1. 0 Presentation to: DCH Stakeholders, Medical Associations & Societies Presented by: Jerry Dubberly, Chief, Medicaid Division June 12, 2013 Georgia Medicaid Initiatives Update

2. 1 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. 2 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. 3 Transition of Children in Foster Care and Adoption Assistance to Georgia Families

5. 4 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. 5 Overview Program Design: ABD Medical Care Coordination

7. 6 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. 7 Technology Improvements

9. 8 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. 9 Title or Chapter Slide (use as needed; feel free to delete) Timely Topics

11. 10 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. 11 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. 12 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. 13 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. 14 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. 15 Title or Chapter Slide (use as needed; feel free to delete) Thank You