Presentation to: DCH Stakeholders, Medical Associations & Societies

1. Georgia Medicaid Initiatives Update Presentation to: DCH Stakeholders, Medical Associations & Societies Presented by: Jerry Dubberly, Chief, Medicaid Division June 12, 2013

2. Topics for Discussion • Medicaid Redesign Project • Foster Care and Adoption Assistance • Aged, Blind, and Disabled Care Coordination • Technology Improvements • Health Information Access • Other Timely Topics • Administrative Simplification • CHIPRA Cycle II Grant • Primary Care Rate Increase • Ordering, Prescribing, Referring Provider Enrollment

3. Medicaid Redesign Initiatives • DCH assessed opportunities for enhancing outcomes and coordination of care for populations currently in Medicaid Fee-for-Service (FFS): • Foster Care and Adoption Assistance (FCAA) • Aged, Blind and Disabled (ABD) • Critical need: Assisting members and caregivers in navigating today’s health care system

4. Transition of Children in Foster Care and Adoption Assistance to Georgia Families

5. Foster Care and Adoption Assistance • Select a single, statewide CMO from the incumbents • Targeted implementation: January 2014 • Develop a portable/virtual health record • Improve medical oversight and outcomes • Better coordinated care through care coordination teams • Enhance coordination across sister agencies • Implement Quality Committee for oversight and monitoring of the FC/AA CMO • Value-based Purchasing

6. Overview Program Design: ABD Medical Care Coordination

7. ABD Approach • Aged, Blind, Disabled (ABD) • ABD data illustrates opportunities for improving clinical, quality and financial outcomes • Features: • Single statewide vendor • Fee-for-Service environment • Intensive Medical Care Coordination • Patient Centered Medical Home • Primary Care Case Management Model • Provider Engagement • Value-based Purchasing

8. Technology Improvements

9. Health Information Access • Development of Statewide Health Information Network (GaHIN) • Applications • Virtual Health Record – November 2013 • Patient Profile – August 2013 • Provider Profile – Mid 2014

10. Title or Chapter Slide (use as needed; feel free to delete) Timely Topics

11. Administrative Simplification • Centralized Prior Authorization (PA) Portal • CMO Newborn Delivery Notification and Pregnancy Notifications 6/1/2013 • Inpatient/Outpatient Hospital/Ambulatory Surgical Centers Pre-certification 7/1/2013 • Expand to other categories of service • Training modules available via Webinar • Centralized Provider Enrollment Portal – March 29, 2013 • Streamlined application • Single point of application

12. CHIPRA Cycle II Accomplishments • Electronic Verification of Citizenship and Identity • Closed the loop between Medicaid and CHIP • March 2013 – 1156 Eligible (73 awaiting premium payment) • Improved member notices and appeal rights • Ability to enroll individuals in the field

13. Primary Care Rate Increase • 100% Medicare Rates for certain services • Effective January 1, 2013 • Medicaid only – Not CHIP • Primary care services • Vaccine administration • Attestation • Time limited: Ends December 2014

14. Ordering, Prescribing, Referring (OPR) Provider Enrollment • 42 CFR 455.410(b) requires that all practitioners that are eligible to order, prescribe or refer services or supplies for a Medicaid recipient be enrolled • Began accepting applications 4/1/2013 • The NPI of the OPR provider must be on the claim • Provider may enroll only as ordering/referring • Expedited application does not enroll them in the Medicaid program as a direct Medicaid provider • List of all providers is publicly available • CMOs must require NPIs on their claims as well

15. OPR Next Steps • DCH will allow a grace period • for OPR enrollment until June 30, 2013 • On July 1, 2013, claims for services • that contain a National Provider Identification number (NPI) of an ordering, prescribing, or referring provider not enrolled in Medicaid (either as a participating provider or as an OPR provider) will be denied

16. Title or Chapter Slide (use as needed; feel free to delete) Thank You