June/July 2014

Volume 3, Issue 4

DCH-i Masthead
Rural Free-Standing Emergency Departments:  
Reaching Out to Serve Rural Georgia

Georgia's new Rural Hospital Stabilization Committee held its first meeting in early June to begin to map out a strategy to preserve access to health care for the citizens of rural Georgia. The 16-member panel, appointed by Gov. Nathan Deal earlier this year, will meet regularly to identify the needs of the rural hospital community and provide potential solutions.

Members of the committee requested additional data to assist in their evaluation of Georgia's current rural health network. That request included:
  • Maps of locations of all rural hospitals, showing their relative locations to possible referral centers.
  • Locations of all current Emergency Medical Services (EMS) providers and air ambulance services.
  • A detailed map of the payer mix throughout Georgia.
"We've asked for very specific data so that we can explore options and opportunities for our EMS workers rural communities as we move forward with our work," said Charles Owens, director of the Department of Community Health's (DCH) State Office of Rural Health (SORH). Owens also serves as facilitator and member of the Rural Hospital Stabilization Committee. "Our goal is to help support the stabilization of health care access in our rural communities."

The three-hour meeting, which was open to the public, took place at 2 Peachtree Street, Atlanta, in the DCH Board Room. It was also accessible through a live webinar, which is now posted on the DCH website.

Recently, the Board of Community Health approved rules to govern a new category for health care facilities -- Rural Free-Standing Emergency Departments.

Those rules include the following stipulations for the establishment of Rural Free-Standing Emergency Departments:
  • Must be currently licensed by the Department of Community Health as a hospital or had been previously licensed by DCH as a hospital whose license expired within the previous 12 months.  
  • Must be located in a rural county (defined as having a total population of 35,000 or less) and no more than 35 miles from a licensed general hospital.
  • Must be open as an emergency department seven days a week, 24 hours a day.
  • Must provide non-elective emergency treatment and procedures periods continuing less than 24 hours.
The rule changes allow the optional provision of services, including elective outpatient surgical treatment and procedures continuing less than 24 hours, basic obstetrics, plus gynecology procedures for periods continuing less than 24 hours.

doctor2.jpg These facilities, which will require licensing through DCH's Healthcare Facility Regulation Division, must make a reasonable attempt to secure written agreements with general hospitals located within 35 miles of the facility to coordinate patient referrals and transfers.

"Identifying the needs of these communities and their residents is a critical step to insure the modeled services are established in such a fashion that they fulfill the needs of the residents and are sustainable long term," Owens said. "This initiative must be a community-driven process to be successful, and we are all mindful of that requirement."

Here is updated information about the Rural Hospital Stabilization Committee and a link to the webinar of the first meeting.

Owens said that the group will soon announce the date, time and location of its next meeting, which is anticipated by the end of the summer. Details will be available on the DCH website.
DCH Issues New Unpaid Funds Policy Effective July 1

Beginning July 1, 2014, the Georgia Department of Community Health initiates its Provider Termination Policy for unpaid funds owed to DCH in the Medicaid and PeachCare for Kids� programs.

Medicaid Providers who owe DCH amounts in excess of what can be collected from provider claims payments will be required to make an immediate payment of the excess funds owed. Providers who fail to make this payment within 15 days of their written notice of payment due will be suspended.

Additionally, once suspended, providers who fail to make the required payment within 30 days of the suspended dates are subject to termination by the department.

In late June, DCH mailed letters to all providers who are past due in moneys owed to the department. The policy has been disseminated to various associations and organizations in the health care arena. It will also be posted on July 1, 2014, in Part 1 of the Provider Manual.

Any provider who is terminated may apply for reenrollment into the Medicaid and PeachCare for Kids programs once the total amount of funds owed to DCH has been paid.
Multi-agency Integrated Eligibility System (IES) To Streamline Application, Verification Processes

By the beginning of 2016, applicants for Georgia programs such as Medicaid, PeachCare for Kids, TANF, Child Care and WIC will be able to provide their information one time online for various types of assistance. Spearheaded by the Georgia Department of Community Health (DCH), the interagency project will include the Department of Human Services, the Department of Public Health and the Department of Early Care and Learning in a collaborative multi-year work plan.

lady-keyboard-hands.jpg The goal is to create a one-stop shop to streamline the application, eligibility and enrollment processes for the state's citizens who are applying for these programs. The IES will become a centralized database of members of programs managed by each of these agencies, providing the most up-to-date and accurate information supplied by members. It will allow these agencies to access the same basic information when working with their members and recipients.

DCH recently awarded a software development consulting contract for the project to Deloitte. The work will include bringing together the necessary technology and services to support the replacement of the state's current eligibility system. The new IES will feature a provider-assisted and member self-service customer-centric web portal and a rules-based engine for eligibility that will streamline the application and review processes.

Work on the new IES has been collaborative among the state's four health and social services agencies. The multi-year project began about two years ago.

 

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Provider Education Key Component of Georgia's Successful  Recovery Audit Programs


On April 15, 2014, Governor Nathan Deal signed into law H.B. 973, a bill that brings the existing Georgia False Medicaid Claims Act into compliance with the federal statute. The implementation of this law is the latest initiative by the Georgia Department of Community Health (DCH) to work with both providers and the federal government to ensure proper allocation of Medicaid funds.

As a result of this bill's passage, Georgia is able to continue to keep its 10 percent enhanced retention of funds recovered through state or federal false claims actions. This means that Georgia will be able to keep whatever part of the recovery was originally paid by state funds, plus 10 percent of the total amount recovered by Georgia.

Recently, DCH's Inspector General Rob Finlayson was interviewed by WSB-TV's Richard Belcher about Georgia's recovery programs and talked about the state's successes. Since 2011, Georgia has recouped an estimated $12 million in enhanced state share funds through state and federal false claims actions.

Provider education is a key component of DCH's enhanced recovery programs. Here are some areas for providers to consider to reduce the chance of violating the False Claims Act:
  • Know and understand Part I, Policies and Procedures for Medicaid/PeachCare for Kids �106.1 that requires certain entities to have written policies, procedures and thorough training for employees about the Federal False Claims Act. Each entity should internally promulgate detailed information regarding its own initiatives to detect and prevent fraud, waste and abuse in federal health care programs including Medicaid. It is recommended that each entity -- no matter its size -- have compliance programs in place.
  • Consistently self-audit and self-report. The Patient Protection and Affordable Care Act allows for a 60-day limit to repay identified overpayments. If you or your staff discovers an error in your claims-filing processes or payments, please report these discrepancies. Details are available about how to self-report in the self-disclosure section of DCH's website.
Lastly, Georgia's Recovery Audit Contractor (RAC) continues to operate very smoothly. With the diligent work of contractor Myers and Stauffer, Georgia is engaging providers in auditing and rectifying possible discrepancies in claims and payments. This approach has provided tremendous feedback, and in many cases, resulted in providers receiving money due to underpayments.
Georgia Families 360�SM Delivers Managed Care

In March of this year, the Georgia Department of Community Health (DCH) began the successful transition of 27,000 children, youth and young adults in foster care, children and youth receiving adoption assistance, plus select youth in the juvenile justice system into Georgia Families 360� managed care. The objective of this program is to improve continuity of health care and access to care for these vulnerable youth.

Amerigroup was selected by DCH as the care management organization (CMO) to coordinate and provide care, focusing on recruiting physicians, dentists and behavioral health providers to serve these populations. To date, more than 90 percent of Georgia's Medicaid fee-for-service providers have enrolled to deliver managed care through Amerigroup, with some providers joining the Amerigroup network expressly to serve Georgia Families 360� members.

The rollout of this project required complex planning and monitoring by DCH and its sister agencies, including the Division of Family and Child Services (DFCS) and the Department of Juvenile Justice (DJJ). Intensive daily meetings among the agency stakeholders were conducted in the first phases of implementation.

Now, the agencies and Amerigroup continue to meet to identify trends, resolve issues, and ensure that relevant stakeholders are included in various processes.

Another successful area of implementation included the 90-day transition period for doctors to enroll in the new system, or for patients to find new physicians, if needed, to help maintain continuity of care for members. Provider enrollment during the transition was so successful that Amerigroup extended the deadline through July 3, 2014, for behavioral health providers to enroll to meet the needs of Georgia's population.

Read more about Georgia Families 360�.
Online-only Institutional Enrollment Begins September 1, 2014

Effective September 1, 2014, the Georgia Department of Community Health (DCH) and Hewlett Packard (HP) will no longer accept paper enrollment applications from institutional providers. All paper applications will be removed from the Georgia Medicaid Management Information System (GAMMIS). Paper applications received on or after September 1, 2014, will be returned to the applicant with instructions to submit the application online through GAMMIS.

DCH is implementing this process to increase efficiency and effectiveness, reduce the administrative burden for the provider community, and expedite the enrollment process, which will reduce the time it takes enroll providers into Georgia Medicaid.

On January 1, 2015, DCH will implement this same process for all individual practitioners. Paper applications received on or after January 1, 2015, will be returned to the applicant with instructions to submit the applications online through GAMMIS. Read more.
Don't Miss the Deadline to Receive Your Incentive Payments  

As we approach the second half of 2014, the Department of Community Health's (DCH) Division of Health Information Technology (Health IT) encourages all eligible Medicaid providers to begin the application process for the Georgia Medicaid Electronic Health Record (EHR) Incentive Program.

Providers have until 2016 to start their Year 1 application for this free, voluntary, 100 percent federally funded program that provides incentive payments to Eligible Hospitals (acute care, critical access and children's hospitals) and Eligible Professionals (physicians, nurse practitioners, certified nurse-midwives, dentists and physician assistants) who adopt, implement, upgrade or demonstrate Meaningful Use of certified EHR technology. This is a critical step toward providing improved coordinated care for Georgia patients.

Electronic Document Management Eligible Professionals can receive up to $63,750 over six years by meeting the program's requirements. As of June 16, more than $218 million has been paid to Georgia health care providers since the program's inception in September 2011. With approximately $300 million remaining, the Division of Health IT encourages all eligible providers to apply for the program.

To help facilitate the technology conversions and to assist providers in completing requirements, the Medicaid EHR Incentive Program has partnered with Hewlett Packard Enterprise Services (HP) and the Georgia Health Information Technology Extension Center (GA-HITEC) to offer free assistance to providers about all facets of the program -- from completing the application process to selecting, implementing and using health information technology. 

Georgia's Medicaid EHR Incentive Program is 100 percent federally funded through the Centers for Medicare & Medicaid Services (CMS) and is administered through the DCH Division of Health IT.

Learn more about the Medicaid EHR Incentive Program.
More than $218 Million Has Been Paid in EHR Incentives Since 2011 

MIP EHR logo Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued more than $218 million in payments of federal funds to eligible providers through June 16, 2014. The program was launched on September 5, 2011.



Board of Community Health Actions in June 2014 

The Board of Community Health took the following actions at its Thursday, June 12, meeting:

The next regular meeting of the Board of Community Health is scheduled for Thursday, July 10, in the 5th Floor Board Room at 2 Peachtree Street, Atlanta.

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In This Issue
Rural Free-Standing ER Updates
New Unpaid Funds Policy Announced
Integrated Eligibility System Progressing
DCH's Audit Programs Successful
Georgia Families 360 Enhances Care
DCH, HP Begin Online-only Enrollment
Deadline Nears to Register for EHR Payments
EHR Incentives
June Board Actions
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DCH-i

 

About DCH-i  

  

DCH-i is the regular 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. 

 

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About DCH

 

2 Peachtree

 

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.      

 

Clyde L. Reese III is the DCH Commissioner.  

 

We are dedicated to
A Healthy Georgia
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www.dch.georgia.gov 

 

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Editor-in-Chief

Pamela A. Keene

 

Additional Contributors

Joye Burton 

David Leblang

 

Director of Communications

and Legislative Affairs

Lisa Marie Shekell

 

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DCH Mission

 

We will provide Georgians with access to affordable quality health care through effective planning, purchasing and oversight.

 

 

We are dedicated to 
A Healthy Georgia.

      

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