Bill Requiring Access By State Employees to Trauma Centers and Critical Access Hospitals Advances

A subcomittee of the House Judiciary – Non Civil Committee amended and advanced a bill that would require insurers providing services to the State Health Benefit Plan to treat all level 1 trauma centers as in network. The amendment added the state’s critical access hospitals to the list that must be in the provider’s network.

House Bill 354 is sponsored by Rep. Barry Fleming of Harlem, and came about after Blue Cross – Blue Shield, which is the provider for the State Health Benefit Plan, decided not to cover treatment at Atlanta’s Grady Hospital as in-network. Grady is one of the state’s five trauma centers–the rest are in Augusta, Savannah and Macon–which are extensively staffed in order to provide any type of care needed when a person suffers a serious injury.

Grady Hospital CEO John Haupert testified before the subcommitee that state employees were having to pay significant costs they can’t afford because Grady is out of network. For example, he cited a woman suffering from gynocological issues who received at $25,000 bill, and an individual with respiratory issues whose bill came to $14,600 out of pocket. Noting that Grady is part of the Medicaid provider network and that the State Health Benefit Plan is self insured, he argued that the state owed its employees the ability to go to where they could get the best care.

If passed, the bill would require a provider of benefits to the SHBP to include Level 1 trauma centers in its network, and would prohibit a provider from contracting with the SHBP if it does not include all Level 1 centers within its service area. The bill also provides for a method of dispute resolution involving binding arbitration if a service provider can’t resolve contract terms within 30 days. If the bill passes, Grady hopes to use that provision to be able to return to being in-network for the SHBP.

At present, Grady is the only trauma center that is is not in Blue Cross’s network, but Fleming is concerned that others could be next. During the hearing, Rep. Mary Margaret Oliver expressed concerns that while coverage by the Level 1 Centers will benefit those who live near them, it doesn’t help those who are further away. Georgia has 34 hospitals that are considered critical access hospitals by the Department of Community Health for Medicaid purposes, and while they don’t have the complete capabilities that a trauma center would provice, they are better able to provide emergency care than smaller hospitals.

One of those critical access hospitals is Polk Medical Center in Cedartown, which has also been in a contract dispute with Blue Cross, and is considered out of network to state employees. Polk Medical Center is in committee member Trey Kelley’s district, and Kelley wrote an amendment to the bill requiring critical access hospitals to be in network the same way level 1 trauma centers would be, should the bill pass.

The amendment was adopted by the subcommittee, and will be part of what is sent to the full committee when it meets next, likely today at 2 PM, although the agenda hadn’t been finalized by the time this was written. If the bill gets a Do Pass from the full committee, it would have to go through the Rules Committee and receive a vote by the full House by Crossover Day, March 13th.

2 comments

  1. nannykkp says:

    So SHBP members get special treatment, but our elected officials will leave the rest of us to fend for ourselves? I thought they were supposed to represent all of us. I would like my insurance company to have to treat my local hospital as in network too.

    • taylor says:

      I’m not sure if this is special treatment or not. The General Assembly should provide greater governance to the SHBP than to private insurance companies. The SHBP is funded by employees and taxpayers.

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