Medicaid News Archive
Please select the links below for complete Medicaid articles and events from past years. View Current Medicaid News
General
10.01.07 Branded Topical Corticosteroids Will Require Prior Approval Beginning Nov. 1, 2007
The Georgia Department of Community Health (DCH), Medicaid FFS program will implement a clinical prior authorization protocol for the branded topical corticosteroids beginning November 1, 2007.
All branded agents will require failure of a generic agent within the same potency class or a higher potency class. Prior Authorization requests may be obtained by contacting SXC Health Solutions at 1.866.525.5827. To view criteria on the Web site, go to Providers - Pharmacy - Prior Authorization Process and Criteria.
View DCH Criteria
10.01.07 President Bush Signs Bill that Delays Tamper-Proof Rx Pad Requirements
On Saturday, President George Bush signed HR 3668, delaying the implementation of the Medicaid tamper-resistant Rx pad mandate for 6 months. Since the provision to require tamper-proof prescription pads was slipped into the Iraq war supplemental appropriation bill, MAG and others have lobbied for an extension to comply with the new regulation. On September 26, our efforts paid off as Congress passed a provision in a continuing funding resolution, which delayed implementation of the regulation. The Georgia Medicaid Fee-For-Service (FFS) Outpatient Pharmacy Program requiring physicians to use tamper-resistant prescription pads for any new prescription will now be effective April 1, 2008. The six-month delay came with the help of Georgia Congressman Nathan Deal (R-9th District), who managed this piece of legislation on the floor of the House.
View Georgia DCH's Announcement
09.14.07 CMS Issues Update to Medicaid's Requirements/Tips for Tamper-Proof Prescription Pads
CMS issued clarifications regarding the Tamper Resistant Prescription Pad requirements. The most significant clarification came in the prescriptions written in the institutional setting. In summary, "CMS has concluded that a written order prepared in an institutional setting where the doctor or medical assistant writes the order into the medical record and then the order is given by medical staff directly to the pharmacy is considered "tamper resistant," so long as the patient never has the opportunity to handle that written order."
Read Medicaid's FAQs
Read CMS Changes/FAQs
09.04.07 Medicaid's Requirements/Tips for Tamper-Proof Prescription Pads Effective Oct. 1
The Georgia Medicaid Fee-For-Service (FFS) Outpatient Pharmacy Program in accordance with Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, and in an attempt to combat fraud and abuse, will require prescribers to use tamper-resistant prescription pads for any new prescription with fill dates on and after October 1, 2007. This requirement applies to hard copy prescription orders for any drug, device or product covered through the Medicaid FFS outpatient pharmacy program whether legend or over-the-counter.
Read Medicaid's FAQs
02.21.07 MAG's In-Depth Look at PeachCare for Kids Crises
MAG's Department of Third Party Payer Advocacy presents an in-depth look at the PeachCare issue. The program faces two funding challenges, which if they are not met will result in the termination or severe restriction of the program. The Medical Association of Georgia supports immediate funding to avoid disruption in the continuity of care Georgia’s physicians provide to children.
View Issue Brief
02.19.07 Chambliss, Isakson Introduce Legislation to Fix Funding Shortfall for SCHIP Program
WASHINGTON - U.S. Senators Saxby Chambliss, R-Ga., and Johnny Isakson, R-Ga., introduced a measure to fix the current funding shortfall for the State Children's Health Insurance Program (SCHIP). The senators filed an amendment to the Continuing Resolution legislation, H.J. Res.20, being considered by the U.S. Senate that provides budget authority for federal agencies and programs to continue in operation until the regular appropriations acts are enacted.
02.01.07 PeachCare for Kids in Pending Financial Crises
In Georgia, PeachCare for Kids began covering children in 1999, providing comprehensive coverage to uninsured children. Currently, Georgia’s PeachCare for Kids program is facing a federal fund shortfall of $131 million, for this year, starting in May or June, and another shortfall in 2008 of over $171 federal dollars and $171.2 in state dollars.
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01.21.07 U.S. Health Spending Estimates
Health care spending growth in the United States slowed for the third consecutive year in 2005, increasing 6.9 percent compared with 7.2 percent growth in 2004 and 8.1 percent growth in 2003, according to a report by the Centers for Medicare & Medicaid Services' Office of the Actuary. The 6.9 percent growth in 2005 marked the slowest rate of growth in health spending since 1999, when growth was 6.2 percent. Healthcare spending reached almost $2.0 trillion in 2005, or $6,697 per person, up from $6,322 per person in 2004.
11.16.06 Governor Perdue announces appointments to Georgia Physician Partnership
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10.04.06 Older driver safety physician survey
As part of a new public health initiative to assess the potential for environmental, educational, and policy changes that support safe mobility for older drivers, the Injury Prevention Section (IPS), Division of Public Health and the Governor’s Office of Highway Safety (GOHS), evaluated the role physicians play in addressing older driver safety in Georgia.
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01.06 Preferred drug list changes for Georgia Medicaid and PeachCare for Kids programs
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09.05 Medicaid’s Georgia Healthy Families Program contractors respond to MAG’s questions
View Questions & Answers
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09.02.05 Health Check Appointment Tracking and HIPPA
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04.27.05 DCH Health Check Update
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03.02.05 DCH Issues RFP for Disease State Management for the Aged, Blind and Disabled
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Medicaid Managed Care
11.21.06 WellCare details OTC benefit for members
Physicians please take special note of the $10/month OTC benefit for all WellCare members and encourage your patients to take advantage of this free benefit so they will have basic pain relievers, cough and cold treatments, topical antipruritics and other standard OTC products on hand for their routine home care needs.
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10.30.06 WellCare modifies prior-authorization process for oncology services
GASCO has been in contact with WellCare concerning problems with their prior authorization procedures for office visits and chemotherapy. Using examples from GASCO practices, the medical review and pharmacy staff at WellCare has modified the approval process. Apparently, their pharmacy department was handling one part of the process and general health services handled another. The process was not appropriate to the manner in which chemo is provided. Effective immediately, they have modified this into a more consolidated process to be coordinated by the pharmacy department and extended the initial approval of treatment plans to include up to six months of care. The approval for an E&M service will cover any level selected based on actual services rather than just one code listed on the prior authorization.
10.26.06 New provider relations territory assignments
If you have a basic question or inquiry, such as authorization requirement protocols, checking claims, eligibility or authorization status, please call the central Provider Services Hotline at 866.231.1821. Otherwise, feel free to contact your PR representative or their respective regional leader directly with any questions or concerns you have regarding WellCare. E-mail is often a much more effective medium for communicating with your WellCare representative - please note that all WellCare e-mail addresses are configured as firstname.lastname@wellcare.com.
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09.01.06 MAG's Letter to Commissioner Medows Regarding Medicaid CMOs
Executive Director David Cook's follow-up letter to Department of Community Health Commissioner Rhonda Medows airing physicians' concerns regarding the statewide implementation of CMOs.
View Letter
09.01.06 Medicaid CMOs roll out statewide
Physicians have reported a number of problems to MAG since the implementation of Georgia’s Medicaid Managed Care program. While MAG has relayed these problems to DCH, they have notified us that they will only address issues in which we provide detailed and specific information. Please report your problems on the hassle factor log and return it to MAG.
View CMO Hassle Factor Log
08.11.06 MAG sends letter to Gov. Perdue about Medicaid Managed Care
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08.11.06 MAG practice alert for physicians and practice managers
MAG is trying to assess the current magnitude of physician office problems with Medicaid CMO Operations in the Atlanta and Central regions. We continue to receive, on a daily basis, a limited number of problem reports. However limited, the problems which are reported are significant: long payment delays, incorrect payment amounts, difficulties in making referrals, too many and too complicated prior authorizations, claim filing difficulties, and so on. We would appreciate hearing from you on the GMGMA List Serve about the degree and kinds of problems being experienced with the CMOs and whether you believe improvements are occurring. We would also appreciate receiving individual patient case examples from your practices for building our case with the Medicaid office. You may contact Cam Grayson with your case examples at 404.881.5053 or 1.800.282.0224. We will be happy to intercede on your behalf if your physicians are MAG members. Following your responses, MAG hopes to escalate its response proportionately.
02.15.06 Medicaid Managed Care program delays implementation until June 1, 2006
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09.05 Medicaid Managed Care program delays implementation until April 1, 2006
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07.19.05 Department of Community Health announces three Medicaid CMO contract awards
Following a closer assessment of the winning contracts, MAG will include comments in the near future.
View DCH Press Release
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03.25.05 MAG meets with proposed Medicaid Care Management Organizations
MAG invited seven of the leading proposed Medicaid Care Management Organizations to speak to MAG’s Third Party Payer Committee and other MAG members about their proposals for the Medicaid Georgia Cares Managed Care Program. Representatives from Centene Corporation, WellCare Health Plan, Coventry Health Care Inc., AmeriGroup Corporation, Wellpoint/ Blue Cross Blue Shield of Georgia, Three Rivers Health Plan, and Americhoice Health Services made presentations and responded to physicians’ questions and concerns.
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01.05 DCH releases HMO RFP for their “Georgia Cares” Medicaid Managed Care Program
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01.01.05 Georgia implements Medicaid Managed Care Program
The Georgia Cares plan will be effective January 1, 2006.
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01.05 MAG’s comments on Gov. Perdue’s proposal for a Medicaid HMO and alternative recommendations
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Payment
02.01.07 Only 20 Percent Have Applied for NPI
Only 20 percent of Georgia's Medicaid providers have applied for their NPIs! Georgia Medicaid will comply with federal regulations and begin using the National Provider Identifier (NPI) as the provider identifier on all standard transactions on or before the May 23, 2007 compliance date.
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Submittal Form
01.01.07 NPI: Get It. Share It. Use It.
Only five months remain until the NPI compliance date - are you ready to use your NPI? A recent survey of the health care industry, conducted by the Workgroup for Electronic Data Interchange (WEDI), indicates that providers should be moving from the enumeration stage into the implementation stage to ensure NPI readiness by the compliance date. Remember, it is estimated that it may take up to 120 days to complete the work needed in order to implement the NPI into your current business practices. The following steps will assist you in your preparation:
- Enumerate: Have you applied for your NPI(s)? Not only should individual providers (Type 1) have enumerated, but organizations and subparts (Type 2) should have enumerated also.
- Update: Have you received your software application updates, upgrades and/or changes relevant to NPI? Be sure that the updates not only addresses the HIPAA Transactions, but includes the CMS1500, UB04 and/or Dental claim form changes.
- Communicate: Have you communicated your NPI(s) to your health plans and other organizations you work with? Keep in mind, as outlined in current regulation, all covered providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes -- including designation of ordering or referring physician.
- Collaborate: Do you know the readiness of your trading partners (such as health plans, TPAs, clearinghouses, etc...)? It's important to work with your trading partners to know their readiness with NPI and how it impacts you.
- Test: Have you started testing the NPI, both internally and externally? Not only do you need to test the HIPAA Transactions such as 837 Claims, but if you process 835 Remittance Advice, be sure to test that your system can process the NPI appropriately. Also, if you submit paper claims, be sure that you've tested the data being printed in the correct fields.
- Educate: Have you educated your staff on what the NPI is and the use of it? It's important that staff who may be using the NPI in day-to-day work, such as verification of eligibility, or other tasks that may need the NPI, be aware of the NPI and the provider identifiers that it replaces. The staff may have to change policies and procedures.
- Implement: Have you implemented the NPI into your business practices? Once testing is complete, changes will go into production. Prior to doing this, you'll need to make sure your trading partners are ready to process with the NPI only.
Frequently Asked Questions
12.04.06 Georgia's National Provider Identifier Deadline is December 31
The NPI replaces all existing health care provider identifiers including numbers assigned by Medicare, Medicaid, Blue Cross, etc. on standard HIPAA transactions. It will be the provider identification number used to identify providers. All active Georgia Medicaid providers must supply their NPI to Georgia Medicaid by December 31, 2006.
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04.06 Codes change for physician injectable drug billing
Pursuant to a Congressional Budget Reconciliation Act of 2006, all State Medicaid programs have been mandated to begin requiring providers to submit claims for injectable drugs administered in the office or outpatient hospital setting using National Drug Code (NDC) numbers, rather than the Health Care Common Procedure Coding System (HCPCS) or Common Procedural Terminology (CPT) codes. The proposed policy change is scheduled to begin January 1, 2007.
The Department will make its approved HCPCS code to NDC number crosswalk information available prior to implementation. Except for use of the NDC number, established billing protocols for injectable drugs shall remain unchanged.
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Practice E-tips
09.11.07 Georgia Medicaid Information Now Available via SXC Web Portal
Register now to access important GA Medicaid information via SXC Web portal. The PBM-SXC's Web portal functionality, upon prescriber registration, allows a physician to review online FFS -Medicaid member's Prescription claim history.
Download Registration Form & Information
08.31.07 Moving Paper RAs to the Web Portal
Effective August 27, all providers who currently have a POA (Provider Office Administrator) ID or a web portal ID will receive their RAs via the GHP web portal. This includes all providers who receive Remittance Advices (RAs) via paper. The RAs will be stored on the Message Center of the GHP web portal.