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

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 March 1, 2008, is Cahaba Government Benefit Administrators, LLC and is located in Birmingham, Ala.

•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.

Fully Insured Accident and Health Insurance Plans

Self-Insured Employee Benefit Plans

Health Insurance Marketplace

GHA Payer News
If you would like 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.