Annual report, 1988

GEORGIA
DEPARTMENT OF MEDICAL ASSISTANCE
Annual Report 1988
Aaron J. Johnson Commissioner

Aaron J. Johnson Commissioner

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

The Honorable J o e Frank H a r r i s Governor of Georgia
Members of t h e General Assembly of Georgia Citizens of t h e S t a t e of Georgia
Ladies and Gentlemen:
I am s u b m i t t i n g f o r y o u r r e v i e w t h e A n n u a l R e p o r t o f t h e D e p a r t m e n t of Medical Assistance. This report summarizes agency a c t i v i t y through t h e f i s c a l y e a r e n d i n g J u n e 3 0 , 1988. D u r i n g t h i s y e a r we made h e a l t h c a r e a r e a l i t y f o r more t h a n one-half m i l l i o n c i t i z e n s .
I w i s h t o e x p r e s s my a p p r e c i a t i o n , a n d t h a t o f my s t a f f , f o r y o u r support and assistance.

An Equal Opportunity Employer

TABLE OF CONTENTS
Abstract .................................................................... 1 Board of Medical Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Organizationchart ...........................................................3 Highlights of the Year .........................................................4 Tablesandcharts ............................................................13
A History of Medicaid Benefits Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Where the Medicaid Dollar Comes From ...................................... 16 Where the Medicaid Dollar Goes ............................................17 FY88 Benefits Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 FY88 Administrative Expenditures ........................................... 19 Collections and Measurable Cost Avoidance. FY85-FY88 . . . . . . . . . . . . . . . . . . . . . . . . 20 Payments and Recipients by Aid Category. Sex. Race. and Age Group .............. 21 Recipients by Aid Category by Type of Service. FY88 . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Benefits Paid by Aid Category by Type of Service. FY88 . . . . . . . . . . . . . . . . . . . . . . . . . 23
Percentage of Expenditures. Percentage of Recipients and Average Yearly Payment
per Recipient by Aid Category. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Number of Visits for Selected Types of Service and Number of Prescriptions by Aid
Category. FY88 ........................................................24 Payments for Services per Recipient per Year. FY85-FY88 ........................ 25 Percentage of Total Recipients Utilizing Each Service for Fiscal Years 1985-1988 . . . . . . 26 Claim Documents Processed by Category of Service. FY88 . . . . . . . . . . . . . . . . . . . . . . . 27 Providers with Paid Claims during FY85-FY88 by Type of Service . . . . . . . . . . . . . . . . . 28 Comparison of Eligibles. Expenditures. and Expenditures per Eligible. FY85-FY88 . . . . 29 Analysis of Recipients and Expenditures by County of Residence . . . . . . . . . . . . . . . . . . . 30 Department of Medical Assistance Advisory Committee .......................... 34

ABSTRACT OF FISCAL YEAR 1988 ANNUAL REPORT
Georgia Department of Medical Assistance
Expenditures Benefits Medicare Premiums Administration
Number of Medicaid claim details processed* Enrolled Providers (as of June 30, 1988) Average number of monthly eligibles Unduplicated count of recipients served annually Average yearly expenditure per recipient

Who is Eligible
I. Categorically Needy (Cash Assistance) A. Aid to Families with Dependent Children (AFDC) Households with dependent children deprived of support due to death, absence or incapacity of one or both parents. B. Supplemental Security Income (SSI) Recipients Aged, blind or disabled.
11. Categorically Needy (No Cash Assistance) A. Families with Dependent Children Pregnant women who would be eligible for AFDC if their children were born and living with the mothers; pregnant women in intact families (including unemployed parent households); children under age 18 in deprived or intact households; foster care and "special needs" (adoption supplement) children; families who are no longer receiving cash assistance due to increased earnings or loss of certain work related deductions. B. Aged, Blind or Disabled Eligible for SSI except for income, institutionalization, or in community care. Any income in excess of a small allowance is applied to the cost of care.
111. Medically Needy Pregnant women in deprived or intact households and children in deprived or intact households. All must meet the same qualifications as the categorically needy, except for income or resources. Income in excess of 133 1/3% of the AFDC standard is applied to the cost of care.

Covered Services
Inpatient and Outpatient Hospital Services
Physician Services Skilled Nursing Facility Intermediate Care Facility Intermediate Care for Men-
tally Retarded Facility Prescribed Drugs Laboratory and Radiological
Services Home Health Services Family Planning Services Early and Periodic Screening,
Diagnosis and Treatment (under age 21) Ambulance and Non-Emergency Transportation Mental Health Clinic Rural Health Clinic Dental Services Durable Medical Equipment Orthotics and Prosthetics Community Care Optometry Services Podiatry Services Psychological Services Nurse Midwife Services Ambulatory Surgical Services

*NOTE: Starting with this FY, claim detailsprocessed instead of claims paid are acc:urndated for the entire fiscal year.

BOARD OF MEDICAL ASSISTANCE
As of June 30,1988
The Board of Medical Assistance is the policy-making authority for the Georgia Department of Medical Assistance. The Board is composed of five persons appointed by the Governor and confirmed by the Senate for four year terms of office. Board meetings are held monthly.

MEMBERS
Ms. Ann McKee Parker, Chairperson Atlanta, Georgia
Joseph H. Patterson, M.D., Secretary Atlanta, Georgia
Ms. Beauty Baldwin Lawrenceville, Georgia
Mr. Richard T. deMayo Atlanta, Georgia
Mr. Charles H. Wilson Atlanta, Georgia

TERM OF OFFICE Through June 30, 1992 Through June 30, 1992 Through June 30, 1989 Through June 30, 1991 Through June 30, 1990

Department of Medical Assistance Organization Chart Effective July 1, 1988
Board of Medical Assistance

Advisory Committee

Commissioner

Deputy Commissioner

I

-

Assistant

Commissioner

I

Office of Alternative

Delivery Services

I
Office of Contract
Administration

Office of Special -- Assistant to the

Services

Commissioner

Program Management

Program Integrity

Systems Management

Administration

HIGHLIGHTS OF THE YEAR
During State Fiscal Year 1988 (July 1, 1987, to June 30, 1988), over $1 billion was paid by the Department for medical care for 520,983 recipients. The cost of administration of the program remained low - only 3.6 percent of the total Medicaid budget.
In the following summary we have included highlights of major Fiscal Year 1988 (FY88) activities within the Department.
PROGRAM MANAGEMENT
The Division of Program Management develops and implements reimbursement, coverage and other policies based on federal laws and regulations, state laws, and directives of the Board of Medical Assistance. The Division also conducts training for providers in program service areas. Effective July 1, 1987, the Division assumed direct responsibility for the claims inquiry function. Nursing Home Services
During FY88 the Department reimbursed 332 providers for 9,982,226 days of nursing home care for 38,829 recipients of service.
1. Audits Pursuant to its contract with the Department, the State Department of Audits performed on-site audits of the 1986 cost reports for 92 nursing facilities during FY88. Including some FY86 reports audited in FY87,50 percent of all 1986 cost reports were audited. Approximately 122 of the 1987 cost reports were audited during FY88, with a goal of completing as many as 30 additional facility audits during FY89. The total of 152 audits will represent approximately 46 percent of the facilities with FY87 cost reports. As a result of the audits, the Department saved an estimated $6,876,000.
Reimbursement Rates A change to the 1987 cost report and application of an additional skilled care allowance resulted in an average rate increase of 8.1 percent. a) Cost Report
The 1986 cost report was used to set rates for nursing homes from April 1, 1987, through March 31, 1988. For the period beginning April 1, 1988, the basis for nursing home rates was changed to the 1987 cost report with a base growth allowance of seven percent for all facilities. b) Additional Care Effective April 1, 1988, intermingled facilities which maintained an average skilled care Medicaid occupancy level of 25 percent or greater during the same reporting period received a two percent intensity allowance in rate calculations. Facilities with a 15-24 percent skilled Medicaid occupancy continued to receive a one percent allowance. All skilled facilities received a two percent intensity allowance. The one or two percent intensity allowance was added to cover the cost of oxygen, catheters, parenteral supplies and other special supplies associated with an increasingly disabled patient case mix.

3. On-Site Reviews Pursuant to its contract with the Department, the Georgia Medical Care Foundation (GMCF) completed 819 on-site reviews and 64,958 recipient reviews of care in nursing facilities during FY88. This represented an increase of 6,590 recipient reviews. A total of 27,798 pre-admission certifications of level of care were completed during FY88. This represented an increase of 6,907 preadmission certifications of level of care. The increase in pre-certifications was possible, in part, because of a new computer-assisted process. The new computer enables the GMCF to retrieve records much faster than the old manual process. This system also provides more accurate statistical data for review and comparison.
4. Patient Care In order to ensure quality patient care the Department increased the number of "Special Review" teams at the GMCF from two to three in FY88. Each team consists of a registered nurse, social worker and a physician as team leader. These on-site review teams perform follow-up reviews of facilities that have been cited for significant non-compliance by the regular review teams or by other agencies or parties. During FY88, the Board of Medical Assistance authorized the creation of a study committee to review the current Medicaid nursing home reimbursement methodology. The committee is charged with recommending to the Board a reimbursement methodology for patient needs. It is anticipated that implementation of a new system could occur in state fiscal year 1991.
Hospital and Hospice Services
The Department reimbursed 362providers for 608,782days of inpatient hospital care for 98,198 admissions during FY88. This represented an increase of 63,015 days and 3,401 admissions.
1. Staff Claim Review Staff review of claims for mandatory outpatient surgical procedures resulted in $70,988 in savings. Staff review of out-of-state payments resulted in a savings of $845,750. Review of outpatient claims with charges greater than $5,000 resulted in savings of $26,321.
2. Rate Determination Effective January 1, 1988, each hospital's fiscal period 1986 cost report was used to determine its base period cost per case.
3. Outliers Hospitals were paid $3,138,403 in FY88 for inpatient claims with unusually high charges ("outliers").
4. Hospice Services The Department completed all of the prelimary tasks in FY88 to begin coverage of hospice services on July 1, 1988. Reimbursement for hospice services is generally the same as that under the Medicare program.
5. Claims Inquiry The Hospital and Hospice Inquiry Unit received and responded to 24,675 telephone and written inquiries during FY88.

Individual Practitioners Services
1. Rate Increase Effective January 1, 1988, reimbursement rates for services provided by individual practitioners were increased to provide more reasonable and equitable reimbursement. Physician, optometrist, podiatrist and nurse midwife rates were increased to the 50th percentile of submitted charges. Psychology rates increased by eight percent.
2. Independent Laboratory Program Anatomical pathology rates were increased to the 50th percentile of submitted charges. Clinical laboratory rates were adjusted effective April 1, 1988.
3. Billing Patterns Ninety-seven individual practitioners were referred to the Surveillance and Utilization Review Section because of aberrant billing patterns. Refunds of $135,211 were associated with these referrals.
4. Provider Training Eighteen formal policy workshops were held for individual practitioners and their billing staff. Four hundred. and seventy-four participants attended. Additional assistance in resolving claims payment problems was provided to physicians and other providers statewide.
5. Multiple Surgery and Podiatry Review Prepayment review of multiple surgery and podiatry claims resulted in estimated savings of $1,370,375.
6. Other Prior Approval and Prepayment Review In FY88 the Department saved approximately $2,879,973 through its review of certain medical surgical procedures prior to the surgery and through review of sterilizations and hysterectomies and other procedures prior to payment.
7. Ambulatory Surgical Centers Effective October 1, 1987, the Department enrolled freestanding ambulatory surgical centers. This program was implemented to provide a lower cost option to inpatient surgery for procedures which can be performed safely in an outpatient setting.
8. Claims Inquiry The Individual Practioners Inquiry Unit received and responded to 41,886 telephone and written inquiries during FY88
Ancillary Services
1. Pharmacy Services The Department paid 1,838 providers for 7,144,834 prescriptions for 405,612 recipients during FY88. Maximum Allowable Cost (MAC) limits were placed on 30 highly utilized generic drugs in 1988, producing estimated savings of approximately $600,000 for the fiscal year. Of the 37,912 drugs on the Medicaid formulary, 21,432 had either a state or federal maximum allowable cost limitation as of June 30, 1988. There were approximately 16,800 requests for exceptions to the monthly six prescription limit; approximately 86 percent of these were approved.
2. Dental Services During FY88 payments were made to approximately 1,165providers for 169,410 recipients of dental care, about 50 percent of whom were children. Effective

July 1, 1987, the Department expanded the adult dental services program to include all dental services covered for children except hospital time, space maintainers and fluoride treatment. Effective January 1, 1988, reimbursement rates were increased by eight percent to provide more reasonable and equitable reimbursement. Pre-treatment review by dental consultants resulted in a savings of over $2,400,000 during FY88.
3. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) The EPSDT program provides periodic examinations and treatment of identified problems in children and youth from birth through age 20. Over 125,000 complete screens were performed in FY88, a n increase of more than 18 percent compared to FY87. On January 1, 1988 the base reimbursement rate for a complete EPSDT screen was increased seven percent. In addition, the number of screens covered per child was increased from 14 to 20 on January 1. In the fall of 1987the Department began sending letters to all children eligible for Medicaid to inform them and their parents about EPSDT and dental services. Each child now receives a letter when he or she is due for a screen examination and an annual reminder about EPSDT.
4. Durable Medical Equipment The Department reimbursed 336 providers for 24,497 recipients of durable medical equipment items during FY88. The Department saved approximately $798,352 as a result of its prior approval review process, a 17 percent annual increase from FY87. On January 1, 1988, base reimbursement rates for all items except for oxygen concentrators were increased eight percent.
5. Orthotics and Prosthetics The Department reimbursed 123 providers for 6,443 recipients for orthotic and prosthetic devices. About 55% of the funds were for adult hearing aid services, which began July 1, 1987. The Department saved an estimated $588,106 as a resulted of its prior approval process. On January 1, 1988, base reimbursement rates were increased eight percent, with the exception of the rate for hearing aids.
6. Claims Inquiry The Ancillary Services Inquiry Unit received and responded to over 33,000 telephone and written inquiries during FY88.
Community Care Program
1. Home Health Services During FY88 the Department paid 80 providers for 586,198 home health visits to 12,697recipients. Utilization review was conducted for 26 home health providers, resulting in recommendations that 141 patients be discharged from service because they did not meet the homebound status criteria for admission into and receipt of continued home health services. Effective January 1, 1988, each home health agency's cost per visit was based on the 1986 cost report.
2. Community Care Services The Department paid 306 providers for services to 9,079 community care recipients during FY88. The number of providers increased by 58, and the number of recipients increased by 2,361. The Department conducted utilization review for 114 community care providers. There were 34 alternative living, 12 adult day rehabilitation, 27 home delivered services, 10 respite, nine emergency response and 22 homemaker providers reviewed. A total of 2,982 clinical patients' records were reviewed and 215 recipients were recommended for discharge. As a result of provider noncompliance, the Department took steps to recover $18 1,803.

3. Non-Emergency Transportation (NET) During FY88, payments were made to 335 providers for services to 38,132 recipients for the NET program. The number of recipients increased by 9,202. Effective January 1,1988,rate increases went into effect, including an increase in the NET ambulance base rate from $45 to $55 for a one way trip and in mileage from $85 to $1.00.
4. Emergency Ambulance Services The Department paid 194 providers for services to 27,665 recipients. Effective January 1, 1988, emergency ambulance rates were increased, including a change in the one-way trip base rate from $75 to $90 and a change in the mileage rate from $2.00 to $3.00.
5. Case Management The Department implemented coverage of case management services effective October 1, 1987. The implementation of this program expanded community based services in certain targeted areas as an alternative to institutionalization for the chronically mentally ill. As funds become available, case management will be phased-in on a statewide basis. During FY88 approximately 400 recipients were served.
6. Waiverfor Services to the Mentally Retarded The Department was given approval for a Home and Community-Based Services Waiver for persons who are mentally retarded. This new program, to be implemented in 1989, will provide services designed to minimize institutionalization of the retarded.
7. Claims Inquiry The Community Care Program Inquiry Unit received and responded to 20,024 telephone and written inquiries during FY88.
PROGRAM INTEGRITY
The Division of Program Integrity is responsible for ensuring compliance with state and federal regulations. Division staff conduct on-site field reviews and investigations of providers and recipients, develop eligibility policy, identify program overpayments and conduct evaluative studies of service program areas.
Medicaid Eligibility and Quality Control
1. Quality Control Unit a) Monitoring Eligibility Determination The Quality Control Unit is responsible for monitoring Medicaid eligibility determinations performed by the Department of Human Resources (DHR). During FY88, the eligibility status of approximately 1,800 Medicaid cases was reviewed. As errors were detected, referrals were made to DHR for corrective action. The Department and DHR conducted an in-depth analysis of error trends and developed an extensive Corrective Action Plan addressing error conditions and implementing measures to correct errors in the eligibility determination process.
b) Corrective Action Strategy The Department conducted approximately 850 Case Action Record Reviews as part of the Department's strategy to reduce errors occurring in the eligibility process. This represented an increase of 450 reviews. Through this review process deficiencies are identified much sooner, allowing the deficiencies to be corrected before possible selection in a Quality Control sample.

2. Eligibility Policy Unit
The Medicaid Eligibility Unit is responsible for making or recommending to the Department's Board certain state Medicaid eligibility policy decisions and developing eligibility policies for implementation by DHR. Activities during FY88 included:
a) Coverage of Disabled Widows and Widowers The Department extended the disabled widows and widowers coverage for individuals whose Supplemental Security Income benefits were terminated due to an increase in their Social Security widow(er) benefits after December 1983.This coverage was available only to individuals who applied before July 1, 1988.
b) Coverage for Disabled Adult Children Beginning July 1,1987,the Department began covering individuals who lost their SSI benefits due to an increase in or entitlement to Social Security disabled adult child benefits on or after July 1, 1987.
c) Increase in Medicaid "Cap" The Department increased its maximum allowable monthly income "cap" for eligibility of nursing home and community care recipients from a net figure of $937 to $977 in January 1988. In May 1988, The Board approved a further adjustment to $1,035, effective July 1, 1988.
Investigations and Compliance
The Investigations and Compliance Section (I&C) is responsible for the investigation of provider fraud in the Georgia Medicaid program. This Section also initiates appropriate action against providers who fail to comply with Medicaid policies. As a part of this work, the I&C Section enforces Title VI and Section 504 requirements through on-site reviews and questionnaires.
In FY88, I&C's investigative efforts led to the conviction of three providers and one recipient. The Section identified $161,693 in overpayments to providers and $35,838 that providers were required to refund to recipients. Judicial fines and penalties of $7,400 were assessed against Medicaid providers. In addition, I&C terminated or suspended 28 providers from the Medicaid program. Four of these adverse actions were taken in concert with the action of the Secretary of State or the Secretary of Health and Human Services.
Surveillance and Utilization Review
The Surveillance and Utilization Review (SUR) Section is responsible for:
providing safeguards against unnecessary or inappropriate use of Medicaid services and against excessive payments;
assessing the quality of services provided to Medicaid recipients; and
controlling the utilization of services in both institutional and ambulatory settings.
The Section's reviews are prompted by automated exception reports generated as a subset of the Medicaid Management Information System (MMIS). SUR also responds to external complaints or Departmental concerns about provider and recipient abuse.
In FY88 SUR completed over 300 provider audits, identifying $1,663,287 in funds to be paid back to Medicaid. Over 350 recipients were reviewed, prompting several fraud cases and identifying over 15 recipients to be placed on the Department's "lock-in" program.

The SUR section monitors all enrolled hospitals' compliance with federal and state requirements for utilization control through a structured delegated hospital review program. One hundred and sixty-two hospitals perform reviews for the Department and nine hospitals have 100% of their claims reviewed retrospectively by SUR staff.
The Section has entered into an agreement with the Department of Human Resources to assist in the identification of abused children and battered persons. Quarterly, SUR structures special profiles to identify possible abuse victims and provides this information to the DHR Division of Family and Children Services to enhance their review of possible abuse.
Third Party Liability
The Third Party Liability (TPL) Section is responsible for identifying coverage for medical care through insurance or other liability sources in order to ensure that Medicaid is the payor of last resort. The Third Party Liability Section in FY88 administered the cost avoidance program, saving the State a total of $309,969,835, including amounts paid by Medicare. The Section also manages a direct recovery program which resulted in total recoveries of $5,758,025.
1. Health Insurance Unit This Unit is responsible for developing leads about insurance coverage. Through June 30, 1988, 58,866 Medicaid recipients had been identified as having third party resources for medical care. Once resources are verified and added to the TPL data base, claims payment is deferred until a claim is made against the private insurance coverage. Use of this process allows Medicaid to avoid paying claims until all other resources are exhausted. During FY88 more than $309 million was cost avoided. Further, $3,424,060 was recovered for claims paid prior to the Department's knowledge that private insurance or Veteran's Administration coverage was available. Finally, $1,982,554 was recovered through providers' forwarding of insurance payments received after Medicaid payments had been made.
2. Casualty and Liability Unit The Casualty and Liability Unit investigates and develops cases involving accidental injuries which result from negligence and for which a third party may be liable. Through questionnaires sent each month to all recipients with trauma-related diagnoses and contact with insurance carriers and attorneys, the Unit identifies and collects monies which had been paid by Medicaid for accident-related medical services. In FY88, this Unit developed cases resulting in direct recovery of $497,894. An additional $61,272 was collected from providers through "recoupment" against later Medicaid payments.
3. Field Review Unit The Field Review Unit identifies overpayments and new TPL resources. This activity leads to recoveries and avoidance of unnecessary payments and insures regulatory compliance. The Unit conducts on-site provider audits and assists caseworkers in the DHR Division of Family and Children Services by providing ongoing training and technical assistance relating to TPL policies. The staff serves as a liaison between the other units in the TPL Section and the provider community, insurance industry and recipients. During FY88 the Field Review staff conducted 55 provider audits and 30 county DFCS reviews. Direct recoveries of $125,400 from providers and $19,650 from recipients were attributed to Field Review activities.

Program Evaluation
The Program Evaluation Section conducts statistical analyses on the effects of Medicaid policy changes, develops cost and serviceprojections, monitors routine reports for accuracy and edits the AnnualReport. In FY88 Program Evaluation's major projects included an analysis of the impact of Federal Medicare catastrophic legislation on the Medicaid program, an estimate of potential savings through limiting reimbursement rates in the pharmacy program, an analysis of sterlization and abortion reporting, estimates of the number of children and pregnant women covered up to 100 percent of the poverty level, revisions to home health rates, projections for a home and community based care waiver program for the mentally retarded and coordination of Federal Systems Performance Review for the Management and Administrative Reporting System.
ADMINISTRATION
The Division of Administration performs those functions necessary to support the day-to-day operation of the Department, including financial services, personnel, purchasing and support services.
Financial Services
Financial Services provides financial management of appropriated Department funds. This unit consists of three sections: Budget, Accounting and Benefits Recovery. The Budget Section prepares the Department's budget requests, both at the State and Federal levels and is responsible for coordinating Federal and State funds. In FY88, Financial Services was responsible for expenditures in excess of $1.1 billion.
The Accounting Section maintains the financial records in a manner conducive to auditing and prepares all financial reports associated with expenditures. Due mainly to stringent State Audit Department requirements, the Department of Medical Assistance has one of the most detailed and complex Medicaid accounting systems in the country.
In FY88 the Accounting Section implemented an Electronic Funds Transfer pilot project for hospital providers. Electronic transfer of Medicaid payments directly to a provider's account reduces waiting time for funds and reduces the number of lost and misposted checks. The program was a success and will be made available to other provider groups in the near future.
The Benefits Recovery Section is responsible for the collection of and proper accounting for all recoveries of misspent medical assistance funds. Among the major sources of this recovery are collections of overpayments resulting from system malfunctions, provider billing errors, third party monies received by the provider after Medicaid reimbursement, and funds received directly from third party carriers, providers, and recipients. Collections through voluntary refunds and accounts receivable totaled $15,806,098 during FY88. An automated program was developed to assist in balancing refunds received against refunds applied to the claims history file. This resulted in enhanced accountability for funds received.
SPECIAL SERVICES
The Office of Special Services is responsible for coordinating all mandated provider, recipient, and applicant hearings for the Department. Such hearings permit the Department to resolve legal disputes with providers without resort to the court system.
During FY88, the Department experienced an unprecedented volume of provider, applicant and recipient hearing requests. The Office handled 56 provider cases during the fiscal year pertaining to Department actions in establishing reimbursement rates,

recovering overpayments and sanctioning and terminating providers. The Office also was responsible for overseeing the appeals process involved in deciding more than 2,600 applicant and recipient hearings. The most significant change implemented by the Office in FY88 was a revision of the state law to unify and simplify the appeals processes for both groups.
ALTERNATIVE DELIVERY SYSTEMS
The Office of Alternative Delivery Systems was established to research and develop cost effective alternative health care delivery systems for the Georgia Medicaid program. During FY88 the Office developed a program that would allow Medicaid recipients the choice of receiving their health care through the usual fee-for-service providers or through Health Maintenance Organizations (HMO) under contract with the Department. The initiation of the prepaid program in Cobb, DeKalb and Fulton counties was postponed in June due to uncertainty over the Atlanta HMO market.
CONTRACT ADMINISTRATION
The Contract Administration Office is responsible for developing Advance Planning Documents for federal funding, requests for proposals and contracts and for conducting related monitoring activities. The Unit conducts ongoing system performance reviews for the Medicaid Management Information System (MMIS) contractor and the Department to ensure compliance with legal, financial and performance standards. It is responsible for all State Plan activities, for the departmental library, and for federal regulations and compliance issues. Staff are located both at the Department's offices and at the fiscal agent's office.
SYSTEMS MANAGEMENT
The Systems Management Division coordinates all data processing services and related activities for the Department. Effective July 1, 1987, the Department's fiscal agent for data processing was E.D.S. Federal Corporation. Also, the Division was reorganized to include two sections: Systems Operations and Systems Maintenance. During the year, the MMIS passed the annual Federal Systems Performance Review.
Systems Operations
The Systems Operations Section is responsible for coordinating all system computer hardware requirements, monitoring the resolution of any systems hardware problems, controlling system access security, maintaining the recipient eligibility data base and coordinating recipient eligibility and nursing home claim inquiries.
System Maintenance
The Systems Maintenance Section staff serve as analysts and liaison between all departmental MMIS users and the contracted fiscal agent. The staff coordinate the definition and submission of all problems with system performance and the requirements definition for any desired system changes. This includes thorough review of fiscal agent-prepared system test results before authorizing implementation of corrections of problem or system changes. The Section is also responsible for submitting test claims on a weekly basis to verify the accuracy of the System.

TABLES AND
CHARTS

Fiscal Year

A HISTORY OF MEDICAID BENEFITS EXPENDITURESa

Cash Benefits Payments b

Percentage Change

Payments By Date of Service

Percentage Change

$308,142,782

-

$338,228,610

10%

$377,658,055

12%

$444,155,517

18%

$536,560,178

21%

$545,307,185

2%

$608,309,046

12%

$649,043,985

7%

$7 17,861,935

11%

$795,950,535

11%

$909,883,869

14%

$1,073,152,160 (est.) 18%

a The figures on this table include Medicare copaymets and deductibles but exclude Medicare premium payments. Paid during each fiscal year. In this Annual Report all "expenditures," "benefits" or "payments" are cash benefits payments, with the exception of "payments by date of service" above (fourth column). Expenditures for servicesprovided during each fiscal year. Since FY77, based on a State Attorney General's ruling, payments have been made from the budget for the same year in which the Medicaid service was rendered. Final expenditure amounts are not known until some time after a fiscal year has ended, since providers have six months from the date of service to file a claim. Date of service figures are expenditures as of June 30, 1988,for FY77-FY87; FY88 is an estimate. Note that the figures for fiscal years before 1987 were revised in 1987 to exclude Medicare premium payments.

. WHERE THE MEDICAID DOLLAR COMES FROM..
Georgia's Medicaid program receives different levels of federal reimbursement for different types of activity. Reimbursement levels for benefits, family planning, the Medicaid Management Information System (MMIS) and for administration of the program are determined each fiscal year by the federal government.

Most Benefits

Medicaid Management Information System & Systems Management Division

FEDERAL FUNDS
Family Planning Benefits
Medical Assistance Only Medicare Premiums

FEDERAL FUNDS
Most Other Administration
STATE FEDERAL FUNDS FUNDS
Total Benefits, Premiums and Administration

Sources of Medicaid Benefits Revenue FY 88
Federal Funds State Funds Total Revenue

. WHERE THE MEDICAID DOLLAR GOES
BENEFITS ADMINISTRATION
$40,503,035
TOTAL EXPENDITURE

FY 88 BENEFITS EXPENDITURES

Category of Service

Amount

Percent of Payments By Service

Skilled Nursing Facilities Intermediate Care-Mentally Retarded Intermediate Care-Other Inpatient Hospital Outpatient Hospital Prescribed Drugs Physicians Dental Other Care
Ambulance Durable Medical Equipment Non-Emergency Transportation Orthotics/Prosthetics Speech Therapy (Medicare only) Physical Therapy (Medicare only) Rehab. Therapy (Medicare only) Optometric-eyeglasses Ambulatory Surgical Mental Health Clinic Family Planning Other Practitioners Chiropractors (Medicare Only) Nurse Midwives Optometrists Podiatrists Psychologists Community Health Services Home Health Community Care Laboratory/Radiology Rural Health Clinics Early and Periodic Screening, Diagnosis and Treatment
--
TOTAL EXPENDITURES

$ 86,825,912 81,731,383 177,963,624 258,681,418 63,873,158 117,766,562 108,434,441 4 1,679,499
2,432,073 6,395,261 5,853,198 3,269,665
15,688 66,833 1,112,226 918,399 35,636 17,637,935 5,423,281
5,982 658,959 2,820,5 13 1,465,160 1,059,675
25,197,266 2 1,663,676
1,660,698 324,721
4,119,279
-
$1,039,092,121

NOTE: Benefit expenditures (by date of payment) are as reported in the SFY88 Annual Statistical Report on Medical Care ("HCFA 2082") and estimated from the SFY88 Medical Expenditures by Recipient County of Residence. "Total Expenditures" includes copayments and deductibles for persons eligible for Medicare and Medicaid, but not Medicare premiums.
In order to enroll into the Medicare program those who are eligible for both Medicare and Medicaid, the State pays the Medicare premiums for those individuals. The State is required to pay the total Medicare premium for a Medicare-Medicaid eligible who lives in an institution and has an income above the SSI Standard. The State paid $6,465,307for these "100% state funds" premiums in FY88. For all other Medicare-Medicaid individuals, the State receives federal reimbursement at the same rate as for most benefits (an average of 64.42% in SFY88). The total state and federal funds paid for these "usual federal match" premiums was $24,802,459in FY88. Thus, total Medicare premium payments were $31,267,766.

FY88 ADMINISTRATIVE EXPENDITURES

Administrative Function
Fiscal Agent Computer Services Department of Human Resources
Interagency Contract *
Systems Management Division Administration Division Program Management Division Program Integrity Division Ga. Medical Care
Foundation Contract Commissioner's Office
TOTAL

Expenditures Percent of Total

$40,503,035

100.0%

* Federal funds only. State match funds appear in Department of Human Resources budget. Services provided
through this contract include eligibility determination, administration and case management for the community
care program, recipient appeal hearings, and certification of facilities for participation in Medicaid.

COLLECTIONS AND MEASURABLE COST AVOIDANCE
Collections Third Party Liability a Hospital Cost Settlement Other Collections Total Collections
Measurable Cost Avoidance
Nursing Home Audit Disallowance
Prior Approval and Prepayment or Pretreatment Review
Third Party Claim Cost Avoidance-Medicare
Third Party Claim Cost Avoidance-Other
Total Measurable Cost Avoidance
GRAND TOTAL
a Beginning in FY86 "voluntary recoveries" with third party liability are reported under "Third Party Liability" collections rather than "other" collections. Includes collections originating from Investigations and Compliance, Surveillance and Utilization Review, audits of providers other than nursing homes, special situation recovery efforts and voluntary refunds. Estimated from base year cost reports. The large increase in cost avoidance for FY88 is a result of increased savings through the adult dental program reviews and through out-of-state hospital reviews. Also, the results of two claim reviews not previously reported were added in FY88: review of hospital charges over $5,000 and prior approval of orthotics and prosthetics. Beginning in SFY88, Medicare Part A is included. Part A is $136,733,065 and Part B is $128,172,448.

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

PAYMENTS

RECIPIENTS

BY AID CATEGORY

BY SEX

BY RACE BY AGE GROUP

RECIPIENTS BY AID CATEGORY BY TYPE OF SERVICEa
FY 88

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

Age 65 or Over

Blind

Disabled

AFDC Adults

AFDC Children

Unduplicated Totals

TOTAL RECIPIENTS

86,935

2,878

106,78 1

107,207

217,182

520,983

a Source: Annual Statistical Report on Medical Care ("HCFA 2082" for SFY88). Medicare copayments and deductibles are included, but Medicare premiums are not. Aid category subtotals not available for "other" service types on the "HCFA 2082" report (see notes b and d below). There were 14,726 "medically needy" recipients included in the AFDC subtotals: 4,658 pregnant women ("AFDC Adults") and 10,068 children. bThe number of recipients served for "other practitioners": chiropractors (197), nurse midwives (1,139), optometrists (76,324), podiatrists (21,008), psycholgists (6,413). Source: Medical Expenditures by Recipient County of Residence. c This number includes home health (12,697) and community care (9,079). Source: Medical Expenditures by Recipient County of Residence. Previously, community care was included under "other care." dThe number of recipients served for "other care": ambulance (27,665), ambulatory surgical (177), durable medical equipment (24,497), non-emergency transportation (38,132), optometrics-eyeglasses (60,295), orthotics/prosthetics (6,443) and therapists (3,950). Source: Medical Expenditures by Recipient County of Residence. The total for "AFDC Children" includes 3,134 "Other Title XIX recipients" (AFDC foster care).

BENEFITS PAID BY AID CATEGORY BY TYPE OF SERVICEa
FY 88

Type of Medical Service

Age 65 or Over

Blind

Disabled

AFDC Adults

AFDC Children

Total Payment

Skilled Nursing Homes Intermediate Care-Other Intermediate Care for the
Mentally Retarded Inpatient Hospital Outpatient Hospital Physician Prescribed Drugs Dental Other Practitioners Mental Health Clinic Family Planning Community Health Services Laboratory/Radiology Early & Periodic Screening,
Diagnosis & Treatment Rural Health Clinic Other Care
TOTAL PAYMENTS

$320,240,905 $8,257,404 $413,953,939 $173,815,298

- -
$122,824,575 $1,039,092,121

a Source: Annual Statistical Report on Medical Care ("HCFA 2082") for SFY88.Medicare copayments and deductibles are included, but not Medicare premiums, which were $31,267,766in FY88. Aid category subtotals not available for "other" servicetypes on the "HCFA 2082" report (see notes b and d below). Payments of $18,731,338 made for "medically needy" recipients are included in the "AFDC" subtotals: $9,164,847 for pregnant women ("AFDC Adults") and $9,566,491 for children. Benefits expenditures for "other practitioners": chiropractors ($5,982), nurse midwives ($658,959), optometrists ($2,820,513), podiatrists ($1,465,160), and psychologists ($1,059,675). Source: Medical Expenditures by Recipient County of Residence, adjusted to sum precisely to "HCFA 2082" total. Home health ($25,197,100) and community care ($21,663,533). Source: Medical Expenditures by Recipient County of Residence, adjusted to sum precisely to "HCFA 2082" total. dBenefits expenditures for "other care": ambulance ($2,432,073), ambulatory surgical ($35,636), durable medical equipment ($6,395,261), non-emergency transportation ($5,853,198), optometric-eyeglasses ($918,399), orthotics/prosthetics ($3,269,665), and therapists ($1,194,748). Source: Medical Expenditures by Recipient County of Residence, adjusted to sum precisely to "HCFA 2082" total. The total for "AFDC children" includes $2,310,719 for "Other Title XIX" (AFDC foster care).

PERCENTAGE OF EXPENDITURES, PERCENTAGE OF RECIPIENTS AND AVERAGE YEARLY PAYMENT PER RECIPIENT BY AID CATEGORY, FY 88 a

Basis of Eligibility (Aid Category)
Aged Blind b Disabled AFDC Adults AFDC Children

Expenditures
$320,240,905 8,257,404
413,953,939 173,815,298 122,824,575

Percentage of Total
30.8% 0.8% 39.8% 16.7% 11.8%

Recipients
86,935 2,878 106,781 107,207 217,182

Percentage of Total
16.7% 0.6% 20.5% 20.6% 41.7%

Average Paid Per Recipient
$3,683.68 2,869.15 3,876.66 1,621.31
565.54

a Source: Tables "Recipients by Aid Category by Type of Service" and "Benefits Paid by Aid Category by Type of Service." b Most aged and a portion of the blind and disabled are covered by Medicare, so expenditures do not reflect the total cost of health care. Medicare coinsurance and deductibles are included.

NUMBER OF VISITS FOR SELECTED TYPES OF SERVICE AND NUMBER OF PRESCRIPTIONS BY AID CATEGORY
FOR FISCAL YEAR 1988

Type of Medical Service
Physician Visits Outpatient Hospital Visits Clinic Visits Home Health Visits Rural Health Clinic Visits Drug Prescriptions

Age 65 or Over
5,633 5 10
85,828 963,543
1,937 2,540,330

Blind
8,940 1,780 7,704 28,144
145 70,034

Disabled
427,195 97,48 1 1,753,206 1,029,803 4,954 2,901,224

AFDC Adults
341,612 110,346 98,443
5,689 3,724 898,458

Note: Source is Annual Statistical Report on Medical Care ("HCFA 2082") for SFY88.

AFDC Children
50 1,797 144,433 145,465
7,182 5,450 734,788

Unduplicated Totals
1,285,177 354,550
2,090,646 2,034,361
16,210 7,144,834

PAYMENTS FOR SERVICES PER RECIPIENT PER YEAR a FOR FISCAL YEARS 1985-1988

Type of Service

Average Payment Per Recipient

85

86

87

88

Nursing Home Intermediate Care-MR Intermediate Care-Other Skilled Care
Inpatient Hospital Community Health Services
Home Health Community Care Mental Health Clinic Physician Dental Drugs Other Care Ambulatory Surgical Ambulance Durable Medical Equipment Non-Emergency Transportation Optometrics-eyeglasses Orthotics/Prosthetics Speech, Phys., Rehab. Therapy Outpatient Hospital Family Planning Other Practitioners Chiropractor Nurse Midwife Optometrist Podiatrist Psychologist Laboratory/Radiology Rural Health Clinic Early & Periodic Screening, Diagnosis and Treatment

Average Payment Per Recipient

for All Services

$ 1,526.48

Annual Percent change

8.50%

$ 1,652.82 8.28%

$ 1,799.89 8.90%

$ 1,994.48 10.81%

a Source: Tables "Recipients by Aid Category by Type of Service" and "Benefits Paid by Aid Category by Type of Service" and previous Annual Reports. Payments and recipients include Medicare copayments and deductibles.
b FY85-FY87 figures reflect changes in reporting in FY88. All therapy categories are now included in "other care." Community Care is now within "Community Health Services." Ambulatory Surgical Services were first provided in FY88. Eyeglasses are now reported separately. The definition of "family planning" was changed in FY88, causing the average to decline.
75

PERCENTAGE OF TOTAL RECIPIENTS UTILIZING EACH SERVICE FOR FISCAL YEARS 1985-1988 a

Type of Service

FY85

FY86

FY87

FY 88

Prescribed Drugs Physician Outpatient Hospital Inpatient Hospital Dental Early & Periodic Screening,
Diagnosis & Treatment Other Care
Ambulatory Surgical Ambulance Durable Medical Equipment Non-Emergency Transportation Optometrics-eyeglasses Orthotics and Prosthetics Speech, Phys., Rehab. Therapy Other Practitioners Chiropractor Nurse Midwife Optometrist Podiatrist Psychologist Family Planning Laboratory and X-Ray Intermediate Care Nursing Facility-Other Mental Health Clinic Skilled Nursing Facility Community Health Services Home Health Community Care Intermediate Care Facility-MR Rural Health
a Source: Table "Recipients by Aid Category by Type of Service" from current and previous Annual Reports. Eyeglasses have been estimated for FY85-87 based on percent of total optometrics with eyeglasses in FY88.

CLAIM DOCUMENTS PROCESSED BY CATEGORY OF SERVICE FY 88 a

Category of Service
Prescribed Drugs Physician Outpatient Hospital Inpatient Hospital Dental Early & Periodic Screening, Diagnosis and Treatment Other Care Ambulatory Surgical Ambulance Durable Medical Equipment Non-Emergency Transportation Orthotics and Prosthetics Other Practitioners Nurse Midwife Optometrist Podiatrist Psychologist Family Planning Laboratory and X-Ray Intermediate Care Nursing
Facility-Other Mental Health Clinic Skilled Nursing Facility Community Health Services
Home Health Community Care Intermediate Care Facility-MR Rural Health Other Medicare Co-insurance and Deductible
TOTAL CLAIM DOCUMENTS

Number of Documents Processed
15,950,139

Percent 100.00%

a Source is Operational Performance Summary Report except for Ambulatory Surgical (Provider Reimbursement Report) and Medicare Coinsurance and deductible (Claims Processing Performance).
The number of claim documents, rather than details ("line items") are reported by category of service starting in FY88. Also, Medicare coinsurance and deductible documents are reported separately. The net effect is to lower the number of "claims" reported, compared to previous years. The total number of claim details processed in FY88 was 18,226,976, an increase of eight percent over total details processed in SFY87.

PROVIDERS WITH PAID CLAIMS a
DURING N85-FY88 BY TYPE OF SERVICE

Type of Service

FY85

Skilled Nursing Homes Intermediate Care-Other Intermediate Care for
Mentally Retarded Inpatient Hospital b Outpatient Hospital b Physician b Prescribed Drugs Child Dental Adult Dental Other Practitioners
Nurse Midwives Optometrists b Podiatrists b Psychologists b Mental Health Clinic Family Planning Home Health Community Care Independent Laboratory and X-ray b Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Rural Health Clinic Other Care Ambulatory Surgical Durable Medical Equipment b Orthotics/Prosthetics b Ambulance Non-Emergency Transportation

282 307
11 218 214 6,799 1,660 959 740
5 308 107 128 110 24 74 73
56 226 24
255
66 178 269

Number of Providers

FY86

N87

N88

a The number of providers with paid claims can be considerably less than the number of providers "enrolled." For example, the number of providers enrolled for inpatient hospital during FY88 was 1,545; for intermediate care nursing home, 311; for pharmacy, 2,063; for physicians, 16,212;and for child dental, 1,878.The total number of providers enrolled at the end of FY88 was 27,967.Out-of-state providers are included for all years. Source: Provider Participation Analysis and manual enrollment records.
b The method for counting providers with paid claims was changed during FY88: claims for Medicare coinsurance and deductible and for adjustments are now excluded. The FY87 figures shown are based on "last year" figures from the FY88 report. FY85 and FY86 figures have been estimated for all categories of service where FY87 figures were different using the new method.
28

COMPARISON OF ELIGIBLES, EXPENDITURES AND EXPENDITURES PER ELIGIBLE, FY85-FY88

July August September October November December January February March April May June
Average Monthly Eligibles
Annual Percent Change

430,825

43 1,489

443,222

452,846

Annual Expenditures (millions)
Annual Percent Change

$694.279

$785.487 13.14%

$900.120 14.59%

$1,039.092 15.44%

Annual Expenditure Per Eligible
Annual Percent Change

$1,611.51

$1,820.41 12.96%

$2,030.85 11.56%

$2,294.58 12.99%

Note: Source for eligibles is Medicaid Eligibles Statewide-End of Month Report. Not all of those eligible are recipients of services. The average number of recipients for whom payments were made each month were 229,438 for FY85, 237,934 for FY86, 248,924 for FY87, and a n estimated 261,106 for FY88. Source for FY85-87 recipients was Provider Participation Analysis; FY88 estimate is based on change in Provider Participation Analysis excluding Medicare coinsurance and deductibles.

County
1 APPLING 2 ATKINSON 3 BACON 4 BAKER 5 BALDWIN 6 BPlNKS 7 BARROW 8 BARTOW 9 BEN HILL 10 BERRIEN 11 BIBB 12 BLECKLEY 13 BRANTLEY 14 BROOKS 15 BRYAN 16 BULLOCH 17 BURKE 18 BUTTS 19 CALHWN 20 CAHDEN 21 CANDLER 22 CARROLL 23 CATOOSCl 24 CHARLTON 25 CHATHAH 26 CHATTAHOOCHEE 27 CHATT006A 28 CHEROKEE 29 CLARKE 30 CLAY 31 CLAYTON 32 CLINCH 33 COBB 34 COFFEE 35 COLQUITT 36 COLUHBIA 37 COOK 38 COWETA 39 CRAWFORD 40 CRISP 41 DADE 42 DAWSON

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1988

Benefits Paid

a Estimated
1988 Unduplicated Population Recipients

X of Population Receiving nedicaid

X of iota1 Expenditures

State

Per

Recipients Recipient

County
DECATUR DEKALE! DODGE DilOL'I DOUSHERTY DOU5LBS EARLY EChOLS EFF INGHAI! ELEERT E?IANi!EL EVARG FCINMIN FAYETTE FtOvD FORSYTH FAAYKLIN FULTD# GILtlER Fjt ASCOCK GLYNN GORDON GRCIDY GREENE GWlFiNETT HAEERSHAfl HALL HANCOCK HAHALSON HARRIS HART dEARD HENRY HOUSTON IRWIN JACKSON JASPES JEFF DAVIS JEFFERSON JENKINS JOHNSON JCIES

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YEAR 1988

Benefits Paid

a Esti8ated
1988 Population

Unduplicated Recipients

% of Population Receiving Hedicaid

2 of Total Expenditures

State

Per

Recipients Recipient

County
85 LAHAR 86 LANIER 87 LAURENS 88 LEE 89 LIBERTY 90 LINCOLN 91 LON6 92 LOUNGES 93 LUHPKIN 94 HACON 95 HADISDN 96 HARION 97 HCDUFFIE 98 HCINTOSH 99 HERIWE7HER 100 HILLER 101 HITCHELL 102 HONROE 103 HDNTGOtfERY 104 HOR68N iQ5 t'lURRAY 106 NUSCOGEE 107 NEWTON 108 OCONEE 109 OSLETHORPE 110 PAULBING 111 PEACH 112 PICKEKS 113 PIERCE 114 PIKE 115 POLK 116 PULASKI 117 PUTNAH 118 QUITHAN 119 AABUN 120 RANDOLPH 121 RICHnOND 122 RDCKDALE 123 SCHLEY 124 SCREVEti 125 SEHINOLE 126 SPILDING

BWALYSIS OF RECIPIENTS AND EXPENDITURES BY COUNTY FOR FISCAL YERR 1988

Benefits Paid

a Estiaated
1988 Population

ilnduplicated Recipients

% of Fopulation Receiving 14edicaid

X uf Total Expenditure;

State

Per

Recipients Recipient

ANALYSIS OF RECIPIENTS AND EXPENDITURES 'BY COUNTY
FOR FISCAL YEAR 1988

County

Benefits Paid

a Estiaated
1988 Population

Unduplicated Recipients

% of Population Receiving nedicaid

% of Total State
Recipients

Expenditures Per
Recipient

127 STEPHENS 128 STE#OtRT 129 SUnTER 133 TI;LBcT
131 TALIAFERHO
i32 T4TTNALL 133 TAYLOR 134 TELFAIR 135 'TERRELL
136 THOnAS
137 TIFT
138 TOORBS
139 TGWNS
149 TREUTLEN
141 TROUP
142 TURNER 143 TW166S 144IJNiON ,
145 UPSON !46 NALKEF! 147 HALTO% 148 WCIRE 149 WARREW 150 WASHIN6TOM
151 WAYNE
152 WEBSTER i53 WHEELER 154 WHITE
155 WHlTFlEiD
156 WILCOX 157 WILKES i58 #ILKINSUN 159 #ORTH
t STkTEWIDE
i
Estiaated population for 1988 based on 1987 and 1990 estimates f r o # Savernor's O f f i c e of Planning and Budget.
b Statewide expenditures and r e c i p i e n t s d i f f e r from f i g u r e s shown elsewhere i n t h i s r e p o r t due t o i n c l u s i o n o f refugees and exciusion of some adjustrents i n t h i s table. Sue o f ' X o f Total State Recipients"exceeds 100% slnce a r e c i p i e n t can reside i n more than one county during a year. Statewide r e c i p i e n t count i s unduplicated for the State.

DEPARTMENT OF MEDICAL ASSISTANCE ADVISORY COMMITTEE AS OF JUNE 30, 1988

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, fifteen representing medical professional groups and one representing consumers, are appointed by the Commissioner and meet at least quarterly or at the discretion of their respective chairpersons. 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 subcommittees and their members are listed alphabetically below.

Community Care

R. H. Sasser, D.D.S.

Swainsboro

Ms. Joyce D. Barlow Sister Diane Brin, Chairperson Ms. Edwina Evans-Williams
Vice Chairperson Mr. Carl Evans Mr. Charles K. Hecht, 111 Mr. Virginia Griffin Ms. Shelia Hunter Ms. Jane McCombs, R.N. Fred McGinnis, Ph.D. Mr. Martin Miller Ms. Mary Mohr, R.N.,

Albany Rome
Macon Winder Columbus Albany Cordele Atlanta Atlanta Valdosta Thomson

Durable Medical Equipment

Mr. Jim Douglas

Atlanta

Mr. Eric Holgate, R.Ph.

Vice Chairperson

Augusta

Mr. James Parkinson, R.R.T.,

Chairperson

Dalton

Mr. Pete Raymer

Dublin

Mr. Charles Rinn, R.Ph.

Columbus

Mr. Richard Smith, R.Ph.

Atlanta

Mr. Steve Stahlman

Marietta

Mr. E. Phillip Stone

Covington

Ms. ~ u b Ny ewsome

Atlanta

Early and Periodic Screening,

Ms. Carol Robinson

Atlanta

Diagnosis and Treatment

Ms. Joann Schjonning, R.N.

Atlanta Ms. Dee Bullard, R.N.,

Consumer

Ms. Annette T. Bowling

Albany

Mr. Otis Burgess, Vice Chairperson Atlanta

Mr. Roy Herzbach

Athens

Ms. Phyllis J. Holmen

Atlanta

Ms. Ethel Mae Matthews

Atlanta

Ms. Dora Miles

Atlanta

Ms. Annie M. Mitchell

Atlanta

Mr. Jeff Roulston, Chairperson Atlanta

Ms. Patsy Sherrod

Waycross

Ms. Carol Trail

Atlanta

Ms. Cindy Wade

Dalton

Vice Chairperson Melody Carter, M.D.
Chairperson B. T. Elliott, Jr., M.D. Lynne Farkas, R.N.C. Ms. Linda Hubbard, R.N. Winton G. King, M.D. Booker Poe, M.D. Ms. Carol Smith, R.N. Melody A. Stancil, M.D. Ms. Barbara Sweeney, R.N. Ms. Sherilyn E. Walker, R.N.

Atlanta
Atlanta Atlanta Marietta Macon Decatur Atlanta Decatur LaGrange Atlanta Atlanta

Home Health

Dental

Ms. Eileen Bland, R.N.

Jesup

Michael Carr, D.D.S

Donalsonville Captain C. C. Dudley,

John C. Dallas, D.M.D.

Arlington

Chairperson

Lavonia

Marion Durst, 111, D.M.D.

Augusta Ms. Margie Fannon, R.N.

Gainesville

Janet H. Harrison, D.D.S. Milledgeville Ms. Hester Fechtel, R.N.

Athens

Doug Henson, D.D.S.,

Ms. Laura Mathis

Marietta

Chairperson

Atlanta Mr. Jack Mills

Brunswick

Matthew McRae, Jr., D.D.S.

Athens Ms. Linda Murphy, R.N.

Tifton

Phyllis P. Mack, D.M.D.,

Ms. Denise Retterbush

Valdosta

Vice Chairperson

Savannah Mr. Tom Shaver,

Lewin R. Manly, D.D.S.

Atlanta

Vice Chairperson

Atlanta

Antonio Nunez, Jr., D.D.S.

Atlanta Mr. Hal M. Smith, Jr.

Eastman

Carolyn S. Rude', D.D.S.

Marietta Ms. Karen Watts, R.N.
34

LaGrange

Hospital

Outpatient Mental Health

Mr. Ken Beverly,

Mr. Jerry Garber

Atlanta

Vice Chairperson

Thomasville Mr. Bill Holland

Atlanta

Mr. Thomas L. Collier

Atlanta Ms. Cynthia A. Luke, R.N.

Mr. Virgil Cooper

Macon

Vice Chairperson

Columbus

Mr. Edward Fechtel, Jr.

Athens Mr. Bill C. Mahaffey,

Mr. Paul Morton Ganeles

Atlanta

Chairperson

Lawrenceville

Mr. David L. Harris

Snellville Ms. Cathy E. McRae

Savannah

Mr. Thomas Kelly, Jr.,

Seth A. Pope, M.D.

Atlanta

Chairperson

Augusta Mr. Carlos C. Stapelton

Atlanta

Mr. Alexis K. Klamke

Atlanta Mr. Billy Warden

Atlanta

Mr. Paul Massengill

Lakeland Ms. Martha J. Williams

Americus

Mr. David H. Seagraves

Americus

Mr. J. Mike Sims

Columbus

Pharmacy

James E. Tally, Ph.D.

Atlanta Mr. Milton C. Bowling,

Mr. William L. Webb

Athens

Jr., R.Ph.

Gainesville

Nursing Home Ms. Rachel Athon Ms. Deborah Beard Mr. Joseph F. Cobis Ms. Thelma Davis Ms. Rosalyn Harbuck Mr. Gene Harrison
Chairperson Mr. Jerry Hogan Ms. Beulah Holmberg

Conyers Atlanta Columbus Brunswick Forsyth
Dalton Savannah
Marietta

Ms. Jean Courson, R.Ph. Mr. Oren H. Harden, Jr., R.Ph.,
Chairperson Mr. Harold Jones, R.Ph. Mr. Jeffrey B. McGhee, R.Ph. Diane Nykamp, Pharm. D. Mr. Neil Pruitt, R.Ph.,
Vice Chairperson Earl S. Ward, Jr., Pharm. D. Mr. Evan Ward, Sr., R.Ph.

Tifton
Sylvester Augusta Marietta Atlanta
Toccoa Atlanta Atlanta

Mr. Bobby Johnson Vice Chairperson
Mr. Frank H. McElroy, Jr. Mr. Frank Shaw Mr. Jimmy Stewart, Jr. Mr. Earl Ray Trip
Optometric

Atlanta Quitman
Atlanta Pineview Hawkinsville

Physician

Joseph Blissit, M.D.

McDonough

William H. Borders, Jr., M.D. Atlanta

Jeff Byrd, M.D.

Thomasville

Mirian E. Chivers, M.D.

Atlanta

Carl N. Gilbert, M.D.

Dalton

Walter Carl Gordon, M.D.

Hamp L. Burney, O.D.

Atlanta

Vice Chairperson

Albany

William Dobbs, O.D.

Vice Chairperson

Covington

Donald Dye, O.D.

Elberton

Larry E. Forth, O.D.

Douglas

Daniel D. Gottlieb, O.D. Stone Mountain

Lorenzo Jones, O.D., Chairperson Macon

Robert McCullough, O.D.

Jonesboro

C. Clayton Powell, O.D.

Atlanta

Clyde Lord, M.D. Wallace D. Mays, M.D. A.A. McNeill, Jr., M.D.,
Chairperson Guerrant H. Perrow, M.D. John H. Reed, Jr., M.D. Fred B. Thomas, M.D. Kun Y. Tong, M.D.

Atlanta Americus
Camilla Jasper
Gainesville Gainesville
Albany

Orthotics and Prosthetics

Asa G. Yancey, M.D.

Atlanta

Mr. James M. Barnes, C.O.

Atlanta

Mr. Hugh Bray, NBC-HIS

Columbus

Podiatry

Mr. Hanif Chaudhary

Decatur Kermit R. Ary, D.P.M.,

Mr. Ted L. Hyde, C.O.

Macon

Chairperson

Albany

Mr. Grover A. Jeffcoat, C.O.,

Perry Horton, D.P.M.

East Point

Chairperson

Savannah Danny Holcombe, D.P.M.,

Mr. John McNeill, C.P.0

Marietta

Vice Chairperson

Roswell

Ms. Carol Walsh, M.A.T.,

Norman I. Kornblatt, D.P.M. Douglasville

Vice Chairperson

Atlanta Martin S. Linde, D.P.M.
35

Atlanta

Psychology Ralph Allsopp, Ph.D. Barbara Calhoon, Ph.D. Gary E. Dudley, Ph.D. Stephen W. Garber, Ph.D. Nancy A. McGarrah, Ph.D.,
Chairperson Albert Bartow Ray, Jr., Ph.D.,
Vice Chairperson Sylvia Shellenberger, Ph.D., Janice Williams, Ph.D.

Atlanta Macon Marietta Atlanta
Atlanta
Americus Macon Atlanta

Transportation Mr. Ken Duke Mr. James E. Eberhart Mr. Michael L. Gallagher Ms. Judy Hagebak Mr. Ben F. Hinson, Jr.,
Chairperson Ms. Jan Law Mr. Don T. Lindsey Ms. June Allen Merritt Ms. Virginia W. Tankersley Mr. Richard A. Tibbetts Mr. Mitch Turner

Forsyth Rome
Gainesville Decatur
Macon Eastman Fitzgerald
Blakely Statesboro LaGrange Douglasville

We wish to reaffirm the Department's full commitment to the principles of Equal Employment Opportunity. The Department's policy is to assure that opportunities for employment, advancement, and for dignity in work are equally available to all. Employees and applicants are evaluated on the basis of performance, skill and experience without regard to race, color, sex, age, religion, national origin or physical disability.

STATE OF GEORGIA DEPARTMENT OF MEDICAL ASSISTANCE 2 MARTIN LUTHER KING, JR., DRIVE S.E.
ATLANTA, GEORGIA 30334