DCH-i February/March 2013, Volume 2, Issue 3

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In This Issue

Medicaid News of Note

SHBP Members Have Wellness and More on Their Minds

Updates from Healthcare Facility Regulation

Survey Responses: Providers May Be Ill-prepared for ICD-10

Medicaid Member Matching Audits Begin

More Than $135 Million Paid in Medicaid EHR Incentives

May 3 CMS Listening Session for EHR Billing, Coding

From Our Readers

Ask DCH-i

Speaking Up!

Board Actions

About DCH-i

DCH-i is the monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important information to you as physicians, dentists, hospitals, third-party payers, vendors, health care advocates, consumers and legislators. Our goal is to help create A Healthy Georgia -- together.

Write us at DCH-i@dch.ga.gov.

About DCH

2 Peachtree Street Building

Through effective planning, purchasing and oversight, the Department of Community Health (DCH)  provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and underserved populations.
DCH is responsible for Medicaid and PeachCare for Kids,® the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia.      
David A. Cook is the DCH Commissioner.  
We are dedicated to A Healthy Georgia.


DCH-i newsletter logo

Pamela A. Keene

Jeffrey L. Holt   

Graphic Artist
Kenya Tolliver

Iris McIlvaine
Denise Smith
Deputy Director Communications
Peggy Woodruff    

Christopher Schrimpf

DCH Mission

The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through effective planning, purchasing, and oversight.

We are dedicated to A Healthy Georgia.

Medicaid News of Note

Save the Date for May 16 Medicaid Fair

Mark your calendars for the Thursday, May 16, Medicaid Fair in Columbus, Ga.  The day-long event will feature knowledge-based sessions for all providers, focusing on new billing, ICD-10, audits and reviews, and hospitals. There will be an opportunity to meet with the care management organizations to talk about claims issues.

Check for updates and the link to the registration form at the Georgia Medicaid Management Information System (GAMMIS) website at www.mmis.georgia.gov.

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DCH Board To Administer Hospital Provider Payment Program

Earlier this year, the Georgia Legislature passed and Governor Deal signed SB 24, designating the Board of Community Health as administrator of the Hospital Provider Payment Program. By passing SB 24, the Hospital Medicaid Financing Program Act, and thus renewing the hospital provider payment process, DCH avoided a potential $685 million deficit in its Medicaid budget.   

The hospital provider payments are collected based upon a percentage of the hospital’s net patient revenue.  Hospitals subject to the payments include public, private, rehabilitative, geriatric, osteopathic and other specialty hospitals but do not include psychiatric hospitals, critical access hospitals or any state-owned or state-operated hospitals. Those hospitals serving Medicaid patients receive additional funding from the payments. In FY2013, DCH projects that $235 million in hospital payments will be deposited into the Indigent Care Trust Fund. These are used to match federal funds and combine to generate $685 million. Of that amount, $251 million will be paid back to Medicaid hospitals and the remaining $434 million will be used to support Medicaid generally.

Under the recently passed legislation, (http://www.legis.ga.gov/Legislation/en-US/display/20132014/SB/24) DCH will administer the Hospital Provider Payment Program much as the agency currently does for nursing homes. Governor Deal signed SB 24 into law in mid-February 2013.

DCH is developing rules and guidelines for review and adoption by the Board of Community Health, which will be making decisions about the Hospital Provider Payment Program in anticipation of its July 1, 2013, enactment date.

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Medicaid Enrollment Required for Ordering, Prescribing and Referring Providers

Any physician or eligible practitioner who orders, prescribes, or refers Medicaid members to Fee-for-Service (FFS) providers or for Medicaid-covered services must soon be enrolled as a Medicaid Ordering, Prescribing and Referring (OPR) provider, according to the Affordable Care Act (ACA), even if they do not submit claims to Medicaid for their services. The Georgia Department of Community Health (DCH) is alerting physicians and providers of this new rule and will begin accepting applications for these OPR providers as of April 1, 2013.

A doctor's stethoscope on a computer keyboardAll FFS claims for items and services that were ordered, prescribed, or referred must contain the National Provider Identifier (NPI) of the licensed health care professional ordering, prescribing or referring the service. Medicaid FFS providers risk not being reimbursed for services if the ordering, prescribing and referring provider is not enrolled in Medicaid as an OPR provider. In other words, if you order, prescribe or refer services for Medicaid recipients, the providers who actually render such services will not be paid unless you enroll in Medicaid and your NPI number is included on the claim submitted by the rendering provider.

DCH has created an expedited enrollment process for OPR providers. The enrollment application will be the same as used by providers who participate in FFS Medicaid; however, it will be streamlined because OPR providers will not be required to submit financial documentation or complete certain sections of the application that pertain to claims or payee information. In addition, OPR providers will sign a simple Statement of Participation that has been modified to reflect that these providers do not submit claims and are not enrolling in order to participate in FFS Medicaid.

Enrolling as an OPR Provider:

  • Does not obligate you to see Medicaid patients;
  • Does not mean you will be listed as a Medicaid provider for patient assignment or referral;
  • Is an expedited enrollment process;
  • Does not require an annual renewal;
  • Allows you to continue to see Medicaid patients without billing the Medicaid program if you so choose; and
  • Helps ensure that your orders, prescriptions and referrals for Medicaid patients are accepted and processed appropriately.

DCH’s fiscal agent, Hewlett Packard Enterprise Services (HPES), will begin accepting applications from OPR providers on April 1, 2013. DCH will allow a grace period until June 30, 2013, for OPR providers to become enrolled. On July 1, 2013, claims for services that contain a National Provider Identification number (NPI) of an ordering, prescribing, or referring provider not enrolled in Medicaid (either as a participating provider or as an OPR provider) will be denied. Providers already enrolled as active Medicaid participating providers do not need to enroll again as OPR providers. The OPR requirement does not apply to claims that are billed to the Medicaid Care Management Organizations (CMO).

OPR providers are encouraged to enroll in Medicaid online through the Georgia Medicaid Management Information System (GAMMIS) Web Portal at: https://www.mmis.georgia.gov/portal/default.aspx.

OPR providers may submit a paper application in lieu of completing an online application. The paper application (with instructions) can also be found on GAMMIS at: https://www.mmis.georgia.gov/portal/default.aspx.

A Frequently Asked Questions (FAQ) document concerning Ordering, Prescribing, or Referring will be placed on GAMMIS soon. The FAQ will provide information regarding enrollment, Statement of Participation, denial of Participating Provider claims when providers who order, prescribe or refer a Medicaid enrollee for care do not enroll as OPR providers, and retroactive enrollment.

For questions or concerns, please contact Hewlett Packard Enterprise Services (HPES) at 800-766-4456, press option #0 for the main menu and then press option #4.

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New Medicaid Providers: Centralized Credentialing Feature Begins March 29

Providers enrolling to accept Medicaid patients for the first time will find the process simplified. Beginning on March 29, 2013, the Georgia Department of Community Health (DCH) will activate its improved centralized credentialing feature for new provider applicants.

These new providers will be able to complete a single credentialing application that will enroll them as a Medicaid provider and a credentialed Medicaid provider with DCH’s three Care Management Organizations (CMO). Providers will still need to complete the contracting process with each CMO. The site is www.mmis.georgia.gov. Go to Provider Enrollment, Enrollment Wizard to apply.

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ACA Mandates Physician Rate Increase for Two Years

The Patient Protection and Affordable Care Act (ACA) mandates a rate increase for certain primary care practitioners from January 1, 2013, through December 31, 2014. The increased rates will be retroactive for services billed on or after January 1, 2013. The Georgia Department of Community Health (DCH) anticipates that the self-attestation process will begin on April 1, 2013, through the Georgia Medicaid Management Information System (GAMMIS) portal at www.mmis.georgia.gov.

A group of doctors in uniformEligible primary care providers include board-certified physicians with a specialty designation of family medicine, general internal medicine and/or pediatric medicine or an associated sub-specialty. If providers do not meet the board-certification requirement, they may be eligible for the rate increase if they self attest that at least 60 percent of their Medicaid billings and services are for evaluation and management (E&M) codes listed in the final rule.

Providers will not need to attest with each CMO separately; DCH will share provider eligibility files with each Medicaid CMO. 

Physician extenders, including physician assistants, nurse practitioners and nurse midwives, are also eligible provided they practice under the direct supervision of an eligible physician with professional responsibility for the care provided.

As the implementation date nears, additional notifications will be posted and sent to providers and associations. If you have additional questions, please send them to gapcplus@dch.ga.gov

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Medicaid Coverage Ends for Elective Births Before 39 Weeks

The state’s proposed budget for FY2014 includes a line item that would end Medicaid coverage for elective births before 39 weeks of pregnancy or whatever is considered full-term for that member. With this change in coverage, the state has projected a savings of $5.12 million in avoided health care costs.

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Medicaid Redesign Moves Forward

Georgia Medicaid is moving forward with plans to transition foster children into managed care. The division is also examining the possibility of bringing care management to our Aged, Blind and Disabled Medicaid population, which is served in a Fee-for-Service setting. Additionally, DCH is working toward the concept of patient-centered medical homes and using value-based purchasing in new or renewed procurements. The agency has also begun work to identify a common Preferred Drug List (PDL) within certain therapeutic drug classes.   

The contracts with our three CMOs -- Amerigroup, Peach State Health Plan and WellCare -- have been extended to June 30, 2014.

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SHBP Members Have Wellness and More on Their Minds

The Wellness logo for the State Health Benefit Plan

More than 20,000 State Health Benefit Plan (SHBP) members have already logged on to

AHealthierSHBP.com, the Plan’s new health education portal. 2013 SHBP Wellness Plan Option members and their spouses (if covered) are required to complete at least one online health education module as part of their 2013 Wellness Requirements.

The first module, “Are You Right On or At Risk?,” was posted on January 1, 2013. Upcoming  modules focus on understanding your health care coverage, taking full advantage of your plan, and setting goals.

SHBP members and their spouses (if covered) enrolled in one of the 2013 Wellness or 2013 Standard Plan Options may each earn a $240 incentive fund contribution in 2014. Eligible members and their spouses, if covered, must complete certain health actions by May 31, 2013, to qualify.

More information about SHBP’s 2013 Wellness Requirements and the 2014 Incentive Fund Requirements can be found on the DCH website at www.dch.georgia.gov/shbp.

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Updates from Healthcare Facility Regulation

GaMap2CareSM Expands with Electronic Plans of Correction

Map with Georgia Map 2 Care logoHealthcare Facility Regulation’s (HFR) GaMap2Care, Georgia’s online health care facility “search, see and select” web portal, will soon be adding electronic Plans of Correction (ePOC) in response to deficiency reports filed during facility inspections of licensed nursing homes, personal care homes and other health care facilities. This means that these ePOCs will be available to show consumers the actions that facilities will take to correct deficiencies.

Visit www.GaMap2Care.info to learn more about this innovative website.

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Licensing Required for Assisted Living Facilities

If you’re operating a personal care home that is being marketed as an assisted living facility, you have until May 1, 2013, to apply for licensure in this new category or to remove all references to “assisted living” from your marketing materials and your name, if applicable.

For information or questions, see Use of the Term "Assisted Living" by Personal Care Homes.

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In Other Top News

Survey Responses: Providers May Be Ill-prepared for ICD-10

Frustrated worker sitting at computerResponses to a recent survey about ICD-10 awareness and readiness, conducted by DCH in conjunction with the Medical Association of Georgia, showed that 62 percent of physicians have not begun to prepare for the conversion to ICD-10 Code Sets.

Eighty-three percent of respondents said that they have either been too busy with other priorities to embrace and implement ICD-10 or are unaware of where to start and what they need to do.

This conversion is a federal mandate, with a compliance deadline of October 1, 2014.

To assist providers and their trading partners for the upcoming transition from ICD-9 to ICD-10 Code Sets, DCH will continue its educational outreach through webinars, e-mail marketing and presentations to medical associations and other related groups.

  • To be added to our e-newsletter mailing list or to request that we speak to your association or large group, drop us a note at icdproject@dch.ga.gov.

Thanks to the Medical Association of Georgia for its assistance with this survey.

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Medicaid Member Matching Audits Begin

The Georgia Department of Community Health’s (DCH) Office of the Inspector General (OIG) hosted a sister-agency meeting in February to launch its renewed commitment to Medicaid Member Matching through the program formerly known as PARIS (Public Assistance Reporting Information System). The program will examine three databases – an interstate system, a federal system and a veterans’ system.

Designed to assure that members are receiving the correct benefits, Medicaid Member Matching is part of the OIG’s Integrus portfolio of audits.

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More Than $135 Million Paid in Medicaid EHR Incentives

EHR Incentive Program logoGeorgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued more than $135 million in federally funded payments to eligible providers through February 25, 2013. The program was launched on September 5, 2011.

Chart of EHR Payments to Eligible Hospitals and Professionals

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May 3 CMS Listening Session for EHR Billing and Coding

The Centers for Medicare & Medicaid Services (CMS) will host a “Listening Session” about Billing and Coding with Electronic Health Records (EHR) on Friday, May 3. The online (or in-person) event for stakeholders, providers and vendors, will delve into many issues related to the adoption of EHRs.

Speakers will discuss key issues including the impact of EHRs on quality and coding, plus coding challenges for various groups including hospitals, physicians and other stakeholders.

For more information about EHR and the session, visit the CMS EHR Incentive Programs website.

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From Our Readers

“The January DCH-i newsletter was very useful. I was really excited about the news for upcoming Centralized Credentialing. In my position as credentialing coordinator for a large multi-specialty group, it has been very time consuming credentialing providers. With the three CMOs it has been taking anywhere from three to six months to complete.

“Thank you so much, DCH.” -- Diane McCallister, Credentialing Coordinator, North Shore Healthcare, Clayton, Ga.

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Ask DCH-i

Ask DCH-i mailbox logoQ -- When will the Q1 2013 Physician Injectable Drug List be online?  This information is critical to providers who are treating Medicaid cancer patients.

A -- The list was posted the third week in January with the annual rates. As you may know, the rates come from the Centers for Medicare & Medicaid Services and the rates are updated annually. In addition, DCH posts quarterly updates to the list that reflect the addition and/or removal of certain drugs. Check the list at the Georgia Medicaid Management Information System (GAMMIS) website: www.mmis.georgia.gov. Click on Pharmacy, then Pharmacy Notices.

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Speaking Up!

Speaker at podium with several microphonesCommissioner Cook will address the following organization in March:

  • Friday, March 15 – Fundamentals of Health Care Law Seminar, State Bar Headquarters

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Board Actions

The Board took the following actions at its February 14, 2013, meeting:

Healthcare Facility Regulation Rules Change Adoptions
Medicaid Public Notice
State Health Benefit Plan Resolutions

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