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Archives for July 2012

Georgia Department of Community Health Conservative with Medicaid Changes

The Georgia Department of Community Health has decided not to move forward with an overhaul of Georgia’s Medicaid program.  There are two main reasons for the change:  (1) the Supreme Court’s decision to uphold the Affordable Care Act and (2) the upcoming election.  The Supreme Court left the decision of whether to expand Medicaid up to the individual states, and Georgia’s governor has not made a definite decision about whether or not the state will move forward with expansion of Medicaid under the Affordable Care Act.  In addition, some political leaders are voicing their intent to repeal the Affordable Care Act.  According to the DCH news release, “[T]he department concluded that the current health care environment is so volatile that acting now with a full redesign would not serve the best interests of all Georgians.”

DCH’s decision to implement only small changes based on information it received from the redesign process seems prudent in light of the current state of federal healthcare reform.  Implementing a complete overhaul of the entire Medicaid system in Georgia without definitive knowledge of whether Georgia will expand Medicaid under the Affordable Care Act or whether the Affordable Care Act will be overturned could create substantial problems for the state on many levels.  One impact is financial – the Medicaid budget is already facing a deficit, and DCH would be in an unfavorable position if it prematurely overhauled Medicaid at unnecessary expense to the State.

One final important point to note about the announcement is that DCH said that a Medicaid overhaul will not occur “at this time”, which means it could still happen after the political turmoil settles down. Any future changes to Georgia’s Medicaid program will be detailed here.

Healthcare Providers Could See an Increase in Centers for Medicare and Medicaid Services Audits

On June 2012, the Department of Justice (DOJ) issued a report from its study of Home and Community Based Services (HCBS) waiver programs.  Seven of 25 states reviewed were found to have systems that were lacking in their ability to provide quality care to waiver program recipients.  In addition, the study found that the Centers for Medicare and Medicaid Services (CMS) did not use all means available to monitor the states’ programs.  As a result, the DOJ recommended that CMS implement additional requirements to ensure quality care.

Going forward, states may see more involvement and oversight on the part of CMS in enforcing compliance with the requirements of the HCBS waiver programs.  The increased attention paid by CMS could mean more site visits, audits, and compliance initiatives aimed at providers.  As with any audit or proposed adverse action, it is always to the provider’s benefit to consult with an experienced healthcare attorney immediately upon receipt of notice of an upcoming audit, audit results or overpayment demand letters.  The attorneys at Jeyaram & Associates have in-depth audit experience and are available for consultation.

Tips on How to Request Medicaid Hearings in Georgia (Part III of III)

In the final part of our “How to Request Medicaid Hearings in Georgia” series, a final tip in this process is to make sure you’re well versed in your policies AND the Department of Community Health’s (DCH’s) policies.  While you may understand and know your own internal policies extremely well, it may be helpful to hire a healthcare attorney that specializes in and has experience with DCH’s policies and administrative appeals to ensure the best possible outcome of your hearing.

Knowledge of the facts and your and DCH’s policies are critical.

For the hearing:

  • Make sure you know the member
  • Determine what the medical records do and do *not* say
  • Identify if information used by DCH was correct
  • Determine if anything has changed


Again, here’s where engaging a healthcare attorney with experience in administrative hearings will be helpful.

Finally,  being proactive will help you minimize the amount of money lost to denied claims and increase your effectiveness in challenging denials issued by the Department.

Jeyaram & Associates has successfully handled more than 200 Medicaid hearings before the Georgia Department of Community Health and is well positioned to help with your administrative hearings. Contact