May 2018

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Medicaid Fair Review

The Department of Community Health (DCH) held its 2018 Spring Medicaid Fair at the University of Georgia's Tifton Campus on April 25th. It was the largest attended Medicaid Fair held in the south region of the state with over 400 providers in attendance. Highlighted sessions included Electronic Visit Verification (EVV), Autism, Administrative Simplification, and the joint Behavioral Health sessions hosted by the Department of Behavioral Health and Developmental Disabilities (DBHDD), DCH, and the Care Management Organizations (CMOs). Other topics included appeals, billing, hospice services, waivers, dental, common denials, and physician hospital services, to name a few.  

During the opening session, Blake Fulenwider, Deputy Commissioner and Medicaid Chief, conducted a real-time poll of the audience. Some of the polling questions required the audience to rate the CMOs, identify if a centralized claims portal would be helpful, and rate the responsiveness of the provider representatives. The feedback received from the participants in the opening session was positive and well received.

DCH is preparing for the upcoming 2018 Fall Medicaid Fair. Additional details will be announced at a later date.
New Licensing Requirements for Durable Medical Equipment Providers

In 2017, Georgia law was amended to require the licensure of Durable Medical Equipment (DME) providers. Any person or entity located in the State of Georgia that provides durable medical equipment to a consumer and submits a claim for reimbursement by a third party, either directly or through a contracted arrangement, must obtain a license issued by the Georgia Board of Pharmacy. 

Additionally, any Medicare enrolled out-of-state DME manufacturer or wholesale distributor that provides DME to a consumer in Georgia and who possess a valid license from another state must obtain a license issued by the Georgia Board of Pharmacy.

The new licensing requirements apply to DME providers enrolled in the Georgia Medicaid/PeachCare for Kids program. Accordingly, all enrolled DME providers will be required to have applied for or obtained the required licensure by December 31, 2018. Failure to have applied for or obtained the required licensure by December 31, 2018 will result in termination from the Medicaid/PeachCare for Kids program. 

The Department of Community Health will issue notices to all DME providers and will post banner messages on the GAMMIS website reminding all enrolled DME providers of the need to comply with the new licensing requirements.

Enrolled providers will need to email a copy of their DME supplier license to  enrollment@dch.georgia.gov . This mailbox should only be used to submit a copy of the required DME license. In order to facilitate a prompt review of the DME license, please include "DME Pharmacy License" in the subject line of the email.

For specific instructions on how to apply for a license, DME providers may contact the Georgia Board of Pharmacy by calling (404) 651-8000 or by logging onto the website at www.gpb.georgia.gov .
New One Year Claim Submission Edit in GAMMIS

The Department of Community Health (DCH) and DXC Technology implemented a new timeliness edit in the Georgia Medicaid Management System (GAMMIS). The new edit is the result of an external audit which found that some paid claims had been adjudicated beyond the 365 life cycle. The system modifications in GAMMIS will limit a claim's life cycle to a maximum of one year in alignment with DCH policy.
 
This timeliness policy requires:

1) The original claim to be submitted within 180 days or six months from the date of service, and 

2) A claim that was denied for missing or erroneous information is to be resubmitted to correct the misinformation within three months from the date of service or when the denial occurred, whichever is later.
 
If you have any questions or need assistance with the new claims submission policy, please contact the DXC Technology Provider Contact Center at 1-800-766-4456 and/or your assigned Provider Representative.
Electronic Visit Verification Update

The Georgia Department of Community Health (DCH) is continuing to move towards the January 1, 2019 implementation date for Electronic Visit Verification (EVV). As mentioned in the November 2017 DCH-i Issue, EVV is a technology that automates the gathering of service information by capturing time, attendance and care plan information entered by a home care worker at the point of care. EVV gives providers, care coordinators, and DCH access to service delivery information in real time to ensure there are no gaps in care throughout the entire course of the service plan.

With respect to personal care services or home health care services, EVV electronically verifies the:
  • Type of service performed;
  • Individual receiving the service;
  • Individual providing the service;
  • Date the service was provided;
  • Location of service delivery; and
  • Time the service begins and ends.
DCH has created an EVV-dedicated website that has information about EVV and the state's implementation efforts.

DCH is also hosting Public Forums and speaking at AAA and CCSP meetings across the state about EVV. 
Please monitor our EVV website to see where our EVV team will be next!
 
If you have any questions or would like more information and updates regarding Georgia's EVV implementation , please feel free to email us at evv.medicaid@dch.ga.gov or visit the DCH EVV webpage .
Congenital Syphilis Prevention Campaign

The Georgia Department of Community Health (DCH) and the Georgia Department of Public Health (DPH) have joined in partnership to promote awareness and education about Congenital Syphilis Prevention. Congenital syphilis occurs when syphilis is passed from the mother to the fetus during pregnancy and is present at the birth of the child.

The Georgia HIV/Syphilis Pregnancy Screening Act of 2015 (O.C.G.A. § 31-17-4.2) provides that every physician and health care provider who assumes responsibility for the prenatal care of a pregnant woman during gestation and at delivery shall be required to test the pregnant woman for syphilis except in those cases where the woman declines the testing.  Additionally, Georgia law mandates that every physician and health care provider who provides prenatal care to a pregnant woman during the third trimester of gestation offer to test the woman for syphilis at the time of the first examination during that trimester or as soon as possible thereafter, regardless of whether the testing was performed during the first two trimesters of pregnancy.

If at the time of delivery, there is no written evidence that a syphilis test has been performed, the physician or other health care provider in attendance at the delivery must order a test for syphilis except in those cases where the woman declines the testing. If at the time of delivery, there is documentation that testing for syphilis occurred during the third trimester of the pregnancy, and the women does not disclose, upon questioning, any activities posing a risk for infection with syphilis occurring more recently than would have been detected by the test, the physician or health care provider in attendance at the delivery is not required to order an additional syphilis test.

If a pregnant woman tests positive for syphilis, counseling services provided by DPH will be made available and the woman shall be referred to the appropriate medical care providers for herself and her child. It is imperative that attending physicians report any positive tests for syphilis to DPH IMMEDIATELY upon receipt of the laboratory report. To report the positive syphilis test immediately:
  • Call the local District Health Office and/or
  • Call 1-866-PUB-HLTH (1-866-782-4584)
The Department will provide reimbursement for the correct ICD-10 diagnosis code with the following Syphilis lab tests procedure codes: 86592 and 86593.

Following the above requirements will help to ensure that one of Georgia's most vulnerable populations is born without congenital syphilis.
2018 DCH Board Meeting Schedule
 
To view the entire Board of Community Health meeting schedule for 2018, as well as actions taken at previous DCH Board meetings, click HERE.

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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.      

 

Frank W. Berry is Commissioner of the Georgia Department of Community Health.  

 

We are dedicated to
A Healthy Georgia
.   

   

www.dch.georgia.gov 

 

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DCH-i

    

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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About DCH-i

DCH-i is the bi-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 and health care advocates.

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