The department of Community Health (DCH) held a Medicaid Fair on Wednesday, November 2, 2022. All presentation materials from the Medicaid Fair are found here. Here are highlights from the opening session that you may find valuable.
The Public Health Emergency (PHE) is potentially ending January 15, 2023. DCH is initiating the PHE Unwinding and providing updates to providers and members via https://staycovered.ga.gov/. DCH encourages providers to read and publish this website to their patients.
Medicaid Member Redetermination:
DCH has not contacted members in 2 years and will begin member redetermination outreach on February 1, 2023. They must initiate contact with all Medicaid members within 12 months and complete the redetermination within 14 months in accordance with CMS guidelines. Members will be contacted during their renewal month. For example, if a member had a historical renewal in April, they will not be contacted until April. If the member utilizes SNAP/TANF, DCH will align with those programs to only contact the member one time.
How can the provider community help?
Please review https://staycovered.ga.gov/ for the latest PHE Unwinding information.
Proactively encourage and remind Medicaid patients to update their personal information on the Gateway website: https://gateway.ga.gov/access/
Share video, images, and the PHE toolkit that are found on https://staycovered.ga.gov/ with your patients.
Georgia Medicaid Provider Revalidation
Provider revalidation has also been voluntary due to the PHE. However, in 2023 the revalidation will become mandatory. Gainwell is reaching out to providers to assist with the revalidation process. The Revalidation/Recredential application is one application. For providers with multiple service locations, you will be required to Revalidate each additional service location. If you are unsure of your providers revalidation dates, log into www.mmis.gammis.gov Select Providers, then Demographic Maintenance, the Revalidation Date is present. Posted on GAMMIS in Provider Notices (9/1/2022) “Presentation-Physician Services-September 2022,” (Slides 25-27)
Lactation Consultants may now enroll via the MMIS web portal, www.mmis.georgia.gov, as an individual practitioner for the Medicaid and Peach Care for Kids programs. Lactation Consultants must have a State Lactation License via the Board of Lactation Consultants and be certified via the International Board of Lactation Consultant Examiners (IBCLC). Additionally, Lactation Consultants must be credentialed.
The scope of services provided by Lactation Consultants includes the provision of lactation care and services to pregnant and lactating women and children who are breastfeeding. Such services include lactation assessment, implementation of a plan of care, and education and counseling. Lactation services may be rendered in the following settings: hospital, physician practice, and home setting.
Providers may bill utilizing one or both of the following codes:
- S4443 (Lactation Class)
- S4445 (Patient Counseling)
Reimbursement is based upon the posted fee schedule. Lactation consultant services are limited to five (5) sessions unless deemed medically necessary.