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Georgia nursing homes in arrears may lose Medicaid

Nursing homes and other medical providers that owe money to a Georgia health agency now face a repayment timetable that could lead to their being cut off from the government Medicaid program.

The new policy on collections, which goes into effect today, defines a series of steps on how delinquent providers can be suspended and then terminated from the Medicaid and PeachCare programs.

Termination could cause financial devastation for a nursing home, where most patients can be Medicaid beneficiaries.

The Department of Community Health, meanwhile, has sent out "past due'' notices to 33 nursing homes, telling them that they owe money. The agency did not identify the nursing homes in arrears.

Community Health said in an email last week to Georgia Health News: "It is important to note that the notices that were sent to these providers do not trigger the new termination policy; instead the notices serve as a notification of the provider's outstanding financial obligation to the department."

Delinquent accounts are most commonly from provider fees, the department said.

These financing mechanisms are a way for the state to gain more federal funding for the Medicaid program — and higher payments for nursing homes and hospitals.

Basically, the provider puts up a fee that's collected by the state, and then the organization can get more money back than its original assessment, after the federal Medicaid agency matches the state money.

Assessing these fees from providers lets states effectively increase the federal spending on their Medicaid programs. Most states use these financing mechanisms.

Medicaid is jointly financed by the state and federal governments. Georgia has roughly 350 Medicaid-certified nursing homes.

It's not immediately clear whether the nursing homes getting past-due notices failed to pay their full provider fee.

As of last year, Georgia's nursing home assessment was 6 percent of patient revenue.

The Georgia Health Care Association, which represents nursing homes, declined comment Wednesday on the past-due notices and new termination policy.

The importance of the hospital provider fee was highlighted last year when a bill to renew the assessment was pushed through the Georgia General Assembly ahead of all other legislation. Gov. Nathan Deal signed it into law almost as soon as it was passed.

The hospital provider fee — called by opponents a "bed tax'' — was designed to fill a nearly $500 million hole in the state's Medicaid program.

Under the new Department of Community Health repayment policy, medical providers that owe the agency "more than can be collected from 12 months of the provider's claims payments will be required to make an immediate payment of the amount owed that exceeds the 12 months of claims payments."

Providers that fail to make payment within 15 days will be placed on suspended status, the agency said. Those organizations will have 30 days to make payment before DCH initiates termination proceedings against them.

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