Annual report, 1979

GEORGIA DEPARTMENT OF MEDICAL ASSISTANCE
ANNUAL REPORT-FISCAL YEAR 1979
Commissioner, Charles K. Pierce

CREDIT FOR COVER DESIGN: State Capitol, Angela B. Witt, Department of Administrative Services, Printing Services.

Clharke p. pierce
~ommieeioner
February 1, 1980
The Honorable George Busbee, Governor Members o f the G e n e r a l A s s e m b l y o f G e o r g i a S t a t e o f Georgia Atlanta, Georgia 30334 Ladies and Gentlemen:
As d i r e c t e d b y the Board o f M e d i c a l A s s i s t a n c e , I am s u b m i t t i n g f o r your r e v i e w the Annual S t a t i s t i c a l R e p o r t o f the Georgia Department o f Medical A s s i s t a n c e summarizing agency a c t i v i t y through the f i s c a l year ending June 30, 1979. This report provides a d i v e r s e range o f data concerning r e c i p i e n t s , services, providers and costs o f the Georgia Medicaid program.
I n a d d i t i o n , a summary i s i n c l u d e d o f endeavors o f the Department i n i t s second year a s an independent agency i n the a r e a s o f program cost containment and provider relations.
W e w i s h t o a c k n o w l e d g e the e s s e n t i a l role o f the Department o f Human R e s o u r c e s , the various h e a l t h professions i n t h e S t a t e and a l l o t h e r associated agencies i n S t a t e Government i n bringing medical assistance t o approximately one-half m i l l i o n Georgians during the past year.
Charles K. Pierce Commissioner

BOARD OF MEDICAL ASSISTANCE
The Board of Medical Assistance is the policy-making authority for the Georgia Department of Medical Assistance. The Board is composed of five ( 5 ) persons appointed by the Governor and confirmed by the Senate for staggered four (4) year terms of office following the initial appointments. Board meetings are held monthly.

MEMBERS
Mr. D. Jack Davis, Chairman Ila, Georgia
Mr. James E. Barnett, Secretary Atlanta, Georgia
Ms. Vivian P. Hartman Milledgeville, Georgia
Mr. Ronald Tigner Atlanta, Georgia
Mr. Clem Hosea Toccoa, Georgia

TERM OF OFFICE Through June 30, 1981 Through June 30, 1983 Through June 30, 1980 Through June 30, 1982 Through June 30, 1980

TABLE OF CONTENTS
Program Abstract ........................................................... 1 Commissioner's Foreword .................................................... 2 Expenditures ................................................................5
A History of Medicaid Benefits Expenditures Benefits Expenditures Sources of Medicaid Revenue (Federal/ State Breakdown) Where the Medicaid Dollar Comes From (FederallState Breakdown) Where the Medicaid Dollar Goes (% Benefits/Administration) FY 79 Benefits Expenditures Administrative Budget Benefits Payments by Aid Category, Sex, Race and Age Group Benefits Paid by County of Residence of Recipient Analysis of Recipients and Expenditures by County
Eligibles, Recipients and Services ..............................................19
Monthly Average Eligibles for All Aid Categories Monthly Average Eligibles by Aid Category by Quarter Types of Services Used by Recipient Group and Type of Service Average Monthly Payments per Recipient by Basis of Eligibility Benefits Paid by Recipient Group and Type of Service Cost of Services per Recipient Cost per Recipient by County of Residence Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 Enrolled Providers by Type of Service Enrolled Primary Care Physicians by County Enrolled Specialist Physicians by County
Department of Medical Assistance Advisory Committee ..........................37

ABSTRACT OF FISCAL YEAR 1979 ANNUAL REPORT
Georgia Department of Medical Assistance

Expenditures Benefits Administration
Number of claims paid
Enrolled Providers (as of June 30, 1979)
Average number of monthly eligibles
Unduplicated count of recipients served
Average yearly expenditure per recipient

401,531

407,127

$

923

Who Is Eligible
Medical assistance eligibility is automatic for recipients of cash payments under the Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) categorical assistance programs. In addition, reimbursement for medical services is made under the Medical Assistance Only (MAO) program for persons who would be receiving cash payments under the above programs if they were not residing in a long-term care institution or who are related to a categorical assistance household but are not personally receiving a cash payment (e.g., 18-21 year-old dependents in A F D C families). The Georgia Medicaid program also pays the "buy-in" medicare premiums for persons who are eligible for both Medicaid and Medicare (coverage for persons 65 and older and certain disabled persons). For these persons, Medicare is the primary payor for medical services with Medicaid paying for only coinsurance, deductibles and any services covered by Medicaid but not by Medicare.

Covered Services
Inpatient and outpatient hospital services; physician services, skilled nursing home and intermediate care facility services; prescribed drugs; laboratory and radiological services; home health services; family planning services; Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for eligibles under 21; ambulance and non-emergency transportation services; mental health clinic services; and services by certain other practitioners.

COMMISSIONER'S FOREWARD
Charles K. Pierce
I would like to take this opportunity to thank Governor Busbee and the members of the 1979-1980 Georgia General Assembly for their support and assistance in making possible the accomplishments of the past Fiscal Year and to express appreciation t o the thousands of providers of medical assistance throughout Georgia for their role in carrying out the program's objectives.
I assumed the duties of the position of Commissioner of the Department of Medical Assistance in early July 1979. Since that date, I have spent a considerable amount of time reviewing the achievements of the Department during Fiscal Year 1979 and formulating plans, goals and objectives for the Georgia Medical Assistance program in the 1980's.
This annual report was designed t o give the reader a statistical overview of the more significant Departmental activities through a presentation of program parameters and service utilization indicators. I would like to preface these charts with a few comments describing some of the major endeavors of the Department in selected program functions.
During Fiscal Year 1979 the Department continued its focus on containing program costs and refining provider reimbursement without sacrificing either the range of services or quality of care rendered to those Georgians eligible for medical assistance.
Financial field audits of the remaining one-third long-term care nursing facilities which were not audited during Fiscal Year 1978 were conducted during the past Fiscal Year. An additional savings amounting to $2,000,000, in terms of decreased costs t o the Department, were realized through this activity as a result of disallowances. Disallowances arose from non-compliance with standard accounting principles and Departmental policies and guidelines relating t o reasonableness and appropriateness of reported costs.
During the past year, the Alternative Health Services Project completed the third year of a federal grant to evaluate the cost-effectiveness of community-based long-term care alternatives to nursing home care. Through a federal waiver, the Project provided home delivered services, adult day health care, and boarding or foster care to Medicaid recipients who had been certified for nursing home care prior to voluntary placement in alternative services.
Preliminary findings developed during the Fiscal Year indicated that the average monthly cost to the Medicaid program of these alternative services was considerably less than the average monthly cost of nursing home care. Further, there was evidence that the alternative services may be effective in prolonging the lives of some of the most vulnerable of those who qualify for nursing home care. Based on these preliminary findings the Department requested that these services be funded by the State for Federal participation beginning in Fiscal Year 1981, with the services to be phased in across the State over a three (3) year period. The plan included comprehensive screening for appropriateness of alternative services of all applicants for Medicaid reimbursed nursing home care who were t o be admitted from their own homes.
Alternative services will continue to be provided under the project through Fiscal Year 1980. A final evaluation report, which will aid State-wide implementation and make recommendations for national policy, will be completed in Fiscal Year 1981.
The Department's ongoing development of a new inpatient hospital reimbursement methodology continued to receive major funding support from the Health Care Financing Administration. Through implementation of this new approach in 1980, the Department intends to provide both limits on reimbursement to high cost hospitals and financial incentives for efficiently operated facilities. Key components of the new system include: (1) identi-

fication of hospital peer groups as a basis for cost comparison; (2) designation of a reimbursement limit or maximum payment for each group; (3) determination of incentive awards t o lower cost facilities in each group; and (4) specification of allowable cost increases between a base and reimbursement period resulting from economic inflation and other factors beyond a hospital's reasonable control. While completion of the full project methodology is not expected until Spring 1980, significant progress occurred in 1979 on each of the above components.
In the next year, the Department will complete developmental work on the reimbursement methodology and begin implementation for hospital fiscal years beginning July 1, 1980. At the request of the Health Care Financing Administration, the Department will establish new reimbursement rates for both Medicare and Medicaid inpatient hospital services in Georgia. It is expected that 164 hospitals will be affected by the new methodology in mid-1981.
In August 1978, the Department assumed the responsibility for generating and mailing the new Medicaid eligibility cards at substantial savings in State dollars. Previously, the issuance of eligibility cards had been handled by the Department of Human Resources and was reimbursed through an inter-agency agreement with that agency. The transfer of this function to the Medicaid Management Information System (MMIS) increased the federal financial participation rate t o 75 percent.
In Fiscal Year 1980, it is planned to cease issuance of eligibility cards to Medicaid recipients who are in nursing homes during the period of their institutionalization, as the probability of a change in their eligibility status is very slight. This measure will save the Department approximately $4,000 a month since eligibility cards are normally issued on a monthly basis.
During Fiscal Year 1979, the expanded Medicaid Quality Control Review System was implemented. In addition to a validation of the eligibility status of a sample of recipients, this system also now identifies the amounts of claims paid on behalf of ineligible recipients and monitors the efforts to obtain reimbursement from third party payors for eligible recipients.
The Benefits Recovery Unit effort resulted in a return of approximately $5,000,000 t o the Department in Fiscal Year 1979. This money is recovered from accident-related insurance claims, absent or divorced fathers, health insurance companies and any other parties who have liability for medical services rendered to Medicaid eligibles. Also included in this amount are dollars refunded or recouped for overpayments to providers or for claims erroneously paid.
The activity of obtaining reimbursement from third party insurance resources was greatly enhanced during this year by the passage of State legislation which will require the automatic assignment of insurance benefits by the recipient as condition of Medicaid eligibility. When the computerized Third Party Recovery Management System approved at the end of Fiscal Year 1979 is implemented, the Department will have the capability t o quickly access a record of whether or not a recipient is known to have private insurance coverage, t o directly bill identified insurance companies for reimbursement for medical services paid on the behalf of eligibles, t o notify a provider of a receivable due the Department on the weekly remittance advices and to automatically recoup such amounts from subsequent payments to providers after the passage of an allotted period of time for voluntary refund or appeal. These capabilities should significantly increase the total amount of recovery in subsequent years.
In addition, the investigations into suspected cases of provider and recipient fraud and abuse of the. Medicaid program during Fiscal Year 1979 resulted in the identification of almost $300,000 due this Department.

Efforts to continue to improve Departmental relations with providers have proceeded on several fronts.
A pharmacy dispensing fee survey was conducted during the year of 1,242 pharmacies in Georgia. In the survey, data were collected on the costs of pharmacy operation including overhead, professional services and profit. The revised dispensing fees, which were formulated from the survey results and which will be implemented in Fiscal Year 1980,should result in a more equitable reimbursement to providers, as should the development of the physician fee schedule described below.
The endeavor to derive a State-wide physician fee schedule was spawned from the desire to simplify the complex requirements imposed by federal regulations on reimbursement to this provider group. The profile system of reimbursement presently utilized is inadequate in that it inequitably reimburses rural versus urban physicians, long-practicing versus new physicians and the amounts paid for the same service. The new physician fee schedule will result in reimbursement for procedures which will not vary by geographical area, length of time in practice or specialty group.
The Board of Medical Assistance approved the fee schedule in Fiscal Year 1979, and a n amount was included in the Department's 1981 Budget to update the amount of funds available for physician reimbursement.
In October 1978, a Provider Relations Section was established in an effort t o concentrate all provider contacts with the Department within one organizational unit and t o better serve the needs of the providers. This new organizational unit was an integration of the previously existing claims inquiry function and a portion of the professional staff in the Division of Program Management.
Now, a provider can call one telephone number to inquire as to the payment status of a submitted claim and, if a reimbursement problem exists, he can be easily connected t o a professional staff member who will answer his questions and attempt to resolve his problem. These professional staff members interpret the Department's policies to providers, serve as the Department liaison with provider professional societies in responding to problems of particular provider groups and conduct provider training sessions in new policies and claims submittal procedures. This last activity is an attempt to reduce the provider error rate in claims submittal and thus reduce the time required by the Department to process and pay the providers' claims.
During Fiscal Year 1979, forty (40) formal training sessions were conducted with provider groups and eighty-five (85) informal sessions were held with staff members of selected providers. During this same period, response time to provider inquiries was also greatly improved: a six months' backlog was reduced to a seven-day turnaround cycle.
In the claims processing area, the Department continued to reduce the average time required for payment to 13.4 days across all claim types at the end of the Fiscal Year. The Direct Provider Input Program was expanded to allow physicians, as well as hospitals and pharmacies to bill the Department on computer tapes and further reduce the payment time required for these claims. At the end of the Fiscal Year, a total of 620 providers were participating in the tape-to-tape program.
It is my hope that the tables following this section will put the activities described above in perspective for the reader. I look forward to reporting to you next year the progress of the Department in Fiscal Year 1980in further speeding payment to participating providers and in meeting the challenge to eliminate unnecessary program expenditures while at the same time analyzing alternatives for expanding the program to include more needed services to more needy Georgians.

EXPENDITURES

A HISTORY OF MEDICAID BENEFITS EXPENDITURES

Fiscal Year

Benefits Expenditures

Percentage Change

* Projected Expenditures
NOTE: Beginning in 1976, expenditures reflect an accrual-based accounting system as opposed t o a cash basis system utilized in previous years.

Several factors have increased Medicaid expenditures since 1968.An inflation rate of over 120 percent has been responsible for the greatest price increase. At the same time, total Medicaid population has increased, although during FY 79, total recipients decreased. New services have been added and services have expanded and become more accessible.
Some of the increase between FY 78 and FY 79 can be attributed t o the addition of Adult Emergency Dental Services to the program.
MEDICAID BENEFITS EXPENDITURES
Dollars in Millions
68 69 70 71 72 73 74 75 76 77 78 79 Fiscal Year

Federal Funds State Funds

SOURCES OF MEDICAID REVENUE FY 79

TOTAL Revenue

*Actual expenditures

$246,428,978 $129,224,944
$375,653,922"

. WHERE THE MEDICAID DOLLAR COMES F R O M . .
Georgia's Medicaid program receives reimbursement for a portion of its budget based on the activity. Reimbursement level for benefits, family planning, the Medicaid Management Information System (MMIS) and for administration of the program is determined each fiscal year by the federal government.

Benefits

Medicaid Management Information System

FEDERAL FUNDS
Family Planning

Administration

Total

Out of each dollar spent for Medicaid benefits, approximately 4 3 . 3 ~goes for skilled nursing care, intermediate care or intermediate care for the mentally retarded. Hospital providers receive 3 0 . 5 ~of each dollar and the remaining 2 4 . 2g~oes t o providers of other care.
Of the administration dollar, the Division of Program Management utilizes 4 1 a~nd computer services account for over a quarter of the dollar. The cost of administration is a mere 4 . 9 ~of the total Medicaid dollar.
. WHERE THE MEDICAID DOLLAR G O E S . .
f-\ LONGTERM CARE 45.3%

FY 79 BENEFITS $375,653,922

HOSPITALS

- &

FY 79 ADMINISTRATION
$19,224.833
*Includes the Division of Quality

FY 79 TOTAI. EXPENDITURES
$394,878,805

BENEFITS

Institutional care accounted for nearly half of the budget expenditures for Medicaid services and Inpatient and Outpatient Hospital care accounted for another 30 percent. Prescribed drugs account for more than 65% of the total number of claims but only 10%of the total dollars paid.

FY 79 BENEFITS EXPENDITURES*

Category of Service

Amount

Percent of Payments By Service

Skilled Nursing Facilities ICF-MR
ICF-Other Inpatient Hospital
Outpatient Hospital Prescribed Drugs Physicians Dental
Other Care **
Clinic (Mental Health) Family Planning
Other Practitioners ***
Home Health Laboratory/ Radiology

TOTAL BENEFITS ADMINISTRATIVE COSTS
TOTAL COSTS

$375,653,922 $ 19,224,883
$394,878,805

* Expenditures reflect an accrual-based accounting system as opposed to a cash-basis
system utilized in previous years.
** Other Care includes: Durable Medical Equipment, Prosthetics/ Orthotics, Ambulance
and Non-Emergency Transportation.
*** Other Practitioners includes: Optometrists, Podiatrists, Chiropractors and Psychia-
trists.

ADMINISTRATIVE BUDGET FY 79

Division
Program Management DOAS Computer Services Operations Administration Commissioner's Office
(includes the Division of Quality Assurance) Investigation and Compliance
TOTAL

Budget

Percent of Total

$19,224,883

100.0%

The typical Medicaid recipient is a n AFDC adult or child. Females out-number males by more than two to one, and more than one-third of the recipients are white and the remaining 61 percent are of other races. Two age groups are heavily represented in the recipient population-ages 65 and over and ages 21 t o 64.
PAYMENTS BY AID CATEGORY, SEX, RACE, AGE GROUP
BY AID CATEGORY
BY SEX
BY RACE
BY AGE GROUP

GEORGIA COUNTIES BY MEDICAID DOLLARS PAID FOR RESIDENTS FISCAL YEAR 1979
Dollar Amounts for Residents in FY 79 Over $4,000,000

0Less than $1,000,000

County
Fulton Richmond DeKalb Bibb Chatham Muscogee Cobb Baldwin Dougherty Lowndes Floyd Clayton Clarke Houston

Counties Receiving Over $4,000,000

Amount

During the past year, recipients received more than $375,000,000 in services. Approximately 8.2% of the population in Georgia was Medicaid eligible. This is a decrease in eligible population from Fiscal Year 1978 of 1.3%. The increasing cost of health care drove the cost per recipient up from $726.86 in Fiscal Year 1978 to $922.69 in Fiscal Year 1979.

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1979

County

Total Benefits
Paid

Population*

(Unduplicated)

% Population County Receiving Recipients/ Medicaid Total Recipients

Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahooc Chattooga
Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Deca t ur DeKalb Dodge Dooly Dougherty Douglas

ANALYSIS OF RECIPIENTS A N D EXPENDITURES BY COUNTY FOR FISCAL YEAR 1979

County

Total Benefits
Paid

Population*

(Unduplicated)

% Population County Receiving Recipients/ Medicaid Total Recipients

Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson .Jones La mar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1979

County

-- -
Total Benefits
Paid

-

-

Population*

(Unduplicated)

% Population County Receiving Recipients1 Medicaid Total Recipients

McDuffie Mclntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs

ANALYSIS OF RECIPIENTS A N D EXPENDITURES BY COUNTY FOR FISCAL YEAR 1979

County

Total Benefits
Paid

Population*

(Unduplicated)

% Population County Receiving Recipients1 Medicaid Total Recipients

Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth STATEWIDE
* U.S. Census 1976 Provisional Estimate

ELIGIBLES, RECIPIENTS AND SERVICES

MONTHY AVERAGE ELIGIBLES FOR ALL AID CATEGORIES

July August September October November December January February March April May June
Monthly Average

45 1,664

- -- - - -- - -- --

-

424,292

401,531

Eligibles decreased significantly in Fiscal Year 1979 in comparison to the two previous years which can be attributed to a n improved economy. Utilization of services during the same period also decreased. The data here is not unduplicated from month t o month and therefore total unduplicated recipients exceeds the average eligibles. The aid category which exhibits the most change in times of economic problems is the A F D C category. All other aid categories appear to be stable.

AFDC SSI MA0
TOTAL

MONTHLY

AVERAGE

ELIGIBLES April 1978

-BJYunAeI D197C9ATEGORY

BY

QUARTER

4th Quarter FY 78

1st Quarter FY 79

2nd Quarter FY 79

3rd Quarter FY 79

4th Quarter FY 79

214,144 162,085 35,9 14

412,143

406,524

404;4 1 1

399,77 1

395,4 18

--
Type of Medical Services

TYPES OF SERVICES USED BY RECIPIENT GROUP AND TYPE OF SERVICE FY 79

-
Age 65 or Over

Blind

Disabled AFDC Adults AFDC Children

Skilled Nursing Homes Intermediate Care Intermediate Care for
the Mentally Retarded Inpatient Hospital Outpatient Hospital Physician Prescribed Drugs Dental Other Practitioners*
w Clinic (Mental Health) Family Planning Home Health Laboratory/ Radiology Other Care**

--
Totals

*Other Practitioners includes: Optometrists, Chiropractors and Psychiatrists.
**Other Care includes: Durable Medical Equipment, Prosthetics/ Orthotics, Ambulance and Non-Emergency Transportation.
***Recipient counts are unduplicated within each category or service, but a single recipient may have received more than one type of service during the fiscal year.

AVERAGE MONTHLY PAYMENTS PER RECIPIENT BY BASIS OF ELIGIBILITY FY 79
Expenditures for the elderly (age 65 and over) and the permanently and totally disabled accounted for over 75 percent of the total spent for medical services in fiscal year 79. A comparison of eligibles to dollars spent in each program is shown in the chart below:

Basis of Eligibility

Expenditures

Percentage of Total

Recipients

Percentage of Total

Average Paid Per Recipient

Elderly (age 65 and over) Blind Disabled AFDC Children AFDC Adults

$144,909,4 18 2,574,225
146,259,514 37,893,820 44,O 16,945

38.6% .7%
38.9% 10.1% 11.7%

101,035 2,509 85,068
149,832 68,683

24.8% .6%
20.9% 36.8% 16.9%

TOTAL

$375,653,922

100.0%

407,127

100.0%

923

Medicaid services are used most frequently by AFDC children and adults. The aged recipient is the second most frequent user of services followed by the disabled and blind. Prescribed drugs are used by more than 75% of the recipients followed by Physician services which are used by 69% of the recipients. Inpatient hospital users account for 21% of the recipients. Only 9% of the recipients are in nursing homes but this account for 45% of all Medicaid costs. Inpatient hospital dollars paid are about 25% of the total Medicaid bill.

Type of Medical Service
Skilled Nursing Homes Intermediate Care Intermediate Care for the Mentally Retarded Inpatient Hospital Outpatient Hospitai Physician Prescribed Drugs Dental Other Practitioners* h, Clinic (Mental Health) Family Planning Home Health Laboratory/ Radiology
Other Care **
TOTAL PAYMENTS***

BENEFITS PAID BY RECIPIENT GROUP AND TYPE OF SERVICE
FY 79
BASIS OF ELIGIBILITY

Age 65 or Over Blindness

Disability AFDC Adults AFDC Children Total Payments

$144,909,4 18 $2,574,225 $146,259,514 $44,0 16,945 $37,893,820 $375,653,922

*Other Practitioners includes: Optometrists, Podiatrists, Chiropractors, and Psychiatrists.
**Other Care includes: Durable Medical Equipment, Orthotics/ Prosthesis, Ambulance and Non-Emergency Transportation.
***Total Payments d o not reflect the "buy-in" payments (Medicare premiums) paid for those persons eligible for both Medicare and Medicaid. "Buy-In" amounted to $12,732,789 in FY 79.

COSTS OF SERVICES PER RECIPIENT FY 79

Type of Service

Average Cost Per Recipient for FY 79

Nursing Homes ICF-MR ICF-Other SNF
Inpatient Hospital Home Health Clinic (Mental Health) Physicians Dental Drugs Other Care* Outpatient Hospital Family Planning Other Practitioners** Laboratory/ Radiology

Average Cost Per Recipient for All Services

*Other Care includes: Durable Medical Equipment, Prosthetics/ Orthotics, Ambulance and Non-emergency Transportation.
**Other Practitioners includes: Optometrists, Podiatrists, Chiropractors and Psychiatrists.

Cost per recipient by county ranged from a low of $28 1.84in Webster County to a high of $2,208.14 in Baldwin County. Specialized facilities are frequently the cause of a high cost per recipient, such as skilled, intermediate care or intermediate care facilities for the mentally retarded. Those counties not having many available health care providers tend to have lower costs per recipients.

County
Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas

COST PER RECIPIENT BY COUNTY OF RESIDENCE
FY 79

Total Cost

Number of Recipients Cost Per Recipient

County
Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon 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

COST PER RECIPIENT BY COUNTY OF RESIDENCE
FY 79

Total Cost

Number of Recipients Cost Per Recipient

County
McDuffie Mclntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union

COST PER RECIPIENT BY COUNTY OF RESIDENCE
FY 79

Total Cost

Number of Recipients Cost Per Recipient

COST PER RECIPIENT BY COUNTY OF RESIDENCE
FY 79

County

Total Cost

Number of Recipients Cost Per Recipient

Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

TOTAL

$375,653,922

407,127*

$ 922.27

*Recipients are unduplicated within each county, but a single recipient may have received medical services in more than one county. The number of recipients served when cross-county duplications are controlled is 407,127.

PROVIDERS

ENROLLED PROVIDERS BY TYPE OF SERVICE* June 30, 1979

Type of Service

Number of Providers

Hospital Nursing Home Pharmacy Ambulance Home Health Independent Laboratory and X-ray Durable Medical Equipment Supplier (DME) Prosthetics/ Orthotics Optical Supplier Mental Health Clinic Health District Family Planning Center County Departments of Family and Children Services (DFACS) Physician Dentist Optometrist Podiatrist Psychologist Chiropractor**

TOTAL

"Includes Medicaid and Medicare providers. **Enrolled in Medicare only.

The number of providers has increased since FY 78, particularly in the physician category. A continuous effort is made by the Providers Relations section to encourage enrollment in the Medicaid program. There continues to be a very uneven distribution of specialist physicians throughout the State, but most Georgia counties have a good to excellent availability of primary care physicians. Note that the number of enrolled physicians during June, 1979 included out-of-state providers and Medicare providers as well a s in-state providers indicated on the maps.

ENROLLED PRIMARY CARE PHYSICIANS BY COUNTY* FY 79 (March)
TOTAL 2,272 *Primary Care denotes: family practice, general practice, internal medicine, obstetrics/gynecology, pediatrics or general surgery.

ENROLLED SPECIALIST PHYSICIANS BY COUNTY FY 79 (March)
TOTAL 1,713

DEPARTMENT OF MEDICAL ASSISTANCE ADVISORY COMMITTEE
A Medical Assistance Advisory Committee was created to give technical advice to the Department and to provide liaison between the Department and each provider community. Sub-committees of this group, representing ten medical professional groups, are appointed by the Commissioner and meet a t the discretion of their respective chairmen. An important function of these sub-committees is t o delineate the effects of proposed policy changes and relay the concerns of their associates to the Department. The sub-committees and their members are as follows:
1. Ambulance Sub-committee Charles B. Gillespie, M.D., Chairman Albany, Georgia Don Sirmans Lakeland, Georgia Doug Waters Jefferson, Georgia
11. Dentists' Sub-committee Dr. B. A. Blackburn, 11, D.D.S., Chairman Atlanta, 'Georgia DeWitt Walton, D.D.S. Macon, Georgia A. J. Webster ,D.D.S. Rome, Georgia Mike Kennedy, D.D.S. Columbus, Georgia
111. Durable Medical Equipment, Orthotics, & Prosthetics Sub-committee A. M. Hancock, Chairman Atlanta, Georgia H. G. Bowden Warm Springs, Georgia Dean Cox Cartersville, Georgia Grant Rice Atlanta, Georgia
IV. Home Health Sub-committee Ms. Hester Fortson, Chairwoman Athens, Georgia Ms. Loretta Roberts Atlanta, Georgia Ms. Aleise Sockell Atlanta, Georgia Ms. Diane Pepper Macon, Georgia

V. Hospital Sub-committee Thomas J. Barbee, Chairman Dalton, Georgia Ewing S. Barnett Newnan, Georgia Charles L. Foster, Jr. LaGrange, Georgia
Charles R. Gaston Macon, Georgia
Charles H. Wilson, Jr. Atlanta, Georgia
VI. Optometric Sub-committee Robert H. Thurmond, 0 .D. East Point, Georgia Joe H. Dew, O.D. Dalton, Georgia Allan V. Wexler, O.D. Savannah, Georgia Lovick H. Williamson, 0.D. Quitman, Georgia
V11. Pharmacy Sub-committee Larry J. Parrish, R. Ph., Chairman Swainsboro, Georgia Wallace G. Whiten, R. Ph. Toccoa, Georgia 1. Peter Mills, Jr., R. Ph. Millen, Georgia William R. Thomas, R. Ph. Thomasville, Georgia Oren H. Harden, Jr., R. Ph. Sylvester, Georgia
V111. Physicians' Sub-Committee David A. Wells, M.D., Chairman Dalton, Georgia W. Carl Gordon, M.D. Albany, Georgia Wesley S. Wilborn, M. D. Atlanta, Georgia Frank T. Robbins, M.D. Hinesville, Georgia Garnett A. Fisher, D.O. Norcross, Georgia
1X. Psychologists' Sub-committee W. .I. Clark, Ph. D. Atlanta, Georgia George Anderson, Ph. D. Dublin, Georgia Fred Huff, Ph. D. Smyrna, Georgia

X. Nursing Home Sub-committee Eugene M. Bishop, Chairman Roswell, Georgia Tom F. Satterfield Atlanta, Georgia Ed L. Stephens Cleveland, Georgia Myrtle Vickers Douglas, Georgia James R. Westbury Jenkinsburg, Georgia

Locations