DCH-i January 2013, Volume 2, Issue 2

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In This Issue

From the Commissioner: A Successful 2012
Ask DCH-i
Provider Updates
CMS Deadlines Approach for EHR
On Call and Online Problem Solving
What’s in a Name?
Does Breakfast Make You Fat?
SHBP Survey Says?
EHR Incentives

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 [email protected].

About DCH


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.



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.

From the Commissioner

A Successful 2012

David A. Cook

As we look forward to a busy and productive 2013, let’s take a moment to reflect on a few of the issues and successes of the past year:

  • Medicaid Redesign – Decided to move forward with key recommendations from the Redesign Task Forces, including transitioning foster children to CMO coverage, using a value-based purchasing model, and enhancing a centralized provider web portal to reduce administrative burdens, streamline the credentialing process and to align performance metrics with areas of improvement.
  • Healthcare Facility Regulation (HFR) – Launched GaMap2Care,SM a comprehensive and robust online facility search program to aid consumers in making informed choices about their health care decisions.
  • State Health Benefit Plan (SHBP) – Managed the nation’s largest wellness plan to promote health and well-being for employees and their dependents. The Plan has moved from a promise-based program to an incentive-based program to further engage members in their own health care. Launched the new SHBP Wellness Learning Center portal, www.AHealthierSHBP.com, to educate members about healthy behaviors.
  • Health Information Technology (Health IT) – Launched Phase I of the Georgia Health Information Exchange with a program featuring GeorgiaDirect, a free, HIPAA-secure messaging platform for patient health information exchange between physicians, hospitals, laboratories, pharmacies and others.
  • Office of the Inspector General (OIG) – Recovered more than $36 million in Fiscal Year 2011 (ending June 30, 2012), including overpayments to Medicaid providers and global settlements and opened more than 2,000 new Medicaid and PeachCare for Kids® cases for investigation.
  • Information Technology (IT) – Successfully transitioned to Version 5010 transaction standards for claims payments and adjudication in preparation for the transition to ICD-10 being tested in 2013.
  • Communications – Completed the migration to a new and improved Department of Community Health website that’s easier to navigate. Ongoing content updates and enhancements will continue in 2013.

Looking forward, we are in full support of Governor Deal’s health care platform and want to share links to his recent remarks at the Eggs and Issues Breakfast that centered on health care and his State of the State address.

As the year progresses, it is our goal to keep you informed of the decisions that affect you, our  physicians, nurses, physician extenders, dentists, third-party payers, vendors, legislators and constituents. Consider sharing this issue of DCH-i with your colleagues and associates so that they can stay informed about DCH as well.

We encourage your feedback and questions at [email protected].

And we wish you a healthy Happy New Year.


David A. Cook, Commissioner

Ask DCH-i

Q -- I understand that a change has been made in the consultation codes for Medicaid. Why wasn’t this covered in the last issue of DCH-i?

A – The procedure is for policy changes that are made by the Centers for Medicare & Medicaid Services (CMS) and other notifications to be posted as banner messages on the Georgia Medicaid Management Information System (GAMMIS) website. Here is a link to the particular topic you’re asking about, with instructions about how to access it:

       www.mmis.georgia.gov> Provider Information> Provider Messages

  • Click on the SEARCH button (all banner messages will appear)
  • Click on the 10/17/2012 Message: Termination of CPT Evaluation and Management Consultation Codes.

In addition to this message being posted on 10/17/2012, the message was also included on remittance advices for six weeks, as is customary for changes to be communicated.

Banner messages are posted regularly any time there is a change in policy.

We'll look at including more information about these changes in future editions of DCH-i. Please be sure to check the GAMMIS portal regularly for policy changes and other banner messages.

Q – I read in DCH-i that foster children are being moved into managed care. What is the name of the program that the foster kids are now being transferred to? Who is the care management vendor that now oversees the foster kids? Is the state accepting new applications for other vendors?

A -- At this time, the program does not have a formal name, and no determination has been made as to the care management vendor that will oversee the transition of foster children into managed care. We will not be accepting applications for new vendors.

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Provider Updates

The Transition to ICD-10 is Not Optional
Will you be ready for ICD-10 when October 1, 2014, rolls around?


Ready or not, ICD-10 is coming.

If you’re NOT using ICD-10 codes for services rendered ON/AFTER October 1, 2014, your claims cannot be processed and paid. This means your cash flow will suffer and you could encounter payer audit problems.

ICD-9 codes, however, must be used for services rendered PRIOR TO October 1, 2014. This means your systems will need to accommodate both ICD-9 and ICD-10 codes starting on October 1, 2014.

More questions for you:  Is your practice assessment complete? Is your staff – medical, coding and billing – being trained? And what about your trading partners and your payers…are they on track and keeping you in the ICD-10 loop?  One more thing…what’s the status with your practice management and EHR systems…will they be a “go” for October 1, 2014…accommodating both ICD-9 and ICD-10 code sets and ready for testing later this year – yes, 2013? 

Within DCH and Georgia Medicaid, the remediation of the Georgia MMIS (GAMMIS) system to accommodate the new ICD-10-CM and ICD-10-PCS codes is well underway and internal testing has already begun.  External testing with clearinghouses and billers is slated to begin here at DCH in October 2013.  In December 2013, we plan to begin testing with our physicians and other providers.  We will be ready for October 1, 2014.

As a reminder: The compliance date for ICD-10, as mandated by HHS and CMS, is October 1, 2014. All HIPAA-covered entities including providers, payers, vendors and their business associates must transition to ICD-10 regardless of their acceptance of Medicaid or Medicare.

Visit ICD-10 on the DCH website and the GAMMIS portal for more information about upcoming webinars and more to assist with your ICD-10 readiness.

E-mail us at [email protected] to become a subscriber to ICD-10 news from DCH.

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Centralized Credentialing on the Horizon

As DCH moves to improve administrative efficiencies for our provider community, we are instituting a centralized credentialing process that will be in place during the first half of 2013.

The program will streamline provider enrollment by implementing a single source application. Physicians and other providers will soon need to complete only one application to enroll as a Medicaid provider and submit their application to become credentialed as a network provider with each of our three CMOs – Amerigroup, Peach State Health Plan and WellCare of Georgia.

Phase I of the process will begin with new Medicaid program applicants (i.e., facilities, professional and ancillary providers) who also wish to participate in the CMO network.

Centralized credentialing will not take the place of contracting with each CMO. You will need to contact each CMO to initiate the contracting process.  However, this new process will eliminate the need for submission of duplicative credentialing application forms.

Recredentialing will be part of Phase II, expected to be initiated late in 2013.

For more information, visit www.mmis.georgia.gov.

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Ordering, Referring and Prescribing Changes

The Patient Protection and Affordable Care Act (PPACA) has mandated that physicians and eligible providers who order, refer or prescribe for Medicaid beneficiaries be enrolled in Medicaid, starting in the second quarter of 2013. Stay tuned for more information and FAQs about this new process.

Services will not be paid for if they are ordered, referred or prescribed by providers who are not enrolled as of the start date, which will be announced soon.

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Compliance Reporting Deadline Has Passed

All Medicaid providers who received $5 million or more from DCH and/or the CMOs for the time period October 1, 2011, through September 30, 2012, must have submitted an Attestation of Compliance as outlined in Medicaid Policy Part I, § 106.1 by December 31, 2012. This requirement applies to all providers.  Failure to comply with this section can subject a provider to suspension or termination. 

If you have not already submitted, please do so immediately by either mail or fax to:

HP Provider Enrollment (Regular Mail)
PO Box 105201
Tucker, GA 30085-5201


HP Provider Enrollment (Certified/Overnight Mail Only)
100 Crescent Centre Parkway, Suite 1100
Tucker, GA 30084-7039


For questions, call 404-463-7432.

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CMS Says EHR Deadlines Approaching

The Centers for Medicare & Medicaid Services (CMS) is reminding eligible providers (EPs) that the reporting year for the Medicare and Medicaid EHR Incentive Programs for 2012 ended on Monday, December 31. CMS says that means “(EPs) must have completed their 90- or 365-day reporting period (within the calendar year) by the end of 2012 to receive an incentive payment.”

And CMS is stressing that “Medicare EPs must complete attestation for the 2012 program year by February 28, 2013, but can attest as soon as their reporting period is complete.” The attestation deadline for the Medicaid EHR incentives program in Georgia is March 1, 2013. (Reminder: the Medicare EHR Incentive program is administered by CMS; the Medicaid EHR Incentive program is administered by DCH.)

Additional Resource links:

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Constituent Services: On Call and Online Problem Solving

Navigating the complex maze of government agencies can be daunting. For those who need answers about a critical medical procedure or how to get assistance for their loved one, it can be exasperating and challenging as well.

Through the Georgia Department of Community Health’s (DCH) Office of Constituent Services (OCS), answers are often just a phone call or an e-mail away. As part of the Office of Legislative & External Affairs, OCS provides accurate, timely responses to any request for information, concern, or complaint.

“Our Constituent Services staff helps citizens with a variety of issues,” said Jesse Weathington, director of Legislative & External Affairs. “We are here to serve the public – whether they’re private citizens, physicians or legislators. It’s our goal to expedite requests for information and assistance.”

Three full-time staff members field nearly 2,000 inquiries annually. They interact daily with some of the state’s 1.7 million Medicaid members, plus providers, legislators and others across the state to answer their questions and connect them with the right services and resources. The majority of calls deal with Medicaid issues, followed by questions about the State Health Benefit Plan.

Acknowledgement of inquiries occurs within 24 hours of receipt. Substantive responses are given within five days; however, the times are usually quicker than the required response times.

To ensure an accurate, timely response, OCS logs each case into an electronic Case Assessment Tracking System to assist in coordinating feedback from the four divisions and seven enterprise offices within DCH. HIPAA-compliant technology is used to protect a constituent’s personal health and identifying information.

“Much of what we do to help the public is dependent on the networking and relationships we have with various agencies and offices throughout the state,” said Warren McNeill, director of Constituent Services. “Our job is to help people get answers quickly.”

The public can access OCS’ contact information through DCH’s website under the Contact Us page. The e-mail address is [email protected] and the telephone number is 404-651-9928.

--Article by Kallarin Richards, DCH Legislative Liaison

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What’s in a Name? Assisted Living Deadline Nears

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.

O.C.G.A. 10-1-393 (26) prohibits a personal care home or assisted living facility from offering, advertising or soliciting the public to provide services “which are outside the scope of personal care services or assisted living care” that the facility is authorized to provide.

Currently a licensed personal care home that uses the term “assisted living” in the name of the home or in any marketing materials must remove the term “assisted living” from its name or any of its marketing materials unless it is applying to become licensed as an “assisted living facility.”

For information or questions, visist Download this pdf file. Asssisted Living Communities under Facility &  Provider Information.

—Article by Pamela A. Keene, DCH Media and Public Relations Manager

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Does Breakfast Make You Fat? 

Does sugar cause diabetes?  Is dessert really bad for you?  And what about salt:  how much is too much?

These and other quick-read bits (and bytes) are covered in the health education modules featured on the new State Health Benefit Plan (SHBP) Wellness Learning Center. Available to SHBP members only, this innovative website (www.ahealthiershbp.com/shbp) launched on January 1, 2013, to help engage SHBP members and their families to get – and stay – healthy.

The first module, entitled “Are You Right On or At Risk?” focuses on the importance of biometric screenings and health assessments as a foundation for SHBP members to learn what their numbers mean and why they matter. Additional modules will focus on making better, smarter health care decisions; increasing use of preventive care and wellness programs; and the importance of setting goals – and sticking to them. 

To encourage these healthy behaviors, both SHBP Standard and Wellness Plan members can earn an incentive fund contribution for 2014 -- provided they complete at least one health education module on the site along with the fulfillment of their other 2013 Wellness Requirements. Members are also asked to complete an online Health Assessment through their health plan vendor’s (either Cigna or UnitedHealthcare) website. For Standard members and new Wellness plan members, a biometric screening is required to earn this incentive. The screening includes measures for body mass index, blood pressure, glucose and cholesterol.

Members will be coming to their providers for their biometric screenings between now and mid-May. Physicians will be asked to complete the 2013 Physician’s Screening Form that includes metrics for blood pressure, glucose, body mass index and cholesterol. Physicians will then sign and fax the completed form as noted.

“As a self-funded, self-insured plan, the cost of SHBP’s health care is directly related to the health of our SHBP members.  So it pays to be healthy in more ways than one,” said Trudie Nacin, director of the Georgia Department of Community Health’s State Health Benefit Plan. 

In 2012, SHBP introduced consumer-driven wellness plans to its membership of nearly 700,000 individuals. Today, SHBP administers one of the largest wellness plans in the country.

--Article by Claire Drogula, SHBP Wellness Manager

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SHBP Survey Says?

Following this year’s Open Enrollment, the State Health Benefit Plan (SHBP) surveyed its family of members to get their thoughts about their plan.

SHBP received a large response. More than 65,000 members, roughly three times the population of the City of Decatur, completed the online survey, representing a diverse cross-section: Wellness Plan members, Standard Plan members and Retirees.

In the spirit of the television game show Family Feud, here are five of the top things we learned from the survey:

  1. Members would like to see more and better incentives for achieving wellness goals
  2. The biggest reason members ended a new healthy habit was because they had become too busy or lost motivation
  3. Most members know that the Wellness Plan options offered premiums six percent lower than the Standard Plan
  4. 89 percent of members thought they were in excellent or good health
  5. 22 percent of members do not regularly review their explanation of benefits or their bill at their provider’s office

SHBP will use this information and more from the survey to help guide its planning for the coming year.

--Article by Chris Schrimpf, Director of DCH Communications

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Nearly $124 Million Paid in Medicaid EHR Incentives

To date, Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued nearly $124 million in federally funded payments to eligible providers through the end of December 2012. The program was launched on September 5, 2011. Nationally, more than $1.2 billion has been paid out to date.

Eligible Hospitals145$88,165,835.38
Eligible Professionals1761$35,833,182.00
Total Payments through December 2012$123,999,017.38

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Speaking Up!

Commissioner Cook will address these organizations during February:

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Board Actions From December

The following actions were taken at the December 13 meeting of the Board of Community Health:

The January 10 meeting of the Board of Community Health was cancelled.

The next Board of Community Health Meeting will take place on Thursday, February 14, 2013