Georgia Association of Homes and Services for Children   

Provider Meeting with Department of Human Resources
March 28, 2006
Summary of Meeting

The Commissioner of DHR announced today that Level of Care as we know it is over.  The Centers for Medical and Medicaid Services (CMS) has mandated that Georgia eliminate the bundled Therapeutic Residential Intervention Services (TRIS or better known as Level of Care) per diem rate which contains costs charged for the mix of behavioral health services in favor of a system in which various behavioral health care services to children are individually authorized and billed to Medicaid.  In other words, the manner in which Georgia is providing (and paying) for services to children in its foster care system must change.  CMS is deferring payment of at least $70 million in Medicaid reimbursements to Georgia until their concerns are resolved.  Georgia will be expected to make major changes in order to “draw down” these federal funds. 

The Department of Human Resources will be looking to its Division of Mental Health, Developmental Disabilities, and Addictive Diseases to coordinate the provision of behavioral health services to children in its foster care system.  DHR will be developing a plan within its existing Rehab Option Services to replace the TRIS or Level of Care System.  DHR’s current initiative to “Bring the Children Home” will serve as a pilot to help both the public and private sectors understand the issues involved in moving from a “bundled residential system” to one of community services.   

Under this plan dollars are promised to follow the child whether the child is in public or parental custody.  Effective July 1, there will be one single point of entry for all behavioral health services for children and adolescents.  External utilization management will ensure that children and adolescents get the “right services, at the right time, and in the right amount.”  The Commissioner emphasized that she is aligning the divisions within DHR for their specific purposes.  DFCS will be about child protection and placement.  DMHDDAD will provide mental health and behavioral health services.    

Agencies which are currently providing Level of Care Services will most likely become providers of “Rehab Option” services.  These are services which the Department of Community Health (DCH) have deemed medically necessary.  Room and board will be paid separately by DFCS.  Each provider will be a Medicaid Provider billing for individual services provided.  Providers would have their own Medicaid number and bill according to services provided.  Foster children are currently “carved out” from Medicaid Managed Care and providers would be paid based on a “fee of service” basis. 

Speciality Psychiatric Hospitals currently providing level six services to children would be the only service provider exempted from the full impact of this announcement.  The State Director of DFCS, Mary Dean Harvey said, “We have to unbundle the services currently provided under Level of Care.  We have to move to a fee for service arrangement with providers.  This is not our decision.  It is the decision of the Federal Government.  It will now be up to the providers to define and defend their billing for services.”   

The Commissioner seemed confident that this plan that has been submitted to CMS will be approved. 

Many details remain to be answered.  The Commissioner made a commitment to bring all stakeholders to the table to work out the many challenges to making this kind of system work.