HB 321, which became effective Oct. 1, 2019, requires tax-exempt hospitals to post an extensive list of finance-related information to the main page of the hospital’s website. The Department of Community Health finalized regulations implementing the requirements in December 2019. Hospitals are required to update the information by July 1 each year. As Georgia lawmakers consider policies related to hospitals, GHA encourages all hospitals to review their webpages to ensure the financial transparency information is up to date and make any necessary efforts to remain compliant. Documents from prior years are required to remain on the hospital’s website indefinitely.

See resources on HB 321.

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.

Georgia Access

GHA Payer News
To receive emails regarding managed care payer communications, please contact Blake Fulenwider. 

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 community care programs through which the VA will pay community providers for services that are unavailable through the VA or not accessible by the veteran.