Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-11 - HOSPITAL DIRECTED PAYMENT PROGRAM › Rule 111-3-11-.02 - Payments to the Segregated Account

Current through Rules and Regulations filed through June 27, 2024
(1) There is established within the Trust
				Fund a Segregated Account for revenues raised through the imposition of the
				Provider Payment. Any Provider Payment assessed pursuant to this Chapter shall
				be deposited into the Segregated Account. No other funds shall be deposited
				into the Segregated Account. All funds shall be invested in the same manner as
				authorized for investing other moneys in the state treasury.
(2) Each Non-Governmental Hospital shall be
				assessed a Provider Payment not to exceed the amount necessary to obtain
				federal financial participation for Directed Payments allowable under
				42 CFR §
										438.6(c). The amount of each
				Non-Governmental Hospital's Provider Payment shall be determined by the
				Department using available hospital financial data and other information as
				applicable, including, but not limited to, hospital cost reports and the annual
				Hospital Financial Survey. The Department shall seek any Waivers and federal
				approvals necessary to fully implement this Chapter.
(3) The Provider Payment shall be paid at
				least annually by each Non-Governmental Hospital to the Department within 14
				calendar days of the Department's notice to the Non-Governmental Hospital that
				payment is due. The Department shall send such Provider Payment notices to each
				Non-Governmental Hospital within 30 calendar days or as soon as reasonably
				practical after the receipt of federal approval of Directed Payment(s) for the
				applicable rating period.
(4) The
				Department or its designee shall prepare and distribute a form on which each
				Non-Governmental Hospital shall submit information to comply with this
				Chapter.
(5) Each Non-Governmental
				Hospital shall keep and preserve for a period of seven (7) years such books and
				records as may be necessary to determine the amount for which it is liable
				under this Chapter. The Department shall have the authority to inspect and copy
				the records of a Non-Governmental Hospital for purposes of auditing the
				calculation of the Provider Payment. All information obtained by the Department
				pursuant to this Chapter shall be confidential and shall not constitute a
				public record.
(6) The Department
				may impose a penalty of up to six percent (6%) for any Non- Governmental
				Hospital that fails to pay a Provider Payment within the time required by the
				Department for each month or fraction thereof that the Provider Payment is
				overdue. If a required Provider Payment has not been received by the Department
				14 days after the payment due date as specified in
				111-3-11-.02(3),
				the Department may withhold an amount equal to the Provider Payment and penalty
				owed from any medical assistance payment due such Non-Governmental Hospital
				under the Medicaid program. Any Provider Payment assessed pursuant to this
				Chapter shall constitute a debt due the state and may be collected by civil
				action and the filing of tax liens in addition to such methods provided for in
				this Chapter. Any penalty that accrues pursuant to this Rule shall be credited
				to the Segregated Account.
(7) If
				the Department determines that a Non-Governmental Hospital has underpaid the
				Provider Payment, the Department shall notify the Non-Governmental Hospital of
				the balance of the Provider Payment that is due. Such payment shall be due
				within thirty (30) days of the Department's notice.
O.C.G.A. §
											31-8-179.3.