DCH-i [Vol. 1, no. 3 (Dec. 2011)]

Georgia Department of Community Health

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Home DCH-i December 2011, Vol. 1 Issue 3
DCH-i December 2011, Vol. 1 Issue 3

DCH-i December 2011, Vol. 1 Issue 3

About DCH-i
DCH-i is the monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important information to you as physicians, dentists, hospitals, third-party payers, vendors, health care advocates, consumers and legislators. Our goal is to help create A Healthy Georgia together. Write us at DCH-i@dch.ga.gov.
Health Information Technology Town Hall
Friday, December 16, 2011 - 10 a.m. to noon
2 Peachtree Street, Fifth Floor Board Room
In This Issue
From the Commissioner Ask DCH-i Medicaid Updates Around DCH Money Follows the Person Q&A - Deputy Commissioner Blake Fulenwider Office of Constituent Services Deborah Bevelle Retires After 34 Years with State Government Recap of November and December Board Meetings Upcoming Meetings & Public Comment Opportunities
Do you have a question or a comment? A special request, perhaps? Tell us what's on your mind at DCH-i@dch.ga.gov.

From the Commissioner Looking Back: Much Accomplished, Still More to Do

As we approach the end of the calendar year and my first year as Commissioner of the Georgia Department of Community Health (DCH), I have spent time reflecting on the past 12 months.

When I came to DCH, I promised three things -- to be a good listener to all our constituents, to be a good partner to those we work with and to be a good steward of the resources entrusted to our agency. I also made a commitment to create A Healthy Georgia and have been sincerely impressed with the dedication of all of our stakeholders in moving this vision forward.

This has been a noteworthy year for DCH in many ways. Here are just a few:

State Health Benefit Plan (SHBP) - DCH took substantive action to preserve the Plan for members and

future retirees by eliminating an $815 million deficit for FY12 and FY13 and significantly reducing future Other

David A. Cook

Post Employment Benefits (OPEB) liability by $11.183 billion by 2043. With a focus on wellness and personal

engagement in health and long-term security and sustainability of the Plan, SHBP offered innovative options

for health insurance coverage of the nearly 700,000 state employees, teachers, school system employees,

retirees and covered dependents. For the first time ever, PeachCare for Kids enrollment became a voluntary option for eligible state

employees.

Department of Public Health (DPH) - Standing up a new Department was a major undertaking for DCH and its Division of Public Health. The transition went smoothly as staff from both agencies worked cooperatively to launch DPH. We are proud of the work that both Departments do to help our state achieve A Healthy Georgia.

Georgia Medicaid and Children's Health Insurance Program (CHIP) Redesign - This project is well underway, with significant input gathered from Medicaid stakeholders around the state. DCH contractor Navigant Consulting is preparing a preliminary report of its findings, expected in January.

MMIS Certification - DCH's Medicaid Management Information System (MMIS) upgrade and subsequent request for CMS certification went exceptionally well, thanks to the hard work of our staff and our fiscal agent partner Hewlett-Packard (HP).

Healthcare Facility Regulation - DCH increased efficiency and reduced overhead by merging the Office of Health Planning with Healthcare Facility Regulation. DCH implemented significant rules impacting assisted living facilities. Additionally, we have reduced reliance on paper and employed geo-mapping technology to better coordinate surveying, inspection and licensing.

Medicaid EHR Incentive Program - Launched in September, the incentive program has paid out more than $16.5 million to date to eligible Medicaid professionals and hospitals who have adopted electronic health records. The federally funded program is expected to pay out more than $480 million to participating Georgia providers through 2021.

Medicaid Quality Recognized by HHS - Georgia's Medicaid and PeachCare for Kids programs were recently recognized for Exceptional Quality Measurement and Reporting in Health and Human Services' 2011 Annual Report on the Quality of Care for Children in Medicaid and CHIP. Georgia was the only state spotlighted.

Medicaid Process Improvements - DCH has reduced administrative burdens by making it easier for providers to enroll and thus increase access to health care. The provider credentialing and enrollment process has decreased from one month to 15 days. The number of prior authorizations has been reduced, co-pays streamlined and headway made to simplify payment models.

We have all worked well with our partners, facing challenges head on and turning them into opportunities. Much of this positive transformation is due to the work you - as our partners and stakeholders - have done all year long.

Thank you for your continuing support and I wish you and your family the happiest of holiday seasons.

David A. Cook Commissioner

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Ask DCH-i

DCH-i answers your questions each month. If you have an issue, a question or a comment, we'd appreciate hearing from you at DCH-i@dch.ga.gov.
Q - Tell us the best way to contact HP for claims payment issues.
A - Call the Georgia Health Partnership Provider Voice Response System at 1-800-766-4456.
Q - How do I update my provider enrollment information? A - DCH has just posted its most current Provider Enrollment Guide to answer many of your provider enrollment questions. Try the link here, or visit the DCH Web site home page at dch.georgia.gov.
Q - Are physicians violating any state or federal law if they refuse to see patients who cannot pay the PeachCare for Kids co-pay in advance? A - The State Children's Health Insurance Program (CHIP) state plan stipulates that a provider cannot refuse to render services to a PeachCare for Kids member on the basis that the family is unable to make a co-payment. As a PeachCare for Kids provider, you would be expected to follow the rules set forth in the State Medical Plan.
NOTE: Currently parents of PeachCare for Kids children are not required to make co-payments for services received by their children. The proposed change to require co-payments has not yet been implemented in Georgia. Providers will be notified by the Department when the payments are required. Please feel free to contact the Provider Contact Center (1-800-766-4456) if you have additional questions.
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Medicaid Updates
Grace Period Announced for 5010 Transaction Standards Enforcement
CMS recently announced a 90-day grace period for enforcement of the use of 5010 Claims Transaction Standards.
"The deadline for compliance remains January 1, 2012," said Sonny Munter, chief information officer with DCH. "The CMS announcement allows for a 90-day grace period without penalty for those who are not 5010 compliant. However, we are urging providers to continue with their updates to Version 5010, the precursor to the ICD-10 conversion, which will be required by October 1, 2013."
Click for information about the conversion from ICD-9 to ICD-10.
Medicaid Redesign - Latest News
As part of the ongoing work on the DCH Medicaid and CHIP review, DCH has developed three key goals and six strategies by which the various programmatic options or models will be pursued and evaluated.
The project is envisioned to provide valuable input as DCH develops strategies to ensure the future fiscal and programmatic sustainability of the programs.
The three key goals are to:
Enhance appropriate use of services by members; Achieve long-term sustainable savings from services provided; and Improve health care outcomes for members.
The six key strategies that are vital to our goal achievement include:
Achieving administrative efficiencies to allow Medicaid and CHIP to become a more attractive payer for providers; Providing timely and appropriate access to care for members within a reasonable geographic area; Ensuring operational feasibility from a fiscal and administrative oversight perspective; Aligning reimbursement with patient outcomes and quality versus volume of services delivered; Encouraging members to be accountable for their own health and health care with a focus on prevention and wellness; and Developing a scalable solution to accommodate potential changes in member populations as well as potential changes in legislative and regulatory policies.
DCH anticipates the delivery of Navigant's Strategy Report in January 2012.
Provider Enrollment Guide Posted
Within the past few weeks, DCH has posted a new and improved Provider Enrollment Guide with frequently asked questions and step-by-step answers.
The purpose of the guide is to provide useful Medicaid enrollment information to the Medicaid provider community. The guide also makes the enrollment and update process less burdensome and easier to navigate. It includes information about changes, additions and other procedures.
Hewlett-Packard Enterprise Services (HPES) is the Fiscal Agent for Georgia Medicaid. DCH's Office of Inspector General (OIG) is responsible for Medicaid Provider Enrollment.
For questions not answered in this guide, please contact HPES at 1-800-766-4456, or visit www.mmis.georgia.gov.
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Around DCH
Improved PERM - Error Rate Lower than National Average
With a federal fiscal year 2010 Medicaid Payment Error Rate Measurement (PERM) of 4.71 percent, Georgia Medicaid is outperforming the national average. During the previous audit in 2007, Georgia's PERM exceeded the national average of 10.50 percent with a PERM of 11.86 percent. The 2010 PERM audit revealed that Georgia has reduced its error rate by more than 60 percent.
In 2005, the Centers for Medicare and Medicaid Services (CMS) developed the PERM program to review improper payments in three areas of Medicaid and CHIP: fee-for-service (FFS) claims, managed care claims, and eligibility cases. CMS adopted a national federal contracting strategy to measure error rates in a subset of states every year. The federal contractors conduct the medical and data processing reviews on claims and collect state claims data and medical policies. The states are responsible for conducting eligibility reviews according to CMS' review guidelines. Through PERM, the state verifies that it is properly paying for services, providing services for appropriately enrolled members and adhering to eligibility policies.
PERM measurements take place on a rolling, three-year, 17-state cycle. Georgia is in Cycle 2.
Update on Medicaid EHR Incentives Program
Since opening registration for the Medicaid EHR Incentive Program in September, DCH has distributed incentive payments to 21 eligible hospitals and 52 eligible professionals. These payments totaled $16,427,895.13 as of the end of November.
The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) are providing funding and support for the program that was created by the Health Information Technology and Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act (ARRA) of 2009. DCH officials anticipate a total payout to qualified providers of $480 million over the life of the program.
Registration for the program is required at both the federal level and the state level. Once eligible participants have attested to meeting all program requirements and their applications have been approved, payments will be made within 45 days.
SHBP and PeachCare for Kids Enrollment
A number of state employees and retirees covered under the State Health Benefit Plan (SHBP) have taken advantage of a new voluntary option to enroll their eligible children in PeachCare for Kids (the Children's Health Insurance Program, CHIP). Currently, approximately 12,000 applications covering 16,000 children have been received.
Although SHBP's Open Enrollment has ended, eligible SHBP families can continue to apply for PeachCare for Kids coverage for children ages 0 through 19 through June 2012. The 60-day waiting period has been waived until June 30, 2012. After that date, the waiting period will apply.
DCH projected that as many as 40,000 children covered by the SHBP are eligible for the switch to PeachCare for Kids. The movement of these dependents to PeachCare for Kids is expected to save the average family approximately $2000 per year and the state up to $32 million.
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More Nursing Home Patients Transitioning into the Community
The number of patients in nursing homes is growing, but because of a CMS program called Money Follows the Person (MFP), many of these patients can be transitioned back to a home, apartment or group setting.
MFP is a rebalancing initiative that was made possible by an 11-year grant to states from the Centers for Medicare and Medicaid Services (CMS). This grant is designed to help individuals who are institutionalized in nursing facilities and intermediate care facilities (ICF) to return to their homes and communities.
"Physicians and other health care providers can help these patients and their families by connecting them with this program," said Jerry Dubberly, Georgia's chief of Medicaid. "Medicaid also offers several waiver programs that can meet the needs of people housed in nursing homes or ICFs and allow them to move into a home or group setting by working with the Money Follows the Person Program."
If the patient has lived in an institution for at least three months he/she may be eligible for assistance in resettling in the community with the help of Money Follows the Person.
The goals of MFP are to:
Increase the use of home- and community-based services, rather than institutional long-term care services; Eliminate barriers in state law and the state Medicaid Plan that may prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible people to receive support for long-term services in setting of their choice; and Increase the ability to serve eligible people in the least restrictive setting of their choice.
Through MFP, participants may receive financial assistance and other support to remove barriers to living in the community.
Learn more about Money Follows the Person to share with your patients and their families.
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A Conversation with DCH's Deputy Commissioner

Periodically, DCH-i will interview DCH leadership about what's going on in various divisions and offices. It's an inside look at the people and policies that affect DCH stakeholders.We're interested in hearing from you. If you have questions for a member of DCH's leadership, share them with us at DCH-i@dch.ga.gov.

This month, DCH-i spoke with DCH's Deputy Commissioner Blake Fulenwider.

Q - What is your role as DCH's Deputy Commissioner?

A - My role as Deputy Commissioner is to support the Commissioner in his role as Chief Administrative Officer of the Department, assist with programmatic oversight and management as well as long-term strategic health planning for the state. Focus areas include Medicaid, Health Information Technology, the development of a new integrated eligibility system for Medicaid and PeachCare for Kids, the Medicaid and CHIP Redesign, and health insurance exchange planning.

Q - Tell us a little about your Health Policy and Legislative experience.

A - Beginning in 2006, I served as a staff member and ultimately Legislative Director for then-Congressman

Blake Fulenwider

Nathan Deal in Washington, D.C. There I worked directly with staff of the House Energy and Commerce Committee on legislation involving the Centers for Medicare and Medicaid Services (CMS), Food and Drug

Administration (FDA), Center for Disease Control and Prevention (CDC) and other federal agencies. Legislative

work at the federal level includes the Patient Protection and Affordable Care Act (PPACA), Children's Health

Insurance Program Reauthorization Act (CHIRPA), Ryan White HIV/AIDS Program Reauthorization Act, food safety and biopharmaceuticals.

When Governor Deal was inaugurated, I continued my health policy work as his chief health policy adviser, providing policy analysis and recommendations about legislation. I serve as chairman of the Georgia Health Insurance Exchange (GHIX) Advisory Committee and am Commissioner Cook's designee on the Board of the Georgia Health Information Exchange Inc. (GHIE).

Q - What initiatives will you focus on for the next 12 months? Why are they important?

A - The three main areas are the Georgia Health Information Exchange, health insurance exchange planning and the Medicaid and CHIP Redesign. All three initiatives are crucial to the delivery of quality cost-effective health care to Georgians.

Q - The Medicaid and CHIP Redesign Initiative is underway. If you could share your insight about one key driver in this critical transformation, what would it be?

A - Improving the quality of patient care and treatment outcomes for Medicaid and PeachCare for Kids consumers is mission-critical for the redesign project. Aligning incentives for patients to become more active in their own health planning and chronic disease management, as well as incentivizing quality outcomes instead of quantity of provider services, have the potential to create transformative improvements in our current programs.

Q - What is your vision for Health Information Technology (HIT) in Georgia?

A - HIT in Georgia is a unique and rare opportunity to fundamentally improve health care delivery and provider collaboration for the benefit of patients. As Georgia moves forward with establishment of a statewide Health Information Exchange -- the interstate of electronic health records -- we must think transformationally. Upon successful deployment, our statewide HIE will connect world-class health care services with state-of-the-art technology, creating a fusion that will drive quality improvement, cost reduction, patient engagement and provider collaboration.

Q - You serve on the Board for the new Georgia Health Information Exchange (GHIE). What can you tell us about the GHIE?

A - GHIE is a non-profit 501(c)(3) entity charged with the HIE's governance. It is an invaluable resource to the state and to DCH as we work through many complicated issues surrounding Health Information Exchange design and establishment. Membership of the Board is diverse and includes physicians and other providers, hospitals, health care stakeholders and state agency officials. It is a robust opportunity to discuss differing needs and challenges and to propose and initiate positive solutions.

Q - How will you be working more closely with providers and other stakeholders?

A - Engaging providers and other stakeholders on issues that affect them is crucial for the success of our work at DCH. Providers, consumers and others are our partners in providing care, and as such, they should be included in the discussion as DCH identifies and pursues policies and initiatives. Having worked in the Governor's office prior to my arrival at DCH, I am fortunate to have established excellent working relationships with hundreds of health care organizations representing the needs of the people of Georgia. I look forward to continuing to work in close collaboration with the health care industry in Georgia because our work is truly a team effort.

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DCH Dedicated to Assisting Constituents

The voice on the phone line is shaky and low. "I need some help for my baby, and I can't see the doctor," the female explained.
"It will be all right," said Jackie Tate in a soothing voice. "You're at the right place now and we will do everything we can to help."
The call is typical of many received each week by Constituent Services in the DCH Office of Legislative and External Affairs. Tate and her staff of two spend the day assisting Georgians to make the connections they need for health care services, and many other resources and services in Georgia.
"We're basically here to help people find what they need, and when people call us our priority is to help connect them to the right agency, even if it's not within DCH," Tate said.
Tate is a wealth of knowledge concerning what's available to assist Georgians. She's worked with DCH for eight years, but her extensive 16-year background with other state agencies has helped her build a knowledge base to effectively respond to all kinds of questions.
"Where can I get food stamps?" "My mother needs to be in a nursing home and I can't find anyone to help her." "I live in the country and there's no doctor for me to see." "Where can I get my baby's shots for school?"
Tate, Gwen Bridges and Liz Echols handle 40 to 50 inquiries each day that come in by telephone, letter or e-mail. Requests may be made directly by citizens or may originate from elected officials or their staffs. Constituent Services frequently handles HIPAA-sensitive information, often reaching out to health care professionals on behalf of a caller.
"We are careful with the information we handle," Tate said. "The nature of our work allows us to represent the constituent with their permission to reach out to providers and other entities on their behalf."
The staff in Constituent Services frequently interacts with other federal, state and county agencies when assisting the public.
"No matter what the problem is, we're always happy to help," Tate said. "We're an information resource with a human touch."
DCH's Constituent Services can be reached at 404-651-8330.
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Deborah Bevelle Retires After 34 Years with State Government

From left: Commissioner Cook, Board Chairman Ross Mason and Deb Bevelle
The Board of Community Health presented Deborah Bevelle, coordinator of the DCH Board and executive assistant to the commissioner, with a Resolution at its December 8 meeting. Bevelle is retiring at the end of 2011 after 34 years of service to the state. Commissioner Cook has named Debbie Ewing, previously with the Legislative Fiscal Office, to replace her.
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Recap of November and December Board Meetings
Recent Board Actions
The following actions were taken by the Board of Community Health at its November 2011 meeting:
Unanimously approved a Resolution entitled "State Employee Plan Employer Contribution Rate Increase December 2011-April 2012 for the State Health Benefit Plan;" and Unanimously approved initial adoption of proposed changes to State Health Benefit Plan Rules 111-4-1-.01, 111-4-1-.02, 111-4-1-.04 and 111-41-.06 to be published for public comment.

The following actions were taken by the Board at its December 2011 meeting:
Unanimously approved a Resolution entitled "State Health Benefit Plan Annuitant Subsidy Policies and Exhibits A & B" Unanimously approved a Resolution entitled "Employer Contributions for Non-Certificated Public School Employees - Three Year Schedule" Unanimously approved initial adoption of a Public Notice entitled "Nursing Facility Services" Unanimously approved initial adoption of a Public Notice entitled "Co-payment Increase for Medicaid and New Co-payments for PeachCare for Kids Rescission" Unanimously approved initial adoption of a Public Notice entitled "Provider Rate Cuts - Rescission" Unanimously approved initial adoption of a Public Notice entitled "New Co-payments for PeachCare for Kids Members"

View these Resolutions. View these Public Notices.

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Meetings and Public Comment Opportunities
Friday, December 16, 2011 - Health Information Technology Town Hall - 10 a.m. to noon, 2 Peachtree Street, Fifth Floor Board Room Wednesday, December 28, 2011 - Public Hearing re: Public Notices (above) - 1 p.m., 2 Peachtree Street, Fifth Floor Board Room Thursday, January 12, 2012 - Board of Community Health 10:30 a.m., 2 Peachtree Street, Fifth Floor Board Room
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Editor-in-Chief Pamela A. Keene
Graphic Design Karen Rothschild
Production Iris McIlvaine
Circulation Denise Smith
Peggy Woodruff Interim Director of Communications

About the Georgia Department of Community Health

DCH conducts the business of health care for Georgians. Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and underserved populations.

DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia.

2 Peachtree

We are dedicated to A Healthy Georgia.

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