Health Care Finance

Price Transparency

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Medicaid

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.

Georgia Families - Care Management Organizations (CMO)

2013 Letter from DCH Inspector General Re: Contractor’s Responsibility Concerning Exclusions

Medicare

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.


Managed Care/Payer Communications

GHA Payer News
If you would like to receive emails regarding managed care payer communications, please contact Donna Hatcher.


VA Community Care Programs

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:

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


Hospital Provider Payment Program

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