Preliminary Budget Recommendations
FY2009 Enhancements – Medicaid Benefits

The ACCESS Healthcare Coalition supports the Georgia Department of Community Health's recent proposal to increase annual medicaid funding by more than $40 million. Following is a summary of the DCH's proposal.

1. Inpatient Hospital Services

Using FY2005 cost reports:

  • Increase cost coverage from 93.6% to 97.5% for Trauma Hospitals
  • Increase cost coverage from 91.0% to 93.5% for Non-Trauma hospitals
Date of last increase for inpatient hospitals was FY2003 with rate reductions in FY2004 and FY2006.

Cost: $46.6 million total funds; $16.8 million state funds*

* Includes the cost to increase rates in PeachCare for Children.

2. Outpatient Hospital Services

Use facility-wide Cost-to-charge ratios to determine cost:

  • 100% of cost for Trauma Hospitals
  • 95% of cost for Non-Trauma hospitals
  • Assume 2.5% average increase in rates linked to RBRVS
  • Increase triage fee for non-emergent use of the ER to $60
  • Increase cap on outpatient services based on increases in inpatient services
Date of last increase for Outpatient Hospital was FY2002 with rate reductions in FY2005 and FY2006.

Cost: $16.9 million total funds; $6.8 million state funds*

* Includes the cost to increase rates in PeachCare for Kids.

3. Physician and Physician Related Services

Change the maximum allowable reimbursement to 88.5% of 2007 RBRVS as specified by Medicare for Georgia Area 1 (Atlanta).

  • Services provided by a physician’s assistant and advanced nurse practitioner will be limited to no more than 90% of the maximum allowable amount paid to a physician.
  • Covers the following practitioners and services: Physician, Physician Assistant, Nurse Midwife, Advanced Nurse Practitioner, Family Planning, Podiatry, Oral Surgery, Children’s Intervention Services, Children’s Intervention School Services, Psychology, Dialysis Professional Services and Vision.
Currently based on the 84.6% of 2000 RBRVS with the date of last increase in FY2003 and a 10% rate reduction in FY2004.

Cost: $24.2 million total funds; $10.0 million state funds *

* Includes the cost to increase rates in PeachCare for Kids.

4. Nursing Homes

  • Provide an additional 1% add-on to the nursing services component of the per diem for facilities that meet the requirements of the Quality Incentive Program.
Date of last rate increase for nursing homes was FY2008.

Costs: $5 million total funds; $1.8 million state funds