Gary B. Redding Commissioner 404.656.4507 404.651.6880 fax Sonny Perdue, Governor 2 Peachtree Street, NW Atlanta, GA 30303-3159 www.communityhealth.state.ga.us The Honorable Sonny Perdue Governor of Georgia Members of the General Assembly of Georgia Citizens of the State of Georgia Ladies and Gentleman: I am submitting for your review the State Fiscal Year 2002 annual report, which summarizes the activities and accomplishments of the Department of Community Health during the period of July 1, 2001, through June 30, 2002. Fiscal Year 2002 has been a productive one for the Department, with numerous milestones and ongoing projects that position the Department as a national leader in innovative health planning, promotion, systems development and services to improve community health. On behalf of the Department, I wish to express my appreciation for your support and assistance. As in the past, the Department is committed to making cost-effective health care available to every Georgian that DCH serves, which currently is over two million citizens. Respectfully yours, Gary B. Redding An Equal Opportunity Employer Table of Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Roles and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Board of Community Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Components of the Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DCH Milestones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 DCH Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Department Divisions and Offices Division of Medical Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Medicaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Medicaid Statistical Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Total Recipients 11-Year Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Expenditures per Recipient 11-Year Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Medicaid Profile of Recipients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Medicaid Expenditures by Category of Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Medicaid Recipients and Expenditures by County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 PeachCare for Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 PeachCare for Kids Statistical Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 PeachCare for Kids Profile of Recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 PeachCare for Kids Expenditures by Category of Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 PeachCare for Kids Recipients and Expenditures by County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Indigent Care Trust Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ICTF Participating Hospitals Regular Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fraud and Abuse Prevention and Detection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Savings, Recoupment, Collections and Restitution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Division of Health Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Statistical Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Planning and Data Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Georgia Health Care at a Glance Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Regulatory Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 CON Activity 11-Year Summary of Applications Submitted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table of Contents Division of Public Employee Health Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Statistical Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Covered Lives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Covered Lives by Plan Member Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Covered Lives by Plan Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Covered Lives by HMO Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Operating Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Vendor Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 System Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Health Improvement Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Office of Women's Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Milestones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Office of Minority Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Milestones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Office of Rural Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Milestones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Commission on Men's Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Milestones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Mission Statement The Georgia Department of Community Health is committed to improving the health of all Georgians through health benefits, systems development, and education. Overview Purpose of the Department On April 19, 1999, Senate Bill 241 became law and established the Georgia Department of Community Health (DCH). The law consolidated three state agencies involved in purchasing, planning and regulating health care in the state. DCH began operating as an official agency on July 1, 1999. The Department was created by the General Assembly in response to growing concern about fragmentation of health care delivery at the state level. The legislation outlined several purposes for the Department: to serve as the lead planning agency for all health issues in the state; to permit the state to maximize its health care purchasing power; to minimize duplication and maximize administrative efficiency in the state's health care systems by removing overlapping functions and streamlining uncoordinated programs; to allow the state to develop a better health care infrastructure more responsive to the consumers it serves while improving access and coverage; and to promote wellness. Our mission and vision statements support the Department's stated purpose: Mission Statement The Georgia Department of Community Health is committed to improving the health of all Georgians through health benefits, systems development, and education. Vision Statement We will be a national leader for innovative health planning, promotion, programs and services to improve community health. Roles and Responsibilities of the Department The Department has several broad responsibilities: insuring over two million Georgians; administering a budget exceeding $7 billion; planning for coverage of uninsured Georgians, currently an estimated one million persons; and coordinating health planning for state agencies. Among its many challenges, the Department must ensure that quality health care services are provided to a diverse population, including members of the State Health Benefit Plan, which covers teachers, state employees, retirees and eligible dependents; children covered under the PeachCare for Kids program; and the aged, low-income, blind, and disabled covered by Medicaid. 1 Overview The Board of Community Health The Department is governed by a nine-person board appointed by the Governor and confirmed by the Senate. The Board of Community Health has policy-making authority for the Department. Board meetings are held monthly. As of June 30, 2002, members of the Board of Community Health were as follows: Ms. Joyce Blevins Thomson, Georgia Mr. Russ Toal Atlanta, Georgia Mr. Lloyd Eckberg Thomasville, Georgia Stephanie Kong, M.D. Atlanta, Georgia Gary Edelman, M.D., Vice Chairperson Tucker, Georgia Frank Rossiter, M.D., Secretary Savannah, Georgia Ms. Carol Fullerton, Chairperson Albany, Georgia Mr. Kent (Kip) Plowman Augusta, Georgia Mr. Richard Holmes Atlanta, Georgia Components of the Department The following describes the role that each entity plays to support the mission of the Department of Community Health: Division of Medical Assistance The largest in Community Health, the Division of Medical Assistance administers the Medicaid program, which provides health care for people who are aged, blind, disabled or indigent. The division also administers the PeachCare for Kids children's health insurance program and the Indigent Care Trust Fund. Other Medicaid programs include Georgia Better Health Care, home- and community-based services, and non-emergency transportation. The division spent just under $6 billion to provide services to over 1.5 million Georgians during the fiscal year. Division of Health Planning The Division of Health Planning works to contain health care costs by developing rules designed to avoid unnecessary duplication of services, equipment and facilities. The rules developed by the division are enforced through the Certificate-of-Need (CON) program, which is administered by the Department's Office of General Counsel. Through the CON program, decisions are made regarding applications to expand health care facilities and services. The division also collects and analyzes health care data and is responsible for the work of the Health Strategies Council, which develops plans and regulatory criteria for health care services. Division of Public Employees Health Benefits The Division of Public Employees Health Benefits is responsible for the day-to-day administration of the State Health Benefit Plan, which covers state employees, teachers, retirees and dependents. Daily administrative responsibilities include monitoring vendors, processing 2 Overview member requests and appeals, determining eligibility, assisting personnel/payroll offices and conducting open enrollment. Also, the division works with the Board of Regents to coordinate health care coverage for university system employees. At the close of the 2002 fiscal year, the State Health Benefit Plan covered more than 600,000 members, with expenditures of $1.5 billion. The Board of Regents Health Plan had 84,000 members. Office of Women's Health The Office of Women's Health addresses women's health issues in a comprehensive state plan. Also, the office works to improve women's health and quality of life through education, research, policy development, and coordination of women's health programming. Attached to the office is an 11-member advisory council. Office of Minority Health This office develops initiatives to improve the health of minority communities and works to eliminate disparities in health status between minority and non-minority populations. The office has a 12-member advisory council. Office of Rural Health Services The mission of the Office of Rural Health Services is to optimize health status and to eliminate health disparities of persons in rural and underserved areas of Georgia through the development of regional systems of quality health care. The following entities are administratively attached to the Department of Community Health. The Governor appoints members to each board. Commission on Men's Health The Georgia Commission on Men's Health develops strategies, public policy recommendations and various programs that are designed to educate Georgia's men on the benefits of preventive health care and healthy lifestyle practices. The commission also monitors state and federal policy and legislation that may affect men's health, and recommends assistance, services and policy changes that will further the commission's goals. Composite State Board of Medical Examiners Twelve physicians and one consumer representative comprise this 13-member board, which is responsible for licensing and regulating physicians, physician assistants, respiratory care professionals, acupuncturists, auricular detoxification specialists, paramedics and cardiac technicians. The board maintains a comprehensive database that offers the public access to information about licensed physicians in the state. The board publishes its own annual report and copies may be requested by calling the board at 404-656-3913. Georgia Board for Physician Workforce This 15-member board develops medical education programs through financial aid to medical schools and residency training programs. The board monitors and evaluates the supply and distribution of physicians by specialty and geographic location to identify underserved areas of the state. For more information, contact the board by calling 404-206-5420. State Medical Education Board This seven-member board administers medical scholarships and loans to promote medical practice in rural areas. Initiatives include the Country Doctor Scholarship and Loan Repayment programs, which encourage physicians to practice in Georgia's underserved areas. The board publishes a biennial report, which is submitted to the Georgia General Assembly. Contact the board at 404-206-5420 to request a copy of the report. 3 Overview FY 2002 DCH Milestones The milestones listed below reflect activities that impacted the performance or operations of multiple DCH divisions and/or sections. Milestones of individual divisions and sections are listed in their respective pages within this annual report. MultiHealth Network Project (MHN) The Department is implementing a comprehensive health care information system for all health plans administered by DCH. The new information system will permit the Department to realize administrative efficiencies, meet Health Insurance Portability and Accountability Act (HIPAA) requirements and provide an integrated, user-friendly access point for members and providers, by including all health plans on one consolidated technology platform. Under the existing systems environment, the Medicaid and PeachCare programs, State Health Benefit Plan and the Board of Regents Health Plan utilize three different computer platforms that do not interface. The lack of interface results in a duplication of processes and unnecessary costs. Additionally, there is a lack of data element uniformity that limits the Department's ability to analyze data across plans. As a result, there are significant opportunities to realize administrative efficiencies and savings from the consolidation. Through a competitive procurement process, DCH selected Affiliated Computer Services, Inc., (ACS) to serve as the prime contractor/ system integrator, with the mission of customizing new, state-of the-art technology to support the needs of DCH in processing health care information for Medicaid, the SHBP and other related entities. ACS is also responsible for maintaining the system to ensure the long-term viability of the project. The new system is called the MultiHealthNet or "MHN." During FY 2002, the Department worked on MHN implementation tasks with actual implementation planned to occur in phases during fiscal years 2003 through 2005. Pharmacy Cost Controls Pharmacy costs are among the fastest rising health care costs in plans administered by DCH. Continued strategies must ensure that members get the right medications, for the right length of time so that treatment is the most effective possible. The cost and utilization of pharmaceuticals has risen at a double-digit rate the past few years. In October 2000, the Department contracted with Express Scripts, Inc. (ESI), a pharmacy benefits manager (PBM) to assist with the management of this program. The PBM was hired to manage the pharmacy benefits for all four health plans administered by the DCH, including Medicaid, PeachCare for Kids, the State Health Benefit Plan and the Board of Regents Health Plan. The PBM adjudicates the pharmacy claims processing for all two million members of the health plans. Through implementation of several initiatives, including: a point-of-sale system, an aggressive maximum allowable cost program, a most-favored-nations program with improved enforcement, a three-tiered co-payment strategy applied to a preferred drug list, an expanded prior authorization program, a policy of cost avoidance for members with other health insurance, and a host of other clinical programs, The Department has reduced the annual growth rate in pharmacy program expenditures within Medicaid and PeachCare from a high of 26.0% during FY 2000, to a rate of 21.7% during FY 2001 and 18.2% during FY 2002. When controlling for the increases in enrollment, growth rates for expenditures dropped more dramatically, ranging from a high of 26% during FY 2000, to a rate of 6% during FY 2001 and 5% during FY 2002. The Department will continue to look for new ways to help contain costs within this fast-growing benefit category. Agency Reorganization The Department recently completed the preliminary phase of a focused, third-party assessment of each of its business processes in an initiative known as the Service Improvement Project. The final outcome of the assessment will be used to facilitate process changes throughout the Department that will be driven by: implementation of MHN, compliance with HIPAA, initiation of other potential major changes in state health plans, analysis of each DCH business unit in detail, and integration of DCH operating units. 4 Overview In April of 2002, DCH integrated its operating units through an agency reorganization based on a standard private-sector model. The new organizational structure supports the overall strategy to meet the new challenges facing the Department while improving efficiency, effectiveness and customer service. The new organization chart is illustrated below, and is followed by a summary of the Department's expenditures. State Agency Coordinating Committee Department of Community Health Board of Community Health Commissioner's Office State Medical Education Board Georgia Board For Physician Workforce Composite State Board of Medical Examiners General Counsel Certificate of Need HIPAA Privacy Legislative Affairs Medicaid Legal Services Program Integrity Financial Services Accounting Financial Services Institutional Reimbursement Non-Institutional Reimbursement Procurement Information Technology Information Technology MHN Project HIPAA Transactions Operations Administrative Services Audits Communications Contract Administration Human Resources Support Services Vendor Management Managed Care & Quality Georgia Better Health Care (GBHC) Quality Improvement Planning & Fiscal Policy Budget Decision Support System Division of Health Planning Strategic Planning & Analysis State Health Benefit Plan Health Improvement Programs Division of Public Employee Health Benefits Operations Plan Management Commission on Men's Health Office of Minority Health Office of Rural Health Services (Cordele, Ga) Office of Women's Health Community Affairs Constituent Services External Affairs Medical Assistance Plans Medicaid & PeachCare For Kids Aging & Community Services Hospital Services Maternal & Child Health Pharmacy Services Professional Services Recipient & 3rd Party Services Regulatory Review 5 Overview FY 2002 DCH Expenditures Benefits Medicaid PeachCare for Kids Indigent Care Trust Fund State Health Benefit Plan Payments Services Support (Contracts) Systems Support Cancer Coalition Other Contractual Support Services Medical Education and Licensing Georgia Board for Physician Workforce State Medical Education Board Composite State Board of Medical Examiners Health Care Planning and Initiatives Health Planning Rural Health Minority Health Women's Health Maternal and Children's Health Managed Care Administration Policy and Reimbursement Legal and Regulatory State Health Benefit Plan Administration General Administration* TOTALS $5,742,507,199 $141,511,109 $516,236,808 $1,486,838,583 $7,887,093,699 97.32% $82,801,895 $2,000,000 $41,670,391 $126,472,286 1.57% $34,360,424 $1,186,150 $1,891,305 $37,437,879 0.46% $1,682,070 $5,776,088 $717,305 $451,060 $2,334,405 $2,857,568 $13,818,496 0.17% $13,420,186 $7,079,335 $4,347,052 $14,425,223 $39,271,796 0.48% $8,104,094,156 100.00% *Includes rent and utilities, state agency services, telecommunications, accounting and auditing, and other support operations. Note: Benefits expenditures based on date of service, not date of payment. 6 Division of Medical Assistance Division of Medical Assistance FY 2002 Milestones Expanded SOURCE Sites During FY 2002, the number of SOURCE sites doubled, growing from five sites to a total of ten. SOURCE stands for "Service Options Using Resources in a Community Environment" and is a demonstration project that was established to improve the health outcomes of persons with chronic conditions, using a cost-effective, comprehensive managed-care model to deliver care. Elderly individuals (65 and older) and individuals under 65 years old with disabilities who receive Medicaid benefits through the SSI or Public Law categories and who qualify for voluntary participation in GBHC are eligible for the program. SOURCE sites served the needs of over 2,000 consumers in a service area consisting of 97 Georgia counties. Nursing Home Applications Over the Internet In September 2001, the Department began offering families the opportunity to use the Internet to apply for nursing home coverage. This initiative began as a pilot program and was offered to families applying for Medicaid while at nursing homes located in the counties of Douglas, Cherokee, Rockdale, Fayette and Henry. Staff working at nursing homes participating in the pilot program were trained to use a special Internet application and were encouraged to assist families in using the new technology when applying for Medicaid. A special unit of the Department of Family and Children Services, with workers located inside of DCH, completes the application process. In early 2002, the pilot was expanded to include nursing homes in Dekalb and Johnson counties. The project now processes over 100 applications per month with an average processing time of just 23 days; the processing time for most non-Internet applications is from 60 to 90 days. Nursing Home Transition Grant Georgia was awarded a transition grant of more than $627,000 to help nursing home residents make the change into a communityintegrated living arrangement by building an outreach and support program. The goal is to provide these individuals with the support necessary to sustain long-term residence and participation in the community that is consistent with their needs and preferences. Community Services for More People The Mental Retardation Waiver Program and the Community Habilitation and Support Services Program offer home and community-based services for people who have mental retardation or a developmental disability. A diagnosis of developmental disability would include mental retardation or other closely related condition, such as cerebral palsy, epilepsy, autism or neurological problem when the level of care required by the patient involves an intermediate-care facility for people with mental retardation. Services offered include help with coordinating care, assistance with daily living activities, home health services, emergency response systems and respite care. The consumer population within these waiver programs has grown substantially, more than doubling in size from approximately 3,500 to 7,500 consumers. Implemented Community Mental Health Program Rehabilitation Option (MH Rehab Option) The MH Rehab Option started on July 1, 2001, with the purpose of promoting recovery and resiliency in adults, children, adolescents and their respective family members. Services are provided in the consumer's home, school, place of work or other natural environment rather than in a doctor's office. Assertive community treatment (ACT) teams work with non-compliant consumers to help them remain in their own communities and to decrease the frequency and length of hospitalization, and crisis services required by the consumer. ACT teams can include peer support specialists, who are people with disabilities that counsel and assist consumers in the MH Rehab Option. Peer supports provide structured, scheduled activities that promote socialization, recovery, self-advocacy, development of natural supports, and maintenance of community living skills, under the direct supervision of a mental health professional. The peer support program received national attention due to its success in meeting the service needs of Georgians. During FY 2002, a total of 50,935 Georgians received community mental health program services. Medicaid/PeachCare Drug Rebates Save $169 Million Georgia Medicaid and PeachCare provide benefits for the products of all drug manufacturers offering rebates to the state, with certain exceptions allowed by federal law. Georgia Medicaid and PeachCare drug rebates for FY 2002 totaled $169 million, which represents more than a 50% increase over the amount recovered in the previous fiscal year. PeachCare Enrollment Enrollment data for FY 2002 shows that PeachCare is making significant strides in reducing the number of uninsured children in Georgia. Since the close of fiscal year 1999, PeachCare enrollment has increased more than 65%, with more than 161,000 children enrolled at the close of the 2002 fiscal year. Well-executed outreach programs, including a partnership with the Department of Education to distribute more than two million flyers to school children, were the driving forces behind the increased enrollment. 8 Division of Medical Assistance Description of Medicaid Medicaid is a jointly funded, federal/state health care assistance program serving primarily low-income individuals, as well as children, pregnant women and persons who are elderly, blind or disabled that meet eligibility requirements. Medicaid reimburses health care providers for services given to eligible individuals. Persons who are eligible for Medicaid receive a card each month to use for health care services from participating providers. The federal government pays the largest share of Medicaid costs. Georgia's Medicaid program receives various levels of federal reimbursement for different services and functions. For example, the federal government pays 90% of the cost for family planning services and almost 60% for most other benefits. Computer costs are 75% federally funded, and most other administrative costs receive 50% federal funding. Medicaid and Medicare are often thought of as two different names for the same program. Actually, they are two different programs. Medicaid is a state-run program designed primarily to help certain people such as children, pregnant women and the aged, blind or disabled who have low incomes and little or no resources. Medicare, on the other hand, is administered by the federal government and, regardless of personal income, provides health care reimbursement to people who are at least 65 years old and meet the length-ofservice requirements for Medicare-covered employment; people less than 65 years old with qualifying disabilities or end-stage renal disease are also eligible for Medicare coverage. The chart below outlines FY 2002 Medicaid statistics. Medicaid Statistical Summary FY 2002 benefits expenditures Medicaid Benefits Medicaid NET Benefits PeachCare for Kids Indigent Care Trust Fund $5,742,507,199 $54,198,612 $141,511,109 $516,236,808 Average yearly benefit expenditure per Medicaid recipient $3,208.06 Total unduplicated count of Medicaid recipients Categorically Needy (TANF, SSI) Medically Needy Right-from-the-Start Medicaid (pregnant women and infants) Qualified Medicare Beneficiaries Breast and Cervical Cancer 1,369,629 744,006 14,864 569,844 40,043 872 Annual unduplicated count of Medicaid eligibles (all persons who received a Medicaid card during FY 2002) 1,481,158 Enrolled Medicaid and PeachCare providers (as of June 30, 2002) 80,596 Medicaid providers with paid claims 29,563 Number of Medicaid claims paid 43,954,862 9 Division of Medical Assistance Medicaid Coverage Eligibility To be eligible for Medicaid, a person must fall into at least one of the following coverage groups: the aged (over 65); the blind; the permanently and totally disabled; pregnant women; children; or parents/caretakers, when they meet income requirements and care for a Medicaid-eligible child. In all cases, the person must meet both the income and resource limits set for their respective coverage group and any established non-financial requirements. Non-financial requirements include criteria such as age, U.S. citizenship or lawful alien status, and Georgia residency. Major Coverage Groups: SSI Recipients Aged, blind or disabled individuals who receive Supplemental Security Income (SSI). Nursing Home Aged, blind or disabled individuals who live in nursing homes and have low income and limited assets. Community Care Aged, blind or disabled individuals who need nursing home care but can stay at home with special community care services. Qualified Medicare Beneficiaries (QMB) Aged or disabled individuals who have Medicare Part A (hospital) insurance, and have income less than 100% of the federal poverty level and limited resources. Medicaid will pay only the Medicare premiums (Parts A and B), coinsurance and deductibles. Hospice Terminally ill individuals who are not expected to live more than six months may be eligible for coverage. Recipients must agree to receive hospice services through a Medicaid participating hospice care provider. Low Income Medicaid (LIM) Adults and children who meet the standards of the old AFDC (Aid to Families with Dependent Children) program. Right-from-the-Start Medicaid for Pregnant Women (RSM Adults) Pregnant women with family income at or below 235% of the federal poverty level. Right-from-the-Start Medicaid for Children (RSM Children) Children under 19 years of age whose family income is at or below the appropriate percentage of the federal poverty level for their age and family size. Medically Needy Any child, pregnant woman, aged person, disabled person or blind individual whose family income exceeds the established income limit may be eligible under the Medically Needy program. The program allows persons to use incurred medical bills, paid or unpaid, to "spend down" the difference between their income and the income limit to become eligible. Breast and Cervical Cancer Program Uninsured women under age 65 who have been screened by a public health department and then diagnosed with either breast or cervical cancer may be eligible for treatment of their condition through Medicaid. Division of Medical Assistance Covered Services Ambulance Services Ambulatory Surgical Services Certified Registered Nurse Anesthetists Childbirth Education Services Children's Intervention Services Diagnostic, Screening and Preventive Services (Health Departments) Dental Services Dialysis Services Durable Medical Equipment Services Family Planning Services Georgia Better Health Care Health Check (Early and Periodic Screening, Diagnostic and Treatment) Health Insurance Premium Payment Program (HIPP) Health Insurance Premiums (Medicare Part A and Part B) Home Health Services Hospice Services Inpatient and Outpatient Hospital Services Intermediate Care for the Mentally Retarded Facility Services Laboratory and Radiological Services Medicare Crossovers Mental Health Clinic Services Non-Emergency Transportation Services Nurse Midwifery Services Nurse Practitioner Services Nursing Facility Services Oral Surgery Services Orthotic and Prosthetic Services Pharmacy Services Physician Services Physician's Assistant Services Podiatric Services Pre-Admission Screening/Annual Resident Review Pregnancy-Related Services Psychological Services Rural Health Clinic/Community Health Center Services Swing Bed Services Targeted Case Management Services Adults with AIDS Children at Risk of Incarceration Chronically Mentally Ill Early Intervention Perinatal Adult and Child Protective Services Therapeutic Residential Intervention Services Vision Care Services Waiver Services Community Care Independent Care Mental Retardation Model Waiver for Oxygen or Ventilator- Dependent Children Community Habilitation and Support Traumatic Brain Injury SOURCE (Service Options Using Resources in a Community Environment) 10 11 Division of Medical Assistance Recipients In FY 2002, Medicaid paid for health care services for 1,369,629 individuals. A total of 1,481,158 individuals were approved as eligible for Medicaid, enrolled in the program and received a Medicaid card during the year. As shown in the following chart, payments for services totaled $4,393,856,380 or approximately $3,208 per recipient. The number of recipients increased by 9.8% from FY 2001. Total Recipients 1992-2002 FY 92 FY 93 FY 94 FY 95 FY 96 FY 97 FY 98 FY 99 FY 00 FY 01 FY 02 848,029 944,378 1,058,918 1,135,212 1,181,092 1,240,885 1,234,741 1,211,567 1,201,669 1,247,256 1,369,629 Since FY 1992, the number of recipients increased 62%, largely due to eligibility expansion, most of which the federal government mandated. Expenditures per recipient have increased just over 30% since FY 1992, as indicated in the following information. Expenditures per Recipient 1992-2002 ** FY 92 FY 93 FY 94 FY 95 FY 96 FY 97 FY 98 FY 99 FY 00 FY 01 FY 02 $2,465 $2,521 $2,595 $2,646 $2,616 $2,539 $2,453 $2,539 $2,782 $2,696 $3,208 12 Division of Medical Assistance Services Making health care available and accessible to medically indigent Georgians is the focus of the state's Medicaid program. A broad array of services addresses the health care needs of those covered by the program. Specific statistics follow. Medicaid Profile By Aid Category Aged, Blind or Disabled Low Income Children Right-from-the-Start Medicaid for Children Low Income Adults Right-from-the-Start Medicaid for Pregnant Women Breast and Cervical Cancer Recipients 296,092 (21.62%) 377,930 (27.59%) 476,160 (34.77%) 124,891 (09.12%) 93,684 (06.84%) 872 (00.06%) Payments ** $2,696,917,554 (61.38%) $557,273,598 (12.68%) $527,655,524 (12.01%) $306,978,298 (06.99%) $296,121,866 (06.74%) $8,909,540 (00.20%) By Age Under 1 year 1 to 5 years 6 to 20 years 21 to 44 years 45 to 64 years 65+ years 164,384 (12.00%) 304,868 (22.26%) 443,861 (32.41%) 241,980 (17.67%) 96,603 (07.05%) 117,933 (08.61%) $429,161,098 (09.77%) $314,176,463 (07.15%) $692,549,983 (15.76%) $1,020,365,216 (23.22%) $823,172,940 (18.73%) $1,114,430,680 (25.36%) By Gender Male Female 541,273 (39.52%) 828,356 (60.48%) $1,587,728,962 (36.14%) $2,806,127,418 (63.86%) By Residence Rural Urban 550,738 (40.21%) 818,891 (59.79%) $1,892,043,939 (43.06%) $2,501,812,441 (56.94%) By Race Unknown White African-American American Indian/Alaskan Native Asian/Pacific Islander Hispanic/Latino 132,062 (09.64%) 544,497 (39.76%) 670,634 (48.96%) 1,036 (00.08%) 12,597 (00.92%) 8,803 (00.64%) $475,646,262 (10.83%) $2,142,020,516 (48.75%) $1,743,317,300 (39.68%) $1,827,606 (00.04%) $24,611,178 (00.56%) $6,433,518 (00.15%) Total 1,369,629 (100%) $4,393,856,380 (100%) 13 Division of Medical Assistance Below are descriptions of covered services, providers with paid claims, recipients and expenditures by category of service. Physician Services Pays for services provided by licensed physicians. Over 72% of all recipients visited physicians last year. Physician services accounted for 11% of benefit expenditures in FY 2002. Reimbursement: Medicare's Resource-Based Relative Value Scale (RBRVS) is used to set the statewide maximum allowable fee. For FY 2002, physician reimbursement rates were increased. The new rates were calculated at 90% of Medicare's 2000 RBRVS rates with no adjustment for inflation. In the previous fiscal year, rates were set at 90% of the 1999 RBRVS rates plus a 3.6% inflation adjustment. Category of service Total Physician Services Providers with paid claims 16,732 FY 2002 recipients 990,755 Expenditures per recipient $505.41 FY 2002 expenditures** $500,732,913 Pharmacy Services Covers drugs requiring a prescription, insulin, diabetic supplies and certain nonprescription drugs; a few require prior approval. Accounted for 17% of benefit expenditures in FY 2002; 69% of recipients used pharmacy services during the year. DCH contracted with Express Scripts to review and process prior approval requests. Rebate agreements with pharmaceutical manufacturers saved the state $169 million in FY 2002. Category of service Total Pharmacy Services * Excludes drug rebates Providers with paid claims 1,910 FY 2002 recipients 940,675 Expenditures per recipient $805.67 FY 2002 expenditures** $757,869,724* Hospital Services Inpatient services are covered when services cannot be provided on an outpatient basis. Most inpatient hospital stays and outpatient surgical procedures must be certified prior to admission. Outpatient services may include emergency room care, outpatient surgery and clinic services. Hospital services accounted for 30% of total Medicaid benefits expenditures in FY 2002. Reimbursement: For inpatient services, a Diagnosis Related Group (DRG) based system is used, which is similar to the one used by Medicare. Reimbursement is based on diagnosis, with payments increasing with the severity of a patient's condition. For outpatient services, interim reimbursement is based on a percentage of charges, with cost settlement for the reporting period at 90% of costs for most hospitals. Critical access hospitals are reimbursed at 100% of costs. Category of service Hospital Services Hospital, Inpatient Hospital, Outpatient Total Hospital Services Providers with paid claims 380 770 FY 2002 recipients 221,346 645,823 Expenditures FY 2002 per recipient expenditures** $3,946.97 $685.76 $873,646,289 $442,879,326 $1,316,525,615 14 Division of Medical Assistance Nursing Facility Services Covers institutional care for recipients who are unable to remain at home or in the community. The quality of nursing home care is regulated by the Office of Regulatory Services, a part of the Georgia Department of Human Resources. Accounted for 20% of total Medicaid benefits expenditures in FY 2002. Reimbursement: Per diem rates are calculated from standardized cost reports. Allowable costs are determined using Department policy, federal principles of reimbursement and audits of cost reports. The June 30, 2000, cost reports and an overall growth allowance of 6.2% were used to set reimbursement rates for FY 2002. Category of service Nursing Facilities Nursing Home Intermediate Care-MR Nursing Home Services Swing Bed Services Total Nursing Facilities Providers with paid claims 13 704 17 FY 2002 recipients 1,341 52,049 137 Expenditures FY 2002 per recipient expenditures** $79,902 $15,021 $4,215 $107,148,842 $781,824,005 $577,483 $889,550,330 Maternal and Child Health Services Covers prenatal and perinatal care and family planning, pays for children's preventive health care through the HealthCheck program, helps children with physical and developmental problems, and assists children at risk through the Family Connection Program. The category represented 2% of total Medicaid benefits expenditures for FY 2002. Category of service Providers with paid claims Maternal and Child Health Childbirth Education Program 22 Children at Risk Case Management 36 Children's Intervention Services 1,608 Early Intervention Case Management 152 Family Planning 91 HealthCheck (EPSDT) 1,795 Perinatal Case Management 93 Pregnancy-Related Services 71 Total Maternal and Child Health Services FY 2002 recipients 563 7,066 25,792 4,584 24,445 326,371 55,005 14,937 Expenditures FY 2002 per recipient expenditures** $31.09 $519.88 $1,668 $17,502 $3,673,455 $43,026,809 $775.68 $109.61 $106.55 $111.78 $98.48 $3,555,702 $2,679,492 $34,773,474 $6,148,259 $1,471,070 $95,345,763 15 Division of Medical Assistance Other Practitioner Services Covers preventive and routine dental services for children and certain emergency services for adults. Dental services were the most widely used services in this category in FY 2002. About 21% of all recipients visited a dentist during FY 2002. Reimbursement rates to dentists increased 3.5% compared to the previous fiscal year. During FY 2002, an additional 64,000 children in Georgia received dental care through Medicaid compared to FY 2000, when reimbursement rates to dentists were increased for common dental procedures. Additionally, the number of dental providers that submitted claims for services performed on children grew by over 21% from FY 2000 to FY 2002. Also includes: optometric services; podiatry and psychology services; the care provided by nurse midwives, nurse practitioners, physician's assistants and certified registered nurse anesthetists (RNA); and reimbursements to county health departments and private providers through the diagnostic, screening and preventive services program, which covers pregnancy and postpartum care, adult immunizations, and screening and treatment of hypertension, tuberculosis and sexually transmitted diseases. Reimbursement for most other services in this category is the lower of the submitted charge or Medicare's Resource-Based-RelativeValue-Scale rate for the procedure. Services in this category accounted for 3.5% of total Medicaid benefits expenditures during the fiscal year. Category of service Providers with paid claims Other Practitioner Services Certified RNA 866 Dental, Adult 738 Dental, Child 986 Dental Oral Surgery 41 Diagnostic, Screening and Preventive Services 34 Nurse Midwife 171 Nurse Practitioner 767 Optometry 678 Physician's Assistant 623 Podiatry 294 Psychology 601 Total Other Practitioner Services FY 2002 recipients 43,225 44,886 235,950 527 72,130 19,527 78,540 86,376 54,931 40,870 27,603 Expenditures FY 2002 per recipient expenditures** $145.79 $282.21 $360.67 $157.19 $6,301,752 $12,667,427 $85,101,003 $82,841 $32.44 $594.07 $86.66 $70.37 $90.97 $85.27 $588.29 $2,340,009 $11,600,362 $6,806,399 $6,077,883 $4,997,099 $3,484,983 $16,238,563 $155,698,321 Mental Health Services Covers a comprehensive range of services provided by out patient mental health clinics. Individuals with chronic mental illness, mental retardation or substance abuse may receive case management services in the community, which help them live more independently and are less expensive than institutional services. DMA worked with the state Department of Audits to complete thorough reviews of selected community service boards, which employ the providers of clinic services. Mental health clinic and case management services accounted for almost 2% of total Medicaid benefits expenditures in FY 2002. 16 Division of Medical Assistance Category of service Providers with paid claims Mental Health Services Mental Health Clinic 74 Mental Health Case Management 1 Total Mental Health Services FY 2002 recipients 50,935 3 Expenditures FY 2002 per recipient expenditures** $1,628.05 $82,924,776 $110.00 $330 $ 82,925,106 Waiver Services for Home and Community-based Care Waiver services include five home and community-based programs and two demonstration projects that are covered by Medicaid using waivers issued by the federal government that allow exceptions to specific Medicaid requirements. Waivers permit the state to pay for home and community-based services as an alternative to institutional care. Each waiver program offers several "core" services, including service coordination, personal support, home health services, emergency response systems and respite care. Additional services are available under each program. Home and community-based alternatives accounted for 7% of benefit expenditures in FY 2002. Per-recipient costs averaged $11,614 for the year. The five home and community-based programs include: - The Community Care program offers services to help elderly and/or functionally impaired or disabled people remain in the community or return to the community from nursing homes. - The Mental Retardation Waiver program and the Community Habilitation and Support Services Waiver program help people who have mental retardation or a developmental disability. - The Model Waiver program covers private duty nursing and medical day care for individuals under age 21 who are respirator or oxygen dependent. - The Independent Care Waiver program (ICWP) helps adult Medicaid recipients with disabilities live in their own homes or in the community instead of living in a hospital setting. ICWP also includes services for adult Medicaid recipients with traumatic brain injuries. Two demonstration projects include: - SOURCE (Service Options Using Resources in a Community Environment) links primary care with an array of long-term health services in a person's home or community to avoid preventable hospital and nursing home care for frail elderly and disabled individuals. In FY 2002 there were ten SOURCE sites providing services within 97 counties. More than 2,000 consumers received assistance. - ShepherdCare provides primary care through an outreach program that is managed by advanced practice nurses who coordinate medical care for severely disabled clients at the Shepherd Spinal Center in Atlanta. Category of service Waiver Services and Demonstration Projects Community Care Mental Retardation Waiver Model Waiver Independent Care Community Habilitation and Support SOURCE Project ShepherdCare Total Waiver Services Providers with paid claims 336 228 12 95 71 59 1 FY 2002 recipients 14,930 7,145 160 670 1,267 1,778 85 *Does not represent all services; includes only case management and some equipment. Expenditures FY 2002 per recipient expenditures** $5,632.61 $18,826.18 $38,506.65 $27,818.70 $38,561.14 $4,908.39 $4,496.11 $84,094,843 $134,513,041 $6,161,064 $18,638,528 $48,856,964 $8,727,115 $382,169* $301,373,724 17 Division of Medical Assistance Transportation Covers both emergency and non-emergency transportation (NET) services to assist recipients who need medical care and have no other means of transportation. For a more cost-effective means of covering non-emergency transportation, Georgia Medicaid uses a broker system where the agency has contracts with two brokers that offer services in the state's five NET regions. Brokers are responsible for contracting with an adequate number of transportation providers to deliver services to eligible Medicaid recipients, including services to recipients that require special accommodations, such as wheelchair lifts. Each broker is reimbursed a set rate per month for each Medicaid recipient residing within the region. The two NET brokers' contracts total $54,198,612. NET payments are accounted for separately from transportation expenditures and are not shown below. The Georgia Department of Audits and Accounts evaluates the brokers' performance. Emergency transportation costs accounted for 0.5% of total Medicaid benefits expenditures in FY 2002. Category of service Total Emergency Transportation Services Providers with paid claims 195 FY 2002 recipients 73,129 Expenditures FY 2002 per recipient expenditures** $295.05 $21,576,640 Equipment and Devices Covers the rental or purchase of medical equipment and devices, including hospital beds, wheelchairs, oxygen equipment, walkers, artificial limbs, braces, eyeglasses and artificial eyes. Services in this category accounted for 1.2% of total Medicaid benefits expenditures for FY 2002. Category of service Providers with paid claims Equipment and Devices Durable Medical Equipment 2,266 Eyeglasses 331 Orthotics/Prosthetics 197 Total Equipment and Devices FY 2002 recipients 116,978 41,796 10,999 Expenditures FY 2002 per recipient expenditures** $379.65 $13.09 $769.51 $44,410,697 $547,194 $8,463,847 $53,421,738 Division of Medical Assistance All Others Covers the services of ambulatory surgical centers and rural health clinics as well as laboratory, x-ray, dialysis, home health, protective services, hospice, therapy and specialized services for specific populations, including adults with AIDS and children at risk of incarceration. Georgia Better Health Care (GBHC) matches Medicaid recipients and primary care providers to improve access to care, enhance continuity of care, and reduce unnecessary use of services. More than three-fourths of all recipients participated in GBHC. GBHC works with a physician advisory committee to assist with a physician profiling initiative designed to improve health outcomes. Category of service Providers with paid claims All Others Adults with AIDS 19 Ambulatory Surgical 108 At Risk of Incarceration 1 Crossover Chiropractic 141 Dialysis 244 Federally Qualified Health Centers 30 Georgia Better Health Care 2,472 Home Health 89 Hospice 67 Laboratory/Radiology 93 Preadmission Screening and Residential Review 1 Protective Services, Adult 1 Protective Services, Child 1 Qualified Medicare Beneficiary 5 Rural Health Clinic 34 Therapeutic Residential Intervention 21 Therapeutic Services Crossover Physical Therapy 27 Crossover Speech 7 Crossover Rehabilitation 33 Traumatic Brain Injury 64 Total All Others FY 2002 recipients 1,440 9,153 9,778 889 783 32,156 1,053,733 7,850 4,121 196,772 2,946 2,924 30,591 11 17,916 5,216 474 113 759 119 Expenditures FY 2002 per recipient expenditures** $250.97 $421.73 $597.18 $56.27 $16,990.43 $361,394 $3,860,119 $5,839,224 $50,021 $13,303,508 $230.53 $25.37 $1,612.20 $6,588.10 $98.03 $7,412,931 $26,733,066 $12,655,772 $27,149,558 $19,289,558 $1,388.30 $1,502.51 $920.76 $927.09 $199.16 $11,068.39 $4,089,936 $4,393,350 $28,166,880 $10,198 $3,568,114 $57,732,738 $140.07 $22.09 $230.42 $33,414.84 $66,391 $2,496 $174,886 $ 3,976,366 $218,836,506 ** All service data is compiled from the department's paid claim history file. This data is subject to change as appeals and disputes are resolved. 18 19 Division of Medical Assistance Medicaid Expenditures by Category of Service - Summary All other services $ 218,836,506 ( 5.0%) Equipment and devices $ 53,421,738 ( 1.2%) Emergency transportation services $ 21,576,640 ( 0.5%) Waiver services $ 301,373,724 ( 6.9%) Mental health services $ 82,925,106 ( 1.9%) Other practitioner services $ 155,698,321 ( 3.5%) Maternal and child health services $ 95,345,763 ( 2.2%) Physician services $ 500,732,913 ( 11.4%) Pharmacy services $ 757,869,724 ( 17.2%) Nursing facility services $ 889,550,330 ( 20.2%) Hospital services $ 1,316,525,615 ( 30.0%) TOTAL: $ 4,393,856,380 (100.0%) 20 Division of Medical Assistance Medicaid Recipients and Expenditures by County - FY 2002 County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Number of Unique Recipients 4,344 2,657 2,942 1,317 8,326 2,428 7,951 13,076 5,444 4,470 39,125 2,589 4,001 4,655 3,579 12,596 7,311 4,054 1,786 6,832 3,139 18,741 7,335 2,524 44,725 1,008 4,848 11,150 16,761 1,310 50,319 2,475 54,156 11,037 Net Payments $15,115,956 $6,785,381 $11,327,551 $2,883,972 $68,621,607 $4,994,705 $22,703,494 $35,580,695 $18,334,611 $14,465,674 $132,471,996 $8,737,513 $10,991,455 $14,791,164 $10,734,176 $35,092,020 $19,891,049 $14,259,724 $6,158,455 $13,798,908 $14,214,874 $54,409,941 $21,504,992 $6,924,194 $148,806,895 $1,619,751 $16,723,279 $34,499,627 $50,639,680 $4,456,865 $112,108,836 $8,242,049 $156,127,165 $32,241,778 Payment/ Recipient $3,479.73 $2,553.78 $3,850.29 $2,189.80 $8,241.85 $2,057.13 $2,855.43 $2,721.07 $3,367.86 $3,236.17 $3,385.87 $3,374.86 $2,747.18 $3,177.48 $2,999.21 $2,785.97 $2,720.70 $3,517.45 $3,448.18 $2,019.75 $4,528.47 $2,903.26 $2,931.83 $2,743.34 $3,327.15 $1,606.90 $3,449.52 $3,094.14 $3,021.28 $3,402.19 $2,227.96 $3,330.12 $2,882.92 $2,921.24 Estimated 2002 Population 17,472 7,571 9,993 4,102 44,806 14,847 48,946 80,026 17,242 16,091 153,549 11,735 14,877 16,397 24,552 56,918 22,591 20,629 6,307 44,061 9,508 91,956 55,197 10,393 232,064 15,134 25,901 152,170 101,800 3,390 246,779 6,833 631,767 37,815 % Population Receiving Medicaid 24.86% 35.09% 29.44% 32.11% 18.58% 16.35% 16.24% 16.34% 31.57% 27.78% 25.48% 22.06% 26.89% 28.39% 14.58% 22.13% 32.36% 19.65% 28.32% 15.51% 33.01% 20.38% 13.29% 24.29% 19.27% 6.66% 18.72% 7.33% 16.46% 38.64% 20.39% 36.22% 8.57% 29.19% % State Recip. Population Living in Co. 0.32% 0.19% 0.21% 0.10% 0.61% 0.18% 0.58% 0.95% 0.40% 0.33% 2.86% 0.19% 0.29% 0.34% 0.26% 0.92% 0.53% 0.30% 0.13% 0.50% 0.23% 1.37% 0.54% 0.18% 3.27% 0.07% 0.35% 0.81% 1.22% 0.10% 3.67% 0.18% 3.95% 0.81% 21 Division of Medical Assistance Medicaid Recipients and Expenditures by County - FY 2002 (continued) County Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Number of Unique Recipients Net Payments 12,778 $36,889,601 8,522 $23,738,069 4,579 $14,645,124 11,078 $30,144,252 2,499 $6,483,612 7,139 $24,075,900 2,338 $7,421,635 2,042 $5,036,444 8,303 $25,062,116 100,280 $274,983,242 4,609 $17,941,158 3,219 $10,337,911 29,268 $76,380,344 12,880 $33,743,372 4,512 $13,627,881 883 $1,801,611 5,576 $15,468,360 4,762 $16,021,020 7,188 $26,581,224 3,450 $9,743,443 3,648 $12,559,366 4,716 $14,616,483 18,862 $75,415,308 5,967 $19,123,426 4,272 $15,040,442 153,517 $406,600,402 4,375 $15,503,133 621 $3,700,714 13,715 $43,368,738 8,919 $25,382,001 6,376 $16,018,557 3,567 $10,036,785 55,519 $140,200,825 5,385 $16,599,531 Payment/ Recipient $2,886.96 $2,785.50 $3,198.32 $2,721.09 $2,594.48 $3,372.45 $3,174.35 $2,466.43 $3,018.44 $2,742.15 $3,892.64 $3,211.53 $2,609.69 $2,619.83 $3,020.36 $2,040.33 $2,774.10 $3,364.35 $3,698.00 $2,824.19 $3,442.81 $3,099.34 $3,998.27 $3,204.86 $3,520.70 $2,648.57 $3,543.57 $5,959.28 $3,162.14 $2,845.83 $2,512.32 $2,813.79 $2,525.28 $3,082.55 Estimated 2002 Population 42,201 92,427 15,855 94,571 12,559 22,133 15,508 17,176 28,175 665,133 19,143 11,651 95,723 96,006 12,282 3,726 39,616 20,648 21,859 10,738 20,661 95,542 91,183 110,296 20,783 816,638 24,349 2,583 68,217 45,555 23,714 14,914 621,528 37,153 % Population Receiving Medicaid 30.28% 9.22% 28.88% 11.71% 19.90% 32.26% 15.08% 11.89% 29.47% 15.08% 24.08% 27.63% 30.58% 13.42% 36.74% 23.70% 14.08% 23.06% 32.88% 32.13% 17.66% 4.94% 20.69% 5.41% 20.56% 18.80% 17.97% 24.04% 20.10% 19.58% 26.89% 23.92% 8.93% 14.49% % State Recip. Population Living in Co. 0.93% 0.62% 0.33% 0.81% 0.18% 0.52% 0.17% 0.15% 0.61% 7.32% 0.34% 0.24% 2.14% 0.94% 0.33% 0.06% 0.41% 0.35% 0.52% 0.25% 0.27% 0.34% 1.38% 0.44% 0.31% 11.21% 0.32% 0.05% 1.00% 0.65% 0.47% 0.26% 4.05% 0.39% 22 Division of Medical Assistance Medicaid Recipients and Expenditures by County - FY 2002 (continued) County Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Number of Unique Recipients 23,598 2,777 5,836 2,839 4,426 2,476 12,212 17,214 2,591 7,749 2,364 3,891 5,574 2,768 2,583 3,305 3,142 2,027 11,882 3,214 10,393 1,636 2,769 20,040 3,258 4,261 5,113 1,953 6,371 2,758 6,046 1,778 7,300 3,701 Net Payments $65,801,234 $10,670,253 $20,119,208 $8,683,271 $15,117,571 $7,202,387 $31,205,178 $48,012,288 $10,635,991 $25,202,544 $6,120,099 $11,475,768 $17,698,132 $8,926,547 $9,544,329 $9,692,716 $9,397,368 $7,188,537 $37,786,331 $9,492,693 $23,531,266 $3,753,114 $7,100,351 $66,095,389 $10,911,552 $15,980,659 $16,357,539 $5,722,604 $17,566,410 $6,879,352 $17,925,992 $6,807,349 $21,009,649 $13,185,349 Payment/ Recipient $2,788.42 $3,842.37 $3,447.43 $3,058.57 $3,415.63 $2,908.88 $2,555.29 $2,789.14 $4,104.98 $3,252.36 $2,588.87 $2,949.31 $3,175.12 $3,224.91 $3,695.06 $2,932.74 $2,990.89 $3,546.39 $3,180.13 $2,953.54 $2,264.15 $2,294.08 $2,564.23 $3,298.17 $3,349.16 $3,750.45 $3,199.21 $2,930.16 $2,757.25 $2,494.33 $2,964.93 $3,828.66 $2,878.03 $3,562.65 Estimated 2002 Population 145,664 10,065 26,255 24,548 23,087 11,229 132,581 113,391 10,028 44,010 11,904 12,762 17,090 8,637 8,578 24,203 16,260 7,140 45,378 25,539 60,107 8,424 10,548 92,250 21,855 14,133 26,214 7,204 21,286 11,085 22,625 6,381 24,053 22,153 % Population Receiving Medicaid 16.20% 27.59% 22.23% 11.57% 19.17% 22.05% 9.21% 15.18% 25.84% 17.61% 19.86% 30.49% 32.62% 32.05% 30.11% 13.66% 19.32% 28.39% 26.18% 12.58% 17.29% 19.42% 26.25% 21.72% 14.91% 30.15% 19.50% 27.11% 29.93% 24.88% 26.72% 27.86% 30.35% 16.71% % State Recip. Population Living in Co. 1.72% 0.20% 0.43% 0.21% 0.32% 0.18% 0.89% 1.26% 0.19% 0.57% 0.17% 0.28% 0.41% 0.20% 0.19% 0.24% 0.23% 0.15% 0.87% 0.23% 0.76% 0.12% 0.20% 1.46% 0.24% 0.31% 0.37% 0.14% 0.47% 0.20% 0.44% 0.13% 0.53% 0.27% 23 Division of Medical Assistance Medicaid Recipients and Expenditures by County - FY 2002 (continued) County Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Number of Unique Recipients Net Payments 2,065 $5,822,331 2,828 $8,160,089 6,673 $18,594,535 39,343 $116,847,897 12,773 $34,363,425 2,286 $6,269,045 2,228 $5,958,478 7,908 $22,706,890 5,586 $13,870,406 3,719 $13,592,115 4,169 $13,004,659 2,191 $6,551,352 8,253 $27,026,268 2,122 $7,366,512 3,563 $9,458,461 823 $1,692,404 2,425 $8,961,875 2,596 $8,274,596 49,196 $177,669,286 9,320 $25,866,799 1,006 $2,206,090 4,129 $12,372,771 2,971 $10,353,649 13,163 $39,578,106 5,633 $19,485,853 1,588 $5,715,439 10,246 $33,106,329 1,724 $4,121,603 584 $1,270,583 5,086 $17,183,555 2,514 $7,813,596 3,698 $14,869,808 3,773 $10,120,443 11,240 $45,577,835 Payment/ Recipient $2,819.53 $2,885.46 $2,786.53 $2,969.98 $2,690.32 $2,742.36 $2,674.36 $2,871.38 $2,483.07 $3,654.78 $3,119.37 $2,990.12 $3,274.72 $3,471.49 $2,654.63 $2,056.38 $3,695.62 $3,187.44 $3,611.46 $2,775.41 $2,192.93 $2,996.55 $3,484.90 $3,006.77 $3,459.23 $3,599.14 $3,231.15 $2,390.72 $2,175.66 $3,378.60 $3,108.03 $4,021.04 $2,682.33 $4,054.97 Estimated 2002 Population 8,361 16,153 37,747 184,134 68,047 27,059 12,969 89,734 24,196 24,776 15,698 14,253 38,843 9,598 19,094 2,610 15,318 7,644 198,366 71,798 3,921 15,177 9,365 59,066 25,651 5,145 33,319 6,703 2,034 22,385 8,836 11,692 10,943 43,012 % Population Receiving Medicaid 24.70% 17.51% 17.68% 21.37% 18.77% 8.45% 17.18% 8.81% 23.09% 15.01% 26.56% 15.37% 21.25% 22.11% 18.66% 31.53% 15.83% 33.96% 24.80% 12.98% 25.66% 27.21% 31.72% 22.29% 21.96% 30.86% 30.75% 25.72% 28.71% 22.72% 28.45% 31.63% 34.48% 26.13% % State Recip. Population Living in Co. 0.15% 0.21% 0.49% 2.87% 0.93% 0.17% 0.16% 0.58% 0.41% 0.27% 0.30% 0.16% 0.60% 0.15% 0.26% 0.06% 0.18% 0.19% 3.59% 0.68% 0.07% 0.30% 0.22% 0.96% 0.41% 0.12% 0.75% 0.13% 0.04% 0.37% 0.18% 0.27% 0.28% 0.82% 24 Division of Medical Assistance Medicaid Recipients and Expenditures by County - FY 2002 (continued) County Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Number of Unique Recipients 10,334 8,540 1,371 1,911 12,832 3,127 2,349 2,907 6,286 11,310 9,467 11,187 1,908 5,312 6,370 520 1,672 3,478 17,264 2,456 2,534 2,431 6,083 Net Payments $31,195,298 $30,975,022 $6,885,255 $6,391,211 $37,682,241 $9,160,883 $7,051,717 $12,070,796 $21,409,441 $38,077,159 $27,022,121 $38,777,870 $6,650,894 $17,085,383 $20,383,649 $1,105,997 $6,299,870 $10,929,790 $50,738,585 $10,563,669 $7,517,024 $6,340,728 $16,357,614 Payment/ Recipient $3,018.71 $3,627.05 $5,022.07 $3,344.43 $2,936.58 $2,929.61 $3,002.01 $4,152.32 $3,405.89 $3,366.68 $2,854.35 $3,466.33 $3,485.79 $3,216.37 $3,199.94 $2,126.92 $3,767.87 $3,142.55 $2,938.98 $4,301.17 $2,966.47 $2,608.28 $2,689.07 Estimated 2002 Population 38,634 26,115 9,641 6,787 59,478 9,621 10,589 17,902 27,711 61,884 65,224 35,540 6,274 21,042 26,945 2,301 6,183 21,182 85,248 8,709 10,688 10,300 21,938 % Population Receiving Medicaid 26.75% 32.70% 14.22% 28.16% 21.57% 32.50% 22.18% 16.24% 22.68% 18.28% 14.51% 31.48% 30.41% 25.24% 23.64% 22.60% 27.04% 16.42% 20.25% 28.20% 23.71% 23.60% 27.73% % State Recip. Population Living in Co. 0.75% 0.62% 0.10% 0.14% 0.94% 0.23% 0.17% 0.21% 0.46% 0.83% 0.69% 0.82% 0.14% 0.39% 0.47% 0.04% 0.12% 0.25% 1.26% 0.18% 0.19% 0.18% 0.44% Totals 1,369,629 $4,393,856,380 $3,208.06 8,383,915 16.34% 100.00% 25 Division of Medical Assistance PeachCare for Kids PeachCare for Kids is Georgia's version of the federal Children's Health Insurance Program that provides medical and dental coverage for children whose parents' income is too high to qualify for Medicaid but who do not have access to private health insurance. In FY 2002, uninsured children could be eligible for PeachCare if their families' incomes were up to 235% of the federal poverty limit but above Medicaid income guidelines. For a family of four in 2002, 235% of the federal poverty limit was $42,535. The federal/state match for PeachCare funds is approximately 72% federal to 28% state dollars, a larger federal share than allowed in the Medicaid program. Statistical Summary PeachCare for Kids Total Eligibles Total Recipients Total Expenditures Expenditures Per Covered Life Expenditures Per Recipient Providers w/ Paid Claims Number of Paid Claims 207,004 203,671 $179,012,108 $864.78 $878.93 17,188 4,065,773 Outreach Thirty percent of new PeachCare enrollees, who had been insured within three months prior to applying for PeachCare, reported they lost their previous health coverage due to layoff or loss of job. To reach families affected by employer cutbacks, PeachCare began working closely with the Georgia Department of Labor (DOL). Through this effort, PeachCare participated in over 75 DOL industryrelated job fairs and workshops. Through a partnership with the Department of Education, PeachCare achieved its largest and most successful statewide outreach campaign. For the third straight year, PeachCare ensured that every child in Georgia received a program flyer within the first week of the school year. By distributing nearly 2.6 million flyers among all public and private schools in the state, PeachCare information reached one million more children than in the previous year. This initiative created an immediate positive reaction, which included a dramatic 300% increase in Web-based applications and an increase of requests for mail-in applications. Grassroots strategies continued to be an essential part of PeachCare for Kids outreach. Through targeted community-based efforts, the Right-from-the-Start Medicaid outreach program as well as community-based organizations have been successful in helping PeachCare reach more families. 26 Division of Medical Assistance Enrollees Enrollment data for FY 2002 shows that PeachCare is making significant strides in reducing the number of uninsured children in Georgia. Since the close of fiscal year 1999, PeachCare enrollment has increased over 65%, with more than 161,000 children enrolled at the close of the 2002 fiscal year. PeachCare for Kids Profile By Age Under 1 year 1 to 5 years 6 to 13 years 14 to 21 years Recipients 1,787 (00.88%) 63,804 (31.33%) 100,052 (49.12%) 38,028 (18.67%) Expenditures $1,055,269 (00.59%) $54,256,066 (30.31%) $86,354,960 (48.24%) $37,345,813 (20.86%) By Gender Male Female 104,159 (51.14%) 99,512 (48.86%) $96,008,910 (53.63%) $83,003,198 (46.37%) By Residence Rural Urban 76,364 (37.49%) 127,307 (62.51%) $74,271,011 (41.49%) $104,741,097 (58.51%) By Race* Unknown White African-American American Indian/Alaskan Native Asian/Pacific Islander Hispanic/Latino 19,520 (09.58%) 103,414 (50.78%) 63,452 (31.15%) 43 (00.02%) 4,127 (02.03%) 13,115 (06.44%) $16,535,146 (09.24%) $106,165,499 (59.31%) $42,986,727 (24.01%) $45,578 (00.03%) $3,094,395 (01.73%) $10,184,763 (05.69%) *Recipient values by race were adjusted based on information provided by Dental Health Administrative and Consulting Services. Premiums and Services Families with children who are at least 6 years old pay a $7.50 monthly premium for one child or a $15 premium for two or more children. The plan requires no premium for children age 5 or younger. The plan pays for preventive services and acute medical care as well as prescription drugs, vision and dental care. PeachCare covers most of the same services that are covered by Medicaid. Exceptions include non-emergency transportation, targeted case management, nursing facilities and community waiver programs. 27 Division of Medical Assistance PeachCare for Kids - Expenditures by Category of Service Providers with Category of service paid claims Physician Services Physician 9,163 Net Payments Sub Total Hospital Services Inpatient Hospital 169 Outpatient Regular 277 Net Payments Sub Total Mental Health Services Mental Health Clinic 42 Net Payments Sub Total Maternal and Child Health Services Family Planning 79 Health Check (EPSDT) 1,579 Early Intervention Case Management 38 Children's Intervention Services 902 Pregnancy-Related Services 1 Net Payments Sub Total Pharmacy Services Drug Net Payments Sub Total 1,764 Equipment and Devices Durable Medical Equipment Orthotics/Prosthetics Eyeglasses Net Payments Sub Total 1,297 105 303 Emergency Transportation Ambulance 161 Net Payments Sub Total FY 2002 recipients 135,550 2,677 66,427 3,392 846 53,003 70 3,376 1 134,762 6,375 631 13,303 1,553 FY 2002 expenditures Expenditures per Recipient $34,967,103 $34,967,103 $257.96 $14,811,621 $32,955,398 $47,767,019 $5,532.92 $496.11 $3,311,506 $3,311,506 $976.27 $103,462 $3,446,551 $35,035 $3,396,716 $120 $6,981,884 $122.30 $65.03 $500.50 $1,006 $120.00 $36,226,784 $36,226,784 $268.82 $1,103,299 $374,906 $173,997 $1,652,202 $173.07 $594.15 $13.08 $521,489 $521,489 $335.79 28 Division of Medical Assistance PeachCare for Kids - Expenditures by Category of Service (continued) Providers with Category of service paid claims Other Practitioner Services Dental 890 Nurse Midwife 59 Dental Oral Surgery 19 Podiatry 182 Psychology 446 Nurse Practitioner 371 Physician's Assistant 338 Diagnostic Screening and Preventative Services 27 Certified RNA 557 Optometry 469 Net Payments Sub Total All Other Services Home Health Independent Laboratory Federally Qualified Health Centers Rural Health Ambulatory Surgical Georgia Better Health Care Residential Therapeutic Services Net Payments Sub Total 19 56 25 31 41 2,043 5 FY 2002 recipients 89,418 116 64 1,217 4,999 12,701 6,780 1,997 3,804 25,091 44 13,822 2,613 1,866 720 202,728 10 FY 2002 expenditures Expenditures per Recipient $33,335,654 $12,935 $11,746 $228,949 $3,104,284 $966,219 $534,721 $372.81 $111.51 $183.53 $188.13 $620.98 $76.07 $78.87 $41,325 $410,468 $1,452,894 $40,099,195 $20.69 $107.90 $57.90 $22,147 $607,311 $545,497 $358,565 $502,292 $5,304,141 $144,973 $7,484,926 $503.34 $43.94 $208.76 $192.16 $697.63 $26.16 $14,497.30 29 Division of Medical Assistance PeachCare for Kids Expenditures by Category of Service - Summary All other services $ 7,484,926 (4.2%) Equipment and devices $ 1,652,202 (0.9%) Emergency transportation services $ 521,489 (0.3%) Mental health services $ 3,311,506 (1.9%) Physician services $ 34,967,103 (19.5%) Other practitioner services $ 40,099,195 (22.4%) Maternal and child health services $ 6,981,884 (3.9%) Hospital services $ 47,767,019 (26.7%) Pharmacy services $ 36,226,784 (20.2%) TOTAL: $179,012,108 (100.0%) 30 Division of Medical Assistance PeachCare for Kids Recipients and Expenditures by County - FY 2002 County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Number of Unique Recipients 756 330 426 138 605 636 1,847 3,140 728 621 3,099 250 688 550 756 1,061 731 619 215 865 307 2,614 1,031 364 4,720 83 573 3,457 1,459 79 8,313 307 12,053 1,314 % State Recip. Pop. Living in County 0.37% 0.16% 0.21% 0.07% 0.30% 0.31% 0.91% 1.54% 0.36% 0.30% 1.52% 0.12% 0.34% 0.27% 0.37% 0.52% 0.36% 0.30% 0.11% 0.42% 0.15% 1.28% 0.51% 0.18% 2.32% 0.04% 0.28% 1.70% 0.72% 0.04% 4.08% 0.15% 5.92% 0.65% Net Payments $809,026 $280,338 $490,179 $127,627 $549,353 $497,665 $1,787,984 $2,731,534 $777,019 $650,644 $2,231,143 $276,294 $662,983 $463,425 $780,109 $957,702 $718,064 $529,960 $191,538 $754,183 $297,613 $2,890,094 $835,876 $326,173 $4,487,051 $78,783 $498,544 $2,991,660 $1,171,533 $79,399 $5,128,944 $242,808 $8,765,404 $1,568,623 Payment/ Recipient $1,070 $850 $1,151 $925 $908 $782 $968 $870 $1,067 $1,048 $720 $1,105 $964 $843 $1,032 $903 $982 $856 $891 $872 $969 $1,106 $811 $896 $951 $949 $870 $865 $803 $1,005 $617 $791 $727 $1,194 Number of Providers 511 282 323 198 429 510 1,114 1,270 379 359 898 245 473 350 563 515 495 555 236 359 234 1,072 505 222 957 193 391 1,567 606 131 2,235 199 3,022 536 31 Division of Medical Assistance PeachCare for Kids Recipients and Expenditures by County - FY 2002 (continued) County Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham % State Recip. Number of Pop. Living Unique Recipients in County 1,371 0.67% 1,711 0.84% 742 0.36% 1,965 0.96% 441 0.22% 641 0.31% 353 0.17% 628 0.31% 1,033 0.51% 18,126 8.90% 495 0.24% 316 0.16% 2,282 1.12% 2,890 1.42% 420 0.21% 155 0.08% 1,231 0.60% 691 0.34% 852 0.42% 385 0.19% 984 0.48% 1,056 0.52% 2,230 1.09% 1,689 0.83% 764 0.38% 13,060 6.41% 1,039 0.51% 103 0.05% 1,688 0.83% 1,484 0.73% 897 0.44% 363 0.18% 16,029 7.87% 1,247 0.61% Net Payments $1,192,899 $1,518,701 $823,346 $2,026,112 $312,414 $543,014 $338,117 $633,444 $959,685 $11,705,694 $495,564 $284,822 $1,788,976 $2,495,745 $487,561 $150,023 $1,148,408 $676,577 $866,941 $305,162 $1,233,499 $888,496 $2,105,960 $1,490,694 $861,571 $8,490,119 $1,045,534 $81,193 $1,588,474 $1,648,939 $720,011 $294,611 $13,084,526 $1,092,936 Payment/ Recipient $870 $888 $1,110 $1,031 $708 $847 $958 $1,009 $929 $646 $1,001 $901 $784 $864 $1,161 $968 $933 $979 $1,018 $793 $1,254 $841 $944 $883 $1,128 $650 $1,006 $788 $941 $1,111 $803 $812 $816 $876 Number of Providers 553 704 391 819 402 307 235 528 463 3,444 339 291 698 1,330 327 150 580 435 497 251 535 674 685 960 578 3,568 653 153 534 695 385 329 3,305 536 32 Division of Medical Assistance PeachCare for Kids Recipients and Expenditures by County - FY 2002 (continued) County Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Number of Unique Recipients 4,621 116 1,024 486 649 456 3,002 2,300 398 1,534 449 614 654 273 230 687 499 298 1,054 779 953 266 220 2,424 900 248 944 224 625 447 574 229 947 627 % State Recip. Pop. Living in County 2.27% 0.06% 0.50% 0.24% 0.32% 0.22% 1.47% 1.13% 0.20% 0.75% 0.22% 0.30% 0.32% 0.13% 0.11% 0.34% 0.25% 0.15% 0.52% 0.38% 0.47% 0.13% 0.11% 1.19% 0.44% 0.12% 0.46% 0.11% 0.31% 0.22% 0.28% 0.11% 0.46% 0.31% Net Payments $3,981,537 $67,464 $1,033,742 $460,731 $546,439 $430,741 $2,222,268 $1,971,973 $365,228 $1,353,452 $415,898 $593,880 $565,549 $263,696 $166,954 $593,313 $417,300 $331,792 $939,683 $921,101 $658,818 $227,571 $166,755 $2,198,798 $966,031 $191,801 $980,405 $169,221 $589,331 $456,019 $445,208 $325,387 $780,458 $523,428 Payment/ Recipient $862 $582 $1,010 $948 $842 $945 $740 $857 $918 $882 $926 $967 $865 $966 $726 $864 $836 $1,113 $892 $1,182 $691 $856 $758 $907 $1,073 $773 $1,039 $755 $943 $1,020 $776 $1,421 $824 $835 Number of Providers 1,340 118 678 458 371 383 1,474 751 274 940 490 364 455 303 242 501 426 223 494 429 409 289 225 534 531 239 570 220 371 284 439 214 496 546 33 Division of Medical Assistance PeachCare for Kids Recipients and Expenditures by County - FY 2002 (continued) County Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas % State Recip. Number of Pop. Living Unique Recipients in County 307 0.15% 575 0.28% 1,172 0.58% 3,176 1.56% 2,254 1.11% 537 0.26% 412 0.20% 2,916 1.43% 692 0.34% 943 0.46% 864 0.42% 423 0.21% 1,373 0.67% 186 0.09% 490 0.24% 68 0.03% 687 0.34% 250 0.12% 3,496 1.72% 2,026 0.99% 142 0.07% 414 0.20% 284 0.14% 1,474 0.72% 799 0.39% 129 0.06% 803 0.39% 195 0.10% 44 0.02% 596 0.29% 276 0.14% 340 0.17% 240 0.12% 1,462 0.72% Net Payments $312,421 $500,885 $1,146,830 $2,497,631 $1,887,307 $496,226 $451,536 $2,643,539 $571,852 $910,192 $825,328 $409,215 $1,595,382 $207,075 $362,295 $30,975 $911,422 $167,068 $2,733,947 $1,574,439 $119,580 $421,039 $324,572 $1,168,389 $1,117,455 $92,448 $801,968 $145,262 $21,863 $500,053 $298,691 $299,620 $222,101 $990,648 Payment/ Recipient $1,018 $871 $979 $786 $837 $924 $1,096 $907 $826 $965 $955 $967 $1,162 $1,113 $739 $456 $1,327 $668 $782 $777 $842 $1,017 $1,143 $793 $1,399 $717 $999 $745 $497 $839 $1,082 $881 $925 $678 Number of Providers 277 453 471 656 1,012 446 391 1,479 451 669 423 358 768 208 372 69 438 179 925 976 140 361 195 763 415 152 401 268 73 447 394 349 233 415 34 Division of Medical Assistance PeachCare for Kids Recipients and Expenditures by County - FY 2002 (continued) County Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Totals Number of Unique Recipients 1,140 947 344 270 1,503 417 306 739 763 1,153 2,140 1,362 143 376 958 47 224 835 3,132 306 285 258 869 % State Recip. Pop. Living in County 0.56% 0.46% 0.17% 0.13% 0.74% 0.20% 0.15% 0.36% 0.37% 0.57% 1.05% 0.67% 0.07% 0.18% 0.47% 0.02% 0.11% 0.41% 1.54% 0.15% 0.14% 0.13% 0.43% Net Payments $1,104,911 $958,238 $418,342 $196,880 $1,252,837 $351,816 $199,793 $845,386 $794,382 $941,868 $1,991,128 $1,418,029 $109,314 $240,739 $938,704 $64,960 $256,840 $781,893 $2,338,960 $334,431 $335,409 $193,046 $853,934 Payment/ Recipient $969 $1,012 $1,216 $729 $834 $844 $653 $1,144 $1,041 $817 $930 $1,041 $764 $640 $980 $1,382 $1,147 $936 $747 $1,093 $1,177 $748 $983 203,671 100.00% $179,012,108 $ 879 Number of Providers 399 474 284 219 515 298 337 435 353 560 1,145 564 174 257 470 109 261 502 693 337 266 320 513 17,188 35 Division of Medical Assistance Indigent Care Trust Fund The Indigent Care Trust Fund (ICTF), which funds and supports programs and facilities serving medically indigent Georgians, completed its twelfth year of operation in FY 2002. Contributions from participating disproportionate share hospitals (DSH) totaled $197,084,536. This added with funding from other sources such as ambulance license fees and investment interest earnings totaled $199,846,895. The Department used these funds to attract $280,793,276 in additional federal Medicaid matching dollars for a total trust fund amount of $480,640,171. No money from the state's general fund is used. Trust fund payments to 89 participating hospitals totaled $433,507,525. Each hospital must submit a plan for using at least 15% of its trust fund receipts to provide and expand primary care in the community. No more than 5% may be used for capital costs. Through the program, even uninsured people who do not qualify for Medicaid may receive health care from participating providers. The ICTF advisory committee assists in making decisions about administering the trust fund program. The panel includes representatives from hospitals, medical schools, public health, consumer advocacy groups, and government agencies. Fraud and Abuse Prevention and Detection Georgia Medicaid is committed to preventing fraud, waste and abuse within the program. Staff work to identify and correct problems in Medicaid policies and procedures, detect and stop potential fraudulent and abusive activity, and develop and implement proactive and reactive techniques for detecting and preventing provider fraud and abuse. The program integrity section is composed of teams with two primary functions: utilization review and investigations. Utilization Review Utilization review conducted by the section monitors the practices of DCH waiver program providers, other medical providers, hospitals and pharmacies. The review of waiver providers involves on-site reviews and mail-in reviews to determine whether services rendered are necessary, compliant with policy and delivered in a quality manner. Reviews result in recommendations to adjust services as needed or can become the basis for termination of waiver providers that are over-billing or providing poor quality care. Other medical providers, including physicians, receive individual retrospective reviews. These reviews are based on comparisons of providers within like specialty groups. Hospital services received by Medicaid recipients are also reviewed. For example, records are examined for medical necessity, quality of care, appropriateness of admission, policy compliance, correctness in coding, and accuracy in the assignment of diagnosis related groups. The program integrity section also monitors pharmacies to identify and review aberrant pharmacy providers. Auditing of pharmacy providers is accomplished through on-site visits and desk reviews, which are conducted by the section and the auditing department of DCH's Pharmacy Benefits Manager, Express Scripts, Inc. Also, the section works with the state's Drug's and Narcotics Agency in the identification and referral of suspected fraudulent and criminal activity of physicians and pharmacies. Additionally, recommendations are made for pharmacy lock-ins, or reviews, for recipients suspected of abusing the Medicaid pharmacy benefit. Investigations Investigations conducted by the section identify potential provider and recipient fraud through computer programs, calls to the investigations hotline, incoming correspondence and referrals from other affiliated state and federal agencies, and complaints from recipients and providers. When provider fraud is determined, the case is referred to the state health care fraud unit. Investigation activities also include working with staff outside the program integrity section to develop prosecutable fraud cases. Total FY 2002 savings, recoupment, collections and restitution: $10,684,127 Division of Medical Assistance ICTF Participating Hospitals - Regular Payments FY 2002 Hospital Appling Hospital Athens Regional Medical Center Atlanta Medical Center Bacon County Hospital Baptist Hospital of Worth County BJC Medical Center Bleckley Memorial Hospital Brooks County Hospital Burke Medical Center Calhoun Memorial Hospital Camden Medical Center Charlton Memorial Hospital Children's Healthcare of Atlanta at Egleston Children's Healthcare of Atlanta at Scottish Rite Cobb Memorial Hospital Coffee Regional Medical Center Colquitt Regional Medical Center Crawford Long Hospital Crisp Regional Hospital Dekalb Medical Center Dodge County Hospital Donalsonville Hospital County Appling Clarke Fulton Bacon Worth Jackson Bleckley Brooks Burke Calhoun Camden Charlton ICTF Payment $1,238,311 $16,583,505 $7,727,955 $992,677 $1,608,469 $1,370,707 $321,861 $582,044 $195,968 $388,997 $1,626,929 $893,950 Primary Care $185,747 $2,487,526 $1,159,193 $148,902 $241,270 $205,606 $48,279 $87,307 $29,395 $58,350 $244,039 $134,093 Local Gov't Contribution $619,156 $8,291,753 $0 $496,339 $0 $685,354 $160,931 $291,022 $97,984 $194,499 $813,465 $446,975 Dekalb $7,506,094 $1,125,914 $0 Fulton Franklin Coffee Colquitt Fulton Crisp Dekalb Dodge Seminole $2,190,087 $638,271 $4,283,515 $2,315,473 $4,159,336 $924,981 $5,774,869 $1,129,475 $849,780 $328,513 $95,741 $642,527 $347,321 $623,900 $138,747 $866,230 $169,421 $127,467 $0 $0 $2,141,758 $1,157,737 $0 $462,491 $2,887,435 $564,738 $0 36 37 Division of Medical Assistance ICTF Participating Hospitals - Regular Payments FY 2002 (continued) Hospital Dorminy Medical Center Early Memorial Hospital East Georgia Regional Medical Center Elbert Memorial Hospital Emanuel Medical Center Emory Parkway Medical Center Evans Memorial Hospital Fairview Park Hospital Fannin Regional Hospital Floyd Medical Center Georgia Baptist Meriwether Hospital Grady General Hospital Grady Health System Habersham County Medical Center Hamilton Medical Center Higgins General Hospital Hughes Spalding Children's Hospital Hutcheson Medical Center Irwin County Hospital Jasper Memorial Hospital Jeff Davis Hospital Jefferson Hospital John D. Archbold Memorial Hospital Liberty Regional Medical Center Louis Smith Memorial Hospital Meadows Regional Medical Center Medical Center of Central Georgia Medical College of Georgia Healthcare Medical Surgical Center Memorial Health University Medical Center Memorial Hospital Memorial Hospital of Adel Miller County Hospital Minnie G. Boswell Memorial Hospital Mitchell County Hospital Monroe County Hospital County Ben Hill Early Bulloch Elbert Emanuel Douglas Evans Laurens Fannin Floyd Meriwether Grady Fulton Habersham Whitfield Haralson Fulton Catoosa Irwin Jasper Jeff Davis Jefferson Thomas Liberty Lanier Toombs Bibb Richmond Baldwin Chatham Decatur Cook Miller Greene Mitchell Monroe ICTF Payment $1,100,407 $1,340,728 $854,599 $904,722 $1,148,413 $793,107 $966,672 $393,930 $749,120 $10,519,094 $1,203,716 $1,377,945 $132,173,434 $1,812,365 $2,085,275 $1,340,991 $4,808,875 $5,219,057 $880,842 $294,845 $425,563 $474,163 $2,506,866 $1,831,267 $597,763 $2,319,184 $24,693,168 $49,544,699 $9,191,661 $19,081,309 $943,961 $543,133 $868,484 $914,038 $911,597 $490,832 Primary Care $165,061 $201,109 $128,190 $135,708 $172,262 $118,966 $145,001 $59,090 $112,368 $1,577,864 $180,557 $206,691 $19,826,015 $271,855 $312,791 $201,149 $721,331 $782,859 $132,126 $44,227 $63,834 $71,124 $376,030 $274,690 $89,664 $347,878 $3,703,975 $7,431,705 $1,378,749 $2,862,196 $141,594 $81,470 $130,273 $137,106 $136,740 $73,625 Local Gov't Contribution $550,204 $670,364 $0 $452,361 $574,207 $0 $483,336 $0 $374,560 $5,259,547 $601,858 $688,973 $66,086,717 $906,183 $0 $670,496 $2,404,438 $2,609,529 $440,421 $147,423 $212,782 $237,082 $0 $915,634 $0 $1,159,592 $12,346,584 $24,772,350 $4,595,831 $9,540,655 $471,981 $0 $434,242 $457,019 $455,799 $245,416 38 Division of Medical Assistance ICTF Participating Hospitals - Regular Payments FY 2002 (continued) Hospital County Murray Medical Center Murray Northeast Georgia Medical Center Hall Oconee Regional Medical Center Baldwin Phoebe Putney Memorial Hospital Dougherty Polk Medical Center Polk Putnam General Hospital Putnam Rabun County Memorial Hospital Rabun Roosevelt Warm Springs Institute Meriwether Satilla Regional Medical Center Ware Screven County Hospital Screven Shepherd Center Fulton Smith Hospital Lowndes South Fulton Medical Center Fulton South Georgia Medical Center Lowndes Southeast Georgia Regional Medical Center Glynn Southwest Hospital & Medical Center Fulton Stephens County Hospital Stephens Sumter Regional Hospital Sumter ICTF Payment $1,178,869 $8,197,178 $2,310,525 $7,124,772 $1,436,541 $557,511 $910,203 $2,054,170 $1,978,218 $292,457 $125,502 $1,529,665 $2,537,926 $4,198,664 $5,119,793 $1,173,541 $3,318,508 $2,338,798 Primary Care $176,830 $1,229,577 $346,579 $1,068,716 $215,481 $83,627 $136,530 $308,126 $296,733 $43,869 $18,825 $229,450 $380,689 $629,800 $767,969 $176,031 $497,776 $350,820 Local Gov't Contribution $589,435 $4,098,589 $1,155,263 $3,562,386 $718,271 $278,756 $455,102 $1,027,085 $989,109 $146,229 $0 $0 $0 $2,099,332 $2,559,897 $0 $1,659,254 $1,169,399 39 Division of Medical Assistance ICTF Participating Hospitals - Regular Payments FY 2002 (continued) Hospital Sylvan Grove Hospital Tanner Medical Center/Villa Rica Taylor Regional Hospital The Medical Center, Inc. Tift Regional Medical Center Union General Hospital University Hospital Upson Regional Medical Center Washington County Regional Medical Center Wayne Memorial Hospital West Georgia Medical Center Wheeler County Hospital Wills Memorial Hospital Totals County Butts Carroll Pulaski Muscogee Tift Union Richmond Upson ICTF Payment $1,161,235 $1,283,257 $684,153 $13,673,338 $2,383,740 $8,589 $10,451,522 $1,185,322 Primary Care $174,185 $192,489 $102,623 $2,051,001 $357,561 $1,288 $1,567,728 $177,798 Local Gov't Contribution $580,618 $641,629 $0 $6,836,669 $1,191,870 $4,295 $5,225,761 $592,661 Washington Wayne Troup Wheeler Wilkes $1,337,897 $939,386 $3,823,516 $833,041 $750,609 $200,685 $140,908 $573,527 $124,956 $112,591 $668,949 $469,693 $1,911,758 $0 $375,305 $433,507,525 $65,026,129 $197,084,536 Division of Health Planning 40 Division of Health Planning Description of the Division of Health Planning Georgia's health planning program was established more than 20 years ago to ensure the financial and geographic accessibility of quality health care services to all Georgians. Formerly the State Health Planning Agency (SHPA), the agency became the Division of Health Planning, part of the Department of Community Health, in July 1999. The division has numerous responsibilities. For example, the division is expected to contain health care costs by taking actions that prevent the unnecessary duplication of services, equipment and facilities. Also, the division helps to enforce quality-of-care standards and encourages providers to assume a share of responsibility for the health care needs of low-income citizens. Additionally, the division works with the Health Strategies Council to develop policies for health care services. Staff also distribute surveys to health care facilities to collect information about capacity and utilization, patient flow patterns, indigent charity care and types of services offered. Furthermore, the division assesses the state's needs within the non-physician workforce and makes relevant information available to policy makers. Through March of FY 2002, the division also administered the review functions of the Certificate-of-Need (CON) program, which approves the development and expansion of health care services and facilities. As of April 1, the Office of General Counsel (OGC) assumed responsibility for the CON review functions, including responsibility for the work of the Health Planning Review Board and for functions related to a patient's right to independent review. Given the mutually dependent duties performed by the OGC and the division, highlights of the CON program are included in this section. Health Planning Review Board The Health Planning Review Board, appointed by the Governor, conducts appeal hearings on CON decisions. The board conducted 11 hearings in FY 2002. Statistical Summary FY 2002 expenditures: Revenue collected: CON applications received: 118 applications representing proposed capital expenditures CON applications approved: 101 applications with capital expenditures totaling Savings from denied, withdrawn or cancelled CON applications: Requests for determinations (on need for a CON): $1,721,487 $125,070 $674,629,286 $572,542,354 $102,086,932 140 Division of Health Planning FY 2002 Milestones Health Care Workforce Policy Advisory Committee Following legislation to create the Health Care Workforce Policy Advisory Committee, the Department appointed committee members and charged them with analyzing and addressing the state's shortage of nursing, allied health and behavioral health care professionals. During FY 2002, the committee initiated a wide range of successful programs to expand educational opportunities, promote workplace excellence, encourage youth and mid-career adults to pursue health careers, and develop data and forecasting models. W. Douglas Skelton, MD, provost and senior vice president for health affairs of Mercer University, chairs the committee. The committee's full report, What's Ailing Georgia's Health Care Workforce, is available through the DCH Web site at www.dch.state.ga.us. Health Strategies Council The Governor appointed new members to the Health Strategies Council in February 2002. The council, consisting of 27 members representing a wide range of health care and consumer interests, is charged with developing Georgia's State Health Plan and addressing policy issues concerning access to health care services through an open, public process. Daniel W. Rahn, M.D., president of the Medical College of Georgia, chairs the council. During FY 2002, the group adopted new bylaws and an aggressive work schedule for the ongoing update and refinement of the state's component health plans. The council's annual report is available through the DCH Web site at www.dch.state.ga.us. New Health Planning Guidelines New planning guidelines and component health plans were adopted for personal care home facilities and for positron emission tomography (PET) units. At the recommendation of the council, the Department repealed the old guidelines for Magnetic Resonance Imaging (MRI) equipment to promote more streamlined access to these routine diagnostic services. The Department retooled all the administrative health planning and review rules to reflect the new structure and practices of the Department of Community Health. An updated set of rules for home health services were adopted. The complex process of updating the twenty-year-old plan and rules governing short-stay hospital beds commenced in early 2002 with completion expected in 2003. Electronic Data Collection and Analysis FY 2002 marked the first year that all hospitals, long-term care facilities and other health care providers could submit annual health planning survey data through fully electronic means. These new systems have greatly enhanced the accuracy and timeliness of data collection and use in planning and analysis. The new data sets have been made available to a wide range of interested parties and the public, thus improving strategic planning and public access to important information on health services and financing. Training and Development The division provided training and support to providers and conducted the Hospital Financial Management Executive Training class for the very first time. The training, offered to all hospital CEOs and CFOs, focuses on expectations for indigent care and charity care provisions, financial reporting and guidelines for participation in the Indigent Care Trust Fund. 42 43 Division of Health Planning Planning and Data Management The division collects and analyzes information about Georgia's health care system, which is used in identifying trends and in developing policy recommendations and planning initiatives. All health care facilities and services operating under the state's CON laws are required to complete an annual survey for review by the Department's Division of Health Planning. The survey reports yield important data used in the Department's CON determination processes and in the overall planning efforts to improve health care for Georgians. The division also uses survey data to show health care trends in the state, such as utilization; to identify payment sources for hospital, home health and nursing home services; and to indicate indigent/charity care provided. Georgia Health Care at a Glance Type of Facility General Hospitals Specialty, Psychiatric and State Hospitals Cardiac Catheterization Open Heart Surgery Obstetrical Hospital Services Ambulatory Surgery Hospital-based Freestanding General Nursing Homes Home Health Agencies Supply 156 hospitals 23,741 beds 3 beds per 1,000 population 27 hospitals 5,439 beds 59 providers (including mobile) 19 providers 98 hospitals 1,766 beds 78% of total surgeries 153 outpatient ORs 438 shared OR equivalents 166 ORs 365 homes 39,525 capacity beds 51 beds per 1,000 age 65+ 113 agencies 2001 Utilization 873,758 admissions 4,171,145 patient days 515 days per 1,000 population 42,655 admissions 935,941 patient days 98,269 catheterizations 73,771 diagnostic 24,498 therapeutic 9,985 surgeries 367,630 patient days 129,501 deliveries 127 procedures per 1,000 population 500,817 patients 93,569 patients 34,354 admissions 13,083,678 patient days 108,729 patients 2,543,139 visits 23 visits per patient Source: Survey reports from providers and facilities, 2001. Civilian Non Institutional population (9/02 release) projections from Governor's Office of Planning and Budget (based on 2000 Census). Note: Supply reflects existing and approved facilities as of September 2002. Utilization reflects data reported during calendar year 2001. 44 Division of Health Planning Regulatory Compliance The Office of General Counsel conducts the CON review program, which is the primary means for implementing policies adopted by the Health Strategies Council. The program helps avoid unnecessary duplication of equipment and facilities and promotes improved quality-of-care standards by requiring health care providers to obtain a CON before offering new services, purchasing major medical equipment or constructing new facilities. Providers who must comply with the CON program include hospitals, nursing facilities, home health agencies, outpatient surgery centers and freestanding centers for diagnostic imaging and radiation therapy. During 2002, a CON was required before a health care facility or provider could: proceed with a construction or renovation project and/or any other capital expenditure that exceeds $1,250,199; purchase or lease major medical equipment that costs more than $694,556; offer a health care service that was not provided on a regular basis during the previous 12-month period; and/or add new beds to a health care facility. The OGC also grants letters of non-reviewability that allow ambulatory surgical centers to bypass the CON review process when the centers meet specific criteria. Surgical centers eligible to bypass the review process include those that are single-specialty, physicianowned or office-based. Since its inception in 1979, the CON review process has saved an estimated $2.7 billion in unnecessary capital expenditures on health care projects that either failed to meet planning guidelines or were withdrawn by the applicants during review. Also, through the CON reporting process, Georgia hospitals documented providing nearly $768 million in uncompensated care in FY 2002 to uninsured individuals meeting the criteria for indigent and charity care services. This sizeable amount of uncompensated care accounted for 5.24% of the total adjusted gross revenues for Georgia hospitals. In FY 2002 the OGC reviewed 118 CON applications, which resulted in 106 approvals, four denials and eight withdrawn applications; ten decisions were appealed, with one reversal. 45 Division of Health Planning Georgia's Certificate-of-Need Activity FY 1992-2002 Status of CON Applications Submitted Amount reviewed: Total cost of projects submitted for review (does not include operational costs) Amount saved: Total cost of projects denied, withdrawn and cancelled (does not include operational costs) Year Submitted FY 1992 FY 1993 FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 TOTALS Applications Submitted 107 133 127 143 76 71 93 95 85 91 118 1,139 Applications Approved 77 71 84 83 59 50 43 69 77 72 101 786 Percentage Approved 72% 53% 66% 58% 78% 70% 46% 73% 91% 79% 86% 69% Amount Reviewed $508,067,933 $371,310,260 $260,435,530 $379,440,268 $420,946,923 $333,674,960 $188,123,943 $465,163,126 $666,854,009 $598,024,749 $674,629,286 $ 4,866,670,987 Amount Saved $140,984,293 $163,967,049 $123,358,966 $107,032,416 $39,338,298 $154,837,181 $96,581,041 $146,532,645 $62,571,261 $68,729,590 $102,086,932 $1,206,019,672 Source: Division records * Information in this table is a "snapshot" of a particular moment in the status of the CON application process. The elements in all columns are subject to change as appeals of the CON applications are considered and decided. 46 Division of Public Employee Health Benefits Division of Public Employee Health Benefits Description of the Division of Public Employees Health Benefits The Georgia Department of Community Health administers the State Health Benefit Plan, which provides health insurance coverage to state employees, school system employees, retirees and eligible dependents. Within DCH, the Public Employees Health Benefits Division is responsible for the day-to-day management of State Health Benefit Plan operations. The SHBP covered 601,972 lives at the close of FY 2002, which represents a 5.5% increase in lives covered since FY 2000. FY 2002 Milestones New Prescription Drug Program Starts Beginning on July 1, 2001, State Health Benefit Plan (SHBP) members saw significant changes within the Prescription Drug Program (PDP). Changes included a new three-tiered co-payment structure, which was designed to encourage the use of generic and preferred brand name drugs and to maintain member choice in drug selection while keeping employee premiums more affordable and controlling Plan costs. The new program also features a separate out-of-pocket spending limit that places a cap on total co-payments paid for certain prescription drugs during each calendar month. Other highlights within the new program included a separate member service unit, which is open 24 hours per day, 7 days per week, and a new claims and benefits manager, Express Scripts, Inc., for prescription drug benefits. PPO Provider Network Expanded Effective July 1, 2001, the Plan implemented a national provider network within the PPO Option through a contract with Beech Street Corporation. Beech Street has a network of over 345,000 physicians and 3,400 acute-care facilities with providers in nearly all states. Anyone eligible for Plan coverage may select the PPO Option and take advantage of the national provider network. Contracts Awarded to Four HMOs The division worked on a request for proposal that sought bids from HMOs interested in becoming a coverage option under the SHBP effective July 1, 2002. Contracts were awarded to four HMOs, including two HMO Options not offered in FY 2002 CIGNA Healthcare of Georgia and United Healthcare of Georgia. Each of the new HMOs is self-insured, which is the first time the Plan has offered this type of HMO. Another first for the Plan under the new contracts includes an open-access model HMO (UnitedHealthcare) in which members do not have to obtain referrals for specialty care. Under the new contracts, many employees in rural counties will have access to HMO Option coverage for the first time. Also, at least one HMO Option will be available in 118 of Georgia's 159 counties, which represents a 236% increase in the number of counties where HMO Option coverage is offered. Member Migration to PPO Option Since the Department's inception, the strategy for premiums has been to: 1) ensure that premiums cover projected claims and generate an appropriate reserve; 2) maintain a fixed employer/employee contribution strategy; and 3) encourage members to choose options that provide the state with the greatest level of cost predictability. The DCH historic premium strategy has resulted in a significant migration of members from the Indemnity Option (formerly the High Option) to the PPO Option. From FY 2000 to FY 2002, PPO membership increased from 32% to 60%, while membership in the Indemnity Option decreased from 40% to 7%. Such a migration has played a key role in the Department's ability to have a positive impact on the rate of medical expense increases for the SHBP. Preventive Care Coverage Added At the start of FY 2002, coverage under the Indemnity Option was enhanced to include coverage for preventive care office visits. Other preventive care coverage, such as for lab work, x-rays and screenings, were increased to match preventive services covered under the PPO Option. Dedicated Member Services Unit for Retirees During the fiscal year, the Plan added a dedicated member services unit for retired members. Retirees call a special help line and can talk to representatives who are specially trained to assist retirees with issues unique to their coverage, including coordination of benefits with Medicare and procedures to change coverage during the Retiree Option Change Period. 48 Division of Public Employee Health Benefits Managing Disease By analyzing data from the SHBP information and utilization management systems, the Plan developed strategies, such as disease state management programs, to improve health outcomes. Disease state management programs provide education, literature and other resources to Plan participants with diabetes; congestive heart failure; asthma; and cancer of the breast, lung, or colon. Program participants have access to enhanced benefits, including coverage for approved educational services. Since FY 2000, the number of actively enrolled members in the various programs has risen dramatically; for example, the number of people participating in the diabetes program grew from 570 to well over 4,000. Open Enrollment and Retiree Option Change Period Activity The following projects were completed at the close of the 2002 fiscal year in preparation for the 2002-2003 Plan year: Processed 57,357 total transactions for Health Plan coverage effective July 1, 2002 -- transactions processed included option changes, terminations and enrollments. Of these transactions, 27,739 were processed through the Health Plan's Web site and 11,633 were processed through the Georgia Merit System's Web site. For payroll locations choosing not to access a Web site, the remaining 17,985 transactions were keyed in by hand based on changes indicated on paper forms. Conducted 35 Meeting Leader Training sessions throughout the state, training more than 1,600 benefit representatives in state agencies and school systems. Held 26 benefit fairs across the state to meet with active members of the Health Plan and answer related questions. Held 87 town-hall meetings in 37 Georgia cities for retirees with questions about upcoming changes to their coverage; more than 3,400 retirees attended. Distributed 350,000 active Health Plan Decision Guides to more than 1,050 payroll locations and sent approximately 4,000 information packages to members paying directly for their coverage. Sent more than 63,000 retired members a special package containing complete Plan information and personalized change forms. Eligibility Verification The division worked on developing a process to ensure that all covered dependents in the Plan are eligible for coverage. When requested by the Plan, members must submit official documentation to verify dependent eligibility. Official documentation includes copies of certified marriage licenses for spouses, and copies of certified birth certificates, court decrees or adoption papers for children or stepchildren. The new process became effective on July 1, 2002. Statistical Summary The table below enumerates the total expenditures by type of health plan and by a breakdown of the subgroups of people covered. Statistical Summary Total FY 2002 expenditures PPO and Indemnity Option Expenditures HMO Premiums Contracts Administrative Support Total covered lives School System Employees, Retirees and Dependents State Employees, Retirees and Dependents Miscellaneous Average expenditure per covered life $1,502,747,414 $1,045,350,824 $375,660,146 $76,977,930 $4,758,514 601,972 418,695 181,191 2,086 $2,496 49 Division of Public Employee Health Benefits Covered Lives The table below describes plan membership by employment group and active or retired status. Total covered lives include members, spouses and other dependents. Covered Lives Plan Member Group State Employees - Active State Employees - Retired Teachers - Active Teachers - Retired School Service Personnel - Active School Service Personnel - Retired Miscellaneous - Retired/Active Grand Total Total Active Total Retired Grand Total Covered Lives 145,395 35,799 221,688 41,624 138,396 16,354 2,716 601,972 Percentage of Total Lives 24% 6% 37% 7% 23% 3% less than 1% 100% 508,180 93,792 601,972 84% 16% 100% In FY 2002, active teachers and school service personnel represented 60% of the covered lives; active state employees accounted for 24%. Overall, retirees accounted for more than 93,000 covered lives, which represents 16% of the entire Plan population. Coverage Options The State Health Benefit Plan offered three coverage models during FY 2002: 1) the Preferred Provider Organization (PPO) Option, including a PPO Consumer Choice Option; 2) the Indemnity Option; and 3) the Health Maintenance Organization (HMO) Options, including multiple HMO Consumer Choice Options and an HMO Medicare + Choice Option. Monthly employee contributions to premiums ranged from $47.73* to $149.93 for single coverage and from $139.33* to $336.43 for family coverage. Total monthly premiums (employee plus employer contributions) ranged from $225.95 to $393.30 for single coverage and from $476.18 to $726.80 for family coverage. *Medicare + Choice premiums ranged from $10 for single to $20 for family coverage (if both members had full Medicare). To be eligible for the Medicare + Choice Option, the member had to be covered by Medicare Parts A and B and reside in selected counties within metro Atlanta. 50 Division of Public Employee Health Benefits The chart below shows the relative number of covered lives in each of the above Plan options. Covered Lives - All Coverage Options HMO Option Covered Lives 183,790 (31%) PPO Option Covered Lives 328,317 (55%) HMO Choice and HMO M+C Option Covered Lives 2,449 (under 1%) Indemnity Option Covered Lives 61,961 (10%) PPO Choice Covered Lives 25,455 (4%) The PPO Option is designed using the preferred provider organization model for the delivery of care. Members have the choice of using either in-network or out-of-network providers, with a higher level of benefit coverage available when in-network providers are used. The Georgia PPO provider network consists of over 14,000 participating physicians and 166 acute-care hospitals. Nationally, the PPO provider network includes over 345,000 physicians and 3,300 hospitals. Members also may select the PPO Choice Option, which has the same benefits as the PPO Option, but also allows members to nominate eligible out-of-network providers to be reimbursed as if the provider was participating within the network. The PPO Option is available to anyone eligible for SHBP coverage. The Indemnity Option is an indemnity plan that also includes some managed-care features. Anyone eligible for SHBP coverage may select the Indemnity Option, which allows members to use any covered provider and receive the same level of coverage, subject to the Plan's allowed amounts and balance billing from non-participating providers. Participating providers are located within the state of Georgia. The HMO Option is available to members who either live or work in a county within an approved service area. In FY 2002, HMOs were available in the metro areas of Atlanta, Augusta, Macon and Savannah. HMO choices for FY 2002 included Aetna US Healthcare, BlueChoice and Kaiser Permanente. Eligible HMO Option members also may select an HMO Consumer Choice Option, which has the same benefits as the respective HMO, but also allows members to nominate eligible out-of-network providers to be reimbursed as if the provider was participating within the HMO's network. Also, some members with full Medicare coverage may select the HMO Medicare + Choice Option, which would replace the member's traditional Medicare coverage with enhanced HMO benefits. Except in emergencies, HMO participants must use network providers to receive coverage. 51 Division of Public Employee Health Benefits Below are the three HMOs offered under the SHBP in FY 2002 and the number of covered lives participating in each HMO at the close of the fiscal year: Covered Lives - HMO Options Kaiser Permanente (available in Atlanta) 54,054 (29%) Aetna US Healthcare (available in Atlanta) 19,764 (11%) BlueChoice (available in Atlanta, Augusta, Macon and Savannah) 112,421 (60%) Expenditures The SHBP contains both self-insured and fully-insured coverage options. The PPO Option, PPO Choice Option and Indemnity Option are self-insured, where employee and employer revenues are used to pay claims expenses directly. The three HMO Options offered by the Plan in FY 2002 were fully-insured and received a premium payment from the Plan. Administration and contracts represented only 5.4% of total expenditures for the fiscal year. FY 2002 expenditures totaled $1,502,747,414. Within the PPO and Indemnity Options, cost-management initiatives with providers generate savings for the Plan. For example, both options use the same prescription benefit manager to help control rising drug costs in a medically appropriate manner. Also, within the PPO, the Plan's provider network manager negotiates with hospitals, physicians and other providers to deliver quality medical care at discounted rates. In the Indemnity Option, DCH contracts directly with all acute care hospitals in the state to help lower costs, and, to manage professional costs, the Plan obtains lower negotiated rates with doctors through the Participating Physician Program. Additional savings were generated through the Medical Certification Program (MCP), which has dedicated staff who perform many Plan services, including pre-certification of hospital admissions and certain outpatient procedures. The MCP also conducts case management, demand management and maintains the Plan's transplant network. Operating Units Within the division there are seven operating units that process member eligibility transactions, assist employer groups, process member appeals, review vendor performance and clinical standards, enforce contract compliance among vendors, manage the annual enrollment/change periods, and conduct member education programs. During FY 2002, for example, operating units: Processed more than 189,000 coverage transactions for Health Plan members; Responded to more than 38,000 letters, phone calls and coverage update requests from employers; Received more than 1,100 appeals, closing more than 850 during the fiscal year; Developed action plans for vendors in order to maintain established performance standards; Monitored claims processing and customer service centers to verify quality of work being provided met standards for accuracy and timeliness; Reviewed clinical standards and practices used within cost-containment programs, including programs for medical and behavioral health utilization management, case management, prior approval, organ and tissue transplants and demand management; 52 Division of Public Employee Health Benefits Participated in over 50 pre-retirement seminars to educate members about continuation of Health Plan coverage into retirement; and Coordinated communications efforts associated with Open Enrollment and the Retiree Option Change Period, including member publications, fairs, training sessions and Web site availability for data entry. The table below lists the Plan's primary vendors during the fiscal year and the principal services each provides: Vendor Services Vendor Blue Cross and Blue Shield of Georgia First Medical Network (formerly MRN/Georgia 1st) Beech Street Centra SubroAudit Public Consulting Group Express Scripts UniCare Magellan Behavioral Health, Inc. MEDSTAT Services Third-party administrator services, including claims processing (3.6 million professional and over 546,000 hospital claims processed), prior approvals, claims pricing and payment, member services (1.3 million calls received), medical policy development and administration of subcontracts for cost-containment programs Management of PPO provider network within the Georgia service area Management of PPO national provider network outside of the Georgia service area Audits of high-cost hospital bills (subcontract through BlueCross) Subrogation services (e.g., auto accident claims), subcontract through BlueCross). Vendor ceased opening new cases effective March 30, 2002. Subrogation services for new cases opened on or after April 1, 2002. Prescription drug benefit management (6.8 million claims processed); preferred drug formulary and rebates; telephone customer service; mail inquiries; publish member handbook Precertification of inpatient/outpatient medical and/or surgical care; case management; manage transplant network; 24-hour demand management; nurse triage program, including emergency room referrals Management of provider network for mental health care and substance abuse treatment; hospital admission certification for mental health care; outpatient therapy authorization; intensive outpatient program; and intensive case management Analysis of claims data and emergency room referrals claims data analysis 53 Division of Public Employee Health Benefits System Support The SHBP operates the Membership Enrollment Management System (MEMS) that captures and maintains member information. MEMS is a mainframe-based system of 430 programs with over 12.5 million records in its database designed to capture and maintain information related to eligibility, enrollment and financial activity for the SHBP. The system records basic demographic information and a history of coverage for all employees, retirees and dependents in the Plan. This internal system enables Plan members to receive SHBP identification cards almost immediately. The Plan also utilizes MEMS to produce billing records for state agencies and local school systems, and to track accounts receivable for claim refunds. The MEMS member information system will be replaced and upgraded during FY 2005. Health Improvement Programs 54 Health Improvement Programs As part of the Department's reorganization in FY 2002, DCH entities that worked toward improving the health of targeted groups were aligned into a single operational section within the Department, which was designated the Health Improvement Programs section. Within this section are the Offices of Women's Health, Minority Health and Rural Health, and the Commission on Men's Health, which are administratively attached to the Department. Office of Women's Health Description of the Office of Women's Health The Office of Women's Health (OWH) envisions quality health and access to healthcare for all women in Georgia. The OWH works to improve women's health status and quality of life through education, research, policy development and coordination of women's health programming. An 11-member Advisory Council is attached to the office and is composed of representatives from major public and private organizations within the state who have demonstrated interest and experience in addressing women's health issues. Advisory Council members serve two-year terms. FY 2002 Milestones Education As a voice and focal point for women in Georgia, the Office of Women's Health provides major public awareness programs to bring important education and prevention messages to women and young girls in the state. The OWH convenes the "Annual Office of Women's Health Summit" each September, and targets health professionals and women throughout Georgia. In FY 2002, the summit, cohosted with the Office of Minority Health, was held in Atlanta, Georgia, and its theme and focus was "Celebrate Healthy Living: Eliminating Disparities in Minority Women's Health." The annual summit serves as the kick-off to regional health fairs, which are held throughout the state. More than 400 people attended the summit and received educational messages. "Take Charge of Your Heart" and "Eliminating Disparities in Ethnic and Racial Minorities" were two major initiatives launched by the OWH in FY 2002. These initiatives were executed throughout the state through regional health fairs under the theme "Celebrate Healthy Living: A Community Health Festival." For FY 2002, the focus was in the faith communities. To date, more than 1,200 women have taken part in this one-day, faith-based initiative aimed at increasing awareness about health issues that significantly impact minority women. This one-day event, held in five different locations, consisted of free preventive health screenings, educational workshops, and exhibits of community resources. A women's health festival titled "A Day Especially for You" was held by the OWH in partnership with Phoebe Putney Memorial Hospital, the American Cancer Society and the Southwest Georgia Rural Health Collaborative. Participants had an opportunity to hear distinguished speakers, receive free wellness screenings, visit exhibits and attend workshops. More than 700 attendees participated in this event. The OWH served on the planning committee for a conference entitled "A Dialogue on Cancer: Closing the Health Gap," which was held by the Georgia Cancer Health Disparity Advisory Committee of the Georgia Cancer Coalition (GCC) in partnership with multiple groups. The dialogue featured some of the top cancer and health specialists in Georgia who delivered speeches to the more than 600 participants attending this event. 56 Health Improvement Programs "Screenings Under the Gold Dome" was an initiative sponsored by the OWH to promote prevention and wellness messages among state legislators and staff members. Free educational materials and screenings were provided to more than 150 attendees. The OWH participated in the National Black Caucus of State Legislators annual meeting, which was held in Atlanta, Georgia. The office served as a member of the health fair planning and implementation committee and provided preventive health screenings for caucus members and the other 300 attendees. Information The OWH also served as a clearinghouse for women's health information, using numerous channels of communication. The Legislative Update newsletter was produced monthly during the session of the Georgia General Assembly and quarterly thereafter. The newsletter contains state and federal legislation that is of interest to women's health advocates and supports the mission and goals of the OWH. Fact sheets were created to address the seven leading causes of death for women in Georgia, as well as other health issues that affect women. The fact sheets were distributed at regional health fairs and public meetings, and were made available online at the OWH Web site, www.dch.state.ga.us. The women's health Web page contains OWH fact sheets; OWH publications, such as the Legislative Update; information pertaining to the OWH mission, vision and goals; and a listing of helpful Web-links for women's health consumers and professionals. In FY 2002, the Web site was expanded to include a calendar of statewide women's health events, observances of federal and state women's health issues, articles written by OWH staff and advisory council members, press releases, newsletters and a Web page where readers could request subscriptions to literature on women's health. It is estimated that more than 12,000 people are reached through these efforts. Two OWH newsletters were developed and disseminated to more than 1,000 readers in FY 2002. Focus on Women's Health is a newsletter oriented toward a professional audience and is distributed biannually in the autumn and spring. Women's Health Today is designed for a lay-audience that is concerned about women's health issues. This newsletter contains important health promotion messages for women and is distributed biannually in the winter and the summer. OWH information packs and cardiovascular disease (CVD) information packs were designed and distributed to approximately 600 people in FY 2002. The OWH information packs contained brochures, bookmarks, fact sheets and other materials designed to educate the public on the goals of the office. The CVD education packs were designed to help prevent the development of the disease by offering fact sheets specific to cardiovascular disease and its risk factors. Both packs were distributed to individuals upon request and at regional health fairs and public meetings. National Women's Health Month Billboards, targeted at minority groups, were designed in FY 2002 to promote Women's Health Month. In concert with the OWH minority women's health initiative, the billboards were placed in low-income neighborhoods and were designed to promote "healthy living" among women within the viewing areas. The OWH reached more than 5,000 people through this initiative. Policy Development and Strategic Planning The OWH is responsible for developing a comprehensive plan to address women's health in Georgia. Formed in FY 2001, a leadership think tank, representing the business community, academic institutions, private organizations, women's groups and faith and ethnic organizations, met twice in FY 2002 to draft the comprehensive plan, which is scheduled for completion in FY 2003. The OWH collaborated with the newly created State Health Planning Committee to ensure that the topic of unequal treatment of minorities was included in the committee's deliberations and action plans. 57 Health Improvement Programs Office of Minority Health Description of the Office of Minority Health The Office of Minority Health helps minority communities improve the health and wellness status of its members. The office also works to eliminate the discrepancy in health status between minority and non-minority populations in Georgia. Work within the office focuses on four major tasks: 1) to identify, assess and analyze issues related to the health of minority populations; 2) to cooperate with public and private organizations to address specific minority community health needs; 3) to monitor state programs, policies and procedures to assure that they are inclusive and responsive to the health needs of minority communities; and 4) to facilitate the development and implementation of research enterprises and scientific investigations that yield minority-specific findings. The office has a 12-member advisory council and each member serves a two-year term. FY 2002 Milestones The Office of Minority Health (OMH) implemented several new initiatives during FY 2002. The Lifeline to Health radio program provided health news, features and interactive call-in segments. The program's purpose is to provide culturally competent health information to improve the health and wellness of minorities by addressing Georgia's health disparities. This monthly, statewide live broadcast is supplemented by a dedicated Web site, www.Lifelinetohealthradio.com, which contains information about current and past programs and identifies resources for available services and culturally appropriate books about the health topics covered. OMH implemented its multi-pronged diabetes initiative that focused on lifestyle changes for prevention and disease management. Five series of faith-based seminars held in African-American churches engaged participants in learning about diabetes and making lifestyle changes to prevent or to reduce their risk of diabetes and associated complications. Additionally, in partnership with Oakhurst Medical Center, diabetic patients at the center were involved in an OMH sponsored, multi-week program where the patients changed their lifestyle behaviors in order to better manage their disease and reduce the risk of complications. Several major cultural-competence projects were implemented. For example, OMH funded medical-interpreter services so that migrant and seasonal farm workers in seven rural, South Georgia counties could receive health screenings and other health care services. OMH also funded the translation of a health careers curriculum into Spanish so that the Southwest Georgia Area Health Education Center could provide services and training to Latino youth and their parents. The services and training were designed to promote health professions as career options and increase the availability of Latino health professionals in Georgia. Additionally, focused radio interviews were done regularly on Latino radio stations in metro Atlanta in support of Esta es la Realidad, OMH's Latino PSA health-awareness project. OMH circulated throughout Georgia, as well as throughout other southeastern states, a print-media campaign that included health-education messages in Chinese, Vietnamese and Korean. As a result, OMH started an information and referral service for Vietnamese populations and an HIV/AIDS prevention and referral service for the Asian-American population. Regional Minority Health Networks were established to help develop action plans that addressed issues and barriers in minority communities and to increase minority participation in local planning for services and program resources related to HIV/AIDS. The OMH HIV/AIDS Demonstration Project continued to provide technical assistance and a series of capacity-building training experiences to Minority Community Based Organizations across the state. Data analyses were done for OMH's second data book on the impact of HIV/AIDS on minorities in Georgia. OMH coordinated the first observance of "Minority Health Month" in April 2002 and published the first "Minority Health Month" calendar of events for activities held statewide. The calendar was multicultural and multi-lingual. A major briefing book was prepared for members of the Georgia Legislative Black Caucus. The book focused on issues and service resources for the six health disparities targeted for elimination by 2010, which include cardiovascular disease, cancer, diabetes, infant mortality, immunizations and HIV/AIDS. The OMH also conducted a legislative workshop on HIV/AIDS issues and services during the caucus' annual legislative weekend. 58 Health Improvement Programs The OMH partnered with the Women of the NAACP to provide community outreach and several education workshops in two Georgia cities about risk reduction for sudden infant death syndrome in the African-American community. Eliminating-disparities contracts were established with six community-based organizations to implement local or regional strategies to address health disparities. Office of Rural Health Services Description of the Office of Rural Health Services The Office of Rural Health Services works to improve access to health care in rural areas and reduce health status disparities between rural and non-rural populations in Georgia. The office has the following objectives: 1) to empower communities to strengthen and maintain the best possible health care using existing resources; 2) to provide up-to-date health systems information and technical assistance; 3) to build strong partnerships to meet local and regional needs; 4) to provide incentives to local areas to implement integrated service delivery systems; and 5) to act as the single point of contact for all regional issues related to health care. The office has a 15-member advisory council and each member of the initial council serves a three-year term, with the length of any subsequent terms determined by lottery, subject to review. FY 2002 Milestones The Office of Rural Health Services (ORHS) focused on building regional rural health systems, increasing the number of community and migrant health centers, supporting rural hospitals, and identifying ways to make health care available to Georgians in underserved rural and urban areas. Major milestones are listed below: General Moved location of office to Cordele, Georgia, to better meet the needs of rural health systems, hospitals and Georgians. Received the new Robert Wood Johnson Foundation Southern Rural Access Program award for improving access to care. Network Development Invested $2.7 million in the Rural Health Systems Development Program to facilitate the creation of eleven networks to provide services through multi-county regions. Invested $1 million in the Access Georgia Rural Health Matching Grants Initiative to develop regional rural health networks in partnership with the Georgia Philanthropic Collaborative and the Robert Wood Johnson Foundation. Amounts invested were used to develop six new networks and expand three existing networks. In partnership with the Georgia Association for Primary Care and the Health Resources and Services Administration (HRSA), Region IV field office, the ORHS facilitated Georgia's first all-HRSA grantee meeting. In partnership with the Georgia Association for Primary Care and HRSA, Region IV field office, the ORHS facilitated a Community Access Program grant-writing workshop that helped to secure three successful awards of approximately $1 million each for Georgia communities. President's Initiative for Community/Migrant Health Center Growth Received federal HRSA funding, for the first time in Georgia in eight years, for a new federally qualified health center as a part of the presidential initiative to expand access to health care. Collaborative partnerships to expand the number of federally qualified health centers and community and migrant health centers will continue as a part of the presidential initiative and as a Department priority. 59 Health Improvement Programs Assisted in the successful placement of health care providers in underserved rural and urban areas of Georgia through the National Health Service Corps Scholar and Loan Repayment Program and the J-1 Visa Waiver Program. Increased the number of migrant and seasonal farm workers participating in Georgia's Farm Worker Health Program (GFHP). Expanded migrant and seasonal farm worker services into new counties, using new federal and state investments in the GFHP. Hospital Services Assisted eight additional hospitals in securing critical-access-hospital certification, bringing the total number of critical-access hospitals to 24, which is the highest total within the Centers for Medicare and Medicaid Services Southeast Region and puts the program in 9th place nationally. Received $5 million from the state Rural Hospital Assistance Program for grants to serve 60 rural hospitals. Partnered with hospital organizations to provide rural hospitals with technical assistance designed to improve financial performance, customer service and quality of care. Georgia Commission on Men's Health Description of the Commission on Men's Health The Georgia Commission on Men's Health works to improve the health status of men in the state of Georgia. To this end, the commission is responsible for developing strategies, public policy recommendations, and programs, including community outreach and public-private partnerships, that are designed to educate Georgia's men on the benefits of regular physical check-ups, early detection of disease through preventive screening tests, and healthy lifestyle practices. The commission monitors state and federal policy and legislation that may affect the area of men's health, and recommends assistance, services and policy changes that will further the goals of the commission. The formal objectives of the commission are to: 1) enhance community awareness of men's health issues; 2) identify the interests and needs of targeted men's groups; 3) promote the health and wellness of men in the state of Georgia; 4) improve health outcomes for men with specific disease conditions that are important to men's health overall; 5) establish the commission as the information repository and coordinating entity for men's health initiatives; and 6) develop a comprehensive plan for men's health to facilitate and improve healthcare access for the uninsured and underinsured. The commission has an 11-member advisory board and terms are two years for legislative members and three years for non-legislative members. FY 2002 Milestones Welcomed commission's Honorary Chairman, Ambassador Andrew J. Young, who was sworn in by Governor Barnes on March 6, 2002. Distributed over 80,000 copies of the Health Guide for Georgia Men, which is a health-education resource. This guide is available in English and Spanish. Coordinated "Men's Health Day at the Capital," which provided health screenings for over 200 Georgia legislators in March of 2002. Implemented the "Men's Health Lecture Series," which began in June of 2002 with "lunch and learn" lectures held across the state. The lecture series was a collaborative effort between the commission and the National Men's Health Network. Participated in the Annual Prostate Cancer Awareness Forum in partnership with the Georgia Prostate Cancer Coalition. The forum attracted more than 100 participants and was held in Atlanta. 60 Conclusion Conclusion The Georgia Department of Community Health completed many important tasks during fiscal year 2002, but continues to face many challenges and opportunities in the coming year. Many changes are necessary to reduce the rate of growth in the expenditures for Medicaid, PeachCare and State Health Benefit Plan programs while also ensuring quality care to our members. The consolidation of the state's health purchasing agencies has allowed the Department to begin to maximize the state's health care purchasing power and create administrative efficiencies in the state's health care system. The Department has major initiatives underway which, when implemented, will make us even more efficient and productive in the future. We will continue to make improvements to ensure that quality, cost-effective health care services are provided to the more than two million Georgians that DCH serves. 61 Notes 62 Notes 63 Published by the Georgia Department of Community Health Office of Communications Georgia Department of Community Health 2 Peachtree Street, NW Atlanta, GA 30303-3159 404-656-4479 www.dch.state.ga.us