DCH-i [Vol. 1, no. 5 (Feb. 2012)]

Georgia Department of Community Health

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Home DCH-i February 2012, Vol. 1 Issue 5
DCH-i February 2012, Vol. 1 Issue 5

DCH-i February 2012, Vol. 1 Issue 5

Georgia eHealth Summit Monday, March 12, 2012 Georgia Tech Research Institute Free; Advance registration required See details in separate article
in DCH-i

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.
In This Issue
From the Commissioner Ask DCH-i
HCPCS and ICD-9 Code Issues Incorrect Payments by CMO Assistance in Enrolling as a Medicaid Provider
Medicaid and CHIP Updates
Medicaid/CHIP Redesign Feedback Deadline Express Lane Eligibility Recognized Nearly $40 Million Paid in EHR Incentive Payments Task Forces Discuss Medicaid Redesign Options Co-Pays of PeachCare for Kids
Register Now for Georgia eHealth Summit SORH EMS Training Program Speaking Up! Board Actions HP Enterprise Services DHS Charity Golf Tournament
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

Working Together To Do the Right Thing

When I became Commissioner of the Georgia Department of Community Health (DCH) 12 months ago, I promised DCH would do three things -- be a good listener, a good partner and a good steward -- to further the Department's mission of A Healthy Georgia.

Last month, DCH had a chance to be all three. When the public responded overwhelmingly to our January 12 Public Notice about proposed changes in payment rates for Medicaid members involved in our New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP) programs, we listened. Administered by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), these programs are funded by federal and state monies but are ultimately the financial responsibility of DCH.

David A. Cook

From the thousands of written and oral comments received, DCH determined that further study is needed, both of the needs of the people served by these programs and of the rates that providers are being paid for these services. We will be working closely with DBHDD Commissioner Frank E. Shelp, MD, MPH, and his staff as we move forward.

DBHDD conducted an independent cost study of the waiver programs' nearly 370 providers. The study, as required under the federally approved Medicaid waiver, assessed costs for all services to determine the appropriate rates to pay providers for various services. As a result of the study, the rate model that DBHDD had proposed was projected to produce a net increase in provider rates by an estimated $24 million per year. The new rates were expected to have been finalized by mid-2013.

The most significant changes found in the proposed rates fall in two areas of service: Community Access Group (CAG) services used to fund day activities, both in congregate centers and those provided on a one-on-one basis in the community; and residential services known as Community Residential Alternative (CRA), the rate for which has been divided into a tiered-rate structure.

The NOW and COMP Waiver Programs serve people with developmental disabilities using a range of community-based services designed to meet the specific needs of participants with varying levels of need. Together, these two programs currently serve approximately 11,000 Georgians with developmental disabilities.

Again, DCH is committed to being a good listener, partner and steward...improving our working relationship with providers and the people we serve through our programs. To do this, we will continue to work with all physicians and providers who care for patients. We will also continue to look for ways to increase our efficiency and effectiveness, ease administrative burdens and improve access to quality health care for all Georgians.

Please, if you have issues, we want to hear about them. You are a vital part of our mission here at DCH. Send your questions, comments and concerns to DCH-i@dch.ga.gov.

And join with us to create A Healthy Georgia.

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 -- Why is there not a mandate that ICD-9 diagnosis codes are updated in your MMIS system on time so that providers are not burdened with keeping otherwise clean claims timely until you can take the appropriate action? Can't these claims be pended rather than denied?
A -- The historical process DCH has used to update ICD-9 diagnostic codes and the Healthcare Common Procedure Coding System (HCPCS) provider codes has been dependent upon the release of a file from CMS. Normally that file would have been provided by CMS in July. However, this past year, the codes were not provided until November. It takes at least three months for HewlettPackard Enterprise Services (HPES) to complete the process of adding and deleting the appropriate codes in the MMIS. The HCPCS codes and the ICD-9 codes' update is in process and should be completed by March 1, 2012.
Pending claims is not a viable option at this point. However, DCH is exploring an alternative process that would not be dependent upon the CMS release date. In the meantime if you receive a denial, resubmit your claim for processing.
Q -- We are having difficulty with one of the CMOs paying the correct amount for claims that we submit. We have reached out to the CMO, but we still cannot get an answer. Can you help us?
A -- While DCH encourages direct discussions with the plan, provider concerns such as this can be escalated to the Department for assistance by calling 1-888-943-5743.
Q -- Can you help me with becoming a provider for one of the Medicaid CMOs?
A -- Contact each Medicaid CMO directly:
Amerigroup Community Care 800-600-4441 www.amerigroup.com
Peach State Health Plan 800-704-1484 www.pshpgeorgia.com
WellCare of Georgia 866-231-1821 georgia.wellcare.com
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Medicaid and CHIP Updates

Redesign Strategy Report: Feedback Deadline Approaches
DCH has posted an overview PowerPoint presentation about the Medicaid and CHIP Redesign Strategy Report. We invite you to view it here.
To share your opinion about the Strategy Report, please let us hear from you.
To submit detailed comments, please use our Feedback Tool. To submit a brief comment or to ask a question, please send us an e-mail at MyOpinion@dch.ga.gov.
The deadline for submitting detailed feedback, comments or questions is February 29, 2012, at 5 p.m. (ET).
Georgia's Express Lane Eligibility Recognized
"In 2011, Georgia became the first state to implement ELE with the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Using WIC as the Express Lane agency is a logical approach for Georgia since individuals are often referred back and forth between the two programs, and preexisting rules draw the two programs together. For example, since Georgia WIC uses the same income verification standards as Medicaid and CHIP, there would be no need to ask a family with a child in WIC to resubmit proof of income for Medicaid," according to the report.Once again, Georgia has been recognized for innovation in Medicaid and CHIP processes. In the 2011 CHIPRA Annual Report, Georgia was cited as one of eight states using the Express Lane Eligibility (ELE) enrollment process. ELE involves using eligibility findings from other public programs to facilitate enrollment in Medicaid and CHIP.
Five states added ELE in 2011. It is one of eight program features that qualify states for CHIPRA performance bonuses, improving children's enrollment and retention. Georgia received nearly $5 million as a CHIPRA bonus in December.
Nearly $40 Million Paid in EHR Incentives to Date
Georgia's Medicaid EHR Incentive Payment Program has issued more than $39 million to providers through January 2012. The program was launched on September 5, 2011.

Task Forces Discuss Medicaid Redesign Options
The Provider Task Force includes individuals in organizations representing hospitals; physicians; behavioral health; dental; home health; nursing homes; pharmacy; speech, physical and occupational therapy; public health; EMS; non-emergency transportation; and durable medical equipment.Earlier this month, DCH convened two task forces that are advisory in nature -- a Provider Task Force and an Aged, Blind and Disabled (ABD) Task Force. These task forces will provide input into the Medicaid and CHIP Redesign Initiative.
The ABD Task Force is providing feedback about the delivery system needs for the Aged, Blind and Disabled populations enrolled in Medicaid. Consumer advocates, representatives from advocacy organizations, health care providers and state agencies are participating in this task force.
Another task force will be convened by DCH to discuss Children and Family Services. DCH and the task force members will meet throughout the recommendation, procurement and implementation phases of the Redesign Initiative.

Co-Pays for PeachCare for Kids Begin April 1
According to Georgia's State Medicaid Plan, health care services must be provided, regardless of the patient's ability to pay a co-pay.Co-pays for PeachCare for Kids patients age 6 and older begin on April 1, 2012. The Board of Community Health approved the co-pays at its January 12, 2012, meeting.
Here's a list of sample co-pays

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Register Now for Georgia eHealth Summit
Space is filling quickly for the in-person attendance for the Monday, March 12, Georgia eHealth Summit "Transforming Health Care Delivery." The summit will also be streamed live online and requires advance registration.
Visit www.dch.georgia.gov/healthIT for more details.

SORH Funds Rural EMS Director Training
The program is designed to assist in improving the financial stability of EMS in rural areas, management and leadership skills of EMS directors, and to enhance communications with hospitals, local governments and the citizens they serve.Emergency Medical Services (EMS) directors in rural Georgia now have access to a formal leadership training course because of a Medicare Rural Hospital Flexibility (Flex) Grant received by the State Office of Rural Health (SORH). The grant's funding will support the curriculum developed by the Georgia Association of EMS in partnership with Georgia Southern University (GSU) Jiann-Ping Hsu (JPH) College of Public Health in 2011.
The pilot program will be delivered this year in four one-week sessions and will be held on campus at the Georgia Public Safety Training Center (GPSTC) in Forsyth and the GSU JPH College of Public Health.
"We are targeting 20 candidates in counties with populations of 35,000 or less to participate in this first-ever statewide training," said Charles Owens, executive director of the SORH. "The program includes 152 hours of classroom instruction as well as 30 hours of online class work, assignments and projects each quarter that will allow each student to apply principles learned to his or her organization."
The online portion of the program will be managed by GSU; the classroom instruction will be performed by both GSU and selected experts in rural EMS.
The program has received two grants: $100,000 for the 2010/2011 cycle, which was used for program development and $100,000 for the 2011/2012 cycle for program delivery.
Contact Courtney Terwilliger, president of the Georgia Association of EMS (GAEMS), cterwilliger@emanuelmedical.org or 478-494-4512, or Kim Littleton, executive director of the GAEMS, kimberly0630@gmail.com or 229-402-2240 for more information about program dates and locations.
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Speaking Up!
Commissioner David A. Cook and Deputy Commissioner Blake Fulenwider will address these organizations during March 2012:
Friday, March 2 -- State Bar of Georgia: Fundamentals of Health Care Law -- www.iclega.org -- Navigant Report -- Commissioner Cook
Tuesday, March 6 -- Central Georgia Health System and Georgia Health Sciences Medical Center: Launch of Georgia Regional Academic Community Health Information Exchange (GRAChIE) -- www.georgiahealth.edu -- Commissioner Cook
Monday, March 12 -- Department of Community Health (DCH), Georgia Health Information Exchange Inc. (GHIE) and the Georgia Health Information Technology Regional Extension Center (GA-HITREC): Georgia eHealth Summit --www.dch.georgia.gov/HealthIT -Commissioner Cook
Thursday, March 15 -- Georgia Chamber Health Care Committee: Navigant Report -- www.gachamber.com -- Deputy Commissioner Fulenwider
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Board Actions
The Board of Community Health took the following actions at its February 9 meeting: Unanimously approved and adopted the January 12, 2012, meeting minutes; Unanimously approved a Resolution entitled "SHBP Employer Contributions: Rate Correction"; Unanimously approved for initial adoption the CHIP Rate Increase Public Notice to be published for public comment; Unanimously approved for final adoption the Nursing Facility Services Public Notice
Next Board of Community Health Meeting -- Thursday, March 8
Have you read HP Enterprise Services' current newsletter?
Check it out for the latest about: Instructions about Mailing Claims & Non-Claims Provider Enrollment Updates Prior Authorization for Nursing Facility Claims
Visit www.mmis.georgia.gov, and click on Provider Information, Provider Notices.

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DHS Sponsors Charity Golf Tournament
The Department of Human Services' (DHS) Annual Charity Golf Tournament will be held Monday, April 23, at Newnan Country Club. Last year, proceeds from the tournament afforded DHS the ability to contribute $4,100 for Christmas gifts to DFCS foster children. DHS's goal is to exceed $4,500 this year. For more information, contact Lisa Marie Shekell at DHS at lmshekell@dhr.state.ga.us.
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Editor-in-Chief Pamela A. Keene
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Peggy Woodruff Interim Director of Communications

About the Georgia Department of Community Health

The Department of Community Health (DCH) conducts the business of health care for Georgia. 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.

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We are dedicated to A Healthy Georgia.

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