Department of Medical Assistance
Annual Report
Aaron J. Johnson, Jr. Commissioner

Aaron J. Johntaon Commiaeioner

State ofGeorgia Department of Medical Assistance
- Floyd Veterans Memorial Bldg. West Tower 2 Martin Luther King, Jr. Drive, S.E. Atlanta, Georgia 30334
October 31, 1983

The Honorable .Joe Frank H a r r i s , Governor Members of t h e General Assembly of Georgia Citizens of the S t a t e of Georgia A t l a n t a , Georgia 30334
I.ad i e s and Cent lcmen :
A s d i r e c t e d by t h e Board of Medical 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 review t h e Annual S t a t i s t i c a l Report of t h e Georgia Department of Medical Assistance. This report summarizes agency a c t i v i t y through the f i s c a l year ending June 30, 1983.
A s t h e Department ends i t s s i x t h y e a r as an independent agency and a s I b e g i n my f i r s t year as commissioner, we would l i k e t o e x p r e s s a p p r e c i a t i o n t o t h e Department o f Human R e s o u r c e s , t h e v a r i o u s health p r o f e s s i o n s i n t h e S t a t e and o t h e r a s s o c i a t e d agencies i n t h e State Covcrnment. With t h i s help, the Department provided medical a s s i s t a n c e f o r n e a r l y one-half m i l l i o n Georgians during t h e p a s t y e a r .

An Equal Opportumity Employer

BOARD OF MEDICAL ASSISTANCE
As of June 30,1983

The Board of Medical Assistance is the policy-making authority for thc (icorgia Ilepartment of' Medical Assistance. The Board is composed of five persons appointed by thc Governor and confirmed by the Senate for staggered four year terms of office following thc initial appointments. Board meetings are held monthly.

MEMBERS
Mr. Robert C. McMahan, Chairman Decatur, Georgia
Mr. Ronald Tigner, Secretary Atlanta, Georgia
Ms. Vivian P. Hartman Milledgeville, Georgia
Mr. Clem Hosea I'occoa, Georgia
Mr. W. Roland Watkins Atlanta, Georgia

TERM OF OFFICE Through .lunc 30, 1983 7'hrough .luno 30, 1986 I'hrc>ugh .lunc 30, I984 'I'hrough .lunc 30. 1984 .rIirough Junc 30. 1985

TABLEOFCONTENTS

I'rograrn Abstract ............................................................ 1 Foreword .................................................................. 2 T'ablesandCharts ........................................................... 6
A History of Medicaid Benefits Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Sources of Medicaid Benefits Revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Where the Medicaid Dollar Comes From ..................................... 7 Where the Medicaid Dollar Goes ............................................ 8 FY 83 Benefits Expenditures ................................................ 9 FY 83 Administrative Expenditures .......................................... 9
Collc~fions .............................................................. 10 I'ayments and Itecipients by hid Category. Sex. Race. and Age Group . . . . . . . . . . . . . 11
Analysis of Recipients and Expenditures by County of Residence . . . . . . . . . . . . . . . . . . 12 Monthly Average Eligibles for all Aid Categories ............................... 16

I'ercentage of Expenditures and of per Recipient by Aid Category

R.e.c.ip.i.e.n.ts.a.n.d..A.v.e.r.a.g.e.Y..ea.r.ly..P.a.y.m..e.n.t ...........

17

Recipients by Aid Category by Type of Service ................................. 18

Henelits Paid by Aid Category by Type of Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

I'ayments for Services per Recipient. FY 81-83 ................................. 20

Percentage :eofFl'otalRecipients Utilizing Each Service for Fiscal Years 1981-1983 ...... 21

Claims Processed by Category of Service ...................................... 22

'l'otal Number of Physicians' Visits by Location ................................. 22

I'roviders with Paid Claims during FY 81-83 by Type of Service ................... 23

Ilcpartment of Medical Assistance Advisory Committee ............................. 24

ABSTRACT OF FISCAL YEAR 1983 ANNUAL REPORT
Georgia Department of Medical Assistance
l<xpct~dLiItWS t3cncSits Adn~inistration
Nilmbcr of' Medicaid claims paid l~nrolledProviders (as of .lunc 30, 1983) Average number of monthly eligibles IJnduplicated count of recipients served annually Average yyerly expenditure per recipient
Who Is Iiligible Medical Assistance eligibility is for recipients ofcash payment under the Supplemental Security
Income (SSI)program and most recipients of Aid to Families with Dependent Children (AFDC) c:~tcgoriculassistance programs. In addition, reimbursement for medical services is made under the Medical Assistance Only (MAO) program for persons who are residing in a long-term care in.\ttti~tionand meet eligibility requirements for SSI, except for income. M A 0 is also extended to lobtcr care children, first time pregnant women who meet the eligibility criteria of the A F D C program and certain other persons with special conditions approved by the federal government. 'I he (icorgia Mcd icaid program pays the "buy-in" Medicare premiums for persons who are eligible I'ot both Medicaid a d Medicare (coverage for persons 65 and older and certain disabled persons). I:or Ihcsc persons, Medicarc is the primary payor for medical services with Medicaid paying for only coinsurance, deduct iblcs and any services covered by Medicaid but not Medicare.
<'overed Services I npitt icnt and outpaticnt hospital services; physician services; skilled nursing home and inter-
rncdiarc care facility services; prescribed drugs; laboratory and radiological services; home health hci-vices; l~tmilyplanning services; Early and I'eriodic Screening, Diagnosis and Treatment (F:I'Sl) I ) 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 pritctitioners.

FOREWORD
During State Fiscal Year 1983(July 1, 1982to June 30, 1983).more than $A 13 million wits paid by the Department for medical care for 444,078 recipients. *l'hecost ol administration of the program remained low - less than four percent of the total Mcdictid b~~cigct.
The ~epartrnent,was reorganized effective .July. 1983 aRcr ii c;trrl'lrl review o l v;trioos approaches to carrying out essential functions. Among the rni~jorchit~~gcas, new 1)ivision 01' Program Integrity was created, incorporating Investigations, Survcillirncc irti(1 Iltili~irtioriII~~vicw, Third Party Liability, Quality Control, and Program Evaluation. I~urthcr.Nursing llomc and Hospital Reimbursement functions were integrated into Kcimburscmcrit/ I'olicy Scctions witlii~i the Division of Program Management. In this foreword, wc have inc1rl.dc.d highlights ol' majorFY83 activities within the Ilepartmcnt.
OPERATIONS
The Operations and Information Systems Ilivision is rc\ponsiblc lo1 the claims pr(xe~sirig function and the coordination of all data processing sesviccs lor the I)cpartrnc~it.
Some of the past year's accomplishments include:
Soliciting bids for a fiscal agent to operate the Medicaid Manirgcmcnt InlOrnintion System, leading to a contract which is expected to save the State $30 million over a five ycar pcriotl.
Contracting of claims microfilming, which succeeded in reducing the claims paynicnt c.yclc by 8 to 10 days.
Procuring of a Micro Computer system which will rcducc thc cost of tliu Quality ('ontrol function substantially and which will allow improvcd automation ol'othcr functions ;IS well.
Procuring of a data processing software package ( M A I'I'EK) which will be uhcd to gcncr;ltc processing reports to monitor more efllcicntly the claims pitytncnt activity lor ~ ~ t i l i / i t t i o ~ l review and audit reports.
SPECIAL SERVICES
In addition to representing the Department at all providcr hcatLingsand providing sound legal advice, the Office of Special Services has bcconic nlorc actively involvetl in the day-to-day administration of the Program. The goal of this increased participation is to avoid some ol'thc technical difficulties experienced in the past due to the complex and highly regulated nat~rl-ocl'the Medicaid Program.
Continuing a pattern set in the last several years, providers arc becoming increasingly sophisticated in their appeals of I>epartment Actions. As a result, 20 ol 35 providers who reqiicstcd hctrings in FY83 were represented by legal counsel, with amounts i n individual controvcrsics ranging up to greater than $700,000.
THIRD PARTY LIABILITY
The Third Party l h b i l i t y Section increased its recovery ellbrts in the iircns ol'casunlty, liability. and health insurance through streamlining clerical procedures and enhancing computer progrirniming \upport. The Section successfully developed direct. on-line data h:rndlingsystcms with nii~iol injurance carrier\. Although budgetary restraint\ prohibited the implcmcntittion ol'thc proposcrl Provider Field Review program. the Section utili~cdan outsidc contractor to conduct 52 provider field reviews. As a result, over one million dollars werc identified as owed to the State I ~ o m providers who had been paid by both the Medicaid I'rogram and a liable third party. 'l'hc total

i~liio~tl0i1l ICCOLCI 1e4t111011gI1(lie ;~pplic;~tio0l1i tlnis~lpiirty liirbiltt> collection procedures b a s $7,005,088. appsoxrnl;~tdy1 .?(If ol the total Mcdtcaid bcnel'its pa) Iincnt4 lot. FYX3.
' I lie Qu;r.lity C'o~ltt.olScctiori hiis [tic l.csponsibilit\. 01' nionitorillg eligibility dctcrminrition l)c-r.lOrl~lchtly (tic. I )cp:rrtrilcr~tol' I Iuriiar~Kesol~l.ccst,he. cl:rinis pa\,nncnt system. and thir-d party t.cbco\,cl.cyl'l'o~.tb01' this I )ep:t~.tl-iient.i n older to idelitilj! crroncouh Medicaid payments. During I,'Y8.1. tlic eligibility st;tlrts 01' i ~ p l ) ~ . ~ ~ i 3~0i0~0 ;M~etd~iclayid c:~scs was re\,iewed. In addition, i ~ ~ q ~ . o x i ~ t i a1t4c,0l6y)0cl:~iliiw~csc t.c\,icwcdto vct.il'ythe accuracy 01' Medicaid reimbu~semcntsand l o tlctcl.~1iincwlnetlicl. all), a\~ail:thlct1nit.d party Irnds were I-eco\,ercd.As errors were detected. ~~c*lL~.w~.itclsn~i;td~c to i~ppropt.ii~It)ccpartincnt stat'l'so thiit I'unds could be recovered. Steps were titken dt~riligtlic yeas to lower the ct-ror rate, including cxtensi~cspecial training of eligibility worl\c.rs. i ~ ~ i tcIlicsChleps II~IL'C i~~ct*c;tstehde ~ I C C L I S ; I C01~' Mcdiciiid eligibility determination.
Ill\,c.stig;~livccl'l'o~.tsin I'Y83 Icd to the discct disco\.cl-y and idcntificatio-n of $57 1.622 in ovcry~;~y~iieo~wietds the I ~ c p i ~ ~ - t ~ ibiyc *p~r~iotvitlcr-sand prodirced deterrent effects as well. In :tdclitioli. S.3.043 was idctitil'icd as Inoncy to be rcl'itndcd to 1.ccipicnts and $6,700 in Sines and pC~iitltics' .I hirty-thrcc ciixcs ol' ;rbiac and 74 crimin:il cases of'fraud wcl-e initiated. Another I24 I'sovitlcr I t ~ l ~ g r i tliycvicws irnd 05 I<ccipiclit Integrity Reviews wcrc pcrforn~edand 20 Contract Violii(io~iswcrc i~lvcstigat~d.
l )ir~-ingthe I'irst Iii~II'ol'Yt(3, the 1)cpartmcnt i~tiii/cdits A1tcrnati1.c Kein~bursernentSystem It)r inpirticnt scl-vices111id~ii1w. aiver I'rom the 0 . S . 1)epartrncnt of' Health and Human Services. 'l'liissystc~iIl-cdilcctl pity nicnts to hospitals by ;~ppr.oxi.~.in:ttc5l'y):;thl-ough peer group comparison iitltl inl'lation contt.ols. 0 1 1 . ~ ; I I I L I ~I . I1I9. Y8.1, the 1)cpartnncnt implemented a Prospcctivc Paynient Systctii birscd on tlic ~~~con~rinc.ncli.io~li'oantassk l'orcc apppointed by former G.overnor George 14ttshcc.'l'liis new systcni co11tinuc.dillI1:rtioli controls and introditccd special incentives to discouritgc t1tlncccss;ll.y :rdrnissions. Hy its prospcctivc naturc, this system also allows the I>epartment to pi'o.jc.c.t h~rdgctiirynccdh rnorc precisely.
IlntlCt.thc new systc~ii.cacll hospital t.cccivcs n sct amount per case admitted. For the new systclil, adlnission la~.gctswcsc wt du~-iligtiY83 l'or each hospital. 'l'he r~ilnibeor f admissions as of Iq'YX2 was dCtcr.tiiincdand a Sf,;growth allowance was added for FYX3 to arrive at the utilization ti~~.gcf*lto.spitirls r . e ~ ~ i1v'1c1lIr e i ~ i n b i ~ ~ ~ ~iret ~thne~isep~enr~t ;iscrate forall admissions up to the target. I,'or l0Of';,to 10.1(,'io. l' this tasgct hospitals will be rcinnburscd at 5O!/i of the per-case rate. For :rdliiissio~isbcyond 103(';8h,ospit;rls will be ~.cimburhcd25(? of the pcrcase rate.
Nursing llome Reimbursement I ) l ~ ~ - i nl.g'YX3, onsitc aildits wc1.c pcrl'ol.tncd on approxin~atcly22!;;, of all facilities. The
I ) C ~ ; I I I 111e~ri0t1 ' Airdits' ~ittrsir~I1go11ie~ ~ : j l ' fa'llditcd 17!:; of nursing hoinc cost reports and con11-irctcc;lritditors completetl :tliothcl. 5f,';.'l'lnis dccreasc in audit activity from the FY82 period was d l ~ cto the lirct thirt 1982 cost t.cpot.ts were not used to set nursing honle rates.
'l'lnc usirril rate ucljustmcnt wits not ilnplcnlented .lanuary 1983, and the reimbursement rates wc1.c bi~scdupon 1980cost 1.cportsusinga 12.6(,:; growth allowance. On April 1, 1983,the growth ;tllowa ncc was inel-eased to 17.S(,!,;',l.'hc cl'li'ct 01' the April 1983 rate change was to increase the avcrilgc rate paill by 3.h(,';.

Finaliy, a new property reimbursement system was instituted, using ii Ilodge ('onstruction Index, which sets a maximum property reimbursement rate paid lor each facility liil\ing i1 transaction such as a sale or lease.
PROGRAM MANAGEMENT
Reimbursement Policy Changes
Physiciau and Podiarrjl Servicc~s a) Effective January 1. 1983the Department inipkmentcd a new rciniburscnicnt mctlio-
dology to minimix unnecessary use of the more expensive Ilospiti~lsetting l o r ccrt;tili services which are comnionly performed in an office. Kcimhurscnicnt I'ol.tlicsc spccil'ically identified services is reduced to no more than h5(,';t01' tlic physician's niilxiniu~il allowed payment if the services are performed in the liospiti~l. b) Effective February 1. 1983, the 1)epartnient implcniotitcd ill1 Incentive I'i~y I'rogr;lni which provides monetary incentives to practitioners who pel-Iiwm certain millor. uncomplicated surgeries or diagnostic proccdurcs in their ofl'icc rather thi111ill a I~ospiti~l setting. c) Effective February 1, 1983, the Department iniplcnicn~cdu M i \ ~ ~ d i ~ tOo rt~ytpaticrlt Services Program on certain minor, uncomplicated scsviccs. II'mcdicaI ncccssity cilnnoI be proven, the Department will disallow payment Sol- thcsc spccifictl scrviccs when performed on an inpatient basis.
2. Hospital Services The new Prospective Payment system is described itbovc under "Administrittion".
3. Pharmacy Services The pharmacy dispensing fee was raised frtrm $2.93 t o $3.19 f'or propl.icti~pr~harnii~cicn\lltl from $2.49 to $2.75 for non-profit pharmacies, cffkctivc May I , 19x2. 'l'hc fee wiis ri~isctl again, effective April 1, 1983, to $3.25 for proprietary pliarmacics i111d to S2.X I for non-profit pharmacies.
4. Non Emergency Transportation A demonstration project using minibus/ van services in lie110 1 ' Ioc;i I taxi tri~veWl ~ I Sinit i;~tctI in April, 1983 in Fulton and Douglas Countieh to dctcrminc thc impact o n progri\lli costs.
5. Nursing Homes Changes in reimbursement are described above under "Adminsitration".
6. Community Mental Health The Department began conducting audits of Community Mental I-lcaltli C'cntcrs in October 1982. Audits were performed in 23 centers located in varioiis arcits th1.0~1gIio1t1litc state.
IJtilizationControl and Provider Relations
1. Surveillance and Utilization Review S wfion (5'llKS) During FY83 SURS expanded its efforts in identifyirlg patterns ol'inappropr~iiitccillc itnd misutilization of services. Automated exception reports and rcIi.rri11s I son1 1k.p;11t nicnt staffgenerated detailed desk and field audits of Medialid providers. One hundred twclily of the reviews were finalbed during the fiscal yciir, resulting in idcntiI'ici~tionol'8448.720 in overpayments owed to the Department. *lheaniount 01 ovcrp;~ymcntsidcntilicd rcllcct ill1 increase of 20% over the previous year. 7'hc Section's ratio ol ovcrpaylncnts idcntilicd to total administrative costs was 2.4 to 1.

'I he voli~t~;i~cn dscope 01' reviews will increase during FY84 as a result of increased staffing. I t isanticip;rtcd that this expanded activity will result in overpayments identified increasing ikt iI greater i.atc ttian in FYX3.
2. l'rior Appro I?U/u ~ t//l~cy)llt~ncvz/ Ho~lir.~? I<cvicw01 certain procedures for 11icdi~;inI c~cssityis ;in on-going process. This process has li~cilitatcdconrpliancr. with Medicaid policy and helped contain incrcaxing cost\.
I'riol- approval is rcquired Sor p11rch;iseof 1)urable Medical Equipment items over $200.00 ;ind lor rcntal in cxccss ol two months. Iluring FY83, savings of $195,000 were realized.
I I1.c I )cpa~.tmcntccnitinucd p~cpi~ynicnrctvicw of all n~ultiplesurgery claims and claims I t om PI-ovidcrswho had hccn identilied as possible abusers. The 24.1 18 reviews performed cluring the year 1.csi11tcdiii s:ivi(~gsof $796,000. Additional savings, which cannot be ~iicasurctl.rcs~llrcdrtuc t o thc dctcrlcnt cfkct of such reviews.
3. t21t-tI, utld 1 ' ~ ~ r i o,~YIsir~(~~>ttitig1l,i~~,qtro.siu.st,id Trcw/tvent (EPSD T) I 11lri1lg!,;Yt(3,about OX, 100children were screened (an increase of about 4%), and twentylotlr llcw physician provider!, wcrc cnrollcd in the Ef'SDT program. Though provider traini~lgis an on-going activity, eight Sormal training sessions were held.
3 . ( ' O I I I I ) I L ( ~ I ; / . I ~('urc In Octobc~.1982, adniinistralion of' t he Alternative Health Services (AHS) Program was
11-ansfi.rrcdto the Ikpartnlcnt of' tlurnun Resources.
I his program continued to expand statewide during FY83, with the number of recipients increasing I'rom itbout 1,000 to about 2,000, and the amount of reimbursement increasing I'roni about $1,500,000 to about $3,000,000. Proposals were approved during FY83 for c x p i r n s i ~01~' A tiS to rtll but one of the Area Agency on Aging districts of the State during l.YX4. In addition, new providers in existing scrviee areas were enrolled during FY83.
'l'llc I lonic tlcrrlth pl-ogram also expanded during FY83, with an increase from about 4,200 lo i~bout0,000 rccipicnts.
I Ilc I Icpartmcllt wol.kcd closcly with thc Department of Human Resources in planning for itt~plclncntittiolit)S the (;eorgia Community Care for the Elderly Act, which mandates a stalcwidc system ol'altcrniitives to nursing home care.
'l'hc tollowing statisticiil tables dcbcriks details of Department activity during FY83.

Fiseal Year

A HISTORY OF MEDICAID BENEFITS EXPENDITlJRES

Cash Benefits Payments*

Percentage Change

Paymenth By ilate of Service*

I'ercentage Change

*Beginning in 1976,expenditures were on an accrual-bascd accounting system as opposed to ;I cash basis system utilized in previous years. A Statc Attorney Gcncl-al's I-t~linhgeld that prrymcnts nlust be made from the budget for the same year in wliicli the Medicaid scl-viccwas I-endcrcd.Iior this reason, final expenditure amounts are not known until somc time al'ter a fiscal yc;t~t-i;~sct~dctl. "Cash benefits payments" are those paid during each fiscal year. "l'aymcnts by dntc ol' scrvicc" reflect expenditures for services provided during each I'iscai year. I)a tc of services I'igi~rcsarc expendituresas ofJune 30. 1982for FY 77-FY 82; FY 83 is;tncstirnrrtc. With thccxccption trl'tlic above table, "expenditures," "benefits" or "paynicnts" givcn in this Atini~alItcport arc "casl~ benefits payments." Total expenditures for services rcndcr-cd during cach I'isa1.1ycttr will usually exceed payments made during that year.

SOURCES OF MEDICAID BENEFITS REVENUE

FY 83

Fcdcral Funds

$407,6 19,336

State Funds

$205,773,44 1

'I'O'l'Al. Rcvonuc

$6 13,392,777

. WHERE THE MEDICAID DOLLAR COMES F R O M . .

(icol-giab Medicaid program reccivcs reimbursement for a portion of its budget based on the activity. licirnhu~scmcntlcvcl lor bcncl'lt\, lrlmily planning. the Medicaid Management Information Syhtcnl ( M M I S ) and I'ol-administration of the program is determined each fiscal year by the iedetal govcrnmcnt.

Most Benefits

Medicaid Management Information System & Operations Division

STAl E FUNDS

Family Planning Benefits

Most Other Administration

Total

Out of each dollar spent for Medicaid benefits. approximately 3 7 . 9 ~gocs for skillcd nursing care, intermediate carc or intermediate care for th,e mentally retarded. Hospital providcrs rcceive 3 5 . 0 ~of each dollar and the remaining 2 7 . 1 ~gocs to providers of'other care.

Of the administrativedollar, the Department of Humi~nKcsc~urucsi~tilircs27.90 and compntcr

services account for over 3 0 o~f the dollar. The cost of administration is 3 . 9 o~f the total Medicaid

dollar.

WHERE THE MEDICA1.D DOI,I,AR GOES ...

BENEFITS $613,392,777

/'
Total Expenditure. $637,198,064

Atllnillisfc.;l~io~l 3.7t1;,

FY 83 BENEFITS EXPENDITURES*

-- . .. ..-

-----

...-

Percent of

Category of Service

-.

--- - -~

-

Skillccl N i~rsing1:acilitics

I ~itcr~ri~rdi(a'atcrc-Mentiilly lietardcd

Intcrmccliatc Care-Ot her

1np;iticnt Iiospital

Outpatient tiospital

1'1rscribed I ) n ~ g s

I'1iysici;ins

I )cnt;il
otllcl~C';11.c **

('linic (Mcnti~tllculth)

1;;tnaily I'l;~n.ning
0thc1.I'ractitioncrs ***

I.lomc I le;~lth

I .abo~.ittoryR/ aclioLopy

I<u~ai.Illcaltll C'linius

I :;~rly;init 1'cr:iodic. Screening

I )ia.gnosis and 'l'rcatnlcr~t

-

--- -- .-

-----

Amount
$ 7 1,916,962 49,019,910 1 1 1,644,078 184,823,995 30,245,803 57,927,920 58,732. 165 1 1,087,114 9.97 1,004 10.1 38,544 4,479,778 2,33 1,256 7,900,500 768,124 247,112
2,158,512

Payments By Service
I 1.7?4, 8 .O% 18.20/, 30.1% 4.9% 9.5% 9.6%
1.8% 1 .WA: 1.7% 0.7% 0.4% 1.3% 0.1%
****
0.4%

'I'(Yl'A1. C'OS'I'S

$6 13,392,777

1 OO.Oq,

MIII)I('AKI: HIJY-IN t ~ I ~ I ) t ! l < ASl .'I/'A'I'L

$ 14,039.921

MtII)l('AK!J HtJY-IN iO(F,+ijS'l'A.l'E (MA())

$ 3,474,818

~
* C'ash hc~lclilpsiiymcnts(by dirk ol'paymcnt)as reported in Annual Statistical Report on Medical Care. Does not ir~cludc$17.5 14.739 i n "Ruy-l n" p;rymcnts (Medicaw I'rerniums) paid for persons eligible for medicare and rncd ica id.
** Other ('arc iocludus: 1)ur-able Medical Equipment, Prosthetics/Orthorics, Ambulance and Non-Emergency
I'ransportutim and Altcrli;~tivcllc~rlthSuvices.
*** Othcr i'ractitioncr> iliclrrdcs: Opton~ctristsI,'odiatrists, Chiropractors and Psychologists. **** I .css than 0.I();,.

FYS3 ADMINISTRATIVE EXPENDITURES

- - ----

- -

Administrative Function
-
I )OAS ('on~putcrScl vices

Expenditures S 7,151,773

Percent of Total 30.1%

I )cp;~~tmcnofl Human Kcsoil~ccs
I liter agency ('ontract *

6,647,259

27.9%

0 p c 1'I.t !OH4 Ad~nin~slrntic)n

3,246,346 1,733,809

13.6% 7.3%

1'1ogr;tm Mnnagenic~it

1,733,357

7.3%

(;cot gra Medical Caru

I < o t ~ n d a t ~Coonnttact

1,40 1,747

5.9%

( ' o m m ~ s s i o r0 1 1ice

457,955

1.9%

Specla1 Scrviccs I nvcst~ gtaion and C'ompllancc

100,359 350,848

0.4%
t .5%$

Qual~tyC'onlrol

461,216

1.9%

1-3-c-nclit-~-l<c-co-vcry - --

--

520,6 18

2.2%

I 0 I Al. -- - -- -- -- -

$23,805,287

1 00.0%

* l.etlcr;tl lund4 only. Stdtc nurlck funds appciir in I)cpa~tnlent ot Human Rebources budget.

COLLECTIONS
Efforts are made to collect money erroneously paid for Medicaid services in a number of areas. Each fiscal year, nursing home audits disallow somc of thc costs hilled to Medicaid. and thcsc adjustments decrease total dollars paid to nursing homes. A third party rccovcry cffort rcsults in collections for cases where a recipient has private insurance. Hcnefits recovery is also made for overpayments to providers dueto fraud, abuse, misutili7ation and other-rcasons and for scttlcmcnt of hospital reimbursements.

Nursing Home Audit Disallowances
Third Party Liability insurance Recoupments
Overpayments/ Erroneous Payments*
Hospital Cost Settlement**

6,825,105 1,973.805 3,292,169

7,227,450 4.1 17,121 9.863.474

7.065.988 1,40 1,447 9.652.40 1

TOTAL
* Includes collections made based on identification of fraud and nbuhc by Invc\tigi~t~onsan(d'ompl~:~ncc
and misutilization by Surveillance and lltiliration Review.
** Hospital settlement collections were made in FY81 and kYX2 bared (mcosts dctcrminctl lo1 c;~rlicr
periods (up to four years earlier). Most of the settlements d~lringFY 8 3 wcrc mndc under t t ~ cAllcrn:~tivc Reimbursement System.
*** The Department continued t o use 1980cost reports. so the audit sitvirigs Ilavc not changed hincc 1:YX I.

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

PAYMENTS

RECIPIENTS

ANALYSIS OF RECIPIENTS AND EXPENDITIJRESBY COIJNTY FOR FISCAL YEAR 1983

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

Total Benefits
Paid

Population*
15.501) 6,100 9.400 3.800 34.700 8,700 2 1.300 40.700 16.000 13.500 1 50,200 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 2 1,700 21,900 5 1,700 74,500 3,500 150,400 6.600 297,700 26,800 35,400
40, loo
13,400 39,300 7,600 19,500 12,300 4,700

Recipients** (Unduplicated)

O/o Population Receiving Medicaid

Recipients/ 'Total
Recipients

('ounty
< 'ost I'er
Ht~ipicnt

ANA1,YSIS OF RECIPfEWTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1983

'I'otal
knefits Paid

% Population Receiving Medicaid

Recipients/ Total
Recipients

County Cost Per Recipient

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1983

County
Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgatl Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screten Seminole Spalding

Total Benefds
Paid

Population*

Recipients** (klnduplicated)

'7/0 I'opulation Receiving Medicaid

Recipients/ Total
Recipients

.--
( 'ounty ('tr\t I'cr Recipient
- --

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY
FOR FISCAL YEAR 1983

-<'ouaty

Total Benefits
Paid

Population*

Recipients*+ (Unduplicated)

% Population Receiving Medicaid

Recipients1 Total
Recipients

County Cost Per Recipient

:pkcns :war1 ;mler ilhot
'I 1t'.l :l <. ) ltlni~ll ;1yl01cllitir cn.cll ~'tlcln1;ls 'I l't 'oo111hs

OWIlS

.'ructlo~l

. sotip

\'urncr

i'wiggs

IInioll

lIps011

Wi~lhcr

Walti)ll

Wnrc

W;irrcll

W;~sl~illgloll

Wayrlc

Wcbslci

Wllcelcr

Wlli~c.

Wllitlicltl

Wilcox

Wilhch

Wilk111ho11

Wor1I1

S- 'l A

'

I

'

I ,W l f ) l
. . -~ -

:

..

* ( l . S .C ~ ~ . l l h U 5
** I Ilc I I I I I I I I ~ C I 01 U C C I ~ I C I III\~~111dt1p1ic;itcwdithin t a c h county, but a recipient may have r w d e d In more than one county d u r ~ n gthe

yca I

MONTHLY AVERAGE EI,IGIBI,ES FOR ALL AID CATEGORIES*

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

420,033

4 1 1.201

4 1 2,982

"SOURCE: Monthly Statistical Report On Medical Cure. Not ill1 eligibles arc rccipicnt\ of services. The average number of recipients for whom payments wcrc niadc crtch non nth werc 215,820 for FYS 1, 210,805 for FY82, and 218,825 Ibr FYX3.

PERCENTAGE OF EXPENDITURES AND OF RECIPIENTS AND Al'ERAGE YEARLY PAYMEXT PER RECIPIENT BE' AID CATEGORY FY 83

Basis of Eligibility
Elderly (age 65 and o\.er) Blind Disabled AFDC Children AFDC Adults
TOTAL

Expediures
S 198.809.383 5.106.386
246.044.303 7 1.27 1.982 92.160.723
56 13.392.777

Percengage of Total
32.45 0.85 40.15 1 1.6% 15.15
100.0~

Recipients
90.230 2.879 89.483
185.994 94.046
444.078*

Percentage of Total
100.0~

*Unduplicated Count

Average Paid Per Recipient
$1.381.27

RECIPIENTS BY AID CATEGORY BY TYPE OF SERVICE* FY 83

Type of Medical Service

Age 65 or Over

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
Z Home Health
Laboratory Radiology Early & Periodic Screening.
Diagnosis & Treatment Rural Health Clinic Other Care***

Btind

Disabled AFDC Adults AFDC ChiMren

* The numbers of recipients ~vithineach type of s e n ice have been estimated based on FJ.83 total unduplicated count and tota1.s b.! a d

**

category and the relationship of Medicaid-only recipients to total reci-picnts in Fl-81 and FJ.82. Other Practitioners isdude: Optometrists. Podiatrists. C h i ~ o p r a n o r sa. nd Psychologists.

*** Other Care includes: Durable Medical Equipment. Orthotics Prosthetics. Ambulance. >on-Emergency Transportationand Alterna-

tive Health Services.
**** Recipients are counted no more than once in each category of seri-icein nhich s e n ice a a j pro\-ided. Recipients are also counted in

each aid category in which they H-ereeligible during the year. This is particularly noticeable in the nursing home catsgorq- where recipients are counted twice when the!- become M.40 ( XledicaI Assistanty on11 ) aitrr ha1 ing recsi\ ed Jlaintenance .4ssistance.
***** The total "AFDC Children" includes 2630 "Other Title NIX recipients."

BESEFITS PAID BY AID CATEGORY BY TYPE OF SERYICE FY 83

Type of .Medical Service
Skilled Sursing Homes Intermediate Care-Other Intermediate Care for the
Mentall! Retarded Inpatient Hospital Outparirnr Hospital Physician Prescribed Drugs Dental Other Practitioners* Clinic (Mental Health) Family Planning Home Health Laboratory Radiolog! Early & Periodic Screening.
Diagnosis & Treatment Rural Health Clinic Other Care*"

Age 65 or O ~ e r

Blind

Disabled AFDC .Adults AFDC Children

Total Payment

TOTAL PAYMENTS***

19-8.809.383 5.106.386 246,044.303 92.160.723

7 1,271,982**** 6 13.392.777

*Other Practitioners include: Optometrists. Podiatrists. Chiropractors and Psychologists. **Other Care includes: Durable Medical Equipment, Or.thotics/ Prosthetics, Ambulance, Non-Emergency Transportation and Alter-
native Health Services. ***Total Payments do not reflect the "buy-in" payments (Medicare premiums) paid for those persons eligible for both Medicare and
Medicaid. "Buy-inWarnountedto: $17.5 14.739 in FY83. State funds in the amount of $3.474.8 18 were used to pay for M A 0 recipients (Medical Assistance Only) in FY83. The usual federal match (65.28% federal) is provided for all other recipients who are Medicare eligible. ****The total for "AFDC Children" includes $1.655,011 for "Other Title XIX Recipients."

PAYMENTS FOR SERVICES PER RECIPIENT FOR FISCAL YEARS 1981-1983

Type of Service
Nursing Homes
Intermediate Care-M R
Intermediate Care-Other Skilled Care 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 and Treatment
Average Payment Per Recipient for All Services

Average Payment Per Recipient

8 1

82

83*

$ 1,167.33

$ 1,244.21

S 1,381.27

* Recipients by type of service estimated for FY83 as dcscribcd o n pagc 18, first notc. "* Other Care includes: Durable Medical Equipment, Orthoticsl Prosthetics, Arnbulancc,
Non-Emergency Transportation and Alternative Health Scrviccs.
*** Other Practitioners include: Optometrists, Podiatrists, Chiropractors and Psychologists,

- -- - -- - -=d=--=c.T/--'

- -- +
a=

-12

- --= = ;<; - ,- '2

2

c r z- -r -- -- = = - . d l

2
- 0

2---

=
- -

i
z

- - - - - .d I,.

5

c-

-r i 4 x
; 2

- t7-;

52

- / - I

=j --

j-----,

= - i

CLAIMS PROCESSi1:I) BY I(-'A'I'I~:(;OH\:0 1 ; SP:HVI('F: I;Y 83

- -.
Category of Service

-- - - -
Number of ('laimr Iprocr.rsecl

* \ t ~ n i n ghomc claims ;II-cub~1;111!oilc c l a ~ mpc.~r.c.cip~c~j1flc.1I . ; I I ~ I I C I ; I I I I I O I . I ~ ~ I

TOTAL, N U M B E R OF PHYSl<'lANS' VISI'I'S BY 1,OC'ATION
FOR FISCAI, YEAR 1983

Place of Visit
l'hysician's Office Hospital Inpatient Hospital Outpatient Clinic Skilled Nursing Home Intermediate Care Nursing Hotnc Recipient's Home Elsewhere
TOI`AL

Number of Visits
1,049,632

I OO.OO(lil

'I'ype of Service

PROVIDERS* WITH PAID CLAIMS DURING FY81-FY83
BY TYPE OF SERVICE

FY81

Number of Providers FY82

FY83

* I \ c l~rtlc\Mcdlc;t~c.0111\ o i I ~ C\,I hilt r~lcli~(loc\~lt-ol-St:~lpero\ ldcr\. I h r i n g a g k c n year.
I I I C r ~ ~ ~ r l r holc rp ~ o \ r t l c l \cnrollc)<lI ~ I ; IL?, I I ?~ o ~ l \ r t l ~ ' ~ 1; t1horl1j1tile I I U I ~ ~ C01S pro\ider\ ~ 1 1 1 1 p,~rtIC.I,IIIII~o\ r C \ ; I I I ~ ~ I C - , 111~r-llr~llbcr01 plo\lticr\ cnrolled dilrlrtg 1 Y83 for ho\pltal \el \ \ ; I \ 1.376, 101 I ~ ( I I \ I I1~10~111~. 335, 101 p11i11I I I ~ I C Y ,1,734; lor pl~j\rcl:tn\, 12,775; and for dcntal. 1.356 I hc total nillnbcl ol provrdcl\ er~lollcdlor t.YU3 wu\ 20,839

DEPARTMENT OF MKDIC'AI, ASSISTANC'E ADVISORY ('OMMlTTKl< AS OF J l J N E30, 1983
A Medical Assistance Advisory ('ontnlittcc was erca~ctilo givc technical :~eiviccto Ihc. Department and t o provide li.aison between tlic' I )cp:~l.ttiic.lrtalitl c;~clipl.ovidcl. col~in~illlily. Subcomniittees of this group. reprcscnting tcri meclical prol'c.shio~l;g~rlortps anti a colistlnicr group, are appointed by the Cornn1issiollc.1.: ~ n dtilcct :II Illc ilisc~.c(io~01'l tllcir ~.cspcc!i\c chairmen. An important I'iinctioti ol'thcsc 5-i1bcoriimitlccsis to d c l i ~ ~ c1:l1~ctd~'lkcts ol' proposctl policy changes and relay the concerns ol' their associates lo ~ l i cI )cl3;11r111~1'lt'l.ie sribcomtnittcc.; and their men~bersare as I'ollous:

I. Ambulance Subcommittcc
. Don Sirman4 I .akeland C icorgi;~ I)oilg Water4
.lei let \ o ~ i (. ;cot gia
11. ('on\u~iicr Sitbcoli~n~lltcc Ms. I'anieta tla~-ri\ Ijecatur. Georgia Phyllis S. Holman Atlanta, Georgiii Ms. Ethel M . Matthcws Atlanta, Georgia Helen Presslcy Atlanta, Georgia Mr. Joe Reidinger Brunswick, (ieorgi;~ Mr. Lewis S~nclair Atlanta, Georgia
Ill. Dentists' Subcommittcc E)eWitt W~tlton,Il.I).S. C'liairnian Macon, (icorgia Mike Kennedy, I1.Il.S. Columbus, Gcorgia Theodore C. l,evita\. I>.11.W Atlanta, Georgia A.J. MeCaslin, D.D.S. Savannah, Georgia Walker Moore, 1I.U.S. Atlanta, Georgia
IV. Durable Medical Equipment. Orthotics, & Prosthetics Subcommittee
H.G. Bowden, Chairman Warm Springs, Georgia
Allen Coleman Doraville, Georgia
Dean Cox Cartersville, (korgia

V . I Io~ilcI. l c . : ~ l r l ~Sr~hco~ii~iiittc-c ( ' l i : ~lc~.5 K . I lc.rhl ('olri~l~ht~(ixco. spi;~ l " i l c ~ ~l fiI i ~ t + ~ i .Icsi,~p(. ieorgii~ 1)arlclic ('ox I3a i 11hritlge, (;cot.gia ( ; l a d y Mc('lclla ncl Wavcl.oss, C icorgi;~
V I . I l o ~ p i t i S~tllhcomliiittcc 1q;rncst Ifacon, ('hail.man all ant:^. (icorgia ]'wing S. I ~ I - n c l t Ncwliali, (icorgia (ilcnti .I. Iflack Mal-ictl;~.( ;corgia <'lrz1rlcs I .. I.'ostcr, .lr. I .:~(;r;~ngc(,icorgia ('liarlcs I I , Wilson, .lr. A ! ~ ; I I ~ ~(i;c- oI ,rgi:~
I . Nursing llomc S~~bco~iirnittcc Ilugcl~cM . Ifisllop. ('ha irinao IXoswcll, (ieolpia 'l'om I.'. S:~tte~~l~ietci Atlanta, (;cot-gia l:d I . Stcpllcns ('leveland, (icorgin
My1 tlc Vickcrs t )ougla\, C icorgia
.lariles K . Wcstbury .Icn k i n d - ~ ~ r(gic,orgiri

VII I.

Optonlctric Subcommittee I<obcrl 1.1. 'l'hurniond. O.D.,Chairman
I'nst I'oint, Georgia .lot 11. I k w , 0.11.
I )allon, Ciuorgi:~ l<arlW. I .usk, 0 . 1 ) .
I );I It o n , (icorgia Alan V. Wcxlcr, 0.I).
Savannah, (;col.gi;~ I.ovick 11. WiI~iam?;on0,. 1 ) .
Quit man, (icoi-gia

I X. I'lial-macy Subconimiltcc I .arry .I. 1':1rrisli, li. 1'11.. Chairman Swainsbor-o, (icorgia W . 0 . I3illlai.d, It.1'11. IT.itstPoint, (;eor.gi:~ ore11 I I. I l;ll-cicll, .Is., l<.l>tl. Sylvcstcr, (;col-gin I. I'ctcr Mills, .lr., K.1'11. Millcn, (icorgia Wa.It.olaccccoa(;,.(Wicohri-tgein:~, li.I'h.

X . I'sysicia 11s'Suhcommittcc I'tlg;~rA. 1'1-octor,('hairm;~n Atlant:~,(icorgia M . I)anicl I3ysd. M.1). Atl;inta, (;col-gi:i (;;11.11ctAt . lyistic~I)~.(,). N 01-cross,(icoi-gia Wcslcy S. Wil horn, M . I 1. Atl~111ti(1;.co~-gi;t

N I . I'aychologists' S t i h c o ~ ~ i ~ i ~ i l t c c
I l11gIlC'li~~isticI',ll. I )., ('I~;I~I.I~I:III (;sif!'in. (;~orgiii
.lo1111Atlarils, l'h. I). St;~tcsboi.o(, icol-gia
(icoi.gc Anderson, I'll.! 1. I )t~.blia(,icorgi;~
l < o ~ i ; ~.jl. ~I3l c1~li1lt'..li. I ). At I;I.II~:I, (;eo~.gi:~
lil~ccl1 I tll'l', I'll. I 1. Mal.ic1t;i. (iet,rgi:~

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 t o 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.

STATE OF GEORGIA D E P A ~ T M E R TOF MEDICAL ASSISTANCE 2 MARTIN LL'THEH KING, JR., DRIVE S.E.
ATLANTA, GEORGIA 30334