Georgia Medicaid State Plan

Georgia Medicaid State Plan

By David L. McGuffey, Certified Elder Law Attorney

The Official version of the State Medicaid Plan is online at the Department of Community Health Website. Researchers should contact the Department for recent changes. As with all pages on this website, this page is provided as a courtesy. It should not be relied on as a substitute for appropriate legal counsel.

State Plan - Single Document (Downloaded February 3, 2008)

CURRENT AS OF DECEMBER 3 2007 FROM STATE WEBSITE

State Plan Under Title XIX of the Social Security Act, Medical Assistance Program (Note: Sections 1 through 7 of this Table of Contents appear in this consolidated PDF document. Attachments and Supplements are linked below)

Section 1: Single State Agency Organization
Section 2: Coverage and Eligibility
Section 3: Services: General Provisions
Section 4: General Program Administration
Section 5: Personnel Administration
Section 6: Financial Administration
Section 7: General Provisions
List of Attachments

Section 1 - Single State Agency Organization

1.1 Designation and Authority

1.2 Organization for Administration

1.3 Statewide Operation

1.4 State Medical Care Advisory Committee

1.5 Pediatric Immunization Program

1.6 State Option for Managed Care

Section 2 - Coverage and Eligibility

Section 3 - Services: General Provisions

3.1 Amount, Duration, and Scope of Services
3.2 Coordination of Medicaid with Medicare Part B
3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
3.4 Special Requirements Applicable to Sterilization Procedures
3.5 Meicare Cost Sharing
3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period

Section 4 - General Program Administration

Section 5 - Personnel Administration

Section 6 - Financial Administration

Section 7 - General Provisions

7.1 Plan Amendments
7.2 Nondiscrimination
7.3 Maintenance of AFDC Effort
7.4 State Governor's Review

List of Attachments

1.1-A Attorney General's Certification
1.1-B Waivers under the Intergovermental Cooperation Act
1.2-A Organization and Function of Medical Assistance Unit
1.2-C Professional Medical and Supporting Staff
1.2-D Description of Staff Making Eligiblity Determination
2.1-A Definition of an HMO that is Not Federally Qualified
2.2-A Group Covered and Agencies Reponsible for Eligibility Determinations
- Supplement 1 - Reasonable Classifications of Individuals under Age of 21, 20, 19 and 18
- Supplement 2 - Definitions of Blindness and Disability
- Supplement 3 - Method of Determining Cost Effectiveness of Caring for Certain Disabled Children at Home
2.6-A Eligibility Conditions and Requirements
- Supplement 1 - Income Eligibility Levels - Categorically Needy, Medically Needy and Qualified Medicare Beneficiaries
- Supplement 2 - Resource Levels - Categorically Needy, Including Groups with Incomes up to a Percentage of the Federal Poverty Level, Medically Needy and Other Optional Groups
- Supplement 3 - Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered under Medicaid
- Supplement 4 - Section 1902(f) Methodologies for Treatment of Income that Differ from those of the SSI Program
- Supplement 5 - Section 1902(f) Methodologies for Treatment of Resources that Differ from those of the SSI Program
- Supplement 5a - Methodologies for Treatment of Resources for Individuals with Incomes up to a Percentage of the Federal Poverty Level
- Supplement 6 - Standards for Optional State Supplementary Payments
- Supplement 7 - Income Levels for 1902(f) States - Categorically Needy Who Are Covered Under Requirements More Restrictive than SSI
- Supplement 8 - Resource Standards for 1902(f) States - Categorically Needy
- Supplement 8 Addendum - Resource Standards for 1902(f) States - Categorically Needy
- Supplement 8a - More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act
- Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act
- Supplement 8c - State Long-Term Care Insurance Partnership
- Supplement 9 - Transfer of Resources
- Supplement 9a - Transfer of Resources
- Supplement 9b - Transfer of Resources
- Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship
- Supplement 11 - Cost Effectiveness Methodology for COBRA Beneficiaries
- Supplement 12 - Eligibility Under Section 1931 of the Act
- Supplement 12 Addendum - Eligibility Under Section 1931 of the Act
- Supplement 13 - Section 1924 Provisions
- Supplement 14 - Consideration of Transfer Assets and Trusts - Undue Hardship
- Supplement 17 - Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
- Supplement 1 - Case Management Services, Part A
- Supplement 1 - Case Management Services, Part AA
- Supplement 1 - Case Management Services, Part AAA
- Supplement 1 - Case Management Services, Part AAAA
- Supplement 1 - Case Management Services, Part B
- Supplement 1 - Case Management Services, Part BB
- Supplement 1 - Case Management Services, Part BBB
- Supplement 1 - Case Management Services, Part BBBB
- Supplement 1 - Case Management Services, Part C
- Supplement 1 - Case Management Services, Part CCC
- Supplement 1 - Case Management Services, Part CCCC
- Supplement 1 - Case Management Services, Part DDD
- Supplement 1 - Case Management Services, Part DDDD
- Supplement 1 - Case Management Services, Part E
- Supplement 1 - Case Management Services, Part EEE
- Supplement 1 - Case Management Services, Part EEEE
- Supplement 1 - Case Management Services, Part F
- Supplement 1 - Case Management Services, Part FFF
- Supplement 1 - Case Management Services, Part FFFF
- Supplement 1 - Case Management Services, Part GG
- Supplement 1 - Case Management Services, Part GGG
- Supplement 1 - Case Management Services, Part GGGG
- Supplement 1 - Case Management Services, Part H
- Supplement 1 - Case Management Services, Part HH
- Supplement 1 - Case Management Services, Part HHH
- Supplement 1 - Case Management Services, Part HHHH
- Supplement 1 - Case Management Services, Part I
- Supplement 1 - Case Management Services, Part II
- Supplement 1 - Case Management Services, Part III
- Supplement 1 - Case Management Services, Part IIII
- Supplement 1 - Case Management Services, Part J
- Supplement 1 - Case Management Services, Part JJ
- Supplement 1 - Case Management Services, Part JJJ
- Supplement 1 - Case Management Services, Part JJJJ
- Supplement 1 - Case Management Services, Part KK
- Supplement 1 - Case Management Services, Part KKK
- Supplement 1 - Case Management Services, Part KKKK
- Supplement 1 - Case Management Services, Part L
- Supplement 1 - Case Management Services, Part LL
- Supplement 1 - Case Management Services, Part LLL
- Supplement 1 - Case Management Services, Part LLLL
- Supplement 1 - Case Management Services, Part M
- Supplement 1 - Case Management Services, Part MM
- Supplement 1 - Case Management Services, Part MMM
- Supplement 1 - Case Management Services, Part MMMM
- Supplement 1 - Case Management Services, Part N
- Supplement 1 - Case Management Services, Part NN
- Supplement 1 - Case Management Services, Part NNN
- Supplement 1 - Case Management Services, Part NNNN
- Supplement 1 - Case Management Services, Part O
- Supplement 1 - Case Management Services, Part OO
- Supplement 1 - Case Management Services, Part OOO
- Supplement 1 - Case Management Services, Part P
- Supplement 1 - Case Management Services, Part PP
- Supplement 1 - Case Management Services, Part PPP
- Supplement 1 - Case Management Services, Part Q
- Supplement 1 - Case Management Services, Part QQ
- Supplement 1 - Case Management Services, Part QQQ
- Supplement 1 - Case Management Services, Part R
- Supplement 1 - Case Management Services, Part RR
- Supplement 1 - Case Management Services, Part RRR
- Supplement 1 - Case Management Services, Part S
- Supplement 1 - Case Management Services, Part SS
- Supplement 1 - Case Management Services, Part SSS
- Supplement 1 - Case Management Services, Part T
- Supplement 1 - Case Management Services, Part TT
- Supplement 1 - Case Management Services, Part TTT
- Supplement 1 - Case Management Services, Part U
- Supplement 1 - Case Management Services, Part UU
- Supplement 1 - Case Management Services, Part UUU
- Supplement 1 - Case Management Services, Part V
- Supplement 1 - Case Management Services, Part VV
- Supplement 1 - Case Management Services, Part VVV
- Supplement 1 - Case Management Services, Part W
- Supplement 1 - Case Management Services, Part WW
- Supplement 1 - Case Management Services, Part WWW
- Supplement 1 - Case Management Services, Part X
- Supplement 1 - Case Management Services, Part XX
- Supplement 1 - Case Management Services, Part XXX
- Supplement 1 - Case Management Services, Part Y
- Supplement 1 - Case Management Services, Part YY
- Supplement 1 - Case Management Services, Part YYY
- Supplement 1 - Case Management Services, Part Z
- Supplement 1 - Case Management Services, Part ZZ
- Supplement 1 - Case Management Services, Part ZZZ
- Supplement 2 - Alternative Health Care Plans for Families Covered Under Section 1925 of the Act
3.1-B Amount, Duration and Scope of Services Provided Medically Need Groups
3.1-C Standards and Methods of Assuring High Quality Care
3.1-D Methods of Providing Transportation
3.1-E Standards for the Coverage of Organ Transplant Procedures
3.1-F Ehnaced Primary Care Case Managers as Disease Management
3.1-F Georgia Better Health Care - DSM Services
3.1-F(i) Care Management Organizations, and Primary Care Case Managers
4.11-A Standards for Institutions
4.14-A Single Utilitation Review Methods for Intermediate Care Facilities
4.14-B Multiple Utilization Review Methods for Intermediate Care Facilities
4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees
4.17-A Liens and Adjustments or Recoveries
4.18-A Charges Imposed on Categorically Needy
4.18-B Medically Needy - Premium
4.18-C Charges Imposed on Medically Needy and other Optional Groups
4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
4.18-E Premiums Imposed on Qualified Disabled and Working Individuals
4.19-A Methods and Standards for Establishing Payment Rates - Inpatient and Hospital Care
- Supplement to Attachment 4.19-A
4.19-B Methods and Standards for Establishing Payment Rates - Other Types of Care
- Supplement 1 - Methods and Standards for Establishing Payment Rates for Title XVIII Deductible/Coinsurance
4.19-C Payment for Reserved Beds
4.19-D Methodis and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services
4.19-E Timely-Claims Payment - Definition of Claim
4.19-F Enhanced Primary Care Case Management Fee
4.19-F Disease Management Enhanced Primary Case Management Fee
4.20-A Conditions for Direct Payment for Physicians's and Dentists' Services
4.22-A Requirements for Third Party Liability - Identifying Liable Resources
4.22-B Requirements for Third Party Liability - Payment of Claims
4.22-C State Method on Cost Effectiveness of Employer-Based Group Health Plans
- Supplement to Attachment 4.22-C
4.30 Sanctions for Psychiatric Hospitals
4.32-A Income and Eligibility Verification Systems Procedures: Requests to Other State Agencies
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35-A Criteria for the Application of Specified Remedies for Nursing Facilities
4.35-B Alternative Remedies to Specified Remedies for Nursing Facilities
4.35-C Enforcement of Compliance for Nursing Facilities, Temporary Management
4.35-D Enforcement of Compliance for Nursing Facilities, Denial of Payment for New Admissions
4.35-E Enforcement of Compliance for Nursing Facilities, Civil Money Penalty
4.35-F Enforcement of Compliance for Nursing Facilities, State Monitoring
4.35-G Enforcement of Compliance for Nursing Facilities, Transfer of Residents
4.35-H Enforcement of Compliance for Nursing Facilities, Additional Remedies
4.38 Disclsoure of Additional Registry Information
4.38-A Collection of Additional Registry Information
4.39 Definition of Specialized Services
4.39-A Nursing Home Preadmission - Categorical Determination
4.40-A Survey and Certification Education Program
4.40-B Process for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property
4.40-C Procedures for Scheduling and Conduct of Standard Surveys
7.2-A Methods of Administration - Civil Rights (Title VI)
Section 901 Scope of Service

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This section of our website is updated regularly and, due to the volume of material we are covering, is still under construction. If you are aware of a case that should be reported here, please call it to our attention. Comments should be sent to david@mcguffey.net.