FY 2005 annual report

DEPARTMENT OF COMMUNITY HEALTH 2005 Annual Report
Tim Burgess, Commissioner
Overview The Georgia Department of Community Health (DCH) is involved in planning, purchasing and regulating health care in the state. Since its inception in 1999, the department's purposes have included the following: Acting as the lead planning agency for health issues in Georgia; Capitalizing on the state's health care purchasing power; Maximizing administrative efficiency in state health care programs; Creating a better health care infrastructure throughout Georgia which improves access and coverage;
and Encouraging a healthy lifestyle for all Georgians.
Mission DCH is committed to improving the health of all Georgians through health benefits, systems development and education.
Vision DCH will be a national leader for innovative health planning, promotion, programs and services to improve community health.
Roles and Responsibilities Insuring over 2.6 million Georgians. Administering a budget that exceeds $9 billion. Coordinating health planning for state agencies.
The department must ensure quality health care services for a diverse population, including the following: Members of the State Health Benefit Plan (SHBP):
o Public school teachers o Retirees o State employees o Public school employees o Eligible dependents Children covered under the PeachCare for KidsTM Program People covered under Medicaid, including those who are: o Aged o Low income o Disabled
The Board of Community Health is a nine-person board appointed by the Governor and confirmed by the Senate, which has policy-making authority for the department. Board meetings are held monthly.
At the end of Fiscal Year (FY) 2005, the Board of Community Health members included: Jeff Anderson Cumming, Chairman Richard L. Holmes Peachtree City, Vice Chairman Christopher Byron Stroud, M.D. Albany, Secretary Mary McCalman Covington Carrollton Inman "Buddy" English, M.D. Warner Robins Kim Gay Sandy Springs Ross Mason Madison
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Ann McKee Parker, Ph.D. Atlanta Mark D. Oshnock Atlanta
COMPONENTS OF THE DEPARTMENT
Division of Medical Assistance 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 PeachCare for KidsTM, the State Children's Health Insurance Program (SCHIP), as well as the Disproportionate Share Hospital (DSH) Program and Indigent Care Trust Fund (ICTF). Other Medicaid programs include: Georgia Better Health Care, home and community-based services and Non-Emergency Transportation. In FY 2005, the division spent approximately $7 billion to provide services for 1.5 million Georgians.
General Counsel Division The General Counsel Division provides overall legal guidance and direction for the department; drafts and reviews contracts, requests for proposal and other procurement documents; provides legal services for all aspects of the SHBP, Medicaid and PeachCare for KidsTM programs; develops policies and procedures for compliance with governing federal and state authorities; and drafts rules and regulations, as well as public notices for consideration by the Board of Community Health. The division is responsible for the department's efforts to detect, prevent and investigate fraud and abuse in Medicaid, PeachCare for KidsTM and the SHBP through its Program Integrity Section.
The division is also responsible for administering the Certificate of Need (CON) program. Created by Title 31 of the Official Code of Georgia Annotated, the CON Program works to contain health care costs by avoiding unnecessary duplication of services, facilities or equipment. Decisions are based on applicable rules and methodologies for expanding health care facilities and services, as well as data collected and analyzed by the Health Planning Section, which serve as the essential basis for the proper planning of the state's health care facility needs. The Health Planning Section develops these rules and methodologies with input from the Health Strategies Council, which is a board of 27 gubernatorial appointees that was created by statute to provide guidance to the Department regarding Health Planning. The division's Health Planning Section also provides staff support for the Health Planning Review Board, an administrative review board appointed by the Governor for CON decisions.
State Health Benefit Plan Division DCH sponsors the State Health Benefit Plan (SHBP), which provides health insurance coverage to state and public school system employees, contract groups, retirees and eligible dependents. Within DCH, the SHBP division is responsible for the day-to-day management of the SHBP operations. At the end of FY 2005, SHBP covered 644,906 lives.
Operating Units Within the division, there are seven operating units. Their responsibilities include the following: processing member eligibility transactions, assisting employer groups, processing member appeals, reviewing vendor performance and clinical standards, enforcing contract compliance among vendors, managing the annual enrollment/change period, and conducting member educational programs and health benefit plan design.
Managed Care and Quality Division The Managed Care and Quality Division is responsible for establishing and directing the managed care efforts of the department. These efforts include planning for the transition of a large proportion of the current Medicaid program into a managed care environment.
Health Improvement Programs The department also administers four Health Improvement Programs dedicated to wellness, prevention and healthy improvement of various populations, both geographic and homogeneous. The programs are as follows:
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The Office of Rural Health Services works to improve access to health care in rural and underserved areas to reduce health status disparities across Georgia
The Office of Minority Health works to eliminate the disparity in health status between minority and non-minority populations
The Office of Women's Health serves as a clearinghouse for women's health information The Georgia Commission on Men's Health recommends ways to promote the benefits of regular
checkups, preventive screening tests and healthy lifestyle practices for men
Division of Financial Management The Division of Financial Management represents the department's financial interests when working with the Governor's Office, General Assembly, Board of Community Health, the Centers for Medicare and Medicaid Services and other stakeholders. The division is comprised of the Office of Planning and Fiscal Analyses, Financial and Accounting Services, Reimbursement Services and the Budget Office.
Information Technology The Project Management Office is responsible for promoting project management standards throughout DCH. As a centralized support function, staff serve as managers for projects with Information Technology components by assisting DCH management in the planning, development and implementation of health care initiatives. The Office of Information Technology (IT) provides technical support at both the desktop and network levels for all the divisions within DCH.
The Medicaid Management Information System (MMIS) unit supports the various systems used for the processing, collecting, analyzing and reporting of information needed to support all Medicaid and PeachCare for KidsTM claim payment functions. The MMIS consists of all federally required subsystems as specified by the Centers for Medicare and Medicaid Services within the U.S. Federal Department of Health and Human Services.
Legislative and External Affairs The Office of Legislative Affairs serves as the department's primary point of contact for all activities related to the Georgia General Assembly and the annual Legislative Session. During each session, the DCH legislative unit analyzes bills that affect Medicaid, SHBP and health care in general. The Legislative and External Affairs Unit also is responsible for ensuring the passage of the department's legislative agenda each year.
The Office of Community Affairs (OCA) assists DCH in providing customer service for Georgia's Medicaid program. OCA interacts daily with members, providers, legislators and others, as well as helping Georgians understand the Medicaid program and the department's business functions as a whole. OCA responds to thousands of calls, e-mails, letters, faxes and inquiries relating to the Medicaid program. This unit also assists community-based health systems in providing access to care to Georgia's uninsured.
Operations Divisions The Operations Division consists of the following units: The Administrative Services Unit has three subunits which are Contract Administration, Vendor
Management and Support Services The Audits Unit conducts and oversees internal and external audits The Communications Unit is responsible for media and public relations, as well as Web site
management The Human Resources Unit provides internal and external employment services for state employees
and constituents. This unit sponsors the annual Charitable Contributions Program which is a Governor's initiative to raise funds for charities and non-profit organizations through donations from state employees The Vendor Operations for Affiliated Computer Services (ACS) is a group of experts who provide support with managing the agency's Medicaid fiscal agent, ACS
In addition, the following three administratively attached agencies are housed in DCH:
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Composite Board of Medical Examiners The Composite Board of Medical Examiners licenses and regulates physicians, physician's assistants, respiratory care professionals, acupuncturists, perfusionists, auricular detoxification specialists, paramedics and cardiac technicians. The composite also maintains a comprehensive database that offers public access to information about licensed physicians in the state. Twelve physicians and one consumer representative serve on this board.
Georgia Board for Physician Workforce The 15-member Georgia Board for Physician Workforce (GBPW) monitors and evaluates the supply and distribution of physicians by specialty and geographic location to identify underserved areas of the state. GBPW also develops medical educational programs through financial aid to medical schools and residency-training programs.
State Medical Education Board The State Medical Education Board (SMEB) administers medical scholarships and loans to promote medical practices in rural areas. Initiatives include the Country Doctor Scholarship and Loan Repayment Programs, which encourage physicians to practice in the state's underserved areas. SMEB has 15 members and publishes a biennial report, submitted directly to the General Assembly.
Auditors' Statements on Annual Reports Independent auditors rendered a "clean" opinion on the financial statements for FY 2005.
Milestones for the Department in FY 2005
The listed milestones reflect activities that affected the performance or operations of more than one DCH division or section. Each division or section lists its milestones in its respective section.
The Georgia Volunteer Health Care Program (GVHP) began in November 2005. Under this initiative, the state of Georgia will provide liability medical coverage for volunteer health care professionals while they treat underinsured Georgia citizens.
Administrative Services' Contracts and Procurement managed 375 contracts with a total annual cost of approximately $1,304,834,310.
Contracts and Fiscal Services (CFS), Administrative Services, processed more than 900 invoices for payment for more than 200 cost-related contracts. CFS accurately tracked and reported the utilization status for each contract to facilitate each division's efficient use of contract dollars.
CFS initiated the renewal process for approximately 400 contracts by developing the listing of contracts along with their current and prior year financial status.
Vendor Management, Administrative Services, developed policies and procedures for consistency and to ensure maximum vendor productivity and adherence to performance standards/contract terms.
The Office of Audits volunteered to participate in the Payment Error Rate Measurement (PERM) pilot program funded by the United States Department of Health & Human Services, Centers for Medicare & Medicaid Services (CMS). Under the project, DCH gained experience in the logistics required to work with CMS to comply in federal fiscal year 2007 with the United States Congress' Improper Payments Information Act.
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FY 2005 DCH Expenditures Benefits Medicaid* PeachCare for KidsTM* Indigent Care Trust Fund Payments to Nursing Homes State Health Benefit Plan Payments (Including HMO Premium Payments)

$6,546,302,757 $263,157,121 $490,913,447 $255,115,084
$1,879,649,443 $9,435,137,852

94.24%

Services Support (Contracts) Systems Support Department of Human Resources Administration Contract State Health Benefit Plan Medicaid and PeachCare for KidsTM Contractual Services

$105,840,751 $109,989,140 $103,297,079 $175,268,130 $494,395,100

4.94%

Medical Education and Licensing Georgia Board for Physician Workforce State Medical Education Board Composite State Board of Medical Examiners

$38,173,049 $1,308,374 $2,144,435
$41,625,858

.42%

Health Care Planning and Initiatives Health Planning Rural Health Minority Health Women's Health
Administration State Health Benefit Plan Administration Medicaid and PeachCare Administration**
Totals

$1,757,555 $5,844,694
$332,429 $147,532 $8,082,210
$8,648,117 $23,348,517 $31,996,634 $10,011,237,654

.08%
.32% 100%

*Based on dates of service and includes claim and non-claim benefit payments. **Includes rent and utilities, state agency services, telecommunications, accounting and auditing, and other support services.

DIVISION OF MEDICAL ASSISTANCE

Accomplishments for FY 2005

Aging and Community Services Accomplishments for FY 2005 Service Options Using Resources in a Community Environment (SOURCE) Program was approved by the Centers for Medicare and Medicaid Services as a state plan service for Enhanced Primary Care Case Management effective January 2005.

DCH Quality Program in Nursing Homes In FY 2005, DCH continues to collaborate with partners in the long-term care industry, which includes nursing homes, Office of Regulatory Services, State Ombudsman's Office in the Department of Human

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Resources, American Association of Retired Persons and Alzheimer's Association, among others, to promote a successful program to measure and monitor quality indicators for improvement. Voluntarily enrolled Georgia nursing homes remain at 100 percent for participation in the program, which offers a range of clinical and quality indicators upon which facilities can conduct self-improvement assessments. A book was developed from a program titled, "Year in Review," which includes statistics and trends, cost data and survey findings. The data included in this report include historical trends, as well as comparison data across councils, regions and national data. This information is now available on the Georgia Health Care Association Web site at www.gnha.org. The DCH program also offered a fun way to get quality improvement training out to employees with the fascinating board game, "Just Ask Why." This game was played by staff members to learn more about quality. The game was presented or mailed to all nursing facilities. Description of Medicaid Medicaid is a joint federal/state health care assistance program for certain individuals and families with low incomes and resources. Those included in the program are individuals with low incomes, children, pregnant women and people who are elderly, blind or disabled who meet the eligibility criteria. Medicaid is the largest source of funding for medical and health-related services for Georgia's most indigent people. Medicaid reimburses health care providers for services administered to eligible individuals. People who are eligible for Medicaid receive a card, very similar to anyone else with health insurance, to use for services from participating providers. The federal government pays the largest share of Medicaid costs. In FY 2005, for every dollar of state funds, Georgia drew down $1.66 in federal-matching funding. The state's Medicaid program receives varying levels of federal reimbursement for different services and functions. For example, the federal government pays 90 percent of the cost for family planning and almost 60 percent for most other benefits. Computer costs are 75 percent federally funded and other administrative costs received 50 percent federal funding. DCH works to make health care available and accessible to indigent Georgians while staying fiscally accountable to the state's citizens. A broad range of services addresses the health care needs of those enrolled in the Medicaid program. The chart below and on the next page summarizes FY 2005 Medicaid and PeachCare for KidsTM benefit figures:
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TOTALS Total Members* Total Patients Average Members Per Year Member Months** Total Expenditures Expenditures Per Member Expenditures Per Patient Providers with Paid Claims

2,026,314 1,708,842 1,577,098.3 18,925,180 $6,227,930,435.64 $3,073.53 $3,644.53
44,681

MEDICAID Total Members* Total Patients Average Members Per Year Member Months** Total Expenditures Expenditures Per Member Expenditures Per Patient Providers with Paid Claims Number of Paid Claims

1,793,332 1,499,661 1,367,759.8 16,413,117 $5,949,090,603 $3,317.34 $3,966.96
44,455 43,883,016

PEACHCARE for KidsTM Total Members* Total Patients Average Members Per Year Member Months** Total Expenditures Expenditures Per Member Expenditures Per Patient Providers with Paid Claims Number of Paid Claims

299,955 249,030 209,338.6 2,512,063 $278,839,833 $929.61 $1,119.70
24,603 3,319,730

*Members are those who are eligible for and enrolled in the Medicaid or PeachCare for KidsTM program. Patients are those members who have received any type of service under these programs. **Member months is the sum of members by month with any coverage type. Based on dates of service from July 2004 to June 2005, date paid July 2004 September 2005 and include claim-based expenditures only.

Eligibility A person must meet the eligibility requirements within one of the following coverage groups to be eligible for Medicaid: the aged (over 65), blind, permanently or totally disabled; pregnant women; children or parents or caregivers, 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.

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Major Coverage Groups Supplemental Security Income (SSI) Recipients Aged, blind or disabled individuals who receive
SSI. Nursing Homes Aged, blind or disabled individuals who live in nursing homes and have low
incomes and limited assets. Community Care Aged, blind or disabled individuals who need regular nursing care and personal
services, but who can stay at home with special community care services. Qualified Medicare Beneficiaries Aged, blind or disabled individuals who have Medicare Part A
(hospital) insurance and have incomes less than 100 percent of the federal poverty level and limited resources. Medicaid will pay the Medicare premiums (A & B), coinsurance and deductibles only. 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 Adults and children who meet the income standards of the Temporary Assistance for Needy Families (TANF) program. Right from the Start Medicaid for Pregnant Women (RSM Adults) Pregnant women with family incomes at or below 200 percent of the federal poverty level. Right from the Start Medicaid (RSM Children) Children from under 1 to 19 years whose family incomes are at or below the appropriate percentage of the federal poverty levels for their age and family size. Medically Needy Pregnant women, children, aged, blind and disabled individuals whose family incomes exceed the established income limit may be eligible under the Medically Needy Program (MNP). The MNP allows a person to use incurred/unpaid medical bills to "spend down" the difference between his/her income and the income limit to become eligible. Breast and Cervical Cancer Program Uninsured and underinsured women under age 65 who have been screened by the public health department and then diagnosed with either breast or cervical cancer may be eligible for treatment of their condition under Medicaid. Emergency Medical Assistance Immigrants, including undocumented immigrants, who would have been eligible for Medicaid except for their immigrant status, were potentially eligible for Emergency Medical Assistance (EMA). This included persons who were aged, blind, disabled, pregnant women, children or parents of dependent children who met eligibility criteria. Services rendered to EMA recipients were limited to emergency care only as described in the Federal Regulations (1903 (v) of the Social Security Act and the Code of Federal Regulation 42 CFR 440.255).
Covered Services Ambulance Services Ambulatory Surgical Services Certified Registered Nurse Anesthetists Childbirth Education Services Children's Intervention Services Community Mental Health Services Diagnostic, Screening and Preventive Services (Health Departments) Dental Services Dialysis Services Durable Medical Equipment (DME) Family Planning Services Georgia Better Health Care Health Check (Early and Periodic Screening, Diagnosis and Treatment - EPSDT) Health Insurance Premium Payment (HIPP) Health Insurance Premiums (Medicare Parts A & B) Home Health Services Hospice Services Inpatient and Outpatient Hospital Services
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Intermediate Care Facility for the Mentally Retarded Services Laboratory and Radiological Services Medicare Crossovers Non-Emergency Transportation Services Nurse Midwifery Services Nurse Practitioner Services Nursing Facility Services Oral Surgery 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 SOURCE (Service Options Using Resources in a Community Environment) Swing-Bed Services Targeted Case Management Services
o Adults with AIDS o Adult Protective Services o Case Management and Support Coordination Services o Child Protective Services o Children at Risk for Incarceration o Early Intervention o Perinatal Therapeutic Residential Intervention Vision Care Services Waiver Services o Community Care Services Program o Community Habilitation and Support o Georgia Pediatric Program (GAPP) Waiver o Independent Care Waiver Program o Mental Retardation Waiver Program o Traumatic Brain Injury
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Georgia Medicaid Patients and Expenditures for FY 1994 through FY 2005

Time Period FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005

Patients 1,058,918 1,135,212 1,181,092 1,240,884 1,234,741 1,213,880 1,201,669 1,270,268 1,369,629 1,320,980 1,422,773 1,499,661

Net Payments $2,747,463,083 $3,003,708,266 $3,089,570,328 $3,151,030,885 $3,028,628,870 $3,115,622,863 $3,343,199,902 $3,745,204,923 $4,393,856,380 $4,808,499,159 $5,587,222,638 $5,949,090,603

Net Pay Per Patient $2,594.59 $2,645.94 $2,615.86 $2,539.34 $2,452.85 $2,566.66 $2,782.13 $2,948.36 $3,208.06 $3,640.10 $3,927.00 $3,966.96

% Change Year over Year N/A 1.98% -1.14% -2.93% -3.41% 4.64% 8.39% 5.97% 8.81% 13.47% 7.88% 10.18%

Based on dates of service from July 2004 to June 2005, date paid July 2004 September 2005 and include claim-based expenditures only.

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MEDICAID PROFILE Aid Category Group Breast/Cervical Cancer Screen

Patients % of Total

3,258

0.22%

Net Payment % of Total

$37,193,858.62

0.63%

Aged with and without Medicare

69,264

4.62% $1,054,230,904.50

17.72%

Blind/Disabled with and without Medicare

212,854

14.19% $2,199,914,860.72

36.98%

Special Low-Income Medicare Beneficiaries

802

0.05%

$262,184.94

0.00%

Other Waivers

16,574

1.11% $185,329,428.80

3.12%

Medically Needy

105

0.01%

$567,014.48

0.01%

Qualified Medicare Beneficiaries

53,222

3.55% $38,812,767.22

0.65%

Low-Income Medicaid

482,248

32.16% $925,759,029.39

15.56%

RSM Child

650,784

43.40% $1,027,954,969.35

17.28%

RSM Adult

131,663

8.78% $476,790,919.74

8.01%

Refugee

1,642

0.11%

$2,274,664.95

0.04%

By Age

1,499,661 100.00% $5,949,090,603 100.00%

Under 1 year

181,859

12.13%

$531,447,859

8.93%

1 to 5 years

351,295

23.42%

$464,358,698

7.81%

6 to 20 years

519,865

34.67% $1,013,285,772

17.03%

21 to 44 years

287,980

19.20% $1,401,781,044

23.56%

45 to 64 years

120,864

8.06% $1,179,232,156

19.82%

65+ years

129,558

8.64% $1,358,985,074

22.84%

1,499,661 100.00% $5,949,090,603 100.00%

By Gender

Male

588,471

39.24% $2,179,037,850

36.63%

Female

912,208

60.83% $3,770,052,752

63.37%

By Residence

1,499,661 100.00% $5,949,090,603 100.00%

Rural

586,709

39.12% $2,439,565,235

41.01%

Urban

941,894

62.81% $3,509,525,367

58.99%

By Race

1,499,661 100.00% $5,949,090,603 100.00%

Unknown

120,414

8.03%

$547,821,408

9.21%

White

656,523

43.78% $2,916,703,913

49.03%

Black

720,127

48.02% $2,388,855,779

40.15%

American Indian/Alaskan

1,285

0.09%

$4,784,405

0.08%

Asian/Pacific Islander

20,816

1.39%

$62,632,639

1.05%

Hispanic

14,075

0.94%

$28,292,459

0.48%

1,499,661* 100.00%* $5,949,090,603
Based on dates of service from July 2004 to June 2005, date paid July 2004 September 2005 and include claim-based expenditures only. *Patients do not necessarily sum to total as members may switch between categories.

100.00%

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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 68.04 percent of all members received services from a physician in FY 2005. Physician services accounted for approximately 10.7 percent of Medicaid benefit expenditures in FY
2005.

Physician Services
Category of Service Physician Services Net Payments Sub Total

Providers w/ Paid Claims
24,523

Unique Patients
1,220,256

Net Payment $635,440,090 $635,440,090

Net Payment Per Patient
$520.74

Pharmacy Services The Drug Utilization Review Board recommends medical criteria standards and educational
intervention methods for drug utilization review. It also advises DCH about products considered clinically effective for the department's health plans. Pharmacy services cover drugs requiring a prescription, insulin, diabetic supplies and certain nonprescription drugs. However, if a proven, lessexpensive treatment known to be safe and effective for most people does not work for an individual, the doctor may wish to change to another more expensive drug. In such a case, a prior authorization may be required to document such a treatment if necessary, depending on the classification of the drug. Pharmacy increased its generic utilization from 50.8 percent to 56.3 percent in FY 2005. Additionally, the supplemental rebate program implemented saved DCH $131,179,656 in FY 2005. These supplemental rebate savings included both supplemental rebate payments to DCH, as well as market share movement. Pharmacy services accounted for approximately 19.2 percent of Medicaid benefit expenditures in FY 2005.

Pharmacy Services
Category of Service Pharmacy Pharmacy DME Supplier Net Payments Sub Total

Providers w/ Paid Claims
2,132
2,001

Unique Patients
1,157,222
69,437

Net Payment $1,129,133,102
$12,386,662 $1,141,519,765

Net Payment Per Patient
$975.73
$178.39

Hospital Services Inpatient hospital services are covered when services cannot be provided on an outpatient basis. Most adult inpatient hospital stays and outpatient surgical procedures must be certified prior to
admission. Outpatient hospital services may include emergency room care, outpatient surgery and clinic
services. Hospital services accounted for approximately 31.1 percent of total Medicaid benefit expenditures in
FY 2005.

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Hospital Services
Category of Service Inpatient Hospital Services Outpatient Hospital Services Net Payments Sub Total

Providers w/ Paid Claims
397
671

Unique Patients
255,323
782,647

Net Payment $1,230,111,314
$620,793,199 $1,850,904,513

Net Payment Per Patient
$4,817.86
$793.20

Nursing Facility Services Covers institutional care for members whose health conditions are such that they are unable to
remain at home or in the community. The Department of Human Resources' Office of Regulatory Services regulates nursing home
licensing and certain quality measures. Accounted for approximately 17.9 percent of total Medicaid benefit expenditures in FY 2005.

Nursing Facility Services
Category of Service Swing-bed Hospital Services Skilled Care in a Nursing Facility Skilled Care in a State-Owned Nursing Facility State-Owned Intensive Care for Mental Retardation Intensive Care Nursing Facility - Mental Retardation Net Payments Sub Total

Providers w/ Paid Claims
30
351

Unique Patients
267
40,629

Net Payment $355,514
$945,244,530

Net Payment Per Patient
$1,331.51
$23,265.27

6

296

$23,114,845

$78,090.69

12

1,029

$90,870,568

$88,309.59

1

120

$6,353,529

$52,946.08

$1,065,938,986

Maternal and Child Health Services Covers prenatal and perinatal care, family planning, pays for children's preventive care through
Health Check, helps children with physical and developmental problems and assists children at risk. Represented approximately 2.1 percent of total Medicaid benefit expenditures in FY 2005.

Maternal and Child Health Services
Category of Service Family Planning Services Health Check Services (EPSDT) Pregnancy-Related Services Children-at-Risk Targeted Case Perinatal Targeted Case Management Diagnostic Screening and Prevention Early Intervention Case Management Children's Intervention Services Childbirth Education Program Children's Intervention School Net Payments Sub Total

Providers w/ Paid Claims
117 2,805
109 27
149 245 221 2,339
11 146

Unique Patients
23,083 462,289
10,585 4,981
34,723 104,633
6,832 26,040
339 18,869

Net Payment $2,375,632
$49,505,707 $924,704
$2,309,157 $3,241,179 $5,463,884 $5,345,491 $42,297,594
$8,310 $15,257,056 $126,728,716

Net Payment Per Patient
$102.92 $107.09
$87.36 $463.59
$93.34 $52.22 $782.42 $1,624.33 $24.51 $808.58

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Other Practitioner Services Includes: physician's assistant services, Health Check dental program for children under 21, adult
dental program, vision care, nurse midwifery, oral maxillofacial surgery, podiatry, psychological services, advanced registered nurse practitioners services and licensed clinical social work. Represented approximately 4.4 percent of total Medicaid benefit expenditures during FY 2005.

Other Practitioner Services
Category of Service Physician's Assistant Services Health Check Dental Program - Under 21 Adult Dental Program Vision Care Nurse Midwifery Oral Maxillofacial Surgery Podiatry Psychological Services Advanced Registered Nurse Practitioners Licensed Clinical Social Work Net Payments Sub Total

Providers w/ Paid Claims
1,382 1,487 1,004
871 213
92 381 780 2,516
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Unique Patients 109,711 403,759
55,528 134,740
22,755 1,753
48,448 36,697 174,350
209

Net Payment $10,044,590
$161,248,810 $19,302,444 $10,328,840 $13,630,805 $237,515 $3,659,557 $21,806,704 $19,068,920 $15,344
$259,343,529

Net Payment Per Patient
$91.55 $399.37 $347.62
$76.66 $599.02 $135.49
$75.54 $594.24 $109.37
$73.42

Mental Health Services Covers a comprehensive range of services provided by outpatient mental health rehabilitative
programs. People with chronic mental illnesses, mental retardation or substance abuse may receive community-
based services, which enable them to continue living independently in the community. Community care is a less-costly alternative to either hospitalization or nursing home care. Accounted for approximately 1.8 percent of total Medicaid benefit expenditures during FY 2005.

Mental Health Services
Category of Service Community Mental Health Services Net Payments Sub Total

Providers w/ Paid Claims
431

Unique Patients
63,011

Net Payment $104,668,140 $104,668,140

Net Payment Per Patient
$1,661.11

Waiver Services for Home and Community-Based Care Waiver services include four home and community-based programs that are covered by Medicaid. These waivers are issued by the federal government and 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 "core" services including the following: 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 seven percent of the total Medicaid benefit expenditures in FY 2005.

The four home and community-based waiver programs are as follows: The Community Care Services Program helps aged or disabled people remain in their homes or
return to the community from nursing homes.

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The Mental Retardation Waiver Program and the Community Habilitation and Support Services Waiver Program help people with developmental disabilities and/or mental retardation remain in their own homes or move to a community residential facility to prevent placement in an Intermediate Care Facility for People with Mental Retardation.
The Independent Care Waiver Program helps adult Medicaid members with severe disabilities live in their own homes or in the community instead of a hospital or nursing home.
Waivered Home Care Services helps children who are ventilator-dependent. The children receive in-home care and services.
Other services included the following: Service Options Using Resources in a Community Environment (SOURCE) links primary care with an
array of long-term health services in a person's home or community to avoid preventable hospitalization and nursing home care for frail, older or disabled people. In FY 2005, there were eight SOURCE sites, providing services in 159 counties, more than 8,000 people in Georgia. Dedicated case management services are used by people needing mental health services and some mental retardation waiver services. Georgia Pediatric Program (GAPP) (GAPP In-home Private Duty Nursing; GAPP Medically Fragile Daycare) serves medically-fragile members under the age of 21. Members must be medically fragile with multiple systems diagnoses and require continuous skilled-nursing care to be considered for GAPP services. Members served by GAPP are required to meet the same level of care for their medical condition that requires skilled-nursing care equivalent to the care received in an institutional setting, i.e., hospital or skilled-nursing facility, or admission to a hospital or nursing facility. In FY 2005, a total of 618 members received GAPP services.

Waiver Services for Home and Community-Based Care

Category of Service

Providers w/ Paid Claims

Dedicated Case Management Services

5

Community Care Services

483

Independent Care Waiver Services

102

Mental Retardation Waiver Program

479

Community Habilitation and Support

78

Waivered Home Care Services

2

SOURCE

171

Georgia Pediatric Program

(GAPP) In-home Private Duty Nursing

(473 Members in FY 2005)

17

Georgia Pediatric Program

(GAAP) Medically Fragile Daycare

(145 Members in FY 2005)

4

Net Payments Sub Total * The above numbers may not add due to rounding

Unique Patients
12,301 13,980
622 7,060 1,197
7 7,222
393
200

Net Payment $16,056,390 $97,697,732 $26,493,926
$152,278,360 $55,337,963 $23,836 $44,584,586

Net Payment Per Patient
$1,305.29 $6,988.39 $42,594.74 $21,569.17 $46,230.55 $3,405.19 $6,173.44

$20,298,515 $51,650.17

$6,321,356 $419,092,665*

$31,606.78

Emergency Transportation Covers Emergency Ground Ambulance and Emergency Air Ambulance Services, which in FY 2005,
accounted for 0.4 percent of total Medicaid benefit expenditures. The Non-Emergency Transportation total for two vendors was $68,790,663. Expenditures were
$56,207,822 for Logisticare and $12,582,841 for Southeastrans respectively. This expenditure is accounted for in "All Other Services."

16

Emergency Transportation
Category of Service Emergency Ground Ambulance Services Emergency Air Ambulance Services Net Payments Sub Total

Providers w/ Paid Claims
202
10

Unique Patients
92,611
834

Net Payment $20,495,235 $2,322,396 $22,817,631

Net Payment Per Patient
$221.30
$2,784.65

Equipment and Devices Covers the rental or purchase of medical equipment and devices such as: hospital beds, wheelchairs,
oxygen equipment, walkers, artificial limbs and braces. Services in this category accounted for 0.8 percent of total Medicaid benefit expenditures in FY 2005.

Equipment and Devices
Category of Service Durable Medical Equipment Services Orthotics and Prosthetics/Hearing Services Net Payments Sub Total

Providers w/ Paid Claims
880

Unique Patients
109,500

233 16,605

Net Payment Net Payment Per Patient

$38,223,409

$349.07

$10,620,376 $48,843,784

$639.59

All Other Services Covered services such as: ambulatory and surgical centers, rural health clinics, non-emergency transportation (NET), laboratory, x-ray, dialysis, home health, protective services, hospice, therapy and specialized services for specific populations including adults with AIDS and children at risk for incarceration.

All Other SSI Services comprised 4.6 percent of total Medicaid benefit expenditures in FY 2005.

All Other Services
Category of Service Home Health Services Independent Laboratory Service Speech Therapy - Medicare Only Physical Therapy - Medicare Only Rehabilitation Therapy - Medicare Only Federally Qualified Health Center Hospital-Based Rural Health Center Free Standing Rural Health Clinic Chiropractics - Medicare Only Ambulatory Surgical Center/Birthing Hospice Dialysis Services - Technical

Providers w/ Paid Claims
96 144
1 114
42 65 54 32 129 147 88 415

Unique Patients
9,301 283,912
8 923 898 43,034 27,315 18,209 815 17,708 5,963 7,356

Net Payment $6,469,446
$23,720,829 $144
$26,128 $24,265 $11,474,095 $4,274,690 $3,567,399 $32,946 $8,443,782 $54,171,985 $38,417,340

Net Payment Per Patient
$695.56 $83.55 $17.95 $28.31 $27.02
$266.63 $156.50 $195.91
$40.43 $476.83 $9,084.69 $5,222.59

Continued on next page All Other Services

17

Category of Service

Providers w/ Paid Claims

Dialysis Services Professional

398

Targeted-Case Management-Aids

15

At Risk of Incarceration

1

Child Protective Services

1

Adult Protective Services

1

Therapeutic Residential Intervention

30

Net Payments Sub Total * The above numbers may not add due to rounding

Unique Patients
3,061 1,042 6,875 36,103 2,617 5,824

Net Payment $1,536,207 $256,280 $5,647,243
$37,905,773 $2,962,609
$74,861,625 $273,792,784*

Net Payment Per Patient
$501.86 $245.95 $821.42 $1,049.93 $1,132.06 $12,853.99

For all services, the department identifies members with other health insurance in an attempt to ensure Medicaid is payer of last resort as shown below: Requiring the third party to pay before Medicaid (cost avoidance); Recouping benefits from the liable third party after the claim has been paid; Trauma, casualty, or accident-related payment cases (tort recovery); Billing the liable party; Paying health insurance premiums for members when it is cost effective and Health Insurance Premium Payment (HIPP) Program.

From Casualty From Other Health Insurance Total
Due to Medicare Due to Other Health Insurance Total

Third Party Liability FY 2005 Totals Dollars Recovered $9,699,278.39 $21,025,309.15 $30,724,587.54
Cost Avoidance Savings $500,768,732.91 $166,928,563.25 $667,697,296.16

18

Medicaid Services Distribution FY 2005

Waiver Programs 7.0%
Other Practitioners 4.4% Emergency Transportation 0.4%

All Other Services 4.6%

Equipment and Devices 0.8%

Pharmacy 19.2%

Maternal & Child Health 2.1%
Nursing Facilities 17.9%

Physicians 10.7%

Physicians Hospital Mental Health Nursing Facilities Maternal & Child Health Pharmacy Equipment and Devices Emergency Transportation Other Practitioners Waiver Programs All Other Services

Hospital 31.1%

Mental Health 1.8%

MEDICAID MEMBERS AND EXPENDITURES BY COUNTY

# of

Unique

Payment/

County

Patients

Net Payments

Patient

Appling

5,320

$23,327,545

$4,385

Atkinson

2,496

$9,213,262

$3,691

Bacon

2,514

$12,264,687

$4,879

Baker

893

$2,519,025

$2,821

Baldwin

9,238

$81,955,344

$8,872

Banks

2,400

$7,872,420

$3,280

Barrow

8,906

$34,533,732

$3,878

Bartow

15,563

$54,447,270

$3,499

Ben Hill

5,104

$22,778,038

$4,463

Berrien

4,260

$17,077,182

$4,009

Bibb

36,577

$165,488,845

$4,524

Bleckley

2,323

$11,090,587

$4,774

Brantley

3,852

$13,541,011

$3,515

Brooks

3,944

$17,028,666

$4,318

Bryan

3,409

$14,893,186

$4,369

Bulloch

10,329

$41,279,317

$3,996

# of Providers
4,024 1,746 1,738
942 4,664 2,539 5,623 6,825 2,608 2,038 7,527 1,807 2,245 1,726 2,171 3,822

% of Total Population
0.35% 0.17% 0.17% 0.06% 0.62% 0.16% 0.59% 1.04% 0.34% 0.28% 2.44% 0.15% 0.26% 0.26% 0.23% 0.69%

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County Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson DeKalb Decatur Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett

# of Unique Patients
6,990 3,845 1,682 6,462 2,883 18,742 7,790 2,398 42,665
833 5,042 14,073 17,016 1,140 54,231 2,171 64,506 10,919 11,377 9,050 4,092 12,668 2,382 6,530 2,381 2,189 104,075 7,811 4,587 3,035 26,773 15,645 4,058
869 6,074 4,597 6,673 2,880 3,910 5,514 20,914 7,056 4,273 146,558 4,695
612 12,933
9,633 6,116 3,217 78,118

Net Payments $25,700,128 $18,051,279 $8,764,861 $18,018,281 $18,551,081 $71,137,693 $28,139,953 $8,887,866
$185,358,267 $2,057,526
$20,587,399 $53,138,056 $69,067,076
$4,468,699 $166,734,339
$9,016,018 $230,189,253
$40,449,059 $44,662,088 $37,495,823 $17,666,777 $43,078,379
$9,510,721 $30,535,179
$9,692,119 $7,570,427 $388,033,499 $29,876,417 $21,814,603 $15,262,266 $100,059,547 $53,932,193 $15,744,497 $2,077,207 $22,699,086 $19,857,316 $30,528,258 $10,846,664 $17,130,027 $22,065,367 $106,136,408 $28,043,814 $19,616,076 $583,927,539 $20,335,567 $4,319,677 $52,356,377 $34,704,474 $19,162,586 $12,388,233 $232,843,903

Payment/ Patient $3,677 $4,695 $5,211 $2,788 $6,435 $3,796 $3,612 $3,706 $4,345 $2,470 $4,083 $3,776 $4,059 $3,920 $3,075 $4,153 $3,568 $3,704 $3,926 $4,143 $4,317 $3,401 $3,993 $4,676 $4,071 $3,458 $3,728 $3,825 $4,756 $5,029 $3,737 $3,447 $3,880 $2,390 $3,737 $4,320 $4,575 $3,766 $4,381 $4,002 $5,075 $3,974 $4,591 $3,984 $4,331 $7,058 $4,048 $3,603 $3,133 $3,851 $2,981

# of Providers
2,499 3,398 1,266 2,252 1,936 7,382 2,708 1,568 6,317
972 2,572 7,669 6,041 1,125 12,834 1,596 14,833 3,979 3,555 3,123 1,998 5,791 2,079 2,752 1,410 2,934 18,029 2,625 2,473 2,185 5,474 8,109 1,945
617 2,406 2,208 3,372 1,762 2,921 4,469 7,662 5,099 3,021 22,842 3,531 1,086 3,742 3,863 1,933 2,306 14,795

% of Total Population
0.47% 0.26% 0.11% 0.43% 0.19% 1.25% 0.52% 0.16% 2.84% 0.06% 0.34% 0.94% 1.13% 0.08% 3.62% 0.14% 4.30% 0.73% 0.76% 0.60% 0.27% 0.84% 0.16% 0.44% 0.16% 0.15% 6.94% 0.52% 0.31% 0.20% 1.79% 1.04% 0.27% 0.06% 0.41% 0.31% 0.44% 0.19% 0.26% 0.37% 1.39% 0.47% 0.28% 9.77% 0.31% 0.04% 0.86% 0.64% 0.41% 0.21% 5.21%

20

County Habersham 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 Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman

# of Unique Patients
5,786 27,534
2,319 5,748 2,613 4,362 2,485 17,535 17,843 2,275 7,889 2,299 3,557 5,037 2,603 2,357 3,382 3,004 2,014 11,569 3,137 11,244 1,556 2,391 20,631 3,512 3,951 4,731 1,920 5,563 2,418 5,477 1,621 6,522 3,614 1,846 2,800 7,856 38,160 15,380 2,146 2,049 10,105 5,043 3,784 4,105 2,228 8,371 1,978 3,307
632

Net Payments $21,792,933
$100,687,253 $10,878,848 $28,039,270 $11,811,163 $19,767,055 $9,135,282 $53,754,255 $67,529,087 $12,468,252 $33,257,004 $8,194,813 $13,800,648 $21,465,633 $10,911,247 $12,590,834 $12,722,563 $12,342,460 $8,566,432 $47,232,685 $11,331,006 $40,665,828 $5,638,916 $8,825,386 $91,250,099 $13,975,532 $22,573,208 $19,847,075 $7,957,778 $21,552,440 $7,838,132 $23,277,729 $8,407,298 $25,604,516 $18,230,115 $7,600,969 $9,899,480 $25,941,430
$151,382,124 $51,547,835 $9,457,778 $8,307,154 $34,995,331 $17,742,293 $17,971,732 $17,814,534 $9,003,558 $34,978,190 $8,897,657 $12,482,449 $1,680,365

Payment/ Patient $3,766 $3,657 $4,691 $4,878 $4,520 $4,532 $3,676 $3,066 $3,785 $5,481 $4,216 $3,565 $3,880 $4,262 $4,192 $5,342 $3,762 $4,109 $4,253 $4,083 $3,612 $3,617 $3,624 $3,691 $4,423 $3,979 $5,713 $4,195 $4,145 $3,874 $3,242 $4,250 $5,186 $3,926 $5,044 $4,118 $3,536 $3,302 $3,967 $3,352 $4,407 $4,054 $3,463 $3,518 $4,749 $4,340 $4,041 $4,178 $4,498 $3,775 $2,659

# of Providers
2,943 8,258 1,820 3,784 2,035 2,475 2,123 8,440 5,334 1,620 4,684 2,372 2,539 2,346 1,932 1,997 2,302 2,642 1,364 4,120 2,157 4,660 1,540 1,602 6,382 2,950 2,661 2,712 1,524 2,233 1,694 3,614 1,176 2,618 2,928 1,846 2,494 2,693 7,230 7,310 1,884 1,671 6,496 2,753 3,314 2,398 2,312 4,151 1,630 2,881
783

% of Total Population
0.39% 1.84% 0.15% 0.38% 0.17% 0.29% 0.17% 1.17% 1.19% 0.15% 0.53% 0.15% 0.24% 0.34% 0.17% 0.16% 0.23% 0.20% 0.13% 0.77% 0.21% 0.75% 0.10% 0.16% 1.38% 0.23% 0.26% 0.32% 0.13% 0.37% 0.16% 0.37% 0.11% 0.43% 0.24% 0.12% 0.19% 0.52% 2.54% 1.03% 0.14% 0.14% 0.67% 0.34% 0.25% 0.27% 0.15% 0.56% 0.13% 0.22% 0.04%

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County Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Unique Count Total

# of Unique Patients
2,445 2,254 46,461 12,072
913 3,780 2,549 13,851 5,412 1,379 9,391 1,499
476 4,744 2,266 3,135 3,049 11,603 9,515 8,010 1,365 1,823 15,148 2,874 1,980 2,957 6,094 11,574 10,564 9,602 1,698 4,742 6,434
544 1,465 3,699 17,861 2,216 2,403 2,229 4,933
1,499,661

Net Payments $11,512,990 $9,743,522
$212,769,879 $39,664,796 $3,058,735 $15,530,124 $10,555,822 $53,567,493 $25,901,284 $7,678,323 $40,100,138 $4,639,229 $1,604,847 $23,761,516 $10,326,038 $17,138,756 $11,560,504 $60,381,518 $38,160,002 $37,281,434 $9,780,907 $9,584,609 $59,986,862 $12,514,353 $8,562,273 $15,332,835 $27,114,595 $53,978,140 $38,898,020 $49,721,262 $7,942,236 $21,854,074 $28,057,204 $1,769,675 $6,866,740 $15,054,710 $63,189,778 $12,577,432 $9,588,462 $8,264,699 $18,289,069

Payment/ Patient $4,709 $4,323 $4,580 $3,286 $3,350 $4,108 $4,141 $3,867 $4,786 $5,568 $4,270 $3,095 $3,372 $5,009 $4,557 $5,467 $3,792 $5,204 $4,011 $4,654 $7,165 $5,258 $3,960 $4,354 $4,324 $5,185 $4,449 $4,664 $3,682 $5,178 $4,677 $4,609 $4,361 $3,253 $4,687 $4,070 $3,538 $5,676 $3,990 $3,708 $3,707

# of Providers
2,057 1,378 6,013 6,159 1,155 2,234 1,402 6,169 3,413 1,324 3,308 1,554
870 2,758 2,481 2,490 1,336 3,971 3,367 3,430 1,680 1,584 5,935 1,795 1,894 2,421 3,243 3,411 6,089 3,575 1,428 2,625 2,885
780 1,363 2,985 4,020 2,118 2,060 1,871 2,406

% of Total Population
0.16% 0.15% 3.10% 0.80% 0.06% 0.25% 0.17% 0.92% 0.36% 0.09% 0.63% 0.10% 0.03% 0.32% 0.15% 0.21% 0.20% 0.77% 0.63% 0.53% 0.09% 0.12% 1.01% 0.19% 0.13% 0.20% 0.41% 0.77% 0.70% 0.64% 0.11% 0.32% 0.43% 0.04% 0.10% 0.25% 1.19% 0.15% 0.16% 0.15% 0.33%

$5,949,090,603

$3,967

44,455 100.00%

Based on dates of service from July 2004 to June 2005, date paid July 2004 September 2005, and include claim-based expenditures only. *Patients and providers do not necessarily sum to total as they may switch between categories.

PeachCare for KidsTM Program The PeachCare for KidsTM Program is the Georgia version of the federal State Children's Health Insurance Program (SCHIP) that provides medical and dental coverage for children of working families whose incomes are too high to qualify for Medicaid, but who do not make enough money to purchase

22

private health insurance. In FY 2005, uninsured children were eligible for PeachCare for KidsTM if their families' incomes were up to 235 percent of the federal poverty level, but above Medicaid income guidelines. For a family of four in 2005, 235 percent of the federal poverty level was $45,492.
In FY 2005, the PeachCare for KidsTM Program increased premiums on a sliding scale based on income. Premiums are now $10 to $35 per child and no more than $70.

PEACHCARE FOR KIDSTM Total Members* Total Patients Average Members Per Year Member Months** Total Expenditures Expenditures Per Member Expenditures Per Patient Providers with Paid Claims Number of Paid Claims

299,955 249,030 209,338.6 2,512,063 $278,839,833 $929.61 $1,119.70
24,603 3,319,730

*Members are those who are eligible for and enrolled in the Medicaid or PeachCare for KidsTM program. Patients are those members who have received any type of service under these programs. **Member months are the sum of members by month with any coverage type.

Important Projects in FY 2005 PeachCare for KidsTM compiled research and analysis on several components of the program. With help from the Georgia Health Policy Center, the program has been able to study the impact of policies on health care utilization, enrollment and member satisfaction. The staff plans to share it with other State Children's Health Insurance Plan Programs as they consider different policy options.

The Consumer Assessment of Health Plans survey informed staff of the general satisfaction and utilization patterns of children enrolled in PeachCare for KidsTM. Sixty percent of PeachCare for KidsTM members report obtaining dental care in the last six months. On a scale of one to ten, 74 percent of PeachCare for KidsTM parents rated overall health care experience a nine or ten. The annual Health Plan Employer Data and Information Set measures show improvement in health care access and continuity of care. There was a two percent increase in the number of PeachCare for KidsTM members who saw their primary care provider at least once in the past year. Eighty-six percent of PeachCare for KidsTM members also stayed with their primary care provider for the whole year.

PeachCare for KidsTM enrollment growth continues, ranking it as the fifth largest number of covered children in the country only behind larger states of California, New York, Texas and Florida. Data show 2,512,059 children were enrolled at the close of FY 2005.

By Age Under 1 year 1 to 5 years 6 to 13 years 14 to 18 years
Continued on next page

PEACHCARE FOR KIDSTM PROFILE

Patients

% of Total

Expenditures

2,059 73,407 130,635 57,003 249,030

0.83% 29.48% 52.46% 22.89% 100.00%

$1,740,038 $74,890,702 $132,296,357 $69,912,737 $278,839,833

PEACHCARE FOR KIDSTM PROFILE

% of Total
0.62% 26.86% 47.45% 25.07% 100.00%

23

By Gender Male Female

Patients

% of Total

Expenditures

126,769
122,837 249,030

50.91%
49.33% 100.00%

$150,088,133
$128,751,699 $278,839,833

% of Total
53.83% 46.17% 100.00%

By Residence Rural Urban

89,775
159,025 249,030

36.05%
63.86% 100.00%

$107,573,104
$171,266,729 $278,839,833

38.58%
61.42% 100.00%

By Race Unknown White Black American Indian/Alaskan Asian/Pacific Islander Hispanic

24,867 123,984
74,310 70
7,111 24,017 *249,030

9.99% 49.79% 29.84%
0.03% 2.86% 9.64% *100.00%

$25,249,354 $156,696,297
$65,012,632 $73,123
$8,608,278 $23,200,149 $278,839,833

Based on dates of service from July 2004 to June 2005, date paid July 2004 September 2005 and include claim-based expenditures only. *Patients do not necessarily sum to total as members switch between categories.

9.06% 56.20% 23.32%
0.03% 3.09% 8.32% 100.00%

Premiums and Services Premiums are required for children ages six and older. Premiums are set on a sliding scale based on income. The cost per month is $10 to $35 and no more than $70. Premiums are due the first day of the month prior to the month of coverage.

The plan pays for preventive services and acute medical care, as well as prescription drugs, vision and dental care. PeachCare for KidsTM covers most of the same services covered by Medicaid, with the exception of non-emergency transportation, targeted case management, nursing facilities and community-waiver programs.

PEACHCARE FOR KIDSTM SERVICES DISTRIBUTION

Category of Service Physician Services Physician Services Net Payments Sub Total

Providers w/ Unique

Net Payment

Paid Claims Patients Net Payment Per Patient

13,846 189,332 $48,450,506 $48,450,506

$255.90

Hospital Services Inpatient Hospital Services Outpatient Hospital Services Net Payments Sub Total Continued on next page

169

3,280 $22,610,324

306 85,238 $46,958,519

$69,568,844

$6,893.39 $550.91

24

Category of Service Mental Health Services Community Mental Health Services Net Payments Sub Total

Providers w/ Unique

Net Payment

Paid Claims Patients Net Payment Per Patient

231

4,740 $5,306,208

$1,119.45

$5,306,208

Maternal & Child Health Services Family Planning Services Health Check Services (EPSDT) Pregnancy-Related Services Children-at-Risk Targeted Case Perinatal Targeted Case Management Diagnostic Screening and Prevention Early Intervention Case Management Children's Intervention Services Children's Intervention School Net Payments Sub Total

112 2,357
2 7 4 210 94 1,364 141

1,631 88,234
2 11
5 3,911
196 3,505 3,335

$174,501 $5,900,019
$169 $1,415
$0.00 $163,413
$97,708 $3,706,840 $2,192,598 $12,236,663

$106.99 $66.87 $84.38
$128.64 $0.00
$41.78 $498.51 $1,057.59 $657.45

Pharmacy Services Pharmacy Pharmacy DME Supplier Net Payments Sub Total

2,006 1,427

189,880 7,085

$66,753,044 $724,310
$67,477,354

$351.55 $102.23

Equipment and Devices
Durable Medical Equipment Services Orthotics and Prosthetics/Hearing Services
Net Payments Sub Total

367

5,292 $1,079,371

141

1,521

$726,596

$1,805,967

$203.96 $477.71

Emergency Transportation Emergency Ground Ambulance Services
Emergency Air Ambulance Services
Net Payments Sub Total

165

2,397

$596,544

$248.87

8

80

$264,112

$3,301.40

$860,656

Other Practitioner Services Physician's Assistant Services Health Check Dental Program Under 21 Vision Care Nurse Midwifes Oral Maxillofacial Surgery Podiatry Continued on next page

710
1,417 687 76 41 259

13,714
150,831 36,501 219 298 1,911

$1,208,710
$57,566,653 $3,038,621 $25,928 $28,649 $330,478

$88.14
$381.66 $83.25
$118.39 $96.14
$172.93

25

Category of Service
Psychological Services Advanced Registered Nurse Practitioners
Net Payments Sub Total

Providers w/ Paid Claims
629

Unique

Net Payment

Patients Net Payment Per Patient

7,321 $4,400,408

$601.07

1,303

26,172 $2,301,848 $68,901,296

$87.95

Waiver Program Services Dedicated Case Management Services Net Payments Sub Total

0

0

$0

$0

$0

All Other Services Home Health Services Independent Laboratory Service Federally Qualified Health Center Hospital-Based Rural Health Center Free-Standing Rural Health Clinic ChiropracticsMedicare Only Ambulatory Surgical Center/Birthing Hospice Dialysis ServicesTechnical Dialysis ServicesProfessional At Risk of Incarceration Net Payments Sub Total

41

116

$33,244

$286.58

98 25,675 $1,182,234

$46.05

57

3,715

$862,566

$232.18

50

3,240

$495,355

$152.89

29

2,141

$382,928

$178.85

0

0

$0.00

$0.00

65

1,857 $1,225,767

$660.08

2

2

$2,914

$1,456.76

3

3

$38,931 $12,977.15

1

1

$8,400

$8,400.28

1

107

$0.00

$0.00

$4,232,340

Unique Count Totals

24,603 249,030 $278,839,833

*Patients and providers do not necessarily sum to total as they may be eligible for more than one category.

$1,119.70

26

PeachCare Services Distribution FY 2005

Waiver Programs 0.0%

All Other Services 1.5%

Other Practitioners 24.7%

Emergency Transportation
0.3%

Equipment and Devices 0.6%

Physicians 17.4%

Physicians Hospital Mental Health Maternal & Child Health Pharmacy Equipment and Devices Emergency Transportation Other Practitioners Waiver Programs All Other Services

Hospital 24.9%

Pharmacy 24.2%

Maternal & Child Health 4.4%

Mental Health 1.9%

PEACHCARE FOR KIDSTM MEMBERS AND EXPENDITURES BY COUNTY

County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks

# of Unique Patients
821 381 509 140 631 723 2,551 3,467 710 769 3,174 284 811 623

Net Payments $1,078,198 $461,823 $638,990 $144,035 $575,945 $885,962 $2,934,314 $3,824,891 $924,914 $1,172,764 $3,246,823 $345,726 $965,023 $633,670

Payment/ Patient $1,313.27 $1,212.13 $1,255.38 $1,028.82 $912.75 $1,225.40 $1,150.26 $1,103.23 $1,302.70 $1,525.05 $1,022.94 $1,217.35 $1,189.92 $1,017.13

# of Providers
590 369 370 204 409 761 1,723 1,683 480 612 1,194 287 594 442

% of Total Population
0.33% 0.15% 0.20% 0.06% 0.25% 0.29% 1.02% 1.39% 0.29% 0.31% 1.27% 0.11% 0.33% 0.25%

27

County Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson DeKalb Decatur Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon

# of Unique Patients
927 1,388
775 712 178 1,071 363 3,233 1,309 365 5,027
97 620 4,940 1,698
93 9,029
285 14,902
1,604 1,559 2,378
798 2,481
471 671 438 709 16,453 1,072 576 366 2,137 3,848 376 186 1,608 755 854 360 1,254 1,491 2,633 2,468 840 12,930 1,175 107 1,877 1,830

Net Payments $1,309,265 $1,746,338 $1,055,144 $718,720 $214,193 $1,167,472 $395,880 $4,441,724 $1,366,661 $463,238 $5,853,365 $101,670 $729,036 $6,038,882 $2,337,422 $113,903 $8,173,239 $448,752
$14,882,228 $2,183,017 $1,696,579 $2,660,320 $969,631 $3,220,425 $481,190 $867,675 $538,537 $734,209
$15,087,860 $1,231,479 $709,384 $355,036 $2,193,190 $4,406,801 $605,295 $215,538 $2,070,019 $804,768 $1,349,270 $403,066 $1,895,965 $1,538,566 $3,273,868 $3,220,550 $1,129,651
$12,503,042 $1,680,149 $142,964 $2,297,391 $2,054,953

Payment/ Patient $1,412.37 $1,258.17 $1,361.48 $1,009.44 $1,203.33 $1,090.08 $1,090.58 $1,373.87 $1,044.05 $1,269.15 $1,164.39 $1,048.15 $1,175.86 $1,222.45 $1,376.57 $1,224.76 $905.22 $1,574.57 $998.67 $1,360.98 $1,088.25 $1,118.72 $1,215.08 $1,298.04 $1,021.64 $1,293.11 $1,229.54 $1,035.56 $917.03 $1,148.77 $1,231.57 $970.04 $1,026.29 $1,145.22 $1,609.83 $1,158.81 $1,287.33 $1,065.92 $1,579.94 $1,119.63 $1,511.93 $1,031.90 $1,243.40 $1,304.92 $1,344.82 $966.98 $1,429.91 $1,336.11 $1,223.97 $1,122.92

# of Providers
724 776 619 761 232 433 320 1,618 635 307 1,250 232 568 2,339 900 181 3,165 256 4,468 686 695 969 528 1,316 506 439 322 710 4,813 522 420 346 857 2,202 396 191 776 433 672 335 714 1,109 1,108 1,608 711 6,407 899 228 692 840

% of Total Population
0.37% 0.56% 0.31% 0.29% 0.07% 0.43% 0.15% 1.30% 0.53% 0.15% 2.02% 0.04% 0.25% 1.98% 0.68% 0.04% 3.63% 0.11% 5.98% 0.64% 0.63% 0.95% 0.32% 1.00% 0.19% 0.27% 0.18% 0.28% 6.61% 0.43% 0.23% 0.15% 0.86% 1.55% 0.15% 0.07% 0.65% 0.30% 0.34% 0.14% 0.50% 0.60% 1.06% 0.99% 0.34% 5.19% 0.47% 0.04% 0.75% 0.73%

28

County Grady Greene Gwinnett Habersham 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 Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike

# of Unique Patients
952 412 25,047 1,534 5,772 112 1,168 591 778 459 4,751 2,614 390 1,822 476 755 611 305 241 865 471 313 1,279 1,028 1,079 284 281 2,801 925 363 1,061 233 771 437 617 198 955 687 365 649 1,593 3,427 3,182 654 525 4,050 645 1,080 854 526

Net Payments $855,376 $393,185
$28,217,227 $1,523,597 $6,407,955 $96,198 $1,679,035 $596,576 $795,814 $591,256 $4,848,716 $3,149,049 $563,428 $2,196,445 $475,521 $916,288 $865,473 $351,299 $301,348 $854,006 $586,324 $378,067 $1,525,267 $1,378,823 $1,108,417 $339,743 $304,193 $3,377,166 $1,080,037 $387,259 $1,508,118 $221,098 $1,019,946 $495,770 $774,460 $296,449 $1,217,350 $842,585 $486,549 $768,401 $1,773,152 $3,589,928 $3,189,375 $830,786 $588,451 $4,632,206 $676,424 $1,406,895 $985,341 $685,338

Payment/ Patient $898.50 $954.33 $1,126.57 $993.22 $1,110.18 $858.91 $1,437.53 $1,009.44 $1,022.90 $1,288.14 $1,020.57 $1,204.69 $1,444.69 $1,205.51 $998.99 $1,213.63 $1,416.49 $1,151.80 $1,250.41 $987.29 $1,244.85 $1,207.88 $1,192.55 $1,341.27 $1,027.26 $1,196.28 $1,082.54 $1,205.70 $1,167.61 $1,066.83 $1,421.41 $948.92 $1,322.89 $1,134.49 $1,255.20 $1,497.22 $1,274.71 $1,226.47 $1,333.01 $1,183.98 $1,113.09 $1,047.54 $1,002.32 $1,270.32 $1,120.86 $1,143.75 $1,048.72 $1,302.68 $1,153.80 $1,302.92

# of Providers
437 357 4,939 739 1,900 179 915 555 552 480 2,390 1,110 423 1,369 575 483 527 354 305 610 533 279 647 634 582 401 296 822 700 330 717 307 571 423 678 180 617 727 397 617 606 982 1,600 601 519 2,416 586 807 505 572

% of Total Population
0.38% 0.17% 10.06% 0.62% 2.32% 0.04% 0.47% 0.24% 0.31% 0.18% 1.91% 1.05% 0.16% 0.73% 0.19% 0.30% 0.25% 0.12% 0.10% 0.35% 0.19% 0.13% 0.51% 0.41% 0.43% 0.11% 0.11% 1.12% 0.37% 0.15% 0.43% 0.09% 0.31% 0.18% 0.25% 0.08% 0.38% 0.28% 0.15% 0.26% 0.64% 1.38% 1.28% 0.26% 0.21% 1.63% 0.26% 0.43% 0.34% 0.21%

29

County Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Unique Count Total

# of Unique Patients
1,496 231 562 62 804 228
3,757 2,466
179 432 318 1,476 897 123 872 167
40 624 255 377 227 1,527 1,444 1,078 389 292 1,887 389 306 835 868 1,522 2,641 1,339 168 468 904
88 231 950 4,385 259 352 266 848 249,030

Net Payments $1,840,010 $230,888 $787,594 $76,773 $987,758 $254,657 $4,112,572 $2,435,558 $252,083 $471,613 $445,933 $1,486,241 $1,615,360 $152,351 $1,269,587 $163,147 $39,142 $731,333 $307,340 $433,624 $310,247 $1,520,679 $1,788,225 $1,454,893 $429,795 $353,866 $1,886,175 $524,064 $309,015 $1,232,365 $961,729 $1,640,747 $3,088,562 $1,554,640 $191,128 $473,266 $989,664 $88,615 $294,408 $1,018,461 $4,425,308 $336,029 $434,478 $291,451 $1,106,152
$278,839,833

Payment/ Patient $1,229.95 $999.52 $1,401.41 $1,238.27 $1,228.55 $1,116.91 $1,094.64 $987.66 $1,408.28 $1,091.70 $1,402.30 $1,006.94 $1,800.85 $1,238.62 $1,455.95 $976.93 $978.54 $1,172.01 $1,205.26 $1,150.20 $1,366.73 $995.86 $1,238.38 $1,349.62 $1,104.87 $1,211.87 $999.56 $1,347.21 $1,009.85 $1,475.89 $1,107.98 $1,078.02 $1,169.47 $1,161.05 $1,137.67 $1,011.25 $1,094.76 $1,006.98 $1,274.49 $1,072.06 $1,009.19 $1,297.41 $1,234.31 $1,095.68 $1,304.42 $1,119.45

# of Providers
974 247 557
98 545 203 1,235 1,396 194 375 237 1,065 532 168 465 282
89 505 384 368 305 595 622 700 337 350 728 348 420 527 444 700 1,726 580 177 355 473 134 339 680 865 346 361 362 594 24,603

% of Total Population
0.60% 0.09% 0.23% 0.02% 0.32% 0.09% 1.51% 0.99% 0.07% 0.17% 0.13% 0.59% 0.36% 0.05% 0.35% 0.07% 0.02% 0.25% 0.10% 0.15% 0.09% 0.61% 0.58% 0.43% 0.16% 0.12% 0.76% 0.16% 0.12% 0.34% 0.35% 0.61% 1.06% 0.54% 0.07% 0.19% 0.36% 0.04% 0.09% 0.38% 1.76% 0.10% 0.14% 0.11% 0.34% 100.00%

Based on dates of service from July 2004 to June 2005, date paid July 2004 September 2005, and include claim-based expenditures only.

30

Indigent Care Trust Fund ICTF, which completed its fifteenth year of operation in FY 2005, funds and supports programs and facilities serving medically-indigent patients in Georgia.
Contributions made to the ICTF in FY 2005 by non-federal sources included the following: Intergovernmental transfers from hospitals participating in the Disproportionate Share Hospital (DSH)
Program. The DSH Program helped compensate hospitals for their uncompensated indigent care; Nursing home provider fees; Penalties for non-compliance with Certificate of Need (CON) requirements; Ambulance license fees and Fees collected from the initial sale of breast cancer license tags.
The ICTF was also allowed to retain for use interest earned from funds contributed into the trust fund.
The fund source contributions match is approximately 60:40 for benefit expenditures and 50:50 for administrative expenditures. No money from Georgia's general treasury was used.
In FY 2005, the use of the ICTF was limited to any one or a combination of the following: To expand Medicaid eligibility and services; For programs that supported rural and other health care providers, primarily hospitals, which served
the medically indigent; and/or For primary health care programs for medically indigent citizens and children in Georgia.
Two exclusions existed in FY 2005 as shown below: Any nursing home provider fees remitted to the ICTF had to be matched with federal Medicaid funds
and made available to provide support to nursing homes that disproportionately served the medically indigent. Certain proceeds from the sale of breast cancer license tags were to be used to fund screening and treatment-related programs for people with breast cancer who were also medically indigent. Programs included the following: education, screening, grants-in-aid to cancer patients, pharmacy assistance programs for cancer patients and other projects to encourage public support for the special license plate and the activities it funded.

FY 2005 Expenditures Disproportionate Share Hospital Payments Medicaid Payments to Nursing Homes Medicaid Expansion for Pregnant Women and Children Ambulance Medicaid Rate Subsidy Programs to Support the Medically Indigent Breast Cancer Initiatives Total

412,837,257 255,042,264
52,631,808 5,588,132 994,010 0
18,862,240 745,955,711

In FY 2005, DSH payments comprised 55.3 percent of ICTF expenditures; nursing home payments were 34.2 percent; medically indigent programs were 0.1 percent of expenditures; Medicaid expansion was 7.1 percent and ambulance rates were 0.7 percent of total expenditures.

31

Facility Name Appling Hospital Athens Regional Medical Center Atlanta Medical Center Bacon County Hospital Barrow Community Hospital Berrien County Hospital BJC Medical Center Bleckley Memorial Hospital Brooks County Hospital Burke Medical Center Calhoun Memorial Hospital Camden Medical Center Candler County Hospital Charlton Memorial Hospital Chatuge Regional Hospital Chestatee Regional Hospital Children's Healthcare of Atlanta at Egleston Children's Healthcare of Atlanta at Scottish Rite Clinch Healthcare Center Cobb Memorial Hospital Coffee Regional Medical Center Colquitt Regional Medical Center Crawford Long Hospital of Emory University Crisp Regional Hospital DeKalb Medical Center Dodge County Hospital Donalsonville Hospital, Inc. Dorminy Medical Center Early Memorial Hospital East Georgia Regional Medical Center Elbert Memorial Hospital Emanuel Medical Center Emory Dunwoody Medical Center Emory Peachtree Regional Hospital Evans Memorial Hospital Fairview Park Hospital Fannin Regional Hospital Flint River Community Hospital

County Appling Clarke Fulton Bacon Barrow Berrien Jackson Bleckley Brooks Burke Calhoun Camden Candler Charlton Towns Lumpkin
DeKalb
Fulton Clinch Franklin Coffee Colquitt
Fulton Crisp DeKalb Dodge Seminole Ben Hill Early
Bulloch Elbert Emanuel DeKalb Coweta Evans Laurens Fannin Macon

DSH Payment
$577,187 $12,014,422
$4,341,284 $821,094 $462,964 $449,097
$1,105,559 $490,619 $612,140 $274,325 $449,072
$1,644,437 $899,897 $981,811 $959,954
$1,313,920

Primary Care Plan Obligation
$86,578 $1,802,163
$651,193 $123,164
$69,445 $67,365 $165,834 $73,593 $91,821 $41,149 $67,361 $246,666 $134,985 $147,272 $143,993 $197,088

Intergovernmental Transfers (IGTs)
$288,594 $6,007,211
$0 $410,548
$0 $0 $552,780 $245,310 $306,070 $137,163 $224,536 $822,219 $449,949 $490,906 $479,977 $0

$5,477,238

$821,586

$0

$2,540,408 $745,391
$1,863,633 $5,488,030 $1,861,177

$381,061 $111,809 $279,545 $823,205 $279,177

$0 $372,696
$0 $2,744,015
$930,589

$3,106,779 $1,908,983 $5,676,721 $2,156,964
$979,408 $893,918 $1,012,358

$466,017 $286,347 $851,508 $323,545 $146,911 $134,088 $151,854

$0 $954,492 $2,838,360 $1,078,483
$0 $446,959 $506,180

$976,861 $1,118,152 $1,562,071
$546,649 $660,039 $1,305,332 $394,181 $832,443 $622,154

$146,529 $167,723 $234,311
$81,997 $99,006 $195,800 $59,127 $124,866 $93,323

$0 $559,076 $781,036
$0 $0 $652,666 $0 $416,222 $0

32

Facility Name Floyd Medical Center Grady General Hospital Grady Memorial Hospital Habersham County Medical Center Hamilton Medical Center Hart County Hospital Higgins General Hospital Hughes Spalding Children's Hospital Hutcheson Medical Center Irwin County Hospital Jasper Memorial Hospital Jeff Davis Hospital Jefferson Hospital Jenkins County Hospital John D. Archbold Memorial Hospital Liberty Regional Medical Center Louis Smith Memorial Hospital McDuffie Regional Medical Center Meadows Regional Medical Center Medical Center of Central Georgia Medical College of Georgia Hospitals and Clinics Memorial Health University Medical Center Memorial Hospital of Adel Memorial Hospital of Bainbridge Miller County Hospital Minnie G. Boswell Memorial Hospital Mitchell County Hospital Monroe County Hospital Morgan Memorial Hospital Northeast Georgia Medical Center Oconee Regional Medical Center Peach Regional Medical Center Phoebe Putney Memorial Hospital Phoebe Worth Medical Center Polk Medical Center Putnam General Hospital Rabun County Memorial Hospital Rockdale Hospital & Health Systems Roosevelt Warm Springs Institute for Rehabilitation

County Floyd Grady Fulton Habersham Whitfield Hart Haralson Fulton Catoosa Irwin Jasper Jeff Davis Jefferson Jenkins Thomas Liberty Lanier McDuffie Toombs Bibb
Richmond
Chatham Cook Decatur Miller Greene Mitchell Monroe Morgan Hall Baldwin Peach Dougherty Worth Polk Putnam Rabun Rockdale
Meriwether

DSH Payment $7,011,404 $1,289,204 $133,531,708 $1,608,228 $1,702,407
$400,553 $972,788 $3,644,573 $4,624,549 $910,199 $390,151 $735,817 $537,681 $259,339 $4,154,372 $2,638,742 $737,976 $741,316 $2,514,933 $19,720,712

Primary Care Plan Obligation $1,051,711
$193,381 $20,989,756
$241,234 $255,361
$60,083 $145,918 $546,686 $693,682 $136,530
$58,523 $110,373
$80,652 $38,901 $623,156 $395,811 $110,696 $111,197 $377,240 $2,958,107

Intergovernmental Transfers (IGTs)
$3,505,702 $644,602
$66,765,855 $804,114 $0 $200,276 $486,394
$1,822,286 $2,312,275
$455,100 $195,076 $367,909 $268,840 $129,669 $2,077,186 $1,319,371
$0 $370,658 $1,257,466 $9,860,356

$29,134,950 $4,370,243

$14,567,475

$16,475,899 $553,765
$1,703,171 $690,257 $595,463 $903,579 $425,657 $733,876
$9,308,141 $2,160,067 $1,037,276 $7,726,343 $1,367,361 $1,641,214
$514,703 $825,610 $1,777,120

$2,471,385 $83,065
$255,476 $103,539
$89,319 $135,537
$63,849 $110,081 $1,396,221 $324,010 $155,591 $1,158,951 $205,104 $246,182
$77,205 $123,842 $266,568

$8,237,950 $0
$851,585 $345,129 $297,732 $451,790 $212,829 $366,938 $4,654,070 $1,080,034 $518,638 $3,863,172
$0 $820,608 $257,351 $412,806 $888,560

$1,083,915

$162,587

$541,957

33

Facility Name Satilla Regional Medical Center Screven County Hospital Smith Northview Hospital South Fulton Medical Center South Georgia Medical Center Southeast Georgia Regional Medical Center Southern Regional Health Center Southwest Georgia Regional Medical Center Southwest Hospital and Medical Center Stephens County Hospital Stewart Webster Hospital Sumter Regional Hospital, Inc. Sylvan Grove Hospital Tanner Medical Center/Carrollton Tanner Medical Center/Villa Rica Tattnall Community Hospital Taylor Regional Hospital The Medical Center Tift Regional Medical Center Union General Hospital University Hospital Upson Regional Medical Center Walton Medical Center Warm Springs Medical Center Washington County Regional Medical Center Wayne Memorial Hospital WellStar Cobb Hospital West Georgia Medical Center Wheeler County Hospital Wills Memorial Hospital Totals

County Ware Screven Lowndes Fulton Lowndes
Glynn Clayton
Randolph
Fulton Stephens Stewart Sumter Butts Carroll Carroll Tattnall Pulaski Muscogee Tift Union Richmond Upson Walton Meriwether
Washington Wayne Cobb Troup Wheeler Wilkes

Nursing Home Provider Fees FY 2005 Enrolled
A.G. Rhodes Home at Wesley Woods, Inc. A.G. Rhodes Home, Inc., The A.G. Rhodes Home, Inc. - Cobb Albany Health Care, Inc. Alvista Healthcare Center, Inc.

DSH Payment $2,565,441
$517,289 $284,971 $2,937,484 $4,128,363

Primary Care Plan Obligation
$384,816 $77,593 $42,746
$440,623 $619,254

Intergovernmental Transfers (IGTs)
$1,282,721 $258,645 $0 $0
$2,064,182

$4,225,977 $8,669,413

$633,897 $1,300,412

$2,112,989 $4,334,706

$1,158,007

$173,701

$579,003

$1,173,922 $2,207,685
$424,499 $2,365,140
$770,641 $4,192,532 $1,037,886
$915,603 $460,403 $11,797,633 $2,047,806 $228,879 $7,227,387 $2,105,467 $688,629 $1,227,246

$176,088 $331,153
$63,675 $354,771 $115,596 $628,880 $155,683 $137,340
$69,060 $1,769,645
$307,171 $34,332
$1,084,108 $315,820 $103,294 $184,087

$0 $1,103,843
$0 $1,182,570
$385,320 $2,096,266
$518,943 $0 $0
$5,898,816 $1,023,904
$114,440 $3,613,693 $1,052,734
$0 $613,623

$1,354,452 $1,368,168 $6,576,334 $2,674,241
$720,945 $873,123 $412,837,257

$203,168 $205,225 $986,450 $401,136 $108,142 $130,968 $62,885,592

$677,227 $684,085 $3,288,167 $1,337,120
$0 $436,562 $188,567,355

FY 2005 Total $371,196.00 $432,722.62 $372,910.00 $489,703.00 $321,671.00

34

Enrolled Appling Convalescent Center Appling Nursing Home Ashburn Health Care, Inc. Ashton Woods Nursing Home and Rehabilitation Center Athena Rehabilitation of Clayton Athens Heritage Home, Inc. Augusta Hills Nursing and Rehabilitation Center, Inc. Austell Health Care, Inc. Autumn Breeze Health Care Center Azalea Trace Nursing Home, Inc. Azalealand Nursing Home Bainbridge Healthcare Banks-Jackson-Commerce Medical Center Nursing Home Baptist Village, Inc. Bayview Nursing Home Beaulieu Convalescent Center, Inc. Bel Arbor Nursing Center Bell-Minor Home, Inc., The Berrien Nursing Center Bethany Home Nursing Center of Millen Bethany Home Nursing Center of Vidalia Beverly Health and Rehabilitation Center - Jesup Beverly Healthcare - Northside Beverly Healthcare Beverly Healthcare - Decatur Beverly Healthcare - Glenwood Beverly Healthcare - Tifton Beverly Healthcare - Windermere Beverly Healthcare at Kennestone Beverly Manor of Augusta Blair House Nursing and Rehabilitation Center Blue Ridge Health Care, Inc. Bolingreen Nursing Center Bonterra Nursing Center Boswell-Parker Nursing Center Brandon Wilde Pavilion Brentwood Terrace Health Center Brian Center Health and Rehabilitation - LaGrange Brian Center Inn Brian Center Nursing Care of Austell Brian Center Nursing Care of Powder Springs Brian Center Nursing Care of Canton Brian Center Nursing Care of Jeffersonville Brian Center of Lumber City Brian Center Nursing Care of Thomasville Briarwood Nursing Center, Inc. Brightmoor Health Care, Inc.
35

FY 2005 Total $217,486.40 $113,069.46 $217,859.00 $438,830.00 $650,088.00 $278,718.00 $326,085.00 $355,589.00 $335,755.00 $352,362.00 $252,292.00 $299,488.26 $573,271.00 $0.00 $186,254.00 $426,494.00 $290,729.00 $297,541.00 $367,566.33 $283,965.00 $596,983.00 $243,105.00 $548,749.00 $257,809.00 $187,768.00 $653,376.00 $271,411.00 $291,034.00 $362,285.00 $247,474.00 $297,326.00 $287,106.00 $323,696.00 $402,597.42 $26,985.74 $158,960.20 $286,554.00 $330,058.00 $327,471.00 $432,654.00 $517,907.00 $232,554.00 $206,317.00 $199,395.00 $124,521.00 $269,647.00 $373,060.00

Enrolled Brown Memorial Convalescent Center Brownwood Healthcare Bryan County Health and Rehabilitation Center Bryant Nursing Center Buckhead Health and Rehabilitation Calhoun Health Care Center, Inc. Calhoun Nursing Home Camellia Gardens of Life Care Candler Hospital Subacute Unit Canterbury Court Canton Nursing Center Carlyle Place Carrollton Manor, Inc. Carrollton Nursing Home and Rehabilitation Center Cedar Springs Health and Rehabilitation Center Cedar Valley Nursing and Rehabilitation Center Chaplinwood Nursing Home Chatsworth Health Care Center Chatuge Regional Nursing Home Cherry Blossom Health Care Center Chestnut Ridge Nursing and Rehabilitation Center Christian City Convalescent Center Chulio Hills Health and Rehabilitation Center Church Home for the Aged (Christ Sanctified) Clarke Health and Rehabilitation Center Claxton Nursing Home CLC - Fort Valley Nursing Center CLC - Jonesboro Nursing Center CLC - Roberta Nursing Center CLC-Jesup Nursing Center Clinch Healthcare Center Coastal Manor College Park Health Care Center Cordele Health and Rehabilitation Center, Inc. Countryside Health Center Covington Manor Nursing Home Crestview Health and Rehabilitation Center Crestwood Nursing Home Crisp Regional Nursing and Rehabilitation Center Cumming Nursing Center Dade Health and Rehabilitation Center Dawson Manor Nursing Home Decatur Health Care Center, Inc. Delmar Gardens of Gwinnett Delmar Gardens of Smyrna Dogwood Health and Rehabilitation Dublinair Health Care and Rehabilitation Center
36

FY 2005 Total $468,396.00 $288,143.00 $316,538.00 $219,394.00 $742,449.17 $302,962.00 $159,458.00 $238,380.00 $6,783.00 $0.00 $288,427.00 $22,738.73 $307,648.00 $458,653.68 $309,017.00 $299,507.09 $303,365.00 $343,311.00 $350,649.00 $221,985.00 $411,864.58 $0.00 $251,770.00 $175,086.00 $257,878.00 $240,744.00 $187,189.00 $321,631.00 $242,501.00 $171,396.00 $207,144.00 $167,394.00 $293,476.00 $258,239.00 $181,700.18 $218,369.00 $9,102.92 $229,303.00 $374,492.00 $241,295.00 $191,760.00 $216,792.00 $252,748.00 $163,764.00 $330,036.00 $202,653.00 $437,525.00

Enrolled Early Memorial Nursing Home Eastview Nursing Home Eatonton Health and Rehabilitation Center Effingham County Extended Care Facility Elberta Health Care Emanuel County Nursing Home EmoryWood Nursing Center Fairburn Health Care Center, Inc. Family Life Enrichment Center Fifth Avenue Health Care Fitzgerald Nursing Home Florence Hand Home Forrest Lake Health Care, Inc. Forsyth Health Care Fort Gaines Nursing Home Fort Oglethorpe Nursing Center Forum Health Care Group, Inc at WildWood Park Forum Group at Moran Lake Nursing and Rehabilitation Center, LLC Forum Group at Mount Berry Nursing and Rehabilitation Center, LLC Fountain City Care and Rehabilitation Fountainview Center for Alzheimer's Disease Four County Health Care Franklin Health Care Center Friendship Health and Rehabilitation Center Fulton Health and Rehabilitation Center Garden Terrace Nursing and Rehabilitation Center Gateway Health and Rehabilitation Center Georgia Baptist Meriwether Nursing Home Gibson Health and Rehabilitation Center Gilmer Nursing Home Glendale Nursing Home Glenn-Mor Nursing Home Glenvue Nursing Home Gold City Health and Rehabilitation Center Gordon Health Care Gracemore Nursing and Rehabilitation Grandview Health Care Center Gray Nursing Home Green Acres Nursing Home Greene Point Health Care Gwinnett Extended Care Center Habersham Home Hamilton House Nursing Center Haralson Nursing and Rehabilitation Center Hart Care Center Hartley Woods Health and Rehabilitation Center Hartwell Health Care Center
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FY 2005 Total $350,272.00 $235,691.00 $296,001.00 $335,289.00 $149,860.00 $146,918.00 $39,177.00 $376,121.00 $250,143.00 $283,143.00 $221,071.00 $433,520.00 $219,806.00 $206,169.00 $189,449.29 $321,912.00 $446,193.72 $289,918.18 $270,246.47 $449,772.00 $359,162.00 $245,687.00 $234,366.00 $248,884.00 $331,000.00 $676,377.00 $169,402.00 $53,262.00 $301,912.00 $303,582.00 $243,581.00 $185,322.00 $490,593.00 $335,000.00 $340,601.00 $157,402.00 $196,658.00 $154,985.00 $295,799.00 $206,133.00 $248,526.00 $255,024.00 $354,339.00 $340,819.11 $335,444.28 $339,442.00 $298,608.00

Enrolled Heardmont Nursing Home Heart of Georgia Nursing Home Heritage of Old Capitol, The Heritage House Nursing Home Heritage Inn Health and Rehabilitation Center Heritage Inn of Barnesville Heritage Inn of Sandersville Heritage Park of Savannah Hill Haven Nursing Home Hilltop Nursing Home Holly Hill Nursing Home Hospitality Care Center of Thomasville Ideal Health Care Center IHS of Atlanta at Briarcliff Haven Jennings Healthcare, Inc. Joe-Anne Burgin Nursing Home Johnson County Nursing Home, Inc. Jonesboro Nursing and Rehabilitation Center Kentwood Nursing Facility Keysville Nursing Home and Rehabilitation Center LaFayette Health Care Center LaFayette Nursing and Rehabilitation Center Lake Crossing Health Center Lakehaven Nursing Home, Inc. Lakeland Villa Convalescent Center Lakeshore Heights Nursing Center, Inc. Laurel Baye Healthcare of Macon Laurel Baye Healthcare of Decatur Laurel Baye Healthcare of Lake Lanier Laurel Park at Henry Medical Center Lee County Health Care Lenbrook Square Life Care Center of Gwinnett Life Care Center of Lawrenceville Life Care Center Lilburn Geriatric Center Inc. Lillian G. Carter Nursing Center Lynn Haven Nursing Home Macon Manor Nursing Home and Rehabilitation Center Madison Health and Rehabilitation Magnolia Manor Methodist Nursing Care Magnolia Manor South Nursing Center Manor Care Nursing and Rehabilitation Center ManorCare of Marietta Nursing and Rehabilitation Center Maple Ridge Health Care Center Marietta Health and Rehabilitation Center, Inc. Mariner Health of Northeast Atlanta
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FY 2005 Total $181,779.00 $458,018.73 $370,497.00 $264,313.00 $264,655.00 $330,882.00 $187,889.00 $283,641.00 $239,402.00 $205,708.00 $278,855.00 $197,584.00 $222,507.00 $490,731.98 $243,536.00 $259,623.00 $165,744.00 $306,123.00 $242,973.00 $173,515.00 $281,471.00 $440,262.00 $304,007.00 $234,392.00 $203,531.00 $265,427.00 $242,599.00 $367,707.00 $321,659.00 $179,412.00 $170,862.00 $884.85 $405,873.00 $298,810.00 $278,017.00 $359,251.00 $290,500.00 $294,641.00 $692,211.07 $211,148.00 $50,561.23 $196,307.00 $306,635.00 $236,166.00 $242,687.00 $330,024.00 $308,953.00

Enrolled Marion Memorial Nursing Home McRae Manor Nursing Home Meadowbrook Nursing Home Meadows Nursing Center Medical Arts Health Facility Memorial Convalescent Center Memorial Manor Nursing Home Memorial Nursing Home Metter Nursing Home, Inc. Middle Georgia Nursing Home Midway Health Care Center Miller Nursing Home Mitchell Convalescent Center Molena Nursing Home, Inc. Montezuma Health Care Center Morgan Memorial Hospital Transitional Care Moss Oaks Health Care Center Mountain Healthcare Center, Inc. Mountain View Health and Rehabilitation Center Muscogee Manor and Rehabilitation Center Nancy Hart Nursing Center New Horizons North New Horizons West New London Health Center NHC Healthcare - Fort Oglethorpe NHC Healthcare - Rossville North Macon Health Care Facility Nurse Care of Buckhead Oak Manor Nursing Home, Inc. Oak Mountain Village Health Care Center Oak View Home, Inc. Oak View Nursing and Rehabilitation Center Oaks Nursing Home Oceanside Nursing and Rehabilitation Center Oconee Health Care Oconee Regional Medical Center Skilled-Nursing Unit (SNU) Osceola Nursing Home Palemon Gaskins Memorial Nursing Home Palmyra Nursing Home Park Place Nursing Facility Parkside at Hutcheson Medical Center Parkview Manor Nursing and Rehabilitation Center Parkwood Developmental Center Parkwood Nursing and Rehabilitation Center Peachbelt Health and Rehabilitation Center Peake Healthcare Center, Pelham Parkway Nursing Home
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FY 2005 Total $189,797.00 $425,690.00 $329,350.00 $59,931.00 $342,160.00 $263,871.00 $319,954.00 $352,190.03 $253,356.00 $248,111.44 $263,999.00 $287,446.00 $143,560.00 $182,022.08 $241,243.00 $17,303.49 $222,635.00 $171,024.00 $402,741.08 $167,434.54 $227,479.00 $342,758.00 $349,918.00 $433,767.00 $381,228.00 $325,716.00 $517,305.00 $653,889.00 $512,526.00 $125,156.00 $292,013.00 $457,092.00 $167,680.00 $294,435.78 $134,347.00 $1,764.00 $242,013.00 $97,956.00 $710,144.00 $275,047.00 $327,895.00 $724,026.53 $354,965.00 $499,049.00 $235,587.00 $330,411.00 $320,064.00

Enrolled Phoebe Putney Memorial Hospital SNF Piedmont Hospital Extended Care Unit Pierce County Nursing Home Pine Knoll Nursing and Rehabilitation Center Pine Manor Nursing Home, Inc. Pinehill Nursing Center, Inc. Pineview Health Care Center, Inc. Pinewood Manor Pinewood Nursing Center Pleasant View Nursing Center Premier Subacute and Rehabilitation Center of Atlanta Presbyterian Home, Quitman, Inc. Presbyterian Village, Inc. Providence Health Care Pulaski Nursing Home, Inc. Quiet Oaks Health Care Center Quinton Memorial Health Care and Rehabilitation Center Regency Park Health Care Center Ridgewood Manor Nursing Home River Willows Nursing Center Riverside Health Care Center Riverside Nursing Center of Thomaston Riverview Health and Rehabilitation Center Rockdale Healthcare Center Rockmart Nursing and Rehabilitation Center Rosemont at Stone Mountain Rosewood Nursing Center, Inc. Ross Memorial Health Care Center Roswell Nursing and Rehabilitation Center Sadie G. Mays Health and Rehabilitation Center Salem Nursing and Rehabilitation Center of Augusta Satilla Care Center Savannah Beach Nursing and Rehabilitation Center Savannah Rehabilitation and Nursing Center Savannah Specialty Care Center Savannah Square Health Center Scenic View Health Care Center Sears Manor Nursing Home Seminole Manor Nursing Home Shady Acres Shamrock Nursing and Rehabilitation Center Shepherd Hills Health Center Shoreham at Marietta Smith Medical Nursing Care Center Social Circle Nursing and Rehabilitation Center Southeast Georgia Regional Medical Center TCU Southern Traditions
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FY 2005 Total $6,438.00 $2,890.00
$237,704.00 $343,635.43 $331,442.00 $261,921.00 $198,708.00 $280,570.00 $329,706.00 $377,192.00 $231,625.98
$35,426.20 $20,208.53 $493,990.00 $236,922.00 $207,341.00 $334,804.00 $274,939.00 $306,733.00 $291,157.36 $396,294.00 $229,734.00 $45,945.87 $251,388.00 $243,465.19 $453,066.00 $332,198.00 $284,797.00 $566,832.68 $119,780.56 $371,007.00 $279,702.00 $169,022.80 $297,072.00 $248,409.00 $152,347.54 $304,947.00 $289,620.00 $161,784.00 $457,455.00 $270,492.00 $320,091.00 $316,609.00 $186,666.96 $176,143.06
$6,714.00 $173,887.48

Enrolled Southland Care Center Southland Nursing Home Spalding Health Care, Inc. Sparta Health Care Center Specialty Care of Marietta Spring Valley Health Care Center, Inc. St. Joseph's Hospital Transitional Care Unit (TCU) St. Mary's Convalescent Center St. Mary's Hospital Long-Term Care Facility Starcrest of Cartersville Starcrest of Conyers Starcrest of Lithonia Starcrest of McDonough Starcrest of Newnan Statesboro Nursing Home, Inc. Summerhill Elderly Living Home and Care SunBridge Care and Rehabilitation for Atlanta SunBridge Care and Rehabilitation for Cartersville SunBridge Care and Rehabilitation for Folkston SunBridge Care and Rehabilitation for Griffin SunBridge Care and Rehabilitation for Hazelhurst SunBridge Care and Rehabilitation for Reidsville SunBridge Care and Rehabilitation for Riverdale SunBridge Care and Rehabilitation for Statesboro SunBridge Care Center for Jesup SunBridge Retirement and Rehabilitation for Seven Hills Sunrise Nursing Home of Georgia, Inc. Swainsboro Nursing Home, Inc. Syl-View Health Care Center Sylvester Home Care, Inc. Tanner Medical Center Subacute Care Unit Tara at Thunderbolt Nursing and Rehabilitation Center Taylor County Health Care The Retreat Nursing Home Thomaston Health and Rehabilitation Thomson Manor Health Care Center Tift Health Care, Inc. Toccoa Nursing Center Toombs Nursing Home Toomsboro Nursing Center Treutlen County Nursing Home Tucker Nursing Center Twin Fountains Home Twin Oaks Convalescent Center Twin View Health Care Center Ty Cobb Healthcare Sytem (Comer) Union County Nursing Home
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FY 2005 Total $390,167.00 $455,620.00 $171,802.00 $244,681.00 $338,151.00 $158,904.00 $8,286.00 $214,209.00 $299,617.00 $355,508.00 $500,138.00 $43,370.40 $466,637.00 $243,968.00 $249,662.00 $458,253.00 $264,758.00 $311,944.00 $200,659.00 $374,574.00 $186,861.00 $200,115.00 $376,757.00 $170,395.00 $167,795.00 $250,721.00 $156,786.00 $228,327.00 $314,503.00 $273,515.00 $3,378.40 $390,711.01 $232,115.00 $173,706.00 $309,270.00 $420,993.00 $464,823.00 $521,161.00 $381,599.00 $180,557.00 $154,666.00 $365,160.00 $358,448.00 $254,904.00 $332,313.00 $370,694.00 $531,968.00

Enrolled University Hospital Extended Care/Westwood University Nursing and Rehabilitation Center Walton Convalescent Unit/Lucy Forrester Warner Robins Rehabilitation Center Warrenton Health and Rehabilitation Center Washington County Extended Care Facility Waycross Health and Rehabilitation Center WellStar Paulding Nursing Center Wesley Woods Of Newnan Peachtree West Lake Manor Health Care Center Westbury Medical Care Home, Inc. Westminister Commons Westview Nursing and Rehabilitation Center, LLC Westwood Care Center Wildwood Health Care, Inc. Wilkes Health Care Center William Breman Jewish Home, The Willowbrooke Court at Lanier Village Estates Willowwood Nursing Center Winder Nursing, Inc. Winthrop Manor Nursing Center Wood Dale Health Care Center Woodlands at Cobblestone Woodstock Nursing and Rehabilitation Center Wrightsville Manor Nursing Home, Inc. Totals

FY 2005 Total $401,428.00 $338,023.00 $187,062.00 $301,548.00 $345,171.00 $200,333.00 $280,175.00 $496,159.00 $24,114.05 $175,202.00 $589,587.00 $189,081.00 $228,795.00 $148,959.00 $154,289.04 $132,477.00 $310,181.00 $18,279.05 $304,690.00 $498,555.00 $287,040.00 $253,412.00 $164,519.00 $433,385.88 $285,861.00
$101,083,244.43

Upper Payment Limits Upper Payment Limits (UPL) are available to eligible hospitals and nursing homes. These reimbursements fill the gap between what Medicaid paid and what Medicare would have paid. The state receives intergovernmental transfers (IGT) from participating public hospitals and nursing homes which are used to match federal UPL funds available. UPL payments are then made back to the eligible hospital or nursing home.

For Nursing Homes in FY 2005: Nursing Home
Appling Convalescent Center Appling Nursing Home Azalea Trace Nursing Center Banks-Jackson-Commerce Medical Center Nursing Home Boswell-Parker Nursing Center Brentwood Terrace Health Care Center Bryant Nursing Center Calhoun Nursing Home Chatuge Regional Nursing Home Cherry Blossom Health Care

FY 2005 Payments $1,306,812 $454,050 $1,555,006
$1,454,853 $130,122
$2,065,781 $1,353,415
$809,648 $538,577 $1,643,028

FY 2005 IGTs $1,089,010 $378,375 $1,295,839
$1,212,378 $108,435
$1,721,484 $1,127,846
$674,707 $448,814 $1,369,190

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Nursing Home Coastal Manor Crestview Health and Rehabilitation Center Crisp Regional Nursing and Rehabilitation Center Dawson Manor Early Memorial Nursing Home Effingham County Extended Care Facility Emanuel County Medical Center Nursing Home Florence Hand Home Four County Health Care Georgia Baptist Meriwether Nursing Home Glenn-Mor Nursing Home Glenvue Nursing Home Gray Nursing Home Greene Point Health Care Gwinnett Extended Care Center Habersham Nursing Home Hamilton House Nursing and Rehabilitation Center Hartwell Health Care Center Heritage Inn of Barnesville Heritage Inn of Sandersville Ideal Health Care Center Joe-Anne Burgin Nursing Home Kentwood Nursing Home Laurel Park Nursing Home Lee County Health Care Lillian G. Carter Nursing Center Lynn Haven Nursing Home Marion Memorial Nursing Home Meadows Nursing Center Memorial Manor Nursing Home Miller Nursing Home Mitchell Convalescent Center Montezuma Health Care Center Muscogee Manor and Rehabilitation Center New Horizons - North New Horizons - West Oak View Home Home, Inc. Oakview Nursing and Rehabilitation Center Oconee Health Care Oconee Regional Hospital - SNF Palemon Gaskins Memorial Nursing Home Parkside at Hutcheson Medical Center

FY 2005 Payments $788,973
$5,259,249 $860,864
$1,174,241 $2,035,103 $2,286,882
$328,102 $867,631 $1,742,205 $1,029,147 $715,647 $2,055,813 $1,432,000 $974,303 $1,228,908 $1,153,264 $1,012,678 $1,071,930 $1,789,372 $888,618 $913,055 $1,129,258 $872,752 $1,235,909 $1,540,880 $1,728,273 $1,831,324 $480,464 $134,545 $1,028,137 $974,297 $525,953 $1,437,943 $4,530,589 $939,577 $1,243,292 $1,706,053 $2,489,441 $894,336
$6,157 $255,209 $1,543,200

FY 2005 IGTs $657,478
$4,382,708 $717,387 $978,534
$1,695,919 $1,905,735
$273,418 $723,026 $1,451,838 $857,623 $596,372 $1,713,178 $1,193,333 $811,919 $1,024,090 $961,053 $843,898 $893,276 $1,491,144 $740,515 $760,879 $941,049 $727,293 $1,029,924 $1,284,067 $1,440,228 $1,526,104 $400,387 $112,121 $856,781 $811,914 $438,295 $1,198,286 $3,775,491 $782,981 $1,036,076 $1,421,711 $2,074,534 $745,280
$5,131 $212,674 $1,286,000

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Nursing Home Pelham Parkway Nursing Home Phoebe Putney Memorial Hospital Skilled Nursing Facility (SNF) Pierce County Nursing Home Providence Healthcare of Sparta Providence Healthcare of Thomaston Riverside Nursing Center Of Thomaston Satilla Care Center Shady Acres Convalescent Center S.E. Georgia Health System Transitional Care Unit Sparta Health Care Center St. Mary's Convalescent Center Starcrest of Cartersville Starcrest Of Lithonia Taylor County Health Care The Retreat Thomson Manor Nursing Home Toombs Nursing Home Treutlen County Nursing Home Twin Fountains Home Twin Oaks Convalescent Center Union County Nursing Home Washington County Extended Care Facility Wellstar Paulding Nursing Center Westwood Nursing Facility Total
For Hospitals in FY 2005: Hospital
Appling Hospital Athens Regional Medical Center Bacon County Hospital BJC Medical Center Bleckley Memorial Hospital Brooks County Hospital Burke Medical Center Camden Medical Center Candler County Hospital Central State Hospital Medical Surgical Center Charlton Memorial Hospital Chatuge Regional Hospital Clinch Memorial Hospital Coffee Regional Medical Center

FY 2005 Payments $1,403,400
$47,469 $681,115 $1,005,493 2,296,108 $1,137,669 $763,851 $3,540,479
$18,076 $1,442,666 $1,481,942 $2,265,798 $4,283,710 $1,355,086
$332,051 $3,223,176 $2,464,420
$840,986 $2,241,747 $1,573,986 $1,688,140
$870,338 $2,782,969 $3,258,027 $108,445,568
FY 2005 Payments $528,798
$17,958,377 $374,446 $680,730 $345,195 $314,761 $403,584 $799,035 $484,527 $23,463 $222,774 $37,410 $703,748
$2,093,546

FY 2005 IGTs $1,169,500
$39,558 $567,596 $837,911 $1,913,423 $948,058 $636,543 $2,950,399
$15,063 $1,202,222 $1,234,952 $1,888,165 $3,569,759 $1,129,238
$276,709 $2,685,981 $2,053,684
$700,822 $1,868,123 $1,311,655 $1,406,784
$725,282 $2,319,141 $2,715,023 $90,371,311
FY 2005 IGTs $440,665
$14,965,315 $0
$567,275 $0 $0
$336,320 $665,863
$0 $21,330
$0 $0 $0 $1,744,621

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Hospital Colquitt Regional Medical Center Crisp Regional Hospital DeKalb Medical Center Dodge County Hospital Dorminy Medical Center Early Memorial Hospital Effingham Hospital Elbert Memorial Hospital Emanuel Medical Center Evans Memorial Hospital Fannin Regional Hospital Floyd Medical Center Georgia Baptist Meriwether Hospital Grady General Hospital Grady Memorial Hospital Gwinnett Medical Center Habersham County Medical Center Hart County Hospital Henry Medical Center Higgins General Hospital Houston Medical Center Hughes Spalding Children's Hospital Hutcheson Medical Center Irwin County Hospital Jeff Davis Hospital Jefferson Hospital Jenkins County Hospital Joan Glancy Memorial Hospital John D. Archbold Memorial Hospital Liberty Regional Medical Center Louis Smith Memorial Hospital McDuffie County Hospital Meadows Regional Medical Center Medical Center of Central Georgia Medical College of Georgia Hospital Memorial Health University Medical Center Memorial Hospital Miller County Hospital Minnie G. Boswell Memorial Hospital Mitchell County Hospital Monroe County Hospital Morgan Memorial Hospital

FY 2005 Payments $2,479,233 $842,486
$24,550,914 $2,323,456 $843,563 $841,889 $182,817 $878,438 $952,784 $971,736 $670,807 $5,728,600 $424,962 $1,271,717
$212,547,642 $3,180,139 $381,581 $658,526 $1,476,296 $429,812 $3,983,933
$10,963,512 $3,426,356 $645,619 $307,478 $436,628 $99,202 $460,473 $3,031,542 $701,736 $423,328 $497,847 $1,301,195
$31,196,076 $61,069,851 $43,137,960
$602,695 $676,735 $154,343 $858,203 $184,352 $374,750

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FY 2005 IGTs $2,066,027 $702,072
$20,459,095 $1,936,214 $702,969 $0 $0 $732,032 $793,987 $809,780 $559,006 $4,773,833 $0 $1,059,764
$176,723,035 $2,650,116 $317,984 $548,772 $1,230,247 $0 $3,319,945 $9,136,260 $2,855,297 $538,016 $0 $363,857 $0 $383,728 $2,526,285 $0 $0 $414,873 $1,084,330
$25,996,730 $50,694,630 $35,948,300
$502,246 $0 $0 $0 $0 $0

Hospital Murray Medical Center Newton General Hospital Northeast Georgia Medical Center Northside Hospital Northside Hospital - Cherokee Oconee Regional Medical Center Peach Regional Medical Center Perry Hospital Phoebe Putney Memorial Hospital Phoebe Worth Hospital Polk Medical Center Putnam General Hospital Rabun County Memorial Hospital Rockdale Hospital Roosevelt Warm Springs Institute Satilla Regional Medical Center Screven County Hospital South Georgia Medical Center Southeast Georgia Regional Medical Center Southern Regional Medical Center Southwest Georgia Regional Medical Center Stephens County Hospital Stewart Webster Hospital Sumter Regional Hospital Sylvan Grove Hospital Tanner Medical Center/Carrollton Tanner Medical Center/Villa Rica Tattnall Memorial Hospital Taylor Telfair Regional Hospital The Medical Center Tift General Hospital Union General Hospital University Hospital Upson Regional Medical Center Washington County Regional Medical Center Wayne Memorial Hospital WellStar Cobb Hospital WellStar Douglas Hospital WellStar Kennestone Hospital WellStar Paulding Hospital WellStar Windy Hill Hospital West Georgia Medical Center

FY 2005 Payments $444,425
$1,593,992 $9,436,815 $16,855,909 $1,376,559 $1,376,733
$447,818 $900,660 $6,022,770 $442,987 $326,532 $156,349 $246,973 $4,457,341 $1,549,127 $1,703,623 $142,172 $7,033,003 $6,137,961 $16,458,888 $300,711 $1,396,619
$62,088 $3,205,855
$504,090 $4,218,542 $1,335,016
$361,361 $177,376 $14,878,765 $1,773,809 $204,385 $14,149,177 $3,117,714 $516,826 $1,996,195 $12,370,592 $1,993,313 $10,582,375 $627,968
$55,696 $3,170,556

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FY 2005 IGTs $370,354
$1,328,327 $7,864,013 $14,046,591 $1,147,132 $1,147,278
$0 $750,550 $5,018,975
$0 $0 $0 $0 $3,714,451 $1,408,297 $1,419,686 $0 $5,860,836 $5,114,968 $13,715,740 $0 $1,163,850 $0 $2,671,546 $0 $3,515,452 $1,112,514 $0 $0 $12,398,971 $1,478,175 $170,321 $11,790,981 $2,598,095 $430,688 $1,663,496 $10,308,827 $1,661,095 $8,818,646 $523,307 $46,413 $2,642,131

Hospital Wheeler County Hospital Wills Memorial Hospital Total

FY 2005 Payments $324,641 $320,201
$605,896,114

FY 2005 IGTs $0 $0
$494,472,525

General Counsel Division The General Counsel Division is responsible for the administration of the following sections' work:

The Legal Services Section provides support and assistance to every unit of the department associated with Medicaid and PeachCare for KidsTM. The section receives hundreds of inquiries from program staff, providers, recipients, corporate counsel and legislators each year. The section also provides support for the Georgia Attorney General with regard to Medicaid/PeachCare for KidsTM matters that are or become the subject of litigation.

Administrative Hearings Fiscal Year 2005 saw a significant increase in the number of matters referred to the Office of State Administrative Hearings (OSAH). The Legal Services Section provides representation to the department at hearings conducted by OSAH. The following is a breakdown of these matters:

Matters Katie Beckett Level of Care Eligibility Cases Provider Appeals Provider Rate Appeals Recipient Appeals Program Integrity Appeals Provider Terminations Total Matters Referred

Number 340 83 18 51 37 5 534

Policy Review and Drafting

The Legal Services Section is responsible for drafting and reviewing proposed policies in Medicaid and PeachCare to assure compliance with legal requirements. During FY 2005, the section drafted or reviewed a number of significant policy revisions:

o Outlier Policy and Administrative Reviews - Drafted o Special Needs Trust Policy - Drafted o Managed Care Policy on Administrative Reviews and Hearings - Drafted o Burial Fund Policy - Drafted o Lock-in Policy - Reviewed and Drafted o General Administrative Review Policy - Drafted o Promissory Note Policy - Reviewed and Drafted o General Part I Policy - Drafted o Qualified Income Trusts - Reviewed o Special Needs Trusts - Reviewed o Emergency Medical Assistance - Continuing Review o Nursing Home Policy - Reviewed o Katie Beckett Policy - Continuing Review o ACS Policy Manuals (multiple) - Continuing Review and Comment o Managed Care Legal Issues - Guidance Provided o Fullard and Favors - Reviews o Estate Recovery - Reviewed o PeachCare for KidsTM Policy - Reviewed

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General Duties In Calendar Year (CY) 2005, the Legal Services Section handled 264 in-house projects, 67 Commissioner-review matters and 8 administrative records.
Additionally, the Legal Services Section provides assistance on an ongoing basis in the following areas:
o General Inquiries on issues including: advance directives, records retention, preservation of electronic medical records, scope of practice and appeals procedure.
o General Inquiries regarding subpoenas, open records and confidentiality. o General provider inquiries regarding Part I Policy. o Maintenance of the Part I Policy Manual. o Special Needs Trust and Medicaid Lien Collections. o Financial Services Support (Recoupment and Collections). o ACS Member Services-Multiple training sessions and continuous support. o Training for the Georgia Medical Care Foundation regarding Hearings. o Olmstead Inquiries and meetings with Office for Civil Rights. o Legal Support for Program Specialists. o Legal Support for Program Integrity including case settlements and withholds.
Program Integrity Section Program Integrity is the section responsible for the identification, investigation and reconciliation of fraud and abuse in Georgia's Medicaid, PeachCare for KidsTM and SHBP. The section's goal is to purge the system of those who would take advantage of it while assisting those entities that made errors with corrective action, education and accountability. PROGRAM INTEGRITY staff includes nurses and clinicians, statistical analysts and investigators all working under the General Counsel Division of the department. The following are the six teams that comprise the unit: Investigations, Hospital, Pharmacy, Physician Services, Waivers and Professional Services.
Cases are received by PROGRAM INTEGRITY through a variety of sources. Some of these sources include a telephone hot-line, the internet and interagency referrals. Once cases are received, a foundation of data analysis is established. PROGRAM INTEGRITY employs the latest technology to comb through claims information and builds reports that support the investigation of fraud and abuse. Investigators then develop the cases and forward them to clinical teams. These teams include professionals with expertise in hospital, pharmacy, physician, mental health and waivers experience. If a question of medical necessity arises, peer reviewers from that specialty are used to review the case. Claims and data analysis are also used to develop studies that can be used to predict fraudulent or abusive trends or identify vague or ambiguous policy.
Program Integrity is committed to working collaboratively with local, state and federal agencies in its pursuit of accountability. Some of the agencies PROGRAM INTEGRITY works with are the Georgia Bureau of Investigation, State Health Care Fraud Control Unit, Office of Inspector General, Federal Bureau of Investigation, Attorney General's Office and the Department of Health and Human Services. By working collaboratively with other agencies, PROGRAM INTEGRITY is better able to detect and pursue fraud and abuse.
In FY 2005, the Program Integrity Unit again experienced a systematic change in the approach to fraud and abuse. This change was the culmination of efforts from previous fiscal years of 2003 and 2004. With a sound business process and information flow in place, the unit's productivity increased and cases were handled more efficiently. In 2005, emphasis was shifted from the traditional complaint driven approach. Data studies and prevention were introduced to broaden the overall scope. Data studies enabled the unit to impact a larger number of providers with less resources. The studies were targeted at specific policy violations that could be evaluated by the claims data. Prevention was accomplished when issues were identified in the policy that could be addressed by an edit in the MMIS.
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Program Integrity participated in the Centers for Medicare and Medicaid Services (CMS) certification of the MMIS by being the central point of contact for the Surveillance and Utilization Review Subsystem (SURS). PROGRAM INTEGRITY staff worked with the CMS reviewers to show that the department had moved from the outdated quarterly reports methodology to a more efficient ad hoc reporting process. Rather than relying on standardized reports for leads, the unit used the SUR subsystem to develop customized reports addressing specific issues. The CMS review resulted in a final report with no findings and certifying the MMIS.
The Certificate of Need (CON) Section administers the CON Program, approving the development and expansion of health care services and facilities pursuant to statutory and regulatory standards. The program requires providers to obtain a CON before offering new services, purchasing major medical equipment, constructing new facilities or engaging in capital renovations that exceed established capital expenditures and equipment thresholds. Facilities, which must comply with the CON rules, include the following: hospitals, nursing homes, home health agencies, Diagnostic, Training and Rehabilitation Centers for outpatient surgery, diagnostic imaging and radiation therapy services. Project proposals to develop or expand health care services are evaluated by health system analysts.
The CON Section, working in conjunction with the CON/Department Health Planning (DHP) attorney, is also responsible for the review and issuance of Letters of Non-Reviewability for Physician-Owned, SingleSpecialty Ambulatory Surgical Centers and major medical equipment, both of which are exemptions to the CON statute. Letters of Determination are also issued to provide guidance and insight to applicants regarding future anticipated project proposals for new or expanded health care services and/or facilities as well as major renovation or construction project proposals.
Post-approval requirement reporting and monitoring are coordinated through the CON Section. Prior approved project proposals have statutory and regulatory commencement and completion schedules to ensure timely provision of services in the respective community. The state architect provides support to CON post approval monitoring through facility architectural plan review and site inspections for major renovations and construction of hospitals, nursing homes and ambulatory surgical centers projects. The CON Section, with the assistance of the CON/DHP attorney, works directly with the Attorney General's Office on litigation preparation and strategy involving appeals of approved or denied project proposals, Letters of Non-Reviewability and Letters of Determination.
Through routine collaboration and interface with the division's Health Planning Section, the CON Section is actively involved in reviewing, updating and developing the State Health Plan. The State Health Plan is a compilation of the regulations that are applied to proposals to develop and/or expand health care services and facilities in Georgia. Moreover, the CON Section recently updated the CON application, which is available on-line, and developed new forms for requests for Letters of Non-Reviewability and Letters of Determination, as well as other CON application supporting documents, all of which help streamline the application process. CON activity is tracked weekly in the Certificate of Need Tracking and Appeals report, which is available on the department's Web site.
Georgia's CON Program was implemented in 1979, and the program remains very active. In June 2005, an 11-member State Commission on the Efficacy of the CON was named "to study and evaluate the effectiveness and efficiency" of Georgia's program. The commission is charged with issuing a final report on its findings on or before June 30, 2007. The commission meets monthly and the meetings are open to the public. Meeting dates and times are posted on the department's Web site. The CON Section along with other division sections provides staff support to the commission.
The chart appearing below provides an overview of the Administrative Costs and Revenues, as well as summarizes the DCH's CON activities during State Fiscal Year (SFY) 2005:
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Certificate of Need and State Health Planning Program Administrative Costs and Certificate of Need Activity
State Fiscal Year 2005

Administrative Costs and Revenues

Expenditures

$1,355,963

Revenue Collected from Various Fees Revenue Collected from Indigent and Charity Care Commitment Shortfalls Total Revenue Collected Certificate of Need Activity CON Applications Received

$659,170 $1,041,331 $1,700,501
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Proposed Capital Expenditures

$906,577,926

CON Applications Approved

79

Capital Expenditures Approved

$822,546,603

CON Applications Denied

7

CON Applications Withdrawn or Cancelled

15

Savings from Denied, Withdrawn, or Cancelled Applications

$84,031,323

CON Applications Appealed (administrative and/or judicial)

9

Requests for Determination or Letter of Non-Reviewability

153

Prepared by: Data Resources and Analysis Section, Division of Health Planning, Office of General Counsel

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Certificate of Need Project Summary for Applications Submitted During State Fiscal Years 1994 to 20051

Fiscal Year Applications Applications Applications

Submitted Submitted Approved

Denied

1994

127

84

24

1995

143

83

28

1996

76

59

8

1997

71

50

13

1998

93

45

36

1999

95

69

14

2000

85

77

2

2001

91

72

8

2002

117

105

4

2003

130

103

16

2004

142

106

28

2005

101

79

7

Totals

1,271

932

188

1 Reflects CON activity for each fiscal year as of January 27, 2006.

Applications Withdrawn
19 32 9 8 12 12 6 11 8 11 8 15 151

Decisions Appealed
37 29 22 28 37 11 1 24 12 29 35 9 274

Decisions Reversed
9 7 3 3 3 4 1 13 4 2 3
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Total Costs of Projects Reviewed $260,435,530 $379,440,268 $420,946,923 $333,674,960 $188,123,943 $465,163,126 $666,854,009 $598,024,749 $673,532,080 $578,867,062
$1,313,074,544 $906,577,926
$6,784,715,120

Healthcare Costs
Avoided2 $123,358,966 $107,032,416 $41,706,298 $154,837,181 $96,616,041 $149,132,645 $90,539,810 $192,353,811 $115,615,945 $69,753,626 $87,761,889 $84,031,323 $1,312,739,951

2 Costs associated with health care construction, equipment, and services that were avoided because CON applications were denied, withdrawn, or projects were cancelled by DCH for non-performance. Does not include operational costs of the projects.

Prepared by: Data Resources and Analysis Section, Division of Health Planning, Office of General Counsel

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Georgia Certificate of Need Regulated Healthcare Facilities at a Glance State Fiscal Year 2005

Type of Facility or Service

General Hospitals

154 hospitals

Supply

915,713 admissions

Utilization

24,305 capacity beds 3 beds per 1,000 population

4,376,969 inpatient days 103 admissions per 1,000 population

49.3% bed occupancy

3,656,344 emergency room visits 410 emergency room visits per 1,000 population

Inpatient Rehabilitation, Psychiatric 26 hospitals

and State Hospitals

4,709 capacity beds

43,221 admissions 884,936 inpatient days

Cardiac Catheterization

124 authorized cardiac catheterization labs or rooms
47 diagnostic-only labs at 43 facilities

124,052 cardiac catheterization procedures performed in 104,545 sessions of cardiac catheterization (adult and pediatric) 90,132 diagnostic cardiac catheterization procedures (79,456 sessions)

Open Heart Surgery

77 diagnostic and therapeautic labs at 20 facilities 20 programs statewide
2 authorized for pediatric OHS

33,920 therapeautic (interventional) cardiac catheterization procedures (25,089 sessions)
8,964 adult open heart surgeries 559 pediatric open heart surgeries 9,523 open heart surgeries in total (1 surgery per 1,000 population)

17 programs were operational for more

than 3 years

1,292 was maximum number of surgeries performed at 3+ year programs

46 was the minimum number of surgeries performed at 3+ year programs 542 was average number of surgeries performed by 3+ year programs

7 of the 3+ year programs performed fewer than 300 OHS

Obstetrical Services (hospital)

1,879 capacity beds at 98 general hospitals 140,365 admissions

145,214 deliveries

Outpatient Surgery at Hospitals

128 dedicated outpatient operating rooms 505,248 surgery patients 600,469 outpatient surgical procedures

Outpatient Surgery at Freestanding CON-Authorized Centers

715 shared outpatient and inpatient operating rooms
144 surgery rooms at 46 CON-regulated freestanding facilities

119,143 surgery patients 214,668 total outpatient surgical procedures

Nursing Homes (not including Intermediate care facilities for the mentally retarded)

362 skilled nursing facilities 39,679 capacity beds 38 beds per 1,000 age 65 and Over

193,683 outpatient surgeries at multi-specialty ambulatory surgery centers 35,167 patients (on June 30, 2005) 40,634 admissions 12,472,316 patient days

13,200 days per 1,000 ages 65 and Over

Home Health Agencies

103 agencies
159 counties served by 2 or more home health agencies

86.1% bed occupancy 114,914 patients 2,325,727 total home health visits 20 average visits per patient

Personal Care Homes (25 beds or more only)

259 personal care homes (with 25 beds or more)

13 patients per 1,000 population 10,625 residents (on June 30, 2005) 5,589 admissions

16,252 capacity beds

10 residents per 1,000 ages 65 and Over

17 beds per 1,000 ages 65 and Over

Notes: Represents the most current data available as of February 8, 2006.

Supply numbers reflect existing and approved (non Federal) facilities and services as of February 8, 2006, Division of Health Planning facilities and services inventories. Utilization reflects data reported for 2004 on Division of Health Planning facility surveys except for Nursing Home and Personal Care Home utilization which reflects State Fiscal Year 2005, and Nursing Home patient days which reflect State Fiscal Year 2004 data.

Population from 2005 projected population of Georgia residents from the Governor's Office of Planning and Budget Resident Population Projections 20002010. Projected Georgia population for 2005 is 8,901,006 total residents with 984,226 residents ages 65 or more. Outpatient surgery data does not include information related to those providers exempt from CON-regulation, such as single-specialty, physician-owned ambulatory surgery facilities.
Prepared by: Data Resources and Analysis Section, Division of Health Planning, Office of General Counsel

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Health Planning Section During 2005, the Health Planning Section spearheaded the following:
o Collaborated with the Health Strategies Council, including providing staff and research support for meetings of the Health Strategies Council Standing, Technical Advisory and other ad hoc committees to develop policies for health care services in Georgia;
o Managed the collection of extensive data and information about Georgia's health care facilities; o Provided programming support, refinements and development of various databases and
specialized programs utilized by the CON Section, Health Planning Section and various other sections within DCH; o Managed the implementation of DCH's first Document Management System; o Managed the state's Patients' Right to Independent Review process; o Planned, coordinated and managed the work of the Governor's Commission on the Efficacy of the CON Program; including providing research, meeting planning and facilitation, and other technical assistance; o Collaborated with the Department of Human Resources/Office of Regulatory Services to update and refine the rules and regulations that govern hospice services; o Worked with the Office of Rural Health Services and a wide range of stakeholders to develop a Rural Health Care Plan for Georgia; and o Reviewed and evaluated Critical Access Hospital applications, on an ongoing basis, as part of the Medicare Rural Hospital Flexibility Program.
Data Management Annually, all health care providers who hold a CON are required by statute to respond to the DCH's request for data and information. During CY 2005, division staff accomplished the following:
o Collected and reviewed over 1,200 electronic facility surveys; o Provided data products and/or analytical support for external customers which resulted in
$10,756.30 in generated revenue (SFY 2005); o Provided administrative support and document duplication which resulted in $42,248.76 in
generated revenue (SFY 2005); o Provided data and analytical support for 102 CON reviews (SFY 2005) and supported several
Health Strategies Council Standing, Technical Advisory and ad hoc committee meetings and the State Commission on the Efficacy of the CON Program; o Identified and initiated collection of $1,041,330.72 in shortfalls for indigent and charity care commitments; and o Developed a more reliable program to transfer electronically facility survey responses and databases to DCH.
Document Management And Programming This year, the CON Section and the Health Planning Section fully implemented the Planning and Review Information System (PARIS). The purpose of this system is to convert the voluminous and unmanageable CON-related and health planning paper files to a standard electronic format. During FY 2005, 1,139 documents and 20,680 pages were imaged. Numerous master files were imaged including all CY 2004 documents and most documents for CY 2003. In addition to numerous refinements and upgrades to the various databases, two major programming projects were completed in 2005. The first was the development of the PARIS Help Desk which provides technical support for users eliminating numerous duplication data entries. The second project was a major revision of the Letters of Determination and the Letters of Non-Reviewability databases.
Patient's Right To Independent Review Program In 1999, the Georgia General Assembly enacted O.C.G.A. 33-20A-31 et seq., giving members of Health Maintenance Organizations (HMO) and other managed care plans the right to appeal an insurer's decision that denied coverage for medical services. Over the last several years, there has been a continual upward trend in the number of requests for review that are processed by division staff for this program. During CY 2005, division staff processed 81 requests for independent review;
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this compares to 74 and 79 requests that were submitted during CY 2003 and CY 2004 respectively. Of those eligible for an independent review, 43 percent were approved in favor of the patient.
The Health Planning Review Board is an independent body whose membership is appointed by the Governor, hears appeals from decisions of officers conducting administrative reviews that grant or deny applications for Certificates of Need. The board selects individual hearing officers from a panel it maintains.
The Health Strategies Council adopts the State Health Plan to address Georgia's health care system for financial, geographic, cultural and administrative accessibility; reviews and makes recommendations on proposed rules governing the CON Program and studies long-term, comprehensive approaches for health insurance coverage for all. The council is an independent body whose membership is appointed by the Governor.
The Program Integrity Section performs all necessary investigations into allegations of misconduct, fraud, waste and abuse in the Medicaid and SHBP programs. The section conducts investigations regarding conduct of employees, vendors, providers and members. Six teams comprise the unit as follows: Investigations, Hospital, Pharmacy, Physician Services, Waivers and Professional Services.
In FY 2005, Program Integrity pursued 831 investigations which yielded seven arrests, six indictments and nine convictions. Program Integrity's FY 2005 savings, recoupment, collections and restitution were over 15.6 million dollars.
Managed Care and Quality Division In 2005, the Managed Care and Quality Division proceeded with the implementation of a managed care system for Medicaid and PeachCare for KidsTM members. In August 2004, the Governor's Office announced the plan, tentatively titled Georgia Cares. The goals of this reform were and are to: 1) Improve the health care status of our member population; 2) Establish contractual accountability for access to and quality of health care; 3) Lower cost through more effective utilization management; and 4) Budget predictability and administrative simplicity. The state was divided into six regions for the procurement. There would be at least two CMOs selected for each of five regions and three to five CMOs selected for the Atlanta region. The CMO implementation would be phased in over the course of a year, scheduled to begin January 2006.
The Division held stakeholders meetings in September and October 2004 to discuss the model. In January 2005, DCH released the Request for Proposals seeking bids from qualified care management organizations (CMOs) to assume the responsibility for the provisions of covered health care services to approximately one million Medicaid and SCHIP members; primarily low-income adults, children and pregnant women. The state held three technical assistance sessions for potential bidders and received nearly one thousand written questions. At least 15 CMOs expressed intent to bid. A final bidders' conference was held in February 2005. By April 2005, DCH received 10 bids. When the evaluation was completed, winners were announced in June 2005. Implementation and readiness plans began immediately, although the contracts were not signed until mid-July 2005 (FY2006).
State Health Benefit Plan Division During FY 2005, the operating units accomplished the following: Processed more than 262,819 coverage transactions for Health Plan members; Responded to more than 179,425 phone calls, 1,706 emails and 2,948 pieces of correspondence; Received 140,765 eligibility calls from Health Plan members; Responded to 38,660 calls from Human Resources staff at payroll locations; Received 652 appeals and closed 677 during the fiscal year (carryover from previous year); Monitored claims processing and customer service centers to verify quality of work being provided
met standards for accuracy and timeliness;
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Reviewed clinical standards and practices used within cost-containment programs, including the following: programs for medical and behavioral health utilization management, case management, prior approval, organ and tissue transplants and demand management;
Processed 949 HIPAA requests for release of information; Produced and mailed 281,595 Preferred Provider Organization (PPO) and Indemnity Identification
cards during the year; Produced and mailed 205,517 dependent audit letters to determine eligibility for coverage and Produced and mailed 264,457 worksheets for active employees/retirees. Coverage Options The State Health Benefit Program offered a Preferred Provider Organization (PPO), Indemnity and four Health Maintenance Organization (HMO) options during FY 2005: The PPO option allows members the choice of using either in-network or out-of-network providers,
with a higher level of benefit coverage available when in-network providers were used. The Georgia PPO provider network consisted of over 14,000 participating physicians and 168 acute-care hospitals. Nationally, the PPO provider network included over 385,000 physicians and 3,300 hospitals. Members could also have selected the PPO Choice option, which had the same benefits as the PPO option, but allowed members to nominate eligible out-of-network providers to be reimbursed as if the provider was participating within the network. SHBP implemented a consumer driven health plan,(CDHP), pilot program for several boards of education. CDHP is a relatively new concept and innovative approach to healthcare dollars. The plan contains a Health Reimbursement Account (HRA) that is funded by the State Health Benefit Plan. Under this plan, members have a greater responsibility to manage their health care dollars wisely, but in return, gain the freedom of choice to make the best decisions about how the health care dollars are used.
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The Indemnity option is a traditional fee-for-service plan that generally provides the same benefit coverage level no matter which qualified medical provider the member uses. This option uses contracted healthcare providers and use of these providers protects members from balance billing.
The HMO option was available to members who either lived or worked in a county within an approved service area. HMO choices for FY 2005 included the following: United Healthcare, BlueChoice, CIGNA and Kaiser Permanente. Eligible HMO option members could also select an HMO Consumer Choice option, which had the same benefits as the respective HMO, but allowed members to nominate eligible out-of-network providers to be reimbursed as if the providers were participating within the HMO's network. Some members with full Medicare coverage were also able to select the HMO Medicare + Choice option, which would replace the member's traditional Medicare coverage with enhanced HMO benefits. Except in emergencies, HMO participants were required to use network providers to receive coverage.
SHBP implemented a consumer driven health plan CDHP), pilot program for several volunteer boards of education. CDHP is a relatively new concept and innovative approach to healthcare dollars. The plan contains a Health Reimbursement Account (HRA) that is funded by the SHBP. Under this plan, members have a greater responsibility to manage their health care dollars wisely, but in return, gain the freedom of choice to make the best decisions about how the health care dollars are used.
All Covered Lives- All Coverage Options

HM O's 243,385, (38%)

PPO 366,940, (58%)

Indem nity 23,406, (4%)
Covered Lives - HMO Options

56

Kaiser 44,901 15%
Blue Choice 145,275 50%

United 84,007 29%
Cigna 17,357 6%

57

Covered Lives by Classification

M e m bers

500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000
0

181,746 95,808
State Members

455,351

Members

Employees

222,690

School Members

2,522 1,512 Misc Members

Open Enrollment and Retiree Option Change Period Activity Open Enrollment dates were April 18 May 17, 2005 for coverage effective July 1, 2005. The following projects were completed prior to the close of FY 2005 in preparation for the 2006 plan year:
729 Web transactions occurred on the Health Plan's Web site for Health Plan coverage effective July 1, 2005;
Data entries of 144,190 were made by SHBP staff to update/correct members' records; Prepared and posted Train-the-Trainer presentations to the DCH Web site for open enrollment
processing instructions for human resources staff in state agencies and school systems; Held 24 benefit fairs across the state and met with 6,000 active members to answer benefit
questions; Distributed 350,000 Health Plan Decision Guides for active employees to more than 750 payroll
locations; Sent 76,254 retiree option change packets to retired members; and Sent 1,653 open enrollment packets to members on COBRA and Leave Without Pay.95.
Covered Lives The table below describes plan membership by employment group and active or retired status. Total covered lives included members, spouses and other dependents.

Plan Member Group
State Employees Active State Employees Retired Teachers Active Teachers Retired School Service Personnel Active School Service Personnel Retired Contract Groups/Board Members COBRA Total Continued on next page

Covered Lives*
143,005 39,768
239,344 49,121
149,535 20,193 2,485 1,455
644,906

Employees
68,544 26,967 103,556 35,055 68,780 14,785
1,499 796
319,982

Dependents
74,461 12,801 135,788 14,066 80,755
5,408 986 659
324,924

% of Total Lives
22.17% 6.17%
37.11% 7.62%
23.19% 3.13% 0.39% 0.23%

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Plan Member Group
Active Retired Contract Groups/Board Members Cobra Total

Covered Lives*
531,884 109,082
2,485 1,455 644,906

Employees Dependents

240,880 76,807 1,499 796
319,982

291,004 32,275 986 659
324,924

% of Total Lives
82.47% 16.91%
0.39% 0.23%

Coverage Option PPO Indemnity Consumer Driven Health Plan pilot HMO
United Cigna BlueChoice Kaiser

Covered Lives* 332,984 14,451 590 291,540
84,007 17,357 145,275 44,901

Employees 180,453 9,749 304 129,480
36,067 7,486
64,195 21,732

Dependents 152,531 4,702 286 162,060
47,940 9,871
81,080 23,169

% of Covered Lives 52% 2% 0% 46%
13% 3%
23% 7%

Active teachers and school service personnel accounted for 61 percent of the covered lives; active state employees represented approximately 23 percent. Overall, retirees comprised nearly 105,000 covered lives, which represented 16.5 percent of the entire plan population.

Expenditures

The table below explains the total expenditures by type of health plan:

Total FY 2005 Expenditures PPO and Indemnity Option Expenditures HMO Premiums Contracts Administrative Support Average Expenditure Per Covered Life

$1,991,594,639 $1,473,349,146
$406,300,297 $103,297,079
$8,648,117 $3,088.19

State Members School Members Miscellaneous Members Total

181,746 455,351
2,522 639,619

Active Members Retired Members Miscellaneous Members Total

526,594 110,503
2,522 639,619

Total Cost/Member

$3,113.72

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Health Improvement Programs As part of the department's reorganization in 2002, offices that worked to improve the health of designated groups were brought together in a single section called the Health Improvement Programs. This section includes the Offices of Women's Health, Minority Health and Rural Health, and the Commission on Men's Health. The Commission on Men's Health is administratively attached to the department.
Office of Women's Health The Office of Women's Health (OWH) envisions quality health and access to health care 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. OWH has an 11member advisory council composed of statewide representatives from major public and private organizations who are interested and experienced in women's health issues. Council members serve twoyear terms.
Proclamation Signing The Office of Women's Health declared Women's Health Month in Georgia on May 12, 2005.
Health Fairs OWH participated in the Clayton State University Health Fair. Approximately 320 students, professors and staff from the university participated in this health fair.
Fifth Annual Women's Health Summit DCH Office of Women's Health held its fifth annual Women's Health Summit entitled, "Women Take Charge!! Continuing the Journey To Wellness: Policy, Possibilities & Progress" on May 19 at the R. Charles Loudermilk Center in Atlanta.
The participants consisted of health advocates, health providers, stakeholders, health administrators and legislators. The summit's focus was on women's health policy and advocacy. The former and 15th U.S. Surgeon General, Dr. Joycelyn Elders, was the keynote speaker. Governor Sonny Perdue, Attorney General Thurbert Baker and Commissioner Tim Burgess opened the summit by welcoming the participants. The first presentation for the day was given by Dr. Dee Baldwin, and a distinguished roster of locally and nationally-recognized experts presented educational workshops.
The following were the summit's objectives:
o Increase awareness and explore policies that impact women's health; o Initiate dialogue among health professionals, advocates, policy makers and community
stakeholders in addressing the status of women's health in Georgia; and o Develop a program that is conducive to networking, sharing of knowledge and generating ideas to
empower women to continue their journey to wellness.
Woman-to-Woman Conference OWH partnered with the American Heart Association for their annual Woman-to-Woman Conference that was held in Atlanta on February 26 at the Omni Hotel. This conference was a day-long conference designed to educate the public about the risk of cardiovascular disease in women. Over 1,200 women attended a wide range of informational workshops on topics such as: women and heart disease, stroke, diabetes, nutrition, exercise and several others. Free health screenings were provided, and the participants enjoyed a heart-healthy exposition and banquet lunch.
Office of Minority Health The Office of Minority Health (OMH) helps minority communities reach a high level of health and wellness. The office also works to eliminate the discrepancy in health status between minority and nonminority populations in Georgia.
OMH focuses on the following: Identifying, assessing and analyzing issues related to the health of minority populations; Working with public and private organizations to address specific minority community health needs;
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Monitoring state programs, policies and procedures to assure that they are inclusive and responsive to minority community health needs; and
Facilitating the development and implementation of research enterprises and scientific investigations to produce minority-specific findings.
The office has a 12-member advisory council and each member serves a two-year term. IN H
HIV/AIDS Take Action, Keep Educated (TAKE) Project The OMH funding cycle for two three-year Demonstration Projects from the Department of Health and Human Services (DHHS), Office of Minority Health, will conclude in September 2005. The objectives for the project were as follows:
o To assist in the identification of needs within the state for HIV/AIDS prevention and care services among minority populations by collection, analysis and/or tracking of existing data on surveillance and existing providers of HIV services for minority communities;
o To facilitate the linkage of minority community-based organizations with other state and local recipients of federal funds for HIV/AIDS to develop greater resource capacity and interventions in the identified areas of need and,
o To assist in coordinating federal resources coming into high need, minority communities including identifying the different programs and facilitating access to federal technical assistance available to minority community-based organizations.
A request for an extension to complete the evaluation phase of the project was granted and will be complete in FY 2006 by Indiana State University.
The HIV/AIDS 2005 report was completed.
A State Partnership Grant was awarded to the TAKE Project for September 30, 2005 to September 29, 2010. The TAKE project will utilize lessons learned from work completed and established working relationship development during the demonstration project to address the following new objectives for the State Partnership Grant:
o To develop a workgroup among intergovernmental agencies statewide whose domain is the continuum of care/prevention services for HIV/AIDS to create a more cohesive approach to identifying and/or addressing minority health issues at the state, county and/or local levels. This goal will further create the necessary system change around information dissemination and sharing to improve the continuum of care/prevention services for minorities with HIV/AIDS;
o To increase knowledge and awareness of the impact of HIV/AIDS among minorities in Georgia; and
o To develop a network of service providers, community leaders, faith-based initiatives, grassroots organizations and community gatekeepers within the Hispanic/Latino population to eliminate cultural and linguistic barriers in the HIV/AIDS continuum of care and to create systemic change for Hispanic/Latino population.
In May 2005, the OMH held its first Summit for the Regional Minority Health Networks (RMHN) in Savannah. RMHN and their partners convened to discuss best practices, challenges and accomplishments as well as next steps for community efforts in developing goals and objectives for addressing HIV/AIDS.
OMH initiatives and activities included the development of prevention and risk reduction health education materials and services.
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Health Information Dissemination The final broadcast of the OMH radio program Lifeline to Health (LTH) (2002 to 2005) aired in May 2005. The program was broadcast as a monthly, live, statewide health education and awareness radio program, www.lifelinetohealthradio.com. The goal of LTH was to increase Georgians' awareness of pertinent health information and to encourage listeners to reduce their health risks and be pro-active in improving and maintaining their health. The program featured interactive call-in segments, health/fitness news and feature stories on timely health issues, particularly as they relate to ethnic minorities and medically underserved populations.
LTH host from 2002 to 2005 was former Executive Director of the Office, Carol Snype Crawford. Kristal Ammons, Program Consultant, served as Executive Producer from 2003 to 2005.
Health Disparities Data Reports The OMH contracted with the Morehouse School of Medicine, National Center for Primary Care (NCPC) to conduct research and data analysis on health disparities in Georgia. Four out of ten reports have been completed and distributed. These reports have been delivered locally and nationally to collaborative partners, community organizations, the general public, etc. The series is available on the DCH/OMH Web site and on the NCPC Web site.
As sponsors of the 2005 Diabetes Expo, the OMH disseminated health education materials. The OMH provided funding as partners with the American Diabetes Association to underwrite costs for free diabetes health screenings in "the Screening Zone" for the Expo.
Medical Interpreters Program A curriculum, training manual and testing process was drafted to establish a Medical Interpreters Qualifications and Certification Program. Once finalized and adopted, the program will develop and maintain an OMH Medical Interpreters Program and Registry to establish a unified system, methods, procedures and policies in providing medial interpreter services.
Internal and External Consultation OMH staff served in an advisory capacity to a variety of organizations, both internal and external, to the state to address minority health issues. Such organizations include: Office of Women's Health; Managed Care (DCH); Chronic Disease Program Management Unit DHR-Chronic Disease and Health Promotion Branch; the African American Health Resource and Information Center (Savannah); the American Heart Association; American Diabetes Association and the Georgia Diabetes Council.
Office of Rural Health Services (ORHS) The Office of Rural Health Services worked to improve access to health care in rural and underserved areas to reduce health status disparities of the populations in Georgia. The office has the following objectives: Empowering communities to strengthen and maintain the best possible health care using existing
resources; Building strong partnerships to meet local and regional needs; Providing incentives to local areas to implement integrated service delivery systems; and Acting as the single point of contact for all regional issues related to health care.
The office has a 21-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.
The 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 projects are listed below:
Received and administered $3,276,316 in federal grant funds for programs supporting the provision of health care for the rural and urban underserved populations of Georgia.
The Georgia Farmworker Health Program provided services to 13,577 migrant and seasonal
62

farmworkers and their dependents in FY 2005. These services accounted for 20,429 medical encounters and 18,603 enabling encounters such as: outreach services, medical interpreting, transportation and health education provided by non-medical personnel. The National Health Service Corps provided loan repayment/scholarships to 101 medical/dental providers in underserved areas of Georgia during FY 2005, receiving a minimum of $975,000 in federal loan repayment. The J-1 Visa Waiver Program placed 30 medical providers in underserved areas of Georgia, resulting in a total of 85 J-1 physicians serving Georgia's underserved areas during FY 2005.
Commission on Men's Health (CMH) The Commission on Men's Health worked to improve the health status of men in the state of Georgia. It has an 11-member advisory board, and its terms are two years for legislative members and three years for non-legislative members.
The focus of the commission is to: Develop 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 physician check-ups, early detection and preventive screening tests and healthy lifestyle practices; Improve health outcomes in diseases such as: prostate and testicular cancer, cardiovascular diseases including heart attacks, high-blood pressure, stroke, depression, suicide and diabetes; Monitor state and federal policy and legislation that may affect areas of men's health; Recommend assistance, services and policy changes that will further the goals of the commission; and Submit a report of the commission's findings and recommendations to the Governor, the President of the Senate and the Speaker of the House of Representatives.
In FY 2005, CMH did not have a director for much of the year. The projects that CMH accomplished are as follows: The commission hosted a Statewide Men's Health Day in collaboration with the Department of
Human Resources' public health districts. The participating districts provided some type of men's health event for their communities to promote men's health. These events were either screenings or distributing information. The men's health guides were distributed and referrals were given to assist men with questions about their health and where to go for regular check-ups. On June 18, 2005, the CMH sponsored a Statewide Initiative for Men's Health Day. The commission worked together with 19 public health districts to help promote men's health awareness.
Conclusion This year, DCH continued to balance the need for adequate health insurance of our constituencies-Medicaid and PeachCare for KidsTM, and of our state employees against rising costs and growth in enrollment. DCH firmed up a smooth transition for the Medicaid and PeachCare for KidsTM members into managed care programs to help them better achieve healthy lives and to reduce costs to the state. DCH will continue to improve health care for all Georgians in the department's charge and care by creating cutting-edge programs and streamlining processes.
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