Georgia’s new surprise billing regulations went into effect Jan. 1, 2021. GHA developed Surprise Billing FAQs to help hospitals answer questions about implementation of the Georgia Surprise Billing and Consumer Protection Act (House Bill 888).

Federal No Surprises Act

Crosswalk of Federal and Georgia Law

Click here to see webinars, CMS resources and other items related to price transparency.

Medicaid Disproportionate Share Hospital Program
The Georgia Disproportionate Share Hospital (DSH) Program is under the umbrella of the Indigent Care Trust Fund (ICTF). Established in 1990, the ICTF's purpose is to expand Medicaid eligibility and services, support rural and other health care providers, primarily hospitals, which serve the medically indigent, and fund primary health care programs for medically indigent Georgians. The Department of Community Health is responsible for administering both the ICTF and state DSH program.
 

Established in 1965, Medicare is available to most people beginning at age 65 and to those with end-stage renal (kidney) disease or total disability. Medicare is an entirely federally funded program. It is overseen at the federal level by the Centers for Medicare and Medicaid Services (CMS) and is administered through contractors known as Medicare Administrative Contractors (MACs). The MAC for Georgia, effective February 26, 2018, is Palmetto GBA, LLC and is located in Columbia, South Carolina.

• Medicare in reference to Disproportionate Share Hospital Programs.

Medicare Advantage Plans
GHA, in conjunction with other state hospital associations through the Multi-State Managed Care Coalition, has advocated for greater oversight of the Medicare Advantage plans by CMS. We have provided a list of issues that our hospitals have experienced in dealing with Medicare Advantage plans and requested CMS's assistance in requiring the plans to resolve these issues.

The Reference-Based Pricing Toolkit*, now available to GHA members, summarizes the use of reference-based pricing by non-network health plans and provides answers to frequently asked questions (FAQs) regarding non-network health plans and reference-based pricing. *A GHA-member username and password are required to access the toolkit.

Fully Insured Accident and Health Insurance Plans

Self-Insured Employee Benefit Plans

Health Insurance Marketplace

GHA Payer News
To receive emails regarding managed care payer communications, please contact Donna Hatcher.

Many hospitals provide services to veterans who are eligible to receive services through Veterans Administration (VA) Health Administration. Veterans are expected to receive services through VA hospitals and clinics whenever possible. However, there are several programs through which the VA will pay community providers for services that are unavailable through the VA or not accessible by the veteran. Such community care is coordinated either directly by the VA or by HealthNet, a managed care company that has the contract to manage VA community care services in our region.

The rules for eligibility, authorization and payment for such services are complex. In order to assist hospitals in better understanding this program, on October 26, 2016, GHA hosted a program, including the following presentations, at which leaders from the VA and HealthNet provided information about the program:

• VA Provider Brief for HFMA 05-18-17
• VA Provider Brief for GHA 10-26-2016  
• HealthNet Presentation for GHA 10-26-2016

In follow up to the program, the VA and HealthNet provided the following additional information and reference guides.

• The Claims Filing Instruction Fact Sheet describes how to determine which VA program to bill
• The Claims Submission Checklist is to be used in conjunction with the Claims Filing Instruction Fact Sheet to ensure proper billing.
• The Emergency Care and VA Coverage Brochure contains information for beneficiaries that should be used to inform ED intake staff of rules of coverage.
• Contact Information for VA Claims Offices for Georgia hospitals
• VA Customer Service Contacts All Regions
• Check payment status
• VA Fee Schedules have been requested but not yet received
• VA Provider Guide
• VA care in the community programs, including registration for the ListServe
• Medical Record Requirements for the VA & Virtual Lifetime Electronic Record (VLER)

Legislatively enacted with a July 1, 2010 effective date, the Hospital Provider Payment Program (HPPP) requires that most Georgia hospitals make quarterly payments to the state based on a percentage of their annual net patient revenue. The HPPP was originally enacted with the passage of House Bill (H.B.) 1055 and was effective for a three-year period through June 30, 2013.

The General Assembly passed Senate Bill (S.B.) 24 in early 2013 that allowed for the continuation of the program through June 30, 2017. S.B. 24 authorized the Department of Community Health to assess one or more provider payments on hospitals for the purpose of obtaining federal financial participation for Medicaid. The department promulgated rules in the spring of 2013 to continue the HPPP program and created a new program, the Hospital Medicaid Financing Program, that will increase Medicaid payments to help hospitals that have net losses from the HPPP program. With its passage of S.B. 70 in 2017, the General Assembly renewed S.B. 24’s authorization which will allow DCH to continue to assess provider payments on hospitals through June 30, 2020.

GHA Public Comments for HPPP-Related Medicaid Payment Increase – March 2017