02/05/2026 Senate Committee on Regulated Industries and Utilities

Regulated industries committee meeting to order. We have two bills on the agenda today. One is my bill dealing with certificate of need for cancer treatment, and the other is representative Earhart had a bill. I believe we passed it last year. Yes.

House bill one eighty five on dietitians practice act.

That's correct.

I'm gonna flip the order because you have promised me you can do your bill in three minutes.

It is fast.

But I want you to take enough time to remind us. We have a couple of new committee members what it's about, why you're bringing it, and what it does.

Happy to do so.

So I'm gonna turn the floor over to you on house bill one eighty five.

Thank you, mister chairman, and thank you to the members of the committee for hearing the bill today. If it looks familiar to some of you, it's because you've passed this bill unanimously twice before. In in Georgia, the diet dietetics practice act has not been updated in thirty two years. It is outdated in in dire need of an overhaul. That's exactly what HB one eighty five does.

It overhauls, cleans up, modernizes the language of the Dietetics Practice Act. It does some key things. It provides additional pathways to licensure for more qualified nutrition professionals, ensuring that patients across, patients have access to competent evidence based nutrition care. Simultaneously, it narrows the licensure requirements focusing in on the practice of medical nutrition therapy, MNT. That is the practice of of nutrition or the diagnosis and prescribing of certain diets to actually treat medical conditions.

This ensures that only those with the highest level of training can manage complex nutrition related conditions. That's one of the most important things that the bill does. It expands licensure exemptions so that nonmedical advice can be given. So what we're talking about there, the folks that would not need to be licenses, those are your, those are your personal trainers, the coaches in the gyms. This ensures that your child's t ball coach doesn't have to have a nutritionist license, to give nutrition advice or tell the kids how to eat healthy.

The bill also facilitates multistate practice, allowing Georgia to enter into a compact a multistate compact, and that is gonna be probably the bulk of what you see, in the bill. You know the advantages of this. It improves the license's portability. It expands employment opportunities, certainly helps our military spouses that relocate to Georgia and reduces the burden of requiring folks to have multiple state licenses. The bill is, it it it was a it was a good bill two years ago.

What was one year ago and two years ago, and we think that it's still a strong bill. I did also want to introduce Robin Stegall. She is with the Georgia Academy of Nutrition and Dietetics. She can she's a better job than I do speaking to the nuances of medical nutrition therapy. That is the bill in a nutshell, and I'm happy to answer any questions if there are any.

Okay. Let me ask you just a couple of questions first, representative. I remember the bill from last year. Everybody may not. Please explain the difference between, you know, a dietitian that needs to be licensed and somebody working in the school lunchroom.

Exactly. Education has a lot to do with it, the educational requirements. Certainly, the nature of a licensed dietitian and I may have Robin she says it so much more eloquently than I can, but the the the licensure with a dietitian, that that is insured. That lie that dietitian has been, medically trained to to use diet to help treat conditions. So this is just not for the purpose of overall health.

This is to treat conditions through medical nutrition therapy. That is the big difference between that and someone who might be teaching kids about the, you know, the food pyramid, the updated, I might add, new food.

Currently licensed?

Yeah. Currently, we have one broad generic, nutritionist license. And and the truth be told, it's it's confusing. Robin, would you like to

speak to me? I'm gonna let me finish with you first. She's the

only person lined

up to speak so we can get it. I'm not gonna make you stand up. I have sympathy for people with leg and

foot injuries. Saw you hobbling.

Is there a nutrition therapy for that? I don't I don't I don't think so. I need it.

So, there is a license. Now it's under nutritionist. Just tell us why you wanna break it out in a separate license. Why not just continue being licensed as a nutritionist?

Right. This this is actually the projection is there might actually be fewer licenses even though we're going from one to two. Right now, the license is overly broad. It doesn't reflect the changes that have been made in in medical nutrition or nutrition therapy in general over the past thirty years. So the concept here is that there is some confusion on the part of consumers, as to whether or not a the a licensed nutritionist has the training and the knowledge to treat a medical condition or just really honestly, someone who really should just be giving advice on healthy eating in general?

And then walk me through why your people would wanna be a member of a compact where the rules and regs are controlled by multiple states rather than just

the state. Understood. Georgia Georgia is setting the rules and the scope of practice in this state. So so if a if a nutritionist or or a licensed dietitian moves into the state, they are going to have to practice under the scope that is outlined in Georgia law. It's simply saying that we will allow, as you know, or if you you you've probably read this, is that when when nutritionists or licensed nutritionists, dieticians move into the state, we will accept their licensure assuming that the state that they came from has an equal or greater higher standard.

Or or a member of the compact.

Or member of the compact. Right.

Is that

why military likes this so much because it helps their people when they get to the

100%. And that I'm I've always been a big fan of of compacts within reason. Certainly, it helps our military personnel. I I grew up on army bases. I that was my life from kindergarten until high school.

I was in a different military base every two years. So I understand, in our military community, what it was like when those families would get transferred. The husband or the wife would transfer in, and then the spouse would come along. It could be nurses, could be dietitians, could be counselors. And it was always a struggle.

And there was often and and we've heard this before for folks that talk about contacts. There's often this period, one, three, six months before that spouse can get licensed in the state of Georgia, due to a number of issues and challenges with getting license licenses. So we think this is a positive

questions for representative Verhart? Mister Pro Tem, you're recognized for question. Representative Hay.

Had to.

So we're adding a license,

which is

Under the sec yeah.

Under the same licensure.

Right. Same licensure, but it's it's, licensed nutritionist, licensed dietitian.

And you're gonna add some people to the licensure board.

Yes. We're gonna add, one person, one additional person.

One additional member to the board.

And then it looks like to me maybe you're gonna require us one specific accrediting agency to be the official accrediting Ascend Accreditation Council for Education and Nutrition and Dietetics.

Mhmm. Mhmm.

And I've, so I've had concern putting specific accrediting bodies by name and code and statute. Have have you shared that concern? And, we we see this quite frequently

Right.

Where you're gonna, you know, put in code this name of this

Particular credit body. Gotta be

you know, bless everybody before they can go to work. Right.

And

I just I got I have a fundamental problem with that. I don't think it's good. Public policy. Their name can change or whatever. It does say or its successor organization, but there could be another entity that comes forward that's equally qualified to credit you know, give accreditation to people.

So where where is that coming from?

Great. And and I I do share your concern on that certainly as relates to k 12 accreditation, higher higher education. My understanding is that there are some limitations on the on the accrediting bodies for nutritionists, and I don't know. And and, Robin, perhaps you can speak to that better than I can.

It's there

I don't think there are as many options for accreditation, but

Yes, sir. Please. Is this on? Yes. My name is Robin Stegall.

I'm a registered dietitian. I'm also the, government affairs committee, chair and public policy coordinator for the Georgia Academy of Nutrition and Dietetics. So if I could, speak to your question, Senator Walker. The, Ascend is the accrediting body for dietetics education, and it's the only, body that accredits programs, for that dietetic internship, which is a large part of our supervised practice, and how, dietitians achieve the thousand, clinical, hours or a thousand hours of of qualified supervised practice to work in high acuity, in and outpatient settings. And Ascend is the body that we rely on for, those programs to be verified and the standards to be set.

But the language within the bill does provide for should a different body or a different group become, the group that is in charge of that for that language to to, also be acceptable.

Can you point to that in the bill where it provides for that?

What, seven twenty eight?

Seven twenty eight.

Seven twenty eight.

Seven eighty eight.

I didn't get that far into it. I didn't

even how'd you get that far?

Next page. If it's part of 788, then that might be part of the licensure compact language. Right here.

Seven eighty eight.

Yeah. Okay. Right. Let me just hold on. Just a second.

So am I gonna do away with the US Department of Education?

No. So the this is this is a very long bill. And the part, senator Walker that you're referring to, that line seven eighty eight, is actually part of the boiler plate language for the licensure compact. That language is not the language that's part of the, specific licensure statute for the folks here in Georgia. So that language so, referring to the standards of practice or the scope of practice for licensed dietitians, the educational requirements, all of that is covered in the first, half of the bill.

And the second part and that ends on page, that ends on line six twenty four, on page 25. The rest of that from line six twenty six onward is the standard, licensure compact language, that that covers our participation in the interstate licensure compact.

Right.

Mister chairman, one more question if you don't mind. One last question. How many states are in the licensure compact currently?

Yep. So we've achieved 11. We've got 15 states that are putting, licensure compact legislation forward, this year.

Thank you. Other members have questions? Stegall, did you have anything to add? You were lined up as a witness.

I

would just say that, this this substitute represents, just, again further refining that we, that took place, during the, when the session adjourned last year. The main language changes were to provide, some clarification around complex versus non complex care, in lieu of the language that we had used prior, which was chronic and acute conditions to define medical medical conditions, just providing additional clarification around complexity of care, and the and the relative level of the location of where that care is provided depending on the stability in the in the of the patient and the health, of the patient and the complexity of their diagnoses. So we just added that language in lieu of the chronic and acute language

Okay.

To tighten it up.

Any other questions? Alright. We're in a posture where I'm willing to receive a motion. We're working off of LC fifty two zero nine eight seven s. It is a new committee substitute.

So moved. Got a motion by chairman Brass to do pass Second. By committee substitute, second by senator Summers. Any discussion or any proposed further amendments? Senator Rhett, you are recognized.

I was just gonna say I won't hold it against her because she grew up on army bases. I tried to eat at some of those child halls, and you need a dietitian.

Alright. We're gonna take that as an indication you favor the bill. Any further discussion? Alright. All in favor, raise your hand.

Leave them up long enough page to get your names down. Alright. All opposed, same sign. We got one opposed. A new committee member causing trouble already.

Alright. The bill passes. Now we're gonna move on to the next bill. We're gonna do this as a hearing only. I have one, two, three, four, five, six, seven.

I got eight people lined up to speak for this bill, and none of them even check the box for or against. So we will be interested to learn what the sentiment is. I have had this bill has been pending since the very end of last session and made one small change, that got some reaction that it didn't have to be exclusively dedicated to cancer, but could also be primarily, dealing with cancer treatment. And, wow, you would have thought I had come up with some new legal term to to say primarily. And I kept being asked, why don't we define it?

And I even went to Westbrook dictionary to try to figure out exactly what it is, and it's exactly what it says. It's either predominantly, mainly, for the most part, chiefly, principally, substantially, largely, mostly. That's what Webster says. I don't believe there's any confusion what primarily is. That's predominantly what you're doing.

And what the amendment changed adding exclusively or predominantly or, excuse me, primarily at several places was just to let it know that you could have some services other than cancer treatment so long as that's your primary purposes to cancer treatment. If somebody out there has a better way to word that or to define it to give you assurance that this isn't allowing somebody to come up and do 10% cancer treatment and avoid the CON process, bring it on. Let me know before we we bring this back up for a vote, at a later meeting. I have also, had it pointed out to me that if you go through the CON process, you are required to do, indigent care at the 3% level. Y'all are all familiar with that language and that it would be a weird anomaly to allow you to be exempted from CON and also not be forced to provide indigent services.

If it were up to me that I could wave the one, not many people in this room would like me because it'd be about 10% and be a whole lot less squishy definition of indigent than we have now. I think all of these hospitals that, say that they're nonprofits or not for profits in particular ought to be doing an awful lot more indigent care than they're doing. So I have an amendment as the first thing in in your folders that makes it clear, and I took the let everybody relax. It's the exact language from 1339 that passed last year that applies to all other, areas that are exempted from CON. It's the 3%, level's the easiest way to say that.

And so but it is verbatim from the language from thirteen thirty nine that passed last year that you should provide this is, for members of the committee after line 37 in the bill in front of you to say provide uncompensated indigent and charity care in amount equal to or greater than 3% of its adjusted gross revenue and own and after 01/01/1927 in an amount equal to or greater than the minimum amount established by the department by rule, which should be at least 3% and which shall be reviewed by the department every twelve months. We will not take that amendment up today. We're not gonna vote on the bill today, but we're gonna get the sentiment of, our public on this. I will tell you that the idea, is pretty clean. Cancer is the second leading cause of death in Georgia, and I think it's important that cancer care and treatment be available to as many Georgians as possible, and the CON process is an impediment to that.

I'm a be interested to hear if there are health care professionals that think we ought to restrict access, to cancer care to to our citizens in any part of the state. But let's hear what people have to say. That is a, relatively, concise explanation. I can tell you I've explained many lobbyists have come talk to me about this bill, to ask what I'm trying to accomplish, what I'm trying to do, and it is that clean. It is a rifle shot as to the illness that I want to make it easier to get treatment for.

It is narrow. It is cancer. Any type of cancer. But the breadth of the CON limitations is broad. It's a shotgun blast.

Anything you're doing, equipment, facilities, new businesses, or whatever to address exclusively or primarily cancer treatment, we wanna get rid of all those those barriers. So it's it's precise and limited as to the, ailment, condition, illness, whatever we're gonna call cancer, which is literally our number two killer. That's only treatment for the that or or primarily that condition, but in many different aspects. So I am going to take people a little bit out of order. I know where a lot of folks stand, and then you'll be surprised how many groups are sort of agnostic on this or neutral on it.

But I wanna hear what you say, good or bad. I'm heck. I'm a, you know, I'm an elected official. We got pretty thick skin. I can take the pros or the cons.

Just let's educate us so we don't do anything dumb, here. I'm gonna start with my friend, doctor Nick, and I I can't pronounce your last name any better than anybody else, and that's why I call you doctor Nick. But if you will take the podium and you can tell him your name, and you might better tell Paige how you spell it, who you're with, and whether you're in favor or against this bill. I hope you're for it because y'all are my motivation.

Oh, it's a no brainer, sir. I am for it. Yes. Thank you, senators. Thank you for inviting us.

I'm a medical oncologist. My name is Petros Nikolenakos. They call me doctor Nick for obvious reasons.

Say that again three times real quick.

That's Petros Nikolenakos. Nikolenakos. It sounds prettier, when I say it.

Glad to

have you here all the way from Greece.

Yes, sir. I'm born I was, yeah, born and raised in Greece. Been here for twenty six years. I represent I'm mostly here as a patient advocate, but I am right now, I work in Athens. We have a big practice there, big cancer center.

I don't know if people know about it, that we built a couple years ago. We have 25 doctors. We have 500 employees. I'm the kind of cancer doctor that gives chemotherapy, but we also have surgeons with us. Doctor Griffin is here, Jim Griffin from Mathis as well.

He's a surgical oncologist, and we have colorectal surgeons that operate the hospital. Radiation doctors that deliver radiation care, radiologists, nuclear medicine doctors, all kinds of people. We see about 13,000 new patients a year in our practice. 13,000. And that number has doubled, by the way, in the last two years.

We've been in Athens since 1983, my practice. It's privately owned. The doctors are independent. They like it that way. They don't enjoy being employed.

They like making decisions, being nimble, and being at the forefront of new treatments and therapies.

What's the name of the center? I'm not sure you've explained.

It's University Cancer and Blood Center. Alright. And so we've been in this business for a long time. It's exploded in terms of new treatments that are available for patients, new procedures, new diagnostics. It is an incredibly complex, orchestrated, effort to bring new cancer treatments.

We have a big research facility in our practice as well, and we try to deliver care locally so they don't have to travel outside the the city. People hate driving anywhere. In order to do all this stuff that we do and take care of patients, and I'm a practicing doctor as well as the president of the University Cancer and Blood Center, but I'm a practicing doctor first and foremost. I just did my clinic this morning and finished and drove up with doctor Griffin here. And I can just give you an example from this morning about how CUN is viewed from a patient's perspective.

It's not viewed as a regulatory policy. It's viewed as a waiting list. And we have to constantly battle wait times. And this may sound like a minor issue, but when you're diagnosed with a potential cancer and you're waiting for treatment for somebody to tell you you've got an incurable cancer, you incurable cancer, or what it is, the word itself is frightening to patients. So being able to tell them in a timely fashion what they have and what we're gonna do about it is very important for these people.

When we have to wait three to four weeks to get a biopsy or do a scan or have surgery and have to fight to get and do favors and and beg and plead staff in hospitals or other facilities that we are not allowed to have access to, that impacts the patient. So I'm just here as an advocate for the patients. We the amount of cancers that we deal with are increasing. The treatments are more complex. We need quicker access to these new treatments, to the established treatments.

We need access to the diagnostics. We need access to the surgeries. We need to be able to take care of these patients in a fair way, in a quick way to eliminate anxiety, to delay diagnosis, to prevent death, to prolong life, to minimize side effects, and to make people's lives better. The COO laws are antiquated. They have they don't apply a lot of states already have eliminated them completely.

And you'll hear from other practices here, people will have sometimes have to go to neighboring states to do what they do, to provide care in a in a in a timely fashion. I can talk about the cost of care and how much cheaper it is in the outpatient. I can talk about how it frees up space in hospitals if we do it in the outpatient so they can do more things that are applicable to a hospital in the inpatient facility. Hospitals have a tremendous, you know, role in the community. They they are undoubtedly important in the delivery of care, especially for emergency room trauma, neonatal care.

But there are a lot of things that don't need to be done in a c o n protected environment within a hospital system that can be done in the outpatient to free space in the hospitals to do what they do best and for us to do what we do best in the outpatient setting. So I'm asking that we free up these rules, just like many other states across the nation, to be able to deliver the care that we need to to for these patients, to eliminate suffering and wait times. And so that's my argument. It's a very simple argument. It's not complicated.

Does UCBC operate under a certificate of need currently? No. Tell me about the PET scan machine you got, yes, last year.

So last year so we we did we went through this process. We were, you know, we were begging the hospital to get another PET scanner. A PET scanner is a is a device that is like a CAT scanner, but you get injected with a radioactive drug, and then the drug goes wherever the cancer is and give up gives up a light signal. So I can see where the cancer is in the body and tell you if it's spread, if it's a stage four and incurable or anything else. The wait times were three to four weeks for years.

Plus, we needed to do tests that were not available and were not brought in. Since we got the PET scanner

Were you able to get a certificate of need for that device?

Well, we

don't need a certificate of need anymore. That was eliminated for that for that study. So we were able to get we got it the next day. And since we we did, we're we're able to do scans in two days.

You're saying the next day after we pass

We submit an application. We put the order in, and we got it right away.

How long had you been attempting to acquire or obtain that type of scanner? Five years. K. And why were you unable to get it before we passed the bill last year?

We were fighting in court with the hospital systems to try to they wouldn't let us. They wouldn't let us. They wouldn't get another PET scanner either. So we were just stuck in court trying to fight it the the way that it was supposed to be fought.

You couldn't purchase one without first getting a certificate of need for

it? Yes, sir.

Alright. And once we passed the law and eliminated that requirement for PET scans, you got it the next day. Yes. What exactly what is it you would like to do in your practice today that requires a certificate of need? And what why do you need this bill?

Or what what exact type of procedures or treatments or facilities or outpatient centers do you want to do that you can't do under the current law?

There's a number of things. The one of the one simple thing that you may not think is important, but it is, is to put a port in in a patient to deliver chemotherapy, is to do an operation in an outpatient facility where they don't have to wait for somebody else to do some other operation in the hospital and free up space. Operations and surgeries are very important in our in our in our in the treatment of cancer. It's not just medicines and drugs. We'd like to free that up so we can have operations in the outpatient setting that can be done appropriately in the outpatient setting, that are now being restricted in hospital settings and added to wait lists and OR availability.

The OR availability is a huge problem, not just in Athens, probably everywhere. People fight to get in line to be able to operate in a hospital to take care of a patient. I like to see that go away. I like to to free that up so anybody who needs a surgery for a life threatening condition like a cancer can get it without restrictions because it is important to treat these patients timely. If you don't do it quickly enough, these cancers will spread, and they will go somewhere else.

And then you don't surgery is not even an option anymore. So I would like to have certain kinds of operations, certain kinds of procedures, certain kinds of endoscopies for diagnosis. I would like to be able to have my patients get something called an ERCP or an EUS, which is endoscopically through the mouth, down the stomach, into the pancreas, where we can biopsy pancreatic lesions, where we can biopsy stomach lesions, where we can do all these things that we need to do that require more advanced anesthesia, for example, that has to be done in a hospital right now. And that's what the CUN restricts. It can be done in the outpatient setting.

It a lot of times, it gets done in the outpatient setting in the hospitals even. But we're not allowed to do it. We have to wait in line to get all these things done, and they're already swamped. I mean, right now, the hospitals are expanding ORs. It takes them years to expand them, and a tremendous amount of of money to really expand an OR space in a hospital.

We've been waiting five years for the hospitals to expand their ORs. Five years. And we're still waiting. And we gotta wait in line. Our patients are waiting to get surgeries that they need, or they have to travel to Atlanta.

They have to go to a different center. An hour and a half, two hour drive sick with their family members to go some other place to do the the procedures.

I have a couple of committee members with questions for you. Senator Summers, do you have a question or did I already ask it?

You you you asked the one I

have one more. You're recognized.

Thank you, kindly, mister chairman. If you do these procedures in your clinic, I'm assuming that's what you'd call it, your your facility

Yes, sir.

Would you not be basically taking away any revenue to the hospital?

The hospital is inundated with these things already. They can't they can't accommodate us. That's sort of that's a great question. When we were fighting for the PET scan in court for four years being opposed by the hospital system, the argument was that it would take away money from the hospital. Well, the hospital wouldn't get another PET scanner, number one.

When we got I was trying to reassure him that the volumes justify not one more PET scanner, but probably two or three, and they wouldn't believe me. So we got the PET scanner a year ago. We need a second and a third. We are maxed out now. They are maxed out, and we still need more scanners.

That argument does not hold water. I wanna pull out that's one argument against that. The other one is I wanna free up things that we can do in the outpatient setting that are a lot cheaper, cost less, bring less money to the hospital, and free the hospital up to do the bigger complex things that need a hospital, that a hospital was made for. And they will make much more money doing that if we free up space and OR time. And they don't have to build more ORs, which is also expensive.

The if we decongest the stuff that can be done in the outpatient setting by eligible, physicians and physician groups that on you know, that are still under the, the proper accreditation, certification, all that stuff, and free up the hospitals to do what they're meant to be doing. We will improve their financials. We will decrease the cost, not just for the hospitals, but for the patients and their co pays and the insurance companies. Because everything we do outpatient is much cheaper for the patient and for the insurance companies, and the hospitals can take on the big things. And they will have plenty of opportunity to make more money than that.

They will not take away from them. That's the same argument I heard with the PET scans, and it's not true. It is just not true. It's sometimes about control. It's sometimes about other things that have nothing to do with the actual patient care.

I'm just advocating for patients.

One follow-up. One follow-up.

Yes, sir.

Okay. I got that. Just to make

sure and passionate. I don't mean to be No.

No. Not yet. Not yet. Very very

if you have these centers and you can open up a center and do your own thing, could you not go do your own thing in in Albany or Columbus or Augusta or Valdosta? I mean, could you not take what you have and go down there and do that same thing and take away from that hospital that might not be overcrowded like you are in Athens? I mean, is that a fair question there?

I'm not interested in going to those places, first of all.

Excuse me. If we if we eliminate the the this con, then it allows other people to do what you're doing, the c o n.

Other people have the same issue. You'll hear from the Augusta physician. They have the same issues. It's everywhere like that. Everywhere it's in we serve the rural communities of Georgia.

I mean, we serve 60 counties in the Northeast Of Georgia. It's not just Athens. It's a 130,000 people. We serve over half a million. We drive an hour away around Athens to different satellite clinics.

We have nine satellites around Athens in rural places of Georgia where we try to bring them for care. We're drawing all these patients to the hospital. We bring volume to the hospitals. The argument that we would go somewhere outside far away or somebody else can do the same thing, I hope they do. That's the whole point, is to decongest the hospitals from unnecessary surgeries that could be done in the outpatient that are lower cost and give them what they actually are supposed to be doing, which is higher cost, and they make more money, and they're free of the ORs, and they're decreasing their expenses.

That's true in every part of Georgia. It's we need to free up unnecessary things to be done in the hospitals. Like, you don't need to do certain things in the hospital, like a small hernia or a small this or small that. You can do that outpatient. Even in in cancer surgery, there are things that we can do that are smaller scale that we should be doing without wait times in an outpatient facility.

I'm not I don't wanna compete against the hospitals. This is not about that. This is about making care more efficient and delivering better care in a timely manner to the patient. It will not take away anything from the hospitals. And if we go to and if there's a practice, like you were here from another practice now, from another practice, they have the same issues.

It's just replicated everywhere from city to city to city.

Thank you for that, mister chairman.

Thank you. That's all the questions we have for you. Let me call on doctor David Squires from Augusta Oncology.

Greetings. Thank you for having me here today. I'm David Squires. I am a practicing medical oncologist. I've been in Augusta since 2003, and I, I had clinic this morning too and made it over here so I could testify.

I appreciate your consideration of this. I am the CEO of Augusta Oncology, also known as AO Multispecialty Clinic. We have many different specialists in our clinic, including medical radiation oncology, surgery, urology, rheumatology, and we serve a population of about 800,000 in the CSRA, which we sit right on the border of South Carolina and Georgia and Augusta. So we have five clinics there. One of them is in North Augusta and the other ones are in Augusta.

And we see about 40,000 patients, active patients, and and they get treatment of one sort or another. We see not only cancer patients, but patients who have iron deficiency, people who need drugs for osteoporosis, any kind of infusion for rheumatology, neurology, etcetera. So we serve a large portion of our community, and it's only us and the Medical College of Georgia that see these oncology patients. Our practice sees probably about seventy five percent of the oncology patients in our community, and we are completely maxed out seeing everybody we possibly can, but so is MCG. And we have a wonderful relationship with those physicians at MCG, which is owned by Wellstar now, and have collaborated with them for many years.

We pay their gynecologic oncologist to come into our offices and see patients so that they don't have to travel too far to go see another gynonc. And that that's been going on for twenty years. We participate in their clinical trials with them. And so we we send patients to them for stem cell transplants for other very highly specialized therapies in oncology that require specialized nursing care, and we appreciate our collaboration with them. We meet with them regularly as well as the CEOs from all the hospitals in our region.

And I have to just comment about this general concept of CONs. These were the CONs certificate of needs were developed in the nineteen seventies under the, consideration that if we had the certificate of needs, it would reduce the cost of health care. And so across the country, the federal government pushed states to enact these laws, and in 1979, Georgia enacted the CON law. But by 1987, it was clear that instead of reducing the cost of care, it was increasing the cost of care. It had exactly the opposite effect.

They were trying to avoid duplication of services Correct. Unnecessarily. Correct.

And and in 1987, the federal government reduced stopped the requirement, the mandate, but then each state gradually has had to make their own decisions. Some have phased it out gradually, and some have eliminated them. Some have kept them. But the whole health care economy has shifted drastically in the last forty five to fifty years. The whole world has changed.

And now in the last five years, three years with AI, I mean, you go back ten years and it's like the dark ages. We have had so many technological advances now. Our cancer patients are living two to three times longer than they used to because of all these crazy drugs and radiation therapies that have come out. It is insane. I have so many patients who are stage four terminal cancers, and they're alive ten years later with no evidence of disease now.

We have technology that has very rapidly outpaced these laws that have been in place for fifty years. And so we have to kinda get out of this scarcity thinking and move into this more abundance type thinking. All health care facilities are overwhelmed. There is no competition in our area for seeing cancer patients because there are just too many for the providers to see. And so we we have to work with the other facilities and say, okay.

Can you take these patients? We'll take these. You're really good at this? We'll send you those patients, and we'll we'll really good at this, and we'll see these patients. It is just like a triage every day trying to take care of these patients and work with the other facilities.

And so we feel no competition with the hospitals. We appreciate them and love working with them. And so I think in our current health care economy, we have room for multiple models of health care, offering innovative and cost effective outpatient options for patients, as well as these robust hospital service lines. But like doctor Nick was explaining, it takes a long time to get patients in for services who have cancer. I myself am a cancer survivor.

I went through chemotherapy for three years after I discovered I had cancer looking at my blood under the microscope, and I was going through medical school during those three years. So it cost me a $100,000 the first six months of my treatment with insurance. Those are my co pays and deductibles back in the nineties. And so I have a a very passionate view about how to help patients with these health care costs. The costs are definitely rising.

Will this bill affect cost? Lower cost

Oh, yeah.

To eliminate CON requirements?

It will. If you do that for outpatient services, particularly for oncology. Yes. I just as an example, we do CAT scans in our offices. And, patient, for example, will come in and say, oh, I got a $250 co pay.

Well, let me do it at the hospital. Well, they go over to the hospital and it's a $500 co pay. They get radiation in our facility. They gotta pay $60 a day. They go to the hospital.

It's a $110 a day to get radiation.

You're able to do radiation? Yeah. Did you have to have a CON to do that?

No. K. In Georgia, we did. And so back in 2022, we decided to purchase a 15 acre piece of property right on the corner of I 20 and Wheeler Road, a half a mile from our current main office on Wheeler Road, because we're maxed out seeing patients in this 25,000 square foot facility. And we needed a bigger facility, and we thought cancer care now is kind of consolidating where radiation and medical oncology and the surgical oncology groups are in a building.

And it's so much better for patients to receive care in that way. And we can deliver care at a much better cost, so we applied for a CON to have radiation at that 15 acre plot that we were we had it all designed and everything. And we went to the state of Georgia and said, hey. Can we do this? And they said, yeah.

Well, you will qualify under the exemption that you will save the state a lot of money for Medicaid and state health insurance because you will charge about half of what the hospitals are charging for the exact same services, outpatient services. And the patients will pay less. So, yes, you'll you should be able to get the c o n. So we did all the work, did all the attorney fees, submitted it, and we had opposition from the two hospitals that had the radiation facilities in Augusta, doctor's hospital and NCG at the time. And so the state came back and said, well, sorry.

Even though you applied under that exemption, we can't do that because of pressure from these hospitals not wanting this to be offered in that area. Well, that they told us that in June 2023. Are you aware of what happened in June 2023 in South Carolina? No. They eliminated the outpatient oncology CON laws in June 2023.

So since we sit right on the river, we said, Well, we got rejected in Georgia. We'll just put it in South Carolina. So immediately, we acquired a property in South Carolina, about a tenth of a mile from the Georgia border. And it's a 60,000 square foot facility. We have 15,000 square feet of radiation, and we opened almost a year ago, 02/17/2025.

And in our ribbon cutting ceremony in 2024 and in our grand opening in 2025, the lieutenant governor, state representatives, and senators came from South Carolina because we were the first group to actually take advantage of the fact that they eliminated the c o n laws for outpatient oncology services. And so we we are treating hundreds of patients now in the radiation facility, and we moved our medical oncologist from one of our facilities in Augusta down by Wellstar and Piedmont Hospital, just over the river, because now they're less than half a mile from the hospitals, but they're just directly right on the other side of the river in this amazing facility, 300,000 square feet medical oncology. So now the patients have to drive just a little bit further, but it does save them money, and we're able to provide them these services rapidly, conveniently. They can walk upstairs, walk downstairs between the two different medical oncology and radiation oncology groups.

Are there other services your, business would like to provide that require a CON that you have not been able to get?

Well, not at the moment. We still have that 15 acre property a half a mile from our other office, one of our offices in Augusta, that we would like to build another similar radiation oncology and medical oncology facility in a few years, but we don't want to go mess with that right now because we'll just get rejected again. And so

So your patients that live in Georgia are driving across the river to your South Carolina facility, and they're getting cheaper medical care because there are no CON restrictions.

Yeah. It only takes them fifteen minutes extra to drive over there, but it saves them $50 a day for radiation oncology. How much? $50 a day.

Okay. And why is it cheaper?

Because we don't have facility fees and we also don't have we don't charge as much. And so the patients pay a percentage of the radiation fee. So they pay 10% of the radiation fee every day. The payer pays 90% and they pay their co pay is 10%.

So Is that pay covered by Medicaid?

Yeah. Medicaid, same thing. I mean, yeah. We're sending our Medicaid, Georgia Medicaid over there, state health, everybody's going over there because we control 80 about 75% of the radiation that occurs in our region, we manage, we control. So we just essentially are sending them all over there.

We foresee a need for this in Georgia too in the next three years, but we don't wanna go through the political, you know, use our resources to go through the political, process of getting the CON there.

Somebody might file an objection to it, block it, and then you're tied up in court for years.

Right. Interestingly, one of the state representatives who opposed us initially on getting the CON now called me and said, hey. What would it take for you to put it back here? I think we could help you with that. I'm like, we don't wanna have an argument.

We have a great relationship with the hospitals here. You know, if if it goes away, then we'll consider putting it over here. We have the property. We're ready you know, we'll do it when that time comes.

It doesn't sound that great if both of them blocked your application for radiology services.

Well, you know, it's interesting. Dollars more. The relationships between providers is very interesting because at the top, the administrators, those who haven't taken the Hippocratic Oath, look at things very differently than physicians do. We are very morally, ethically driven to do exactly the right thing for the patient. We're passionate about that as you heard from doctor Nick.

Like, we want to make sure these patients are taken care of the right way. And and I understand hospital administrators are focused on the finances, and they don't understand what the doctors are seeing. The doctors are overwhelmed. The hospital's overwhelmed, but the administrators have the scarcity mindset often, not all the time, but often, whereas the physicians don't. There's plenty of patients as doctor Nick pointed out.

Anybody got questions for doctor Squires? Senator Gooch, you are recognized for questions.

So I may have I may have missed this in your talk. How do you handle people that are uninsured when they come into your offices?

So that's a really good question, and this is something that a lot of people outside of health care don't understand. Every day, patients are getting diagnosed with cancer who don't have cancer who don't have insurance. Mhmm. And then, also, every day, there are patients who were getting treatment, who have insurance, who've now spent all their money, and they can't keep paying their premiums so they lose their insurance. What do we do with those people?

Well, we have what we call patient account reps, and they educate the patients on their insurance. So when somebody comes in who doesn't have insurance, we say, oh, here's how you apply for insurance. We look at Medicaid. We look at different payers. We hook them up with insurance the best we can.

And in that interim between the time that we have to start treating them and the time that they get insurance, we go and get free drug from pharmaceutical companies so that they can get treatment life saving treatment. And if if they can't get insurance or if they need services that we can't provide, like I already mentioned, some of the stem cell transplants, some of the other things, we send it to Wellstar, which is a three forty b hospital, which buys the drugs at a 40% or more discount to what we can purchase the drugs for. And they charge 30% more than we do.

So Kinda what You can have a follow-up.

What percent of your, payer mix is uninsured?

Probably three to 5% at any given time.

Okay.

So we don't meet the threshold. We're not, you know, we're not a nonprofit. We're never gonna meet the threshold for $3.40 b pricing.

Alright. Thank you for being with us. You mentioned insurance. That got me intrigued here. I have Mike Riley from the Georgia Association of Health Plans that signed up to speak.

I'd love to have your views on this, legislation, Mike.

Yes, sir. Mister chairman, members of the committee, I'm Mike Riley. I'm the vice president of the Georgia Association of Health Plans. We come to you today in support of senate bill three sixty seven. And I believe you also have a a letter in your packets, from our president and CEO, Jesse Weathington, that affirms that position.

I'll be super brief. We think, competition's a good thing. We also think that, cancer patients should be allowed more choices when it comes to, their care. And, we also think that, Senate Bill three sixty seven would help remove some of the barriers that, these patients are currently facing. And, Georgians need more health care providers.

Think this bill would increase or lower health care costs for Georgians?

I think, increased competition, probably would lead to reduced prices, sir.

Yeah. How about insurance rates? We got a Blue Ribbon Commission looking at y'all over at the house right now.

Right. Absolutely. You know, I I think that's something that, you know, is top of mind for, Georgians and as legislators here. You know, it would be good to see, some of what other states have done. And I think, looking at some of the other examples that, some of our previous speakers have mentioned, in South Carolina and other states where they've eliminated CON, we've seen some of those reduced prices.

So it would be, be good to see, sir.

Your company deals with South Carolina as well? No, sir.

We just represent Georgia's insurance carriers.

K. So what's your information about health care costs being lowered in South Carolina after the elimination of CON.

I don't have that on hand, sir. Okay. But I'd be more than happy to do some research for you and get back.

Any other committee members have questions? Alright. I'm intrigued. I have Sydney Roberts from Emory Winship Hospital here. Let's hear what, Emory Hospital has to say about it.

Good afternoon, chairman and members of the committee. Thank you for the opportunity to speak today. My name is Sydney Roberts, and I represent Emory Healthcare and Emory University. I am here to speak in support of SB three sixty seven, particularly on behalf of Georgia's only National Cancer Institute designated comprehensive cancer center in Georgia, Winship Cancer Institute. Winship serves patients from all 159 counties across Georgia, and we treated over fifty eight thousand unique cancer diagnoses in f y twenty five.

Five. Some members of the committee may remember that last year, we came before you requesting letters of support to the Department of Community Health to open the certificate of need batch cycle for linear accelerators or LINACs, which provide radiation oncology. At the time, Winship Midtown operated three LINAC machines that were running above 100% utilization consistently over the past two years and up to 155 utilization in April 2025. Each machine was treating more than 100 patients daily, significantly increasing exceeding the state's threshold of 9,000 visits per machine annually. As you know, delays in cancer treatment can have catastrophic consequences for patients.

We are thankful for the members of the general assembly and DCH for supporting Emory throughout this process, and I am happy to report that we are waiting on the delivery of a fourth linear accelerator, one with even more advanced capabilities than the current three. Additionally, Emory Healthcare has explored expanding our radiology services at Emory Johns Creek Hospital. CON applications were submitted in 2008, 2009, 2010, 2003, and 2024, but all were either withdrawn due to opposition or denied.

So that was Emory Winship, our nationally qualified group. You couldn't get, permission to expand.

Yes, sir. K. Either due to we withdrew due to opposition or were rejected.

Did you get that linear thing after we passed the bill last year?

Yes. We did.

We're scared to try to pronounce it.

Linear accelerator? Yeah. So

you're able to serve more patients now with that?

Awaiting it. We were approved in 06/30/2025 was when they opened the batch cycle. We were approved. There's about a seven month design and then construction phase, so we're kind of in the middle of that right

now.

Who are the biggest cancer treating programs or hospitals in the state? You're one of them, I presume?

Yes. We are the only NCI designated comprehensive cancer.

Afraid of competition in in Fort Valley, Albany, Subban, anywhere else without having to go to the CON process?

No, sir.

You're getting patients from all 159 counties, and you got enough business to keep you busy?

We actually have at least over 10 patients in 135 counties.

Why wouldn't you oppose this to keep competition away? Make those folks down there have to drive to Atlanta to get treatment.

Well, we, you know, definitely appreciate all of our patients from all across Georgia, but we just wanna make sure that they're getting the care they need when they need it and where they need it. And being able to, you know, expand our radiology services

is part

of that. Would the elimination of CON requirements for cancer treatment allow you to expand your radiology program?

Yes, sir.

Any other programs you'd like to expand that this would, help you do?

Make it easier? Speak to other programs. I know that most of the excitement right now is expanding our radiology oncology.

Educate me on that. Radiology oncology.

Yes. So the linearity

radiology is taking x rays or films. Right? Or you're talking about radiation?

Oh, sorry. Thank you.

Okay. I got that. Alright. So that's a treatment modality that's serious.

Yes.

You can't just give radiation treatment without a CON

Yes.

Permission. And you're not able to get that you would expand locations or the scope of your program? What do you want to do?

We would expand it. We would get a linear accelerator in Johns Creek, so that would make people in North Georgia have to drive a little less far for their care. And, you know, after that, there's talk of more expansion, but I can only speak direct play to Midtown and Johns Creek for immediate.

You're willing to take your chances with the competition that the other folks would also be able to expand their radiology services?

Yes. We will.

Any other committee members got questions, for miss Roberts? Senator Gutt, you're recognized. Alright.

Sydney, does Emory support the full repeal of CON statewide?

We are actively working on reviewing the impact of a full repeal right now. We don't have a definitive position to share at this time, but we're committed to working with the general assembly on a resolution to make sure that, patients have access to care.

Thank you. Senator, again, you're recognized for a question.

Thank you, mister chair. Sydney, one of the things I I was born at Emory. I I go to Emory to an eye doctor, said they, you know, you've got campuses and facilities in different places. Said they, would this be just the Winship location, or would this be other location? Would you build more locations around the state?

What would this what would this look like in reality?

I can't speak to the, you know, larger scale potentially, exceeding our current footprint. And with Winship, right now, we have our locations and our current facilities.

You think you you think you would build other facilities?

I think that's probably above my pay grade, but I can get back to you with that.

That'd be great. Alrighty.

I'm hitting my limit. The Pro Tem just had to go present a bill in the insurance committee that I'm a member of, but I've got folks that have come from a long way to be heard here. Anybody that, made special effort to be here today, let me know, and I'll take you out of order. Monte Veasey came all the way from South Georgia. Okay.

Well, I got Ray Williams is up ahead of you on the list. Ray, you came in all the way from Newnan?

All the way from Newnan.

Try to keep it really brief for us here. I I know, there's a couple of us gotta get to another committee.

I'll do that. I I'd first have to say, I think I'm having a deja vu moment, from being in this room seven years ago. But, and where where was this bill seven years ago, twenty years ago? But, I don't

know if anybody else is here that remembers it.

I don't know.

Well, I certainly do.

But thank you for allowing me to speak to it. We are City of Hope now. CTCA was acquired by City of Hope in 2022. We became a nonprofit in '23, and, we now have facilities where the largest footprint of cancer providers around the country, Southern California, big research clinical trial facility there. We are an NCI designated facility there in California, and that does sometimes accrue to our system even though we're not NCI designated in, Newnan.

We support this legislation, because it's about patients, and it's about patient access. And the more opportunities patients have to be treated, the better off we are. We're not afraid of competition. Iron does sharpen iron, and I also think it lends itself to collaboration. We're in talks with multiple hospitals around the state, particularly in rural Georgia, to see how we can bring oncology to those areas that don't have it today.

It's about the patient, and it's about the why. If you will, allow me to digress just a moment. Seven years ago, sat right there at that table, and I brought a lady in named Pam Alford who was in support of our legislation. She was a patient of ours. She couldn't get in.

She finally got in. I introduced Pam as the why to you guys. This is why we need to remove barriers to access to cancer care. And And I'm gonna mention something personal here, and it's about UCBC. My best friend and his wife, my wife's best friend, is treating at UCBC.

I want her to have the best care that she can get, access to the best equipment, that she can get, the best care that she can get. She loves doctor Gunn. I've tried to get her down to City of Hope, but she loves the way she's being treated at UCBC. This isn't about competition. It's about collaboration and how we can work together as facilities.

It's about the why. There's not a person in this room that doesn't have a why about cancer care and why folks need to have access to it. So why you should support it is for your neighbors, for your friends, for your family that have cancer.

So I was here for that battle. The we your CTCA Yes. At that time. I bet there are a lot of lobbyists that retired with all the money they've made fighting you guys.

Some of them are still here.

Yeah. They're they're wealthy. They're the ones driving the Range Rovers and such. But, teasing you there. Did you put anybody out of business?

You were fought tooth and nail that you were gonna destroy health care in rural Georgia. You were gonna put Northside Hospital out of business. And what was the effect on other medical providers in Georgia after your exclusive cancer treatment facility was allowed to open up?

To my knowledge, sir, no other hospital has gone out of business. And in fact, as we were talking earlier, with the with the doctor from Augusta Medical, the modalities and the treatment plans that we have and the doctors all in one place have actually been, if you will, copycatted and and fashioned in other facilities. So I I think bringing, allowing us to be here to see more patients. Didn't put in any anybody out of business, and I think it enhanced, cancer care around the state.

Any committee members have questions? Well, just in kind of the, circle of life, you will remember, Senate Pro Tem Tommy Williams was the proponent of that bill. I believe he was a sponsor.

He was.

He definitely drove it. And, I don't know that it would have passed without his weight behind it. He is I'm not revealing secrets. He is open about this. He has now been stricken with cancer and is getting treated at your hospital.

He is.

And he helped, create the pathway for y'all.

So

And and we wouldn't have been here if it not been for senator Williams back in in 2008, and the work that Sheila Hummerstone and others did on there to get the bill passed. So thank you for that.

Appreciate you being with us. I've got one other piece of business I needed to mention to the committee. We passed Senate Bill 86, and I had the wrong LC number. The appropriate LC this has already happened, was LC560556S. And so I wanna just clarify that's what we passed out.

This was the one on the discounts for alcohol, Tuesday afternoon. So reflect your records that the true LC number was LC560556S. No words changed, but, just wanna make that clear on our record. Okay. Unfortunately, we'll have to adjourn for today.

We will resume this subject matter later. Mani, Anna, Chris, sorry. You are the three that signed up, that I didn't get to yet. I understood that, Anna, that your group, Georgia Hospital Association, was neutral on the bill. Is that an accurate reflection?

If you have suggested refinements to this, bring them to me. Mister Veasey, I understand your group's opposed to it, and if you would show us their problems.

That that is not

so. Oh, really? I'm sorry. I saw a letter somebody forwarded to me urging your members to contact us to oppose the bill. So I assume that meant y'all were opposed.

K. Because I've had some committee members share with me emails that they got, I thought, from you requesting them to lob to your members to tell us to vote no on the bill. So I misinterpreted that as opposition. Okay. Well, please come share those with me as we try to work to get something that is, good for Georgia.

Rachel King, who is

Hey, miss King. Sure.

Director of state health planning. Great. And, she was gonna express the concerns we have.

Great. Well, y'all, come see me before our next meeting. And, Chris Denson, you already have, but if you'll get any, info you wanna share with the committee, please do so. And with that, we are adjourned.