%lopb 31~terane3fl~morinlPuilbing - P e e f &olaer
2 P b r t i n Tnther Eing, yr. Bribe, L$p
October 1, 1982
The Honorable George Rusbee, Governor Members of the General Assembly of Georgia State of Georgia Atlanta, Georgia 30334
Ladies and Gentlemen:
As directed by the Board of Medical Assistance, I am submitting for your review the Annual Statistical Report of the Georgia Department of Medical Assistance summarizing agency activity through the fiscal year ending June 30, 1982. This report provides a diverse range of data concerning recipients, services, providers and costs of the Georgia Medicaid program.
In addition, a summary is included of endeavors of the Department in its fifth year as an independent agency in the areas of program cost containment and provider relations.
We wish to acknowledge the essential role of the Department of Human Resources, the various health professions in the State and all other associated agencies in State Government in bringing medical assistance to approximately one-half million Georgians during the past year.
Respectfully submitted,
Charles K. Pierce Commissioner

BOARD OF MEDICAL ASSISTANCE
As of June 30,1982

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. G. W. Hogan, Chairman Atlanta, 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, 1985 Through June 30, 1983 Through June 30, 1984 Through June 30, 1982 Through June 30, 1984

TABLE OF CONTENTS
Program Abstract ............................................................. 1 Commissioner's Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Expenditures ................................................................. 7
A Decade of Medicaid Benefits Expenditures FY 82 Medicaid Benefits Expenditures Sources of Medicaid Benefits Revenue (Federal/ State Breakdown) Where the Medicaid Dollar Comes From (Federal/ State Breakdown) Where the Medicaid Dollar Goes (% Benefits/ Administration) Benefits Expenditures Administrative Budget Collections Benefits Payments by Aid Category, Sex, Race and Age Group Services Paid by Aid Category, Sex, Race and Age Group Georgia Counties by Medicaid Dollars Paid for Recipients Analysis of Recipients & Expenditures by Recipient County of Residence
Eligibles, Recipients, Services, Claims and Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Monthly Average Eligibles for All Aid Categories Types of Services Used by Recipient Group and Service Category Average Yearly Payments per Recipient by Basis of Eligibility Claims Processed by Category of Service Medicaid Recipients Utilizing Services by Percentage Benefits Paid by Recipient Group and Type of Service Cost of Services per Recipient Total Number of Physicians' Visits by Location Enrolled Providers by Type of Service Glossary of Terms
Department of Medical Assistance Advisory Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

ABSTRACT OF FISCAL YEAR 1982 ANNUAL REPORT
Georgia Department of Medical Assistance
Expenditures Benefits Administration
Number of Medicaid claims paid Enrolled Providers (as.of June 30, 1982) Average number of monthly eligibles Unduplicated count of recipients served annually Average yearly expenditure per recipient
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. After November, 1, 1981, persons who are related to a categorical assistance household but are not personally receiving a cash payment (e.g., 18-21 year-old dependents in AFDC families)were no longer eligible for Medicaid. The Georgia Medicaid program pays the "buy-in" Medicare premiums for persons who are eligible for both Medicaid and Medicare (coveragefor 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 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; rural health clinic services; dental services; and services by certain other practitioners.

COMMISSIONERS FOREWORD
Charles K. Pierce
I would like to take this opportunity to thank Governor George Busbee and the Georgia General Assembly for their continued support during the past fiscal year and to recognize the cooperation of thousands of providers throughout the state in the delivery of health services to Georgians in need of medical assistance.
During State Fiscal Year 1982(July I , 1981 to June 30,1982), more than $542 million was paid by the Department for medical care for 435,866 recipients.
The Department has continued to make progress toward its goal of administration of a quality and cost-effective medical assistance program. The cost of program administration remained low -approximately 4.4% of the total Medicaid budget.
Throughout the Department, each division has attempted to make a contribution to a more effective Medicaid program administration. Below are some of the past year's accomplishments.
OPERATIONS
The Direct Provider Input Program has continued to exhibit a strong growth and acceptance. Through this program pharmacy, physician, hospital and laboratory providers may submit claims on magnetic tape or computer diskette instead of on paper. The number of providers now using this method has increased nearly 30% over the previous year to a total of 1,496.
A new automated drug pricing system was implemented to update drug prices and improve payment of drug claims. This has significantly reduced the payment errors and increased the efficiency of publishing the drug formulary.
The capability to directdial the recipient eligibility file has been developed and tested. This service is now available t o hospitals which have the necessary computer terminals and desire t o obtain eligibility information on recipients.
SPECIAL SERVICES
Legal Services
In addition to representing the Department at all provider hearings and providing sound legal advice, a number of changes were implemented by the Legal Services Office. All law-related activities by the Department involved in provider hearings were closely coordinated with the activities of the Attorney General's office in light of the litigation which has ensued concerning cost containment and the budget constraints of the new federalism.
An automated procedure for processing hearing requests was implemented in conjunction with the new manual provisions which were written last year and which took effect in January, 1982.
Of the 34 hearing requests received by the Department during FY 82, the legal staff obtained eight withdrawals and negotiated settlements in six cases, resulting in a significant savings in Hearing Officer and court reporter fees compared to projected expenditures. In addition, the first year's activity in hearings for benefits recovery action was concluded with decisions in favor of the Department in all cases.
BENEFITS RECOVERY
Total funds recovered this year by the Office of Benefits Recovery was more than $21 million, an increase of $9 million over the previous year. Increases occurred in every major category of

recovery as a result of an increased staff and broadening knowledge of the methods of maximizing recoveries.
In FY 83,the Office of Benefits Recovery plans to conduct field reviews and training sessions to teach provider staffs methods of maximizing all third party resources for Medicaid recipients. This will ultimately result in a reduction of Medicaid benefits expenditures and an increase in benefits recoveries.
ADMINISTRATION
Budget
The Department's fiscal year 1982 budget was initially $67 million below estimated expenditures. With the assistance of providers, the legislature, and the Governor's Office, that shortfall was erased and the budget obligation was met. It appears that future funding difficulties, though expected, will not be of this magnitude.
Nursing Home Reimbursement
During FY 82, audit activity was increased so that approximately 38% of all facilities were onsite audited. The Department of Audits nursing home staff audited 25% of nursing home costs reports and contracted auditors completed another 13%.This increased audit activity will result in a significant savings to the program when new nursing home rates are set.
The effect of the November 1981 cost containment effort was a reduction in the average rate by 6.2%. In addition, the usual January rate adjustment was not implemented. However, on April 1, 1982, nursing home rates were restored to the higher pre-November levels.
Hospital Reimbursement
During FY 82, the Alternative Hospital Reimbursement System continued operation under a waiver from the Department of Health and Human Services.This system limits the increased cost of inpatient hospital care through peer group cost comparison and inflation controls.
INVESTIGATION AND COMPLIANCE
The Department's investigative efforts, both through direct discovery and resulting deterrent effects, resulted in the identification of $1,355,891 in overpayments owed to the Department of Medical Assistance in FY 82. In addition, $5,348 was identified as money to be refunded to recipientsand another $8,180 identified as finesand penalties. Seventeencases of abuse and 39 cases of fraud were initiated.Another 132Provider Integrity Reviews and 41 Recipient Integrity Reviews were performed and 23 contract violations were investigated.
PROGRAM MANAGEMENT
The Division of Program Management has the responsibility for policy development, reimbursement policy, cost containment, provider training and utilization control for 21 program areas. All policies are developed, interpreted and implemented based on federal regulations, state laws and Board of Medical Assistance rules.
Reimbursement Policy Changes
In order to slow the increase in Medicaid expenditures during FY 82, the Division developed program edits, provider notifications, policy revisions and monitored program operations. The goal was to reduce anticipated accrued expenditures by $67 million. The following policies were implemented to contain costs beginning November 1, 1981.
1. Physician Services - Recipients are limited to 12 physician office visits per year, 12

physician visits per year in a nursing home and two physician office visits per year for family planning services.
2. Hospital Services - Recipients are limited to 20 inpatient hospital days per year. No reimbursement is made for the day of admission if it is on a Friday, Saturday or the day before a holiday except for emergencies or when surgery is scheduled for the next day.
3. Pharmacy Services -The number of prescriptions is limited (including refills) to six per month per recipient. All new drugs on the market are evaluated before they can be considered for addition to the formulary. A Georgia maximum allowable cost was established for highly utilized generic products and co-payments for drugs are now based on the price of the prescription. The dispensing fee was lowered to $2.93.
4. Psychological Services - Recipients must be referred by a physician or social service agency. Providers are reimbursed for only five hours of psychological therapy and/ or evaluation and testing per recipient per calendar year.
5. Podiatry Services -Recipientsare limited to twelve officevisits per year and only one visit the day before an operation is performed. Reimbursement for nail debridement (removal of dead or damaged tissue) is permitted only if the patient is diabetic or has peripheral vascular disease.
6. Adult Dental Services -A sliding scale of co-payments was implemented based on the cost of services rendered.
7. Youth Dental Services - Reimbursement for initial and periodic examinations are eliminated as is management time for difficult children and the procedure for hospital time. No reimbursement is made for appliances to control harmful habits. Providers are reimbursed at the 40th percentile of the amount billed based on calendar year 79 data.
8. Non-Emergency Transportation - Changes were made to reimburse non-emergency ambulance transportation at a base rate of $30 plus 70c per mile. Volunteers receive additional reimbursement when transporting multiple passengers. Prior approval for taxi transportation is required except for specified diagnoses, physical or mental conditions.
9. Home Health - Visits are limited to 100 per calendar year. After the first 24 speech or physical therapy visits, additional visits must have prior approval.
10. Nursing Homes - Growth allowance was decreased to 4.5% and the calendar yearend rate adjustment was eliminated.
Additional state funding permitted some increased program benefits in the hospital, pharmacy, nursing home and youth dental services in April and May 1982. In pharmacy and physician services, exceptions to policy allow for life-sustaining circumstances.
Utilization Control and Provider Relations
During FY 82, the Surveillance and Utilization Review Unit (SURS) became active in identifying patterns of inappropriate care and misutilization of services. Automated exception reports and referrals from Department staff precipitated detailed desk and field audits of Medicaid providers resulting in identification of $381,371 in overpayments made by the Department.
The use of prior approval and prepayment review resulted in savings of $5,949,492 in FY 82. The 100,640reviews performed this year also resulted in savings that cannot be measured due to the deterrent effect. The savings does not include claims which are rejected by the system because no prior approval was obtained or any savings involved in the revision of dental treatment plans.
In the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT), 65,770 individuals were screened during FY 82. Of the total of 100 physician providers enrolled in the EPSDT program, 29 new participants and staff members were trained during the fiscalyear. Local

health departments continue to provide the majority of screens.
Continuous Ambulatory Peritoneal Dialysis (CAPD) became a covered service in November, 1981. This less expensive type of dialysis will reduce hospital outpatient program expenses for recipients with end-stage renal (kidney) disease.
During FY 82, a study of the Non-Emergency Transportation Program resulted in requiring prior approval for taxi rides and an increase in the rate paid to volunteer drivers. Seventeen training sessions were held for 638 participants. Approximately 40 new providers were enrolled in the program. Improved data collection methods, cost containment efforts and desk reviews saved approximately $450,000 in expected expenditures.
A number of changes in the physician program area resulted in a total of $441,634 in measurable savings. A physician consultant working with the medical staff reviewed claims for multiple surgeries during the last five months of FY 82 for savings of $191,000 of that amount. A podiatry consultant's review resulted in savings of another $218,000 of the total. Staff review of claims resulted in another $31,000 in refunds through SURS or Benefits Recovery sections.
Increasing physician participation and enrollment was a major goal of this division. Physician enrollment increased more than 18% in FY 82.
Beginning January 1, 1982,prepayment review of inpatient hospital claims was implemented. This review permits detailed examination of the hospital's itemized bill and claim for payment. Reduction of the claim prior to payment eliminates the administrative cost of recoupment after erroneous payment has been made.
The Alternative Health Services Program (AHS), which provides alternatives to nursing home care, expanded to include eight additional Area Agency on Aging (AAA) districts of the state. The seven county metropolitan Atlanta area and ten counties surrounding Athens already have program services available. The new areas include Coosa Valley, Coastal Georgia, Central Savannah River, Altamaha, Lower Chattahoochee, Middle Georgia, North Georgia and Southeast Georgia. Statewide implementation is expected to be complete by FY 84.
Redesign of the recipients' monthly eligibilitycertification card in November, 1981,enabled the Department to notify providers if recipients had exceeded program limitations.
The telecommunications network (TELNET) was used to conduct provider training of hospital billing office staff at minimal administrative cost. In addition, sixty-four provider training workshops were held throughout the state to assist new and current providers and their staff with policy interpretation. The training of over 1,100 providers resulted in the reduction of provider billing errors and in savings to the Medicaid program.
During FY83, residents of Intermediate Care Facilities for the Mentally Retarded (ICF-MR) will be permitted to receive $40 of their earnings for personal needs provided this money is earned in fulfillment of contracts obtained by ICF-MR facilities. The work programs, which must be approved by the Department, will not sustain eligibility penalties for the resident for a two-year period.
It is hoped this annual report will add depth to the accomplishments of the Department during Fiscal Year 82 as depicted on the charts which follow.

EXPENDITURES

Fiscal Year

A DECADE OF MEDICAID BENEFITS EXPENDITURES

Cash Benefits Payments*

Percentage Change
-
33% -3% 45% 1% 18% 8% 9% 16% 19% 4%

Payments By Date of Service*
$

Percentage Change

308,9 12,584

-

347,256,588

12%

390,OO 1,680

12%

457,860,989

17%

554,023,859

21%

603,925,762 (est.)

9%

*Beginningin 1976,expenditures were on an accrual-based accounting systemas opposed to a cash basis system utilized in previous years. A StateAttorney General's ruling held that payments must be made from the budget for the same year in which the Medicaid service was rendered. For this reason, final expenditure amounts are not known until some time after a fiscal year has ended. "Cash benefits payments" are those paid during each fiscal year. "Payments by date of service" reflect expenditures for services provided during each fiscal year. Date of service figures are expenditures as of June 30,1982 for FY 77-FY 8I; FY 82 is an estimate. With the exception of the above table, "expenditures," "benefits" or "payments" given in this Annual Report are "cash benefits payments." Total expenditures for services rendered during each fiscal year will usually exceed payments.

MEDICAID BENEFITS EXPENDITURES
Dollars in Millions
72 73 74 75 76 77 78 79 80 81 82 Fiscal Year

SOURCES OF MEDICAID BENEFITS REVENUE FY 82
Federal Funds
State Funds

TOTAL Revenue

*Cash Payments

. 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

STATE FUNDS

FEDERAL FUNDS
Family Planning Benefits

FEDERAL FUNDS
Administration

MAO-Buy In (See Page 33)
STATE

Total

Out of each dollar spent for Medicaid benefits, approximately 4 1 . 9 ~goes for skilled nursing care, intermediate care or intermediate care for the mentally retarded. Hospital providers receive 3 2 . 2 ~of each dollar and the remaining 2 5 . 9 ~goes to providers of other care.
Of the administrative dollar, the Department of Human Resources utilizes 2 5 . 9 ~and computer services account for over 3 0 o~f the dollar. The cost of administration is 4 . 4 ~of the total Medicaid dollar.
. WHERE THE MEDICAID DOLLAR G O E S . .
BENEFITS
ADMINISTRATION
FY 82 Total Expenditure

FY 82 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 Rural Health Clinics EPSDT

TOTAL BENEFITS ADMINISTRATIVE COSTS
TOTAL COSTS

$542,306,6 12 $ 25,040,144
$567,346,756

*Other Care includes: Durable Medical Equipment, Prosthetics/Orthotics, Ambulance and Non-Emergency Transportation and Alternative Health Services. **Other Practitioners includes: Optometrists, Podiatrists, Chiropractors and Psychologists. ***Less than .1%

ADMINISTRATIVE BUDGET FY 82

Administrative Function
DOAS Computer Services Department of Human Resources
Interagency Contract Operations Administration Program Management Georgia Medical Care
Foundation Contract Commissioner's Office Special Services Investigation and Compliance Quality Control Benefits Recovery
TOTAL

Budget

Percent of Total

$25,040,144

100.0%

COLLECTIONS
Efforts are made to collect money erroneously paid for Medicaid services in a number of areas. Each fiscal year, nursing home audits disallow some of the costs billed to Medicaid and these adjustments decrease total dollars paid to nursing homes.
The Office of Investigationand Compliance recoups funds paid to providers for claims in cases of fraud or abuse. In some cases, when a recipient has received Medicaid services fraudulently, the recipient is required to make restitution to the Department. A third party recovery effort attempts to collect payments in cases where a recipient has private insurance and where overpaymentswere made to providers.

Nursing Home Audit Disallowances
Investigation & Compliance Recipient & Provider Recoupments
Third Party Liability Insurance Recoupments Overpayments/Erroneous Payments Hospital Cost Settlement

285,386
6,108,951 1,209,424

TOTAL

$1 1,374,126

* Estimated ** Begun in FY 81, reflects four years collections.

77,06 1
6,825,105 1,973,805 3,292,169**
$16,135,540

1,355,891
7,227,456 4,117,121 9,863,474
$29,063,942*

PAYMENTS BY AID CATEGORY, SEX, RACE, AGE GROUP
BY AID CATEGORY BY SEX BY RACE BY AGE GROUP

RECIPIENTS BY AID CATEGORY, SEX, RACE, AGE GROUP
BY AID CATEGORY BY SEX BY RACE BY AGE GROUP

GEORGIA COUNTIES BY MEDICAID DOLLARS PAID FOR RECIPIENTS FISCAL YEAR 1982

Counties Receiving Over $5,000,000

County
Fulton Richmond DeKalb Chatham Bibb Muscogee Cobb Dougherty Floyd Lowndes Clayton Hall W hitfield Douglas Clarke Baldwin Ware Carroll Troup

Amount

During the past year recipients received more than $542,000,000 in Medicaid services. These 19 counties accounted for more than half of the dollars paid to recipients.

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1982

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

Total Benefits
Paid

Population*

$ 1,824,202 981,718
1,415,109 333,690
5,719,120 417,221
2,250,952 2,337,254 3,115,559 1,840,844 16,143,113 2,180,694
646,965 3,941,149
648,606 3,5 17,678 3,20 1,062 1,994,032 1,069,235 1,157,177 2,080,838 5,404,347 1,983,771
928,658 18,389,331
143,725 1,703,691 2,336,728 5,824,7 16
7 15,405 6,647,163 1,222,200 10,792,708 3,570,520 3,63 1,479 1,458,106 1,603,014 2,9 16,975
848,493 3,24 1,282
709,02 1 406,739

15,500 6,100
9,400 3,800 34,700 8,700 2 1,300 40,700 16,000 13,500 150,200 10,800 8,700 15,200 10,100 35,700 19,300 13,600 5,700 13.300 7,500 56,300 37,000 7,300 202,200 21,700 2 1,900 5 1.700 74,500 3,500 150,400
6,600 297,700 26,800 35,400 40,100
13,400 39,300
7,600 19,500 12,300 4,700

Recipients (Unduplicated)

% Population Receiving Medicaid

Recipients1 Total
Recipients

County Cost Per Recipient

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1982

County
Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones

Total Benefits
Paid

Population*

Recipients (Unduplicated)

% Population Receiving Medicaid

Recipients/ Total
Recipients

County Cost Per Recipient

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1982

County
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 Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding

Total Benefits
Paid

Population*

Recipients (Unduplicated)

% Population Receiving Medicaid

Recipients/ Total
Recipients

County Cost Per Recipient

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1982

County

Total Benefits
Paid

Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Truetlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth STATEWIDE
*U.S. Census - 1980 Final

Population*

Recipients (Unduplicated)

% Population Receiving Medicaid

Recipients1 Total
Recipients

County Cost Per Recipient

ELIGIBLES, RECIPIENTS, SERVICES, CLAIMS AND PROVIDERS

MONTHLY AVERAGE ELIGIBLES FOR ALL AID CATEGORIES
July August September October November December January February March April May June
Monthly Average

TYPES OF SERVICES USED BY RECIPIENT GROUP AND TYPE OF SERVICE
RECIPIENTS RECEIVING MAINTENANCE ASSISTANCE AND M A 0 (MEDICAL ASSISTANCE ONLY) FY 82

Type of Medical Services
Skilled Nursing Homes Intermediate Care-Other Intermediate Care for the
Mentally Retarded Inpatient Hospital Outpatient Hospital Physician Prescribed Drugs Dental Other Practitioners* Clinic (Mental Health) Family Planning Home Health Laboratory/ Radiology Early & Periodic Screening,
Diagnosis & Treatment Rural Health Clinic Other Care**

Age 65 or Over

Blind

Disabled

Unduplicated

AFDC Adults AFDC Children

Totals

*Other Practitioners includes: Optometrists, Chiropractors and Psychologists. **Other Care includes: Durable Medical Equipment, Prosthetics/ Orthotics, Ambulance, Non-Emergency Transportation and Alterna-
tive Health Services. ***Recipientsare counted no more than once in each category of service in which service was provided. Recipientsare also counted in each
aid category in which they were eligible during the year. This is particularly noticeable in the nursing home category where recipients are counted twice when they become M A 0 (Medical Assistance Only) after having received Maintenance Assistance.

AVERAGE YEARLY PAYMENTS PER RECIPIENT BY BASIS OF ELIGIBILITY FY 82
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 FY 82. These aid categories receive more nursing home, inpatient hospital and pharmacy services than any other recipient group. The largest group of users is AFDC children & adults. The aged recipient ,is the second largest group followed by the disabled &the blind. A comparison of recipients to dollarsspent 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

$187,059,451 4,573,947
220,662,052 56,830,151 73,181,012

34.5% .8%
40.7% 10.5% 13.5%

100,119 2,922
94,101 182,774 86,997

h,

TOTAL

0\

$542,306,612

100.0%

435,866*

100.0%

$1,244.2 1

*Unduplicated Count

CLAIMS PROCESSED BY CATEGORY OF SERVICE FY 82

Category of Service
Prescribed Drugs Physician Outpatient Hospital Nursing Homes Inpatient Hospital Other
TOTAL

Number of Claims Processed 9,543,866

Percent 100.0%

"Nursing home claims are usually one claim per recipient per calendar month.

Prescribed drugs are used by more than 759t:of the recipients followed by physician services which are used by 74% of the recipients. Inpatient hospital users account for 2 1% of the recipients. Only 9$i of the recipients are in nursing homes but this accounts for 42% of all Medicaid costs. Inpatient hospital dollars are about 289; ';of the total Medicaid bill.

MEDICAID RECIPIENTS UTILIZING SERVICES BY PERCENTAGE FY 82

Total Recipients

435,866

100.0%

Prescribed Drugs Physicians Outpatient Hospital Inpatient Hospital Dental EPSDT Other Care* Other Practitioners** Family Planning Laboratory and X-Ray ICF Mental Health Clinic SNF Home Health ICF-M R Rural Health

*Other Care includes: Durable Medical Equipment, Orthotics/Prosthetics, Ambulance, Non-Emergency Transportation and Alternative Health Services. **Other Practitioners includes: Optometrists, Podiatrists, Chiropractors and Psychologists.

BENEFITS PAID BY RECIPIENT GROUP AND TYPE OF SERVICE
FY 82 BASIS OF ELIGIBILITY

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

Age 65 or Over Blindness Disability AFDC Adults AFDC Children TotalPayments

$187,059,45 1

$4,573,947 $220,662,052 $73,181O, 12 $56,830,151 $542,306,612

*Other Practitioners includes: Optometrists, Podiatrists, Chiropractors, and Psychologists. **Other Care includes: Durable Medicaid Equipment, Orthotics/ Prosthetics, Ambulance, Non-Emergency Transportation and Alterna-
tive Health Services. ***Total Payments do not reflect the "buy-in" payments (Medicare premiums) paid for those persons eligible for both Medicare and
Medicaid. "Buy-In" amounted to: $16,523,755 in FY 82.

COSTS OF SERVICES PER RECIPIENT FOR FISCAL YEAR 1982

Type of Service
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 Rural Health Clinic Early & Periodic Screening,
Diagnosis & Treatment
Average Cost Per Recipient for All Services

Average Cost Per Recipient for FY 81

*Other Care includes: Durable Medical Equipment, Prosthetics/Orthotics, Ambulance, Non-Emergency Transportation and Alternative Health Services. **Other Practitioners includes: Optometrists, Podiatrists, Chiropractors and Psychologists.

TOTAL NUMBER OF PHYSICIANS' VISITS BY LOCATION
FOR FISCAL YEAR 1982

Place of Visit
Physicians' Office Hospital Inpatient Hospital Outpatient Clinic Skilled Nursing Home Intermediate Care Nursing Home Recipients' Homes Elsewhere
TOTAL

Number of Visits 988,273

Percent 100.00%

ENROLLED PROVIDERS BY TYPE OF SERVICE* June 30,1982

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 Non-Emergency Transportation Physician Doctor of Osteopathy Dentist Optometrist Podiatrist Psychologist Chiropractor** Rural Health Services Speech, Occupational and Physical Therapist** Outpatient Mental Health

TOTAL

19,369

*Includes Medicaid and Medicare providers. **Enrolled in Medicare only.
The number of enrolled 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. It should be noted that the top 550 physicians recieve more than 50% of the total payments.
Enrolled providers include both in-state and out-of-state providers.

Medicaid and Medicare

GLOSSARY OF TERMS

Medicaid and Medicare are two governmental programs which exist to pay for health care for two different, but overlapping, groups of Americans.

Medicaid buys medical care for several low-income groups, including people of all ages. Medicare buys medical care for most elderly people, including some people from all income groups. Many aged people who h a ~ leow incomes are eligible for both Medicaid and Medicare, and those who are eligible for both get a Medicaid card and a Medicare card. For those people Medicare pays most of their medical bills, and Medicaid pays the balance. or most of it.

Medicaid is administered by the state governments and thus each program is different. There are Medicaid programs in 49 states and Puerto Rico, Guam, the Virgin Islands and Washington, D.C. Arizona does not have a Medicaid program. Medicare is administered by the federal government and the program coverage is uniform throughout the nation.

Eligibles and Recipients

Eligibles are people who have Medicaid cards and thus are eligible for health care service paid for by Medicaid.

Recipients are people who actually received one or more medical services for which Medicaid paid all or part of the bill.

Providers

All physicians, dentists, hospitals, nursing homes, and other individuals or businesses that provide medical care are called providers.

Charges, Payments and Expenditures

A charge is the amount of money the provider requests for a service when he submits his bill t o Medicaid.

A payment is the amount Medicaid pays for a service. Medicaid rules limit payments, so sometimes a provider cannot be paid as much as he requests.

Expenditures are the total dollars which Medicaid paid for services and may include the dollars paid for program administration.

Health Care Services

Medicaid pays for the following categories of service:

Nursing Homes Drugs Mental Health Clinics EPSDT (Early & Periodic
Screening & Diagnostic Treatment) Alternative Health Services Durable Medical Equipment

Orthotics/ Prosthetics Hospitals Dental Optometry Rural Health Clinics Laboratory/ Radiology Chiropractic Non-Emergency Travel

Physicians Family Planning Home Health Podiatry Ambulance Psychiatric

Buy -In

Medicaid buys insurance from Medicare to cover physicians' services for those who are eligible for Medicare and already receive hospital coverage without payment. State funds in the amount of $3,304,899 were used to pay for insurance for M A 0 recipients (Medical Assistance Only) in FY 82. The usual federal match (66.28% federal, 33.72% state) is provided for all other recipients who are Medicare eligible.

DEPARTMENT OF MEDICAL ASSISTANCE ADVISORY COMMITTEE AS OF JUNE 30,1982

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. Subcommittees of this group, representing ten medical professional groups and a consumer group, are appointed by the Commissioner and meet at the discretion of their respective chairmen. An important function of these subcommittees is to 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:

I. Ambulance Subcommittee Charles B. Gillespie, M.D., Chairman Albany, Georgia Don Sirmans Lakeland, Georgia Doug Waters Jefferson, Georgia
11. Consumer Subcommittee Ms. Pat Kalmans, Chairwoman Atlanta, Georgia Mr. Joe Reidinger Brunswick, Georgia Mr. Lewis Sinclair Atlanta, Georgia Ms. Pamela Harris Decatur, Georgia Ms. Eloise Pitts Atlanta, Georg- ia
111. Dentists' Subcommittee DeWitt Walton, D.D.S. Chairman Macon, Georgia Mike Kennedy, D.D.S. Columbus, Georgia Walker Moore, D.D.S. Atlanta, Georgia A.J. McCaslin, D.D.S. Savannah, Georgia Theodore C. Levitas, D.D.S Atlanta, Georgia
IV. Durable Medical Equipment, Orthotics, & Prosthetics Subcommittee
A.M. Hancock, Chairman Atlanta, Georgia
H.G. Bowden Warm Springs, Georgia
Dean Cox Cartersville, Georgia
Grant Rice Atlanta, Georgia

V. Home Health Subcommittee Mary Suther Atlanta, Georgia Eileen Blond Jesup, Georgia Darlene Cox Bainbridge, Georgia Charles K. Hecht Columbus, Georgia Gladys McClelland Waycross, Georgia
VI. Hospital Subsommittee Ernest Bacon, Chairman Atlanta, Georgia Ewing S. Barnett Newnan, Georgia Charles L. Foster, Jr. LaGrange, Georgia Glenn J. Black Marietta, Georgia Charles H. Wilson, Jr. Atlanta, Georgia
VII. Nursing Home Subcommittee 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

VIII. Optometric Subcommittee Robert H. Thurmond, O.D., Chairman East Point, Georgia Joe H. Dew, O.D. Dalton, Georgia Alan V. Wexler, O.D. Savannah, Georgia Lovick H. Williamson, O.D. Quitman, Georgia Earl W. Lusk, O.D. Dalton, Georgia
IX. Pharmacy Subcommittee Larry J. Parrish, R.Ph., Chairman Swainsboro, Georgia Wallace G. Whiten, R.Ph. Toccoa, Georgia I. Peter Mills, Jr. R.Ph. Millen, Georgia W.O. Bullard, R.Ph. East Point, Georgia Oren H. Harden, Jr., R.Ph. Sylvester, Georgia
X. Physicians' Subcommittee David A. Wells, M.D., Chairman Dalton, Georgia W. Carl Gordon, M.D. Albany, Georgia Wesley S. Wilborn, M.D. Atlanta, Georgia Garnett A. Fisher, D.O. Norcross, Georgia M. Daniel Byrd, M.D. Atlanta, Georgia William H. Stuart, M.D. Atlanta, Georgia
XI. Psychologists' Subcommittee Irving P. Unikel, Ph.D., Chairman Decatur, Georgia George Anderson, Ph.D. Dublin, Georgia Fred Huff, Ph.D. Marietta, Georgia John Adams, Ph.D. Statesboro, Georgia Hugh Christie, Ph.D. Griffin, Georgia Ronald J. Berlin, Ph.D. Atlanta, Georgia

CREDIT FOR COVER DESIGN: Floyd Veterans Memorial Building, Suzanne Allen, Department of Administrative Services.
We feel that it is appropriate in this Annual Report to reaffirm our full commitment to the principles of Equal Employment Opportunity. Our policy is to assure that opportunities for employment, advancement, and for dignity in work are equally available to all. Employees and applicants, including handicapped individuals, are evaluated on the basis of performance, attitude, skill and experience without regard to race, color, sex, age, religion, or national origin.