 314 | 314 | | the commissioner's designee, and a designee of the third-party administrator shall be ex271 |
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| 315 | 315 | | officio members of the committee.272 |
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| 316 | 316 | | (d) The chairperson and vice chairperson shall be elected by a majority of the committee273 |
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| 317 | 317 | | members.274 |
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| 318 | 318 | | (e) The chairperson shall establish the meeting schedule. The oversight committee shall275 |
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| 319 | 319 | | meet at least quarterly.276 |
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| 320 | 320 | | (f) Members of the oversight committee shall serve without compensation but shall receive277 |
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| 321 | 321 | | the same expense allowance as that received by members of the General Assembly and the278 |
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| 322 | 322 | | same mileage allowance for the use of a personal car or a travel allowance of actual279 |
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| 323 | 323 | | transportation cost if traveling by public carrier as that received by all other state officials280 |
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| 324 | 324 | | and employees.281 |
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| 325 | 325 | | (g) Members of the oversight committee shall serve four-year terms, except that legislative282 |
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| 326 | 326 | | members shall serve for terms concurrent with their legislative terms.283 |
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| 327 | 327 | | (h) The oversight committee is attached to the department for administrative purposes,284 |
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| 328 | 328 | | including staffing.285 |
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| 329 | 329 | | (i) The oversight committee may contract for services that will help members carry out286 |
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| 330 | 330 | | their duties, subject to available funding.287 |
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| 331 | 331 | | 49-4-210.288 |
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| 332 | 332 | | (a) To provide reports and make recommendations to the General Assembly, the oversight289 |
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| 333 | 333 | | committee shall review:290 |
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| 334 | 334 | | (1) Data from and activities by the department and the Department of Labor related to291 |
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| 335 | 335 | | the healthcare and workforce development activities undertaken pursuant to the HELP292 |
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| 336 | 336 | | Act;293 |
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| 337 | 337 | | (2) The state Medicaid program; and294 |
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| 338 | 338 | | (3) The delivery of healthcare services in Georgia.295 23 LC 33 9274 |
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| 339 | 339 | | H. B. 62 |
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| 340 | 340 | | - 13 - |
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| 341 | 341 | | (b) The department and the Department of Labor shall report the following information296 |
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| 342 | 342 | | to the oversight committee quarterly:297 |
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| 343 | 343 | | (1) The number of individuals who were determined eligible for Medicaid-funded298 |
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| 344 | 344 | | services pursuant to Code Section 49-4-202;299 |
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| 345 | 345 | | (2) Demographic information on program participants;300 |
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| 346 | 346 | | (3) The average length of time that participants remained eligible for medical assistance;301 |
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| 347 | 347 | | (4) The number of participants who completed an employment or reemployment302 |
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| 348 | 348 | | assessment;303 |
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| 349 | 349 | | (5) The number of participants who took part in workforce development activities;304 |
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| 350 | 350 | | (6) The level of participant engagement in wellness activities or incentives offered by305 |
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| 351 | 351 | | healthcare providers or the third-party administrator;306 |
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| 352 | 352 | | (7) The number of participants who reduced their dependency on the HELP Act307 |
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| 353 | 353 | | program, either voluntarily or because of increased income levels; and308 |
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| 354 | 354 | | (8) The total cost of providing services under this article and Code Section 34-2-17,309 |
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| 355 | 355 | | including related administrative costs.310 |
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| 356 | 356 | | (c) The oversight committee shall review and provide comment on administrative rules311 |
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| 357 | 357 | | proposed for carrying out activities under this article and Code Section 34-2-17. The312 |
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| 358 | 358 | | oversight committee may ask the appropriate administrative rule review committee to313 |
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| 359 | 359 | | object to a proposed rule as provided in Chapter 13 of Title 50, the 'Georgia Administrative314 |
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| 360 | 360 | | Procedure Act.'315 |
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| 361 | 361 | | (d) The oversight committee shall:316 |
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| 362 | 362 | | (1) Review how implementation of the HELP Act is being carried out, including the317 |
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| 363 | 363 | | collection of copayments and premiums for healthcare services;318 |
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| 364 | 364 | | (2) Evaluate how healthcare services are delivered and whether new approaches could319 |
|---|
| 365 | 365 | | improve delivery of care, including, but not limited to, the use of medical homes and320 |
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| 366 | 366 | | coordinated care organizations;321 23 LC 33 9274 |
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| 367 | 367 | | H. B. 62 |
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| 368 | 368 | | - 14 - |
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| 369 | 369 | | (3) Review ideas to reduce or minimize the shifting of the payment of unreimbursed322 |
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| 370 | 370 | | healthcare costs to patients with health insurance;323 |
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| 371 | 371 | | (4) Evaluate whether providing incentives to healthcare providers for meeting324 |
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| 372 | 372 | | measurable benchmarks may improve the delivery of healthcare services;325 |
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| 373 | 373 | | (5) Review options for reducing the inappropriate use of emergency department services;326 |
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| 374 | 374 | | (6) Review ways to monitor for the excessive or inappropriate use of prescription drugs;327 |
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| 375 | 375 | | (7) Examine ways to:328 |
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| 376 | 376 | | (A) Promote the appropriate use of healthcare services, particularly laboratory and329 |
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| 377 | 377 | | diagnostic imaging services;330 |
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| 378 | 378 | | (B) Increase the availability of mental health services;331 |
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| 379 | 379 | | (C) Reduce fraud and waste in the Medicaid program; and332 |
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| 380 | 380 | | (D) Improve the data sharing among healthcare providers to identify patterns in the use333 |
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| 381 | 381 | | of healthcare services across payment sources;334 |
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| 382 | 382 | | (8) Receive regular reports from the department on the department's efforts to pursue335 |
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| 383 | 383 | | contracting options for administering services to members eligible for Medicaid-funded336 |
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| 384 | 384 | | services pursuant to Code Section 49-4-202;337 |
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| 385 | 385 | | (9) Coordinate its efforts with any legislative committees that are working on matters338 |
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| 386 | 386 | | related to healthcare and the delivery of healthcare services; and339 |
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| 387 | 387 | | (10) Recommend future funding options for the HELP Act program to future340 |
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| 388 | 388 | | legislatures.341 |
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| 389 | 389 | | (e) The committee shall summarize and present its findings and recommendations in a342 |
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| 390 | 390 | | final report to the Governor and the General Assembly no later than August 15 of each343 |
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| 391 | 391 | | even-numbered year. Copies of the report shall also be provided to the health related344 |
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| 392 | 392 | | House and Senate standing committees.345 23 LC 33 9274 |
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| 393 | 393 | | H. B. 62 |
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| 394 | 394 | | - 15 - |
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| 395 | 395 | | 49-4-211.346 |
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| 396 | 396 | | (a) The department shall be authorized to promulgate rules and regulations consistent with347 |
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| 397 | 397 | | and necessary to carry out the provisions of this article.348 |
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| 398 | 398 | | (b) The department and the Department of Labor may, in coordination, adopt rules as349 |
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| 399 | 399 | | necessary for the implementation of the employment and reemployment assessments and350 |
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| 400 | 400 | | workforce development activities provided for in Code Section 34-2-17."351 |
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| 401 | 401 | | SECTION 3.352 |
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| 402 | 402 | | Chapter 2 of Title 34 of the Official Code of Georgia Annotated, relating to the Department353 |
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| 403 | 403 | | of Labor, is amended by adding a new Code section to read as follows:354 |
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| 404 | 404 | | "34-2-17.355 |
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| 405 | 405 | | (a) The General Assembly finds that:356 |
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| 406 | 406 | | (1) Georgia has a disproportionately high number of uninsured individuals who do not357 |
|---|
| 407 | 407 | | have healthcare coverage compared to states that have expanded Medicaid;358 |
|---|
| 408 | 408 | | (2) Georgians value independence and self-sufficiency;359 |
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| 409 | 409 | | (3) Investing in Georgia citizens is a legislative priority;360 |
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| 410 | 410 | | (4) Participants in the HELP Act program are largely low-wage workers; and361 |
|---|
| 411 | 411 | | (5) An opportunity exists to match individuals who need self-sustaining employment362 |
|---|
| 412 | 412 | | with the jobs the economy needs, including newly created healthcare jobs.363 |
|---|
| 413 | 413 | | (b) The purpose of this Code section is to create a collaborative effort between the364 |
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| 414 | 414 | | Department of Labor and the Department of Community Health to:365 |
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| 415 | 415 | | (1) Identify workforce development opportunities for program participants;366 |
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| 416 | 416 | | (2) Gather information from state agencies on existing workforce development programs367 |
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| 417 | 417 | | and opportunities; and368 |
|---|
| 418 | 418 | | (3) Establish a comprehensive plan for coordinating efforts and resources to provide369 |
|---|
| 419 | 419 | | workforce development opportunities.370 |
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| 420 | 420 | | (c) The Department of Labor shall implement a workforce development program that:371 23 LC 33 9274 |
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| 421 | 421 | | H. B. 62 |
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| 422 | 422 | | - 16 - |
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| 423 | 423 | | (1) Focuses on specific labor force needs within the State of Georgia;372 |
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| 424 | 424 | | (2) Has the goal of reducing the number of people depending on social programs,373 |
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| 425 | 425 | | including the HELP Act program; and374 |
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| 426 | 426 | | (3) Increases the earning capacity, economic stability, and self-sufficiency of program375 |
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| 427 | 427 | | participants so that, among other benefits, they are able to purchase their own health376 |
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| 428 | 428 | | insurance coverage.377 |
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| 429 | 429 | | (d) As used in this Code section, the term:378 |
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| 430 | 430 | | (1) 'Department' means the Department of Labor.379 |
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| 431 | 431 | | (2) 'HELP Act' or 'act' means the Georgia Health and Economic Livelihood Partnership380 |
|---|
| 432 | 432 | | Act provided for in Article 10 of Chapter 4 of Title 49 and this Code section.381 |
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| 433 | 433 | | (3) 'Program participant' means an individual participating in the HELP Act program.382 |
|---|
| 434 | 434 | | (e) The department shall provide individuals receiving assistance for healthcare services383 |
|---|
| 435 | 435 | | pursuant to Article 10 of Chapter 4 of Title 49 with the option of participating in an384 |
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| 436 | 436 | | employment or reemployment assessment and in the workforce development program385 |
|---|
| 437 | 437 | | provided for in this Code section. The assessment must identify any potential barriers to386 |
|---|
| 438 | 438 | | employment that exist for the member.387 |
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| 439 | 439 | | (f)(1) The department shall notify the Department of Community Health when a388 |
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| 440 | 440 | | participant has received all services and assistance under subsection (d) of this Code389 |
|---|
| 441 | 441 | | section that can reasonably be provided to the individual.390 |
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| 442 | 442 | | (2) The department is not required to provide further services under this Code section391 |
|---|
| 443 | 443 | | after it has provided the notification provided for in paragraph (1) of this subsection.392 |
|---|
| 444 | 444 | | (3) A participant who is no longer receiving services under this Code section does not393 |
|---|
| 445 | 445 | | meet the criteria of paragraph (3) of subsection (f) of Code Section 49-4-205 for the394 |
|---|
| 446 | 446 | | exemption granted under subsection (f) of Code Section 49-4-205.395 |
|---|
| 447 | 447 | | (g) The department shall report the following information to the oversight committee396 |
|---|
| 448 | 448 | | provided for in Code Section 49-4-209:397 23 LC 33 9274 |
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| 449 | 449 | | H. B. 62 |
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| 450 | 450 | | - 17 - |
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| 451 | 451 | | (1) The activities undertaken to establish a workforce development program for program398 |
|---|
| 452 | 452 | | participants; and399 |
|---|
| 453 | 453 | | (2) The number of participants in the workforce development program and the number400 |
|---|
| 454 | 454 | | of participants who have obtained employment or higher paying employment.401 |
|---|
| 455 | 455 | | (h) The department shall reduce fraud, waste, and abuse in determining and reviewing402 |
|---|
| 456 | 456 | | eligibility for unemployment insurance benefits by enhancing technology system support403 |
|---|
| 457 | 457 | | to provide knowledge-based authentication for verifying the identity and employment404 |
|---|
| 458 | 458 | | status of individuals seeking benefits, including the use of public records to confirm405 |
|---|
| 459 | 459 | | identity and to flag changes in demographics.406 |
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| 460 | 460 | | (i) The department shall be authorized to promulgate rules and regulations consistent with407 |
|---|
| 461 | 461 | | and necessary to carry out the provisions of this Code section and may coordinate as408 |
|---|
| 462 | 462 | | necessary with the Department of Community Health in adoption of such rules and409 |
|---|
| 463 | 463 | | regulations."410 |
|---|
| 464 | 464 | | SECTION 4.411 |
|---|
| 465 | 465 | | All laws and parts of laws in conflict with this Act are repealed.412 |
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