First Quarter 2014 Volume 3, Issue 2 Revalidation and Application Fees Begin April 1, 2014 Starting April 1, 2014, two requirements of the Affordable Care Act (ACA) -- Revalidation of Enrollment (Revalidation) and Application Fees -- will be implemented by the Department of Community Health (DCH). All providers are urged to update their contact information in the Georgia Medicaid Management Information System (GAMMIS, www.mmis.georgia.gov) as soon as possible to assure proper continuity of communication. The process will begin with providers who enrolled in Georgia Medicaid before December 31, 2012. Hewlett Packard (HP) will notify providers by letter when it is time for them to revalidate their information. Please do not begin the Revalidation process until you receive correspondence from HP to do so. The correspondence will include process details. Revalidation is applicable to all providers at all service locations. Application Fees will impact only certain facility types, not individual practitioners. Both ACA requirements were enacted into law to help reduce fraud, waste and abuse of the Medicaid program. Also, the ACA requires that Revalidation be conducted every five years. Application Fees will be collected at initial enrollment and at Revalidation or every five years. For additional questions, please read the detailed Frequently Asked Question documents about both topics that are posted on the DCH website under Provider News. Or contact ApplicationFeeEnrollment@dch.ga.gov for questions about Application Fees and RevalidationEnrollment@dch.ga.gov for questions regarding Revalidation. OPR Claims Edits To Begin for All Providers The Affordable Care Act now requires that Ordering, Prescribing and Referring (OPR) physicians be enrolled in Medicaid, even if the OPR provider is not filing claims. OPR providers should access the Georgia Medicaid Management Information System (GAMMIS) website at www.mmis.georgia.gov to register. During the enrollment process, individual practitioner applicants have the option to list both their Individual and/or Organizational National Provider Identifier (NPI) numbers on the enrollment application. If the enrolling provider orders, prescribes or refers services for Medicaid members, the individual practitioner's NPI must be listed on the claim, not an organizational NPI. Editing for OPR Pharmacy claims began on October 1, 2013. Claims without the OPR provider's individual NPI are being denied. Editing for other OPR claims will begin on April 1, 2014. The edit will be informational through May 31, 2014. As of June 1, 2014, DCH will begin to deny claims that require an enrolled ordering, prescribing or referring provider. For complete information, read the Frequently Asked Questions on the DCH website. Georgia Families 360sm Managed Care Launched In a move designed to improve continuity of health care and better health outcomes, the Georgia Department of Community Health (DCH) has transitioned more than 27,000 children in foster care and adoption assistance, as well as select youth in the juvenile justice system into a single Care Management Organization (CMO). Follow Us! In This Issue Provider Rate Increase Begins November 1 Register for November Medicaid Fair On the Road to ICD-10 National Rural Health Day Provider Update: OPR Edits Begin News for Providers -- Revalidation, Application Fees EHR Incentives September, October Board Actions About DCH-i DCH-i is the regular 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. The program, called Georgia Families 360sm, is the result of collaboration between DCH, a number of child-serving state agencies, and the Children and Families Task Force that includes stakeholders and advocates. "The focus of Georgia Families 360 is on the well-being and betterment of the youth our agencies serve in Georgia," said DCH Commissioner Clyde L. Reese III, Esq. "We are very pleased with all the cross-agency work and planning that has gone into this new program and are certain that the health of these members will be improved." The transition of members began on March 3, 2014, after months of study, preparation, planning and agency training. It is the outgrowth of DCH's ongoing Medicaid Redesign Program that was launched in 2011. Amerigroup Community Care of Georgia, one of the state's CMOs, is providing health care coverage for these populations. Do you have a question or a comment? Tell us what's on your mind at DCH-i@dch.ga.gov. About DCH Program goals are to: Improve access to health care services, particularly for physical and behavioral health services covered by the Medicaid program. Increase continuity of care, including when members transition in and out of foster care. Enhance health outcomes, providing additional care coordination and improved physical and behavioral health oversight. Each member will have an assigned care coordination team to work closely with Division of Family and Children Services (DFCS) and Department of Juvenile Justice (DJJ) personnel and affiliated providers across the state. The collaboration of the care coordination teams and agency staff will involve the development of health care plans and the monitoring and measurement of each member's health outcomes. Members will also have a medical and dental home to promote consistency and continuity of care. Providers, foster parents, adoptive parents and other caregivers will be involved in the ongoing health care plans to ensure that the physical and behavioral health needs of these populations are met. Electronic Health Records (EHRs) are being used to enhance effective delivery of care. The EHRs can be accessed by Amerigroup, physicians in the Amerigroup provider network, and DCH sister agencies, including the DFCS, regardless of where the child lives, even if the child experiences multiple placements. Ombudsman and advocacy staff are in place at both DCH and Amerigroup to support caregivers and members, assisting them in navigating the health care system. Additionally, medication management will focus on appropriate monitoring of the use of psychotropic medications, to include ADD/ADHD medications. Background about Georgia Families 360 In an exceptional collaboration, seven state child-serving agencies have come together for this transition -- the Department of Community Health, the Department of Human Services, the Department of Behavioral Health and Developmental Disabilities, the Department of Public Health, the Department of Juvenile Justice, the Department of Education, and the Department of Early Care and Learning. These state agencies bring a focused commitment to the transition and added emphasis on outreach, education and communication with key stakeholders, members, caregivers, foster parents, adoptive parents and providers. As part of the Medicaid Redesign, DCH formed a Children and Families Task Force to study ways to improve care. The work done during the redesign, plus input received from members of the task force, assisted DCH in identifying opportunities for improvement in the delivery of care for these populations. Georgia Families 360 is the result of this collaboration. For more information, visit Georgia Families 360 on the DCH website. Through effective planning, purchasing and oversight, the Department of Community Health (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. Clyde L. Reese III is the DCH Commissioner. We are dedicated to A Healthy Georgia. www.dch.georgia.gov Editor-in-Chief Pamela A. Keene Director of Communications and Legislative Affairs Lisa Marie Shekell DCH Mission We will provide Georgians with access to affordable quality health care through effective planning, purchasing and oversight. Spring Medicaid Fair Set for May 22; Focuses on ICD-10 With a focus on ICD-10 readiness, the 2014 Spring Medicaid Fair is scheduled for Thursday, May 22, at the Gwinnett Convention Center. In addition to the basic sessions for providers and office support staff, special sessions throughout the day will provide detailed information about the upcoming federally mandated transition to ICD-10 Code Sets, starting on October 1, 2014. The day-long session will include presentations, panel discussions and an opportunity to talk one-on-one with various exhibitors about claims issues and other topics. Registration will be open soon. Watch your email for registration details. We are dedicated to A Healthy Georgia. Ready, Set, Test: ICD-10 Moves Forward ICD-10 will go live on October 1, 2014. With a little more than six months until this mandated transition, the Department of Community Health (DCH) and Georgia Medicaid have begun testing with providers. The DCH ICD-10 team hosts frequent webinars to assist providers, trading partners and other stakeholders with making the transition. Here are some of most frequently asked questions about testing that DCH is receiving: Is it necessary for us to do Beta-testing? It is not a requirement to test with DCH. However, to determine your facility's readiness for the ICD-10 transition, it is highly suggested that you participate in testing with your trading partners/clearinghouse if possible. What are the benefits of testing? Having hands-on experience prior to October 1, 2014, is a simple way to help minimize issues that may occur on October 1, 2014. Who is DCH planning to test with? DCH and Georgia Medicaid's testing initiatives will occur with the following: Selected Beta Testers Trading Partners -- clearinghouses, billing firms, others Providers -- small rural providers; border providers; high-volume/high-dollar providers Sister Agencies Department of Corrections (DOC) Department of Public Health (DPH) Department of Behavioral Health and Developmental Disabilities (DBHDD) Care Management Organizations (CMOs) Amerigroup Community Care Peach State Health Plan WellCare Prior Authorization Vendors TPL Vendors Auditing Vendors What are the DCH testing guidelines? Limit the number of claims submitted in an 837 file to 100 claims. A maximum of three test files may be submitted. Do not submit production-size files due to limited testing environment capacity. Ensure that the necessary analysis and corrections have occurred within your systems prior to files being resubmitted. The ability to use a simulated ICD-10 effective date for User Acceptance Testing (UAT) purposes. When will testing begin? ICD-10 external testing began in early 2014. If you have not already volunteered for testing, send an email to ICD10project@dch.ga.gov. You will be contacted by Lena Gomes, DCH external testing lead, to begin the process. Stay Informed ICD-10 information is just a click away. Visit www.dch.georgia.gov/icd-10 for more information and resources, as well as the most recent webinar schedule. The website also includes links to previous webinars. Join the mailing list to receive updates to ICD-10 news, webinars and events by emailing AskDCH@dch.ga.gov. Providers Receive ACA Rate Increase Payments As of January 1, 2014, DCH began making the Fee-for-Service (FFS) payment increases retroactive to January 1, 2013. All retroactive payments are now current for FFS, except for a subset of HealthCheck claims that will be complete by the end of March. The state's contracted care management organizations (CMOs) began making retroactive payments to providers in early January 2014. Each CMO has developed its own schedule for making these payments to providers. According to self-reported schedules from the CMOs, here are the expected dates for retroactive payments for dates of service between January 1 and December 31, 2013: Amerigroup, February 24; Peach State Health Plan, March 28; and WellCare, May 19. Nearly $213 Million Paid in EHR Incentives Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued nearly $213 million in payments of federal funds to eligible providers through March 17, 2014. The program was launched on September 5, 2011. Board Actions First Quarter 2014 The Board of Community Health January 9, meeting was canceled. The Board of Community Health took the following actions at a special called meeting on Monday, January 27: A Resolution: State Health Benefit Plan, Plan Design Changes -- 01-27-14 Because of inclement weather, the Board of Community Health did not meet in February. The Board of Community Health took the following actions at its Thursday, March 13, meeting: Emergency Air Ambulance for Adults Public Notice -- Initial Adoption -- 03-13-14 The Board of Community Health took the following actions at a special called meeting on Monday, March 24: RULE -- HFR Chapter 111-8-40 Rules and Regulations for Hospitals -- Initial Adoption -- 03-24-14 The next regular meeting of the Board of Community Health is scheduled for Thursday, April 10, in the 5th Floor Board Room at 2 Peachtree Street, Atlanta.