DCH-i [Vol. 1, no. 7 (May 2012)]

Georgia Department of Community Health

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Home DCH-i May 2012, Vol. 1 Issue 7
DCH-i May 2012, Vol. 1 Issue 7

DCH-i May 2012, Vol. 1 Issue 7
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.
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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.
In This Issue
A Look Back at the Legislative Session DURB Seek Nominees for Board Ask DCH-i
Annual Report Webcasts of Board Meetings Website Redesign at DCH
Medicaid and CHIP Redesign Update OIG Successes SHBP Largest Wellness Program in U.S. Medicaid Fair Preview EHR Total Incentive Payments to Date Speaking Up! Board Actions from April 12 Meetings and Opportunities for Public Comment
Save The Dates

Tuesday, May 8 Semi-Annual Georgia Medicaid Fair The Classic Center Athens, Ga. See article with registration information in this issue

Thursday, June 28 DCH Health IT Town Hall 2 Peachtree Street Atlanta, Ga. Details to come

From the DMT

From time to time, DCH-i will feature articles and insight from members of the Department Management Team (DMT). This month, Legislative & External Affairs Director Jesse Weathington writes about the recent legislative session.

A Look Back at the 2012 Legislative Session

At 12:03 a.m. on Thursday, March 29, the Georgia General Assembly adjourned "Sine Die" at the conclusion of the 40th day of the annual legislative session. Speaker of the House David Ralston and Lt. Gov. Casey Cagle simultaneously gaveled the session to a close with a thunderous cheer and a confetti-like hail of shredded bills and resolutions.

The department's Legislative Affairs team covered the session "gavel-to-gavel." This year, DCH proposed two pieces of legislation -- SB 407 and HB 1110 -- both of which were adopted. SB 407 is awaiting Gov. Nathan Deal's signature; Gov. Deal has signed HB 1110 into law.

Jesse Weathington

SB 407 cuts red tape by abolishing two defunct advisory panels: the Clinical Laboratory, Blood Bank and Tissue Bank Advisory Committee; and the Health Strategies Council. Both of these advisory boards are defunct and unable to fulfill their statutory responsibilities; therefore, department leadership decided to eliminate them. The bill passed the General Assembly unanimously. Sen. Renee Unterman (R-45) sponsored the bill through the State Senate to the Georgia House of Representatives, where Rep. Kevin Cooke (R-68) carried it to final passage.

HB 1110 addresses unlicensed personal care homes. HB 1110 gives the department's Healthcare Facility Regulation Division and the Georgia Bureau of Investigation enhanced enforcement authority to protect those who live in personal care homes. It also stiffens the penalties for operating this kind of facility without a license. Rep. Sharon Cooper (R-41) sponsored the measure through the House, and Sen. Unterman carried it through the Senate. Lt. Gov. Cagle was also instrumental in getting the bill onto the floor and voted upon. It passed the Senate unanimously.

Legislative Affairs worked on numerous other issues, including FY 2012 Amended and FY 2013 Budget bills, and tracked nearly 200 other pieces of legislation about health care, public agencies, or other issues affecting the department or our constituents. This is in addition to our year-round work to help citizens interact with DCH, working with stakeholders, and monitoring Congress and the federal government.

Now we begin the work of reviewing legislation and implementing the new laws passed by the General Assembly.

-- Article by Jesse Weathington, DCH Legislative & External Affairs Director

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DURB Seeks Nominees for Board -- June 1, 2012 Deadline
The Georgia Department of Community Health (DCH) is seeking nominees for appointment to the Drug Utilization Review Board (DURB). A start date of September 20, 2012, and service duration of three years will be the term of this appointment.
The DURB was established under the authority of Section 1903 (3) A of the Omnibus Budget Reconciliation Act of 1990, (OBRA '90). The board's purpose is to make recommendations to the department regarding the various aspects of pharmacy benefits provided to members of Georgia Medicaid.
Physicians or pharmacists submitting information for appointment to the DURB will be considered based on areas of expertise and varied practice sites involving the prescribing, dispensing, teaching and monitoring of outpatient medications. All members serve at the pleasure of the Commissioner for a three-year term. Members are reimbursed per diem for their one day per quarter participation and compensated for parking and round-trip travel mileage. For more information about how to apply, please go to the letter with details.
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 -- When will the DCH Annual Report for FY2011 be available?
A -- It is in final production and will be published online soon.
Q -- Representatives from our firm cannot attend every DCH Board Meeting. Will these meetings be available as a webcast or other format in the future?
A -- That is certainly our intention. We're currently evaluating various technologies and delivery systems and should have a decision soon.
Q -- Will DCH be undergoing a website redesign? If so, may I make suggestions to the Webmaster?
A -- Yes. The website redesign is currently underway, and we encourage and welcome any comments or suggestions that you have. Send them to DCH-i@dch.ga.gov.
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Medicaid and CHIP Redesign Update
We have also heard from stakeholders and others that the timeline posted may be too aggressive. Please be assured that DCH is committed to developing a thoughtful decision about the delivery model(s) that will best meet our stated goals and strategies.Stakeholder task forces and workgroups are making valuable contributions to the decision-making and recommendation phase of the Georgia Department of Community Health's (DCH) Medicaid and CHIP Redesign Initiative.
The three task forces that were created and constituted to serve throughout the redesign implementation -Providers; Children and Families; and Aged, Blind and Disabled -- include professional experts and advocates and have each met multiple times to provide insight and feedback to DCH. The department has also created a stakeholder workgroup focused on Substance Abuse and Mental Health. Internal DCH workgroups are focused on planning details that include financial and data modeling, operations and procurement.
As a reminder, the ACA's expansion of the Medicaid population begins on January 1, 2014. Additionally, the department's current contracts with the three Care Management Organizations that serve Medicaid members are in force through June 30, 2014.Currently, DCH is reassessing the redesign process timeline that was announced earlier this year. A revised timeline is forthcoming that will include the necessary time to address the continued input from stakeholders, the need for further data and financial modeling, and the imminent ruling on the Affordable Care Act (ACA) by the U.S. Supreme Court.
On the budgetary front, funding for Fiscal Year 2013 for the redesign initiative was reduced, shortening the timeframe for overall implementation of the redesign. Bearing in mind our commitment to developing the most effective model(s) to improve the cost-effective delivery of health care while easing administrative burdens, DCH is thoughtfully and purposely proceeding with the redesign.
We welcome your comments at MyOpinion@dch.ga.gov.
--Article by Pamela A. Keene, DCH Media and Public Relations Manager
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DCH Office of Inspector General
OIG Ensures Medicaid Patient Safety, Program Integrity, Recovers Millions
DCH's OIG has recently contracted with Myers and Stauffer as the Recovery Audit Contractor (RAC) for Georgia Medicaid. The Affordable Care Act (ACA) requires that all Medicaid agencies contract with RACs to identify and recover overpayments as well as to identify all underpayments for collection.Fraud, waste and abuse -- the Georgia Department of Community Health (DCH) keeps a watchful eye on state and federal dollars that fund Medicaid and PeachCare for Kids through the Office of the Inspector General (OIG). During the past four years, the OIG has recovered more than $110 million that had been lost due to improper payments within Medicaid. To date in Fiscal Year 2012, the office has recovered more than $17 million.
"The RAC acts as an agent of the department to supplement the work being done by the Program Integrity Unit of OIG," said DCH Interim Inspector General Toni Prine.
The Office of Inspector General has a staff of nearly 60 employees who spend a majority of time on cases that are not related to criminal fraud. If criminal fraud is suspected, the case is referred to the Medicaid Fraud Control Unit of the Georgia Attorney General's office for further investigation and possible prosecution.
While the OIG functions with a strong fiduciary responsibility, it has another charge -- the safety and security of every Medicaid member.
"Surprisingly, everyone thinks that we spend all our time investigating fraud," said former Inspector General Rob Finlayson. "Most of our recovery work centers on audits, data mining and recovering mis-payments made to providers that are the result of human error, incomplete or insufficient documentation, or services that were determined not to be necessary."
Investigations may be triggered in a variety of ways: through random examination of data, periodic financial and payment system audits, complaints received by the OIG or other agencies, follow-up regarding trends reported in other states, on-site and desk reviews of medical records and prescriptions, or responses to questionnaires sent to patients who have received Medicaid services.
The OIG interfaces with numerous federal, state and local agencies, including the U.S. Attorney's Office, the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), HHS Office of the Inspector General (HHS OIG), the Federal Bureau of Investigation (FBI) and the Social Security Administration, as well as state and local law enforcement.
"In all, our job is to protect the safety and security of our Medicaid patients and to assure that the monies entrusted to Georgia Medicaid are properly spent," Prine said. "Our mission is to reduce fraud, waste and abuse."
Editor's Note: Former DCH Inspector General Rob Finlayson has taken a position in the private sector. As of May 1, 2012, Deputy Inspector General Toni Prine has been named Interim Inspector General. Prine joined DCH in July 2006 and was named Deputy Inspector General in October 2009.
--Article by Karen S. Rothschild and Pamela A. Keene, DCH Communications
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Georgia Leads Nation in Wellness Engagement
Health care providers play an important role in helping members keep the Wellness Promise, by collecting four biometric measures -- blood pressure, cholesterol, glucose and body mass index -- and faxing the completed biometric screening fax form to each member's health plan administrator -- either Cigna or UnitedHealthcare. Wellness members will be coming to providers through June to have a biometric screening with the understanding that their results will be faxed to their respective health plan administrator by June 30, 2012, to meet the Wellness Promise deadline. Knowing and understanding these measures is considered crucial to good health.New wellness plan options make Georgia's State Health Benefit Plan (SHBP) the largest wellness plan in the nation. Nearly 355,000 state employees, teachers, school employees, retirees and covered spouses have been asked to fulfill the Wellness Promise, which includes undergoing a biometric screening and completing an online health assessment. That figure represents more than 53 percent of all those covered by the SHBP.
Wellness examinations are covered for SHBP members at 100 percent. Coding these examinations as 99381-99387, 99391-99397, 9940199404 and 99411-99412 will ensure that they will be paid as preventive care; each of the biometric screenings is also covered at 100 percent if coded properly and the member is seeing an in-network physician.
Wellness members must fulfill the Wellness Promise requirements by June 30, 2012, deadline to be eligible for the valuable Wellness Plan options in 2013. These options may have lower deductibles, lower premiums and lower out-of-pocket costs than the Standard options.
"Engaging people in their own health care promotes wellness and it makes good sense," said DCH Commissioner David A. Cook. "When we examined plan options for this calendar year, we saw the positive effects of including wellness, and more than half of our members chose a wellness plan for their health insurance coverage. This is a trend that's sweeping the nation and now Georgia's state employees, teachers, school personnel and retirees are able to take advantage of the benefits of wellness plan options."
According to the 2011 Willis Health and Productivity Survey, more employers are starting wellness programs, and the majority of organizations with programs currently in place are looking to invest and expand. Sixty percent of employers recently reported that they have some type of wellness program in place.
Nearly 1,600 employers were surveyed, including public, corporate, education, law, technology and non-profits. The survey also showed an increase of 13 percent in the creation of wellness programs compared with 2010 responses.
The survey further showed that 58 percent of employers plan to expand their wellness initiatives by adding programs and resources.
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Keeping the Wellness Promise
How Physicians Can Help

SHBP is encouraging members to work more closely with their physicians to become more engaged in their health and well being as they work toward wellness goals.
SHBP members/patients should take the "physician screening fax form," available at www.dch.georgia.gov/shbp, with them to their physician appointment. SHBP members/patients should have completed the Patient Information Section and will ask you, their practitioner, to sign and complete the rest of the form with lab results included. Then you or your staff will fax it directly to the fax number shown on the form for the respective health plan administrator -- Cigna or UnitedHealthcare.
If you are a practitioner who treats SHBP's Wellness Plan patients, please help them obtain their biometric screening as soon as possible so they can fulfill their participation promise to the state.
"By choosing a Wellness Plan option, each member (and covered spouse) made the commitment to fulfill their Wellness Promise by obtaining a biometric screening between July 1, 2011, and June 30, 2012, and completing an online health assessment with their health plan administrator between January 1, 2012, and June 30, 2012," said Trudie Nacin, division chief of SHBP. "The biometric screening measurements can also be collected at a SHBP-sponsored onsite employment location or at the member's physician's office. Since the SHBP-sponsored screening sites are limited, many of Wellness Plan members will see their physician to obtain the biometric screening."
The deadline for receipt of the physician screening fax form showing the biometric screening results is June 30, 2012. SHBP is advising members to plan ahead and allow a minimum of two to three weeks for processing lab results and for the completion and faxing of the forms by their physician's office.
If you as a physician or other provider have questions, please contact Michealla James at 404-651-6117.
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Are You Attending the Medicaid Fair?
DCH Medicaid Chief Jerry Dubberly, Pharm.D., will begin the day with a presentation about the redesign as well as updates on 5010 and ICD-10 initiatives.On Tuesday, May 8, DCH and HP Enterprise Services (HPES) will host the semi-annual Medicaid Fair in Athens, Ga. Last May, more than 1,000 people attended the first Medicaid Fair at the Georgia World Congress Center. This year, the Medicaid and CHIP Redesign will be one of many hot topics for the full-day fair.
All active or prospective Medicaid providers (physicians, nurses, dentists, practice management and billing staff, hospital services, third-party payers and more) are encouraged to attend. DCH and HPES have developed presentations that will benefit attendees on topics including Medicaid eligibility, ICD-10 and a review of the remittance advices.
This year, providers are being asked to register for each of the Care Management Organization (CMO) sessions. Amerigroup Community Care, Peach State Health Plan and WellCare of Georgia will offer panel discussions and/or presentations. Sessions designed for new office staff have been added. Providers may also select the Medical Assistance Provider Incentive Repository (MAPIR) session to learn more about the Medicaid EHR Incentive Program and the incentive payments available to eligible professionals and hospitals for incorporating electronic health records into their practices. Session options are available on the registration form.
The Medicaid Fair
Tuesday, May 8 7:30 a.m. to 5:30 p.m. ET
The Classic Center 300 N. Thomas Street Athens, Ga. 30601
Sign-in -- 7:30 a.m. Opening Session -- 8:30 a.m. Parking is free.
Register online Attendees must register to reserve a seat for each individual session.
For location and directions as well as dining and lodging options in the area, please visit http://www.classiccenter.com.
Medicaid provides medical assistance for eligible low-income individuals, as well as those who are aged, blind or disabled, and is supported by state and federal tax dollars. In Georgia, DCH administers the Medicaid program, covering nearly 1.7 million adults and children.
--Article by Karen S. Rothschild, DCH Communications Deputy Director
More than $63 Million Paid in EHR Incentive Payments
Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued more than $63 million to eligible providers through April 2012. The program was launched on September 5, 2011.

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Speaking Up!
Commissioner Cook will address these organizations during May and June: Thursday, May 17 -- Sandy Springs Perimeter Chamber of Commerce -- www.sandyspringsperimeterchamber.com Sunday, May 20 -- Society of Neurological Surgeons -- http://www.societyns.org Thursday, May 24 -- DeKalb Medical Society -- http://www.dekmedsoc.org Friday, June 15 -- Georgia State Medical Association -- http://gsmanet.org
Deputy Commissioner Fulenwider will address these organizations during May: Wednesday, May 23 -- The Corporate Volunteer Council of Atlanta -- http://www.cvcofatlanta.org
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Recent Board Actions
At its Thursday, April 12, meeting, the Board of Community Health took the following actions: Resolution: SHBP Revised State Employees Plan Employer Contribution Rates FY 2012 Public Notice: Nursing Facility Services (Initial Adoption)
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Meetings and Public Comment Opportunities
Next Board of Community Health Meeting -- Thursday, May 10 -- 10:30 a.m. -- 2 Peachtree Street, 5th Floor Board Room, Atlanta.
Get News You Can Use Join our mailing list for DCH-i at DCH-i@dch.ga.gov.

Editor-in-Chief Pamela A. Keene
Graphic Design Karen Rothschild
Webmaster Jeffrey L. Holt
Production Iris McIlvaine
Circulation Denise Smith
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.
We are dedicated to A Healthy Georgia.
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