Adult day services providers are a wonderful complement to communities. Reimbursement for services varies nationally, with higher rates in Pennsylvania, New York and California.  Many rely upon payment from Medicaid waiver programs, with fees for service set by federal guidelines.  Today, the State of Georgia announced that as of July 1, 2017, it has approval to increase Medicaid rates for both half-day and full-day adult day care participation.

Here is the bulk of the email from Mr. Tom Underwood, Medicaid Chief in the State of Georgia:

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“Here’s an update on the Adult Day Health rate increase, which DCH is making effective as of July 1, 2016.  DXC has updated the rates in GAMMIS for CCSP and SOURCE provider IDs.

GMCF has updated all the SOURCE PAs for 7/1/2016 and after, so you can go ahead and start billing the new rates for SOURCE claims for dates of service of 7/1/2017 or after.

DXC updated all the CCSP PAs for the months for July 2016 through February 2017, but Mediware is still working on an update of the CCSP SAFs in Harmony for March 2017 through the current month, so hold off on billing the new rates for CCSP until I notify you that the SAF update is complete, including transmission to GAMMIS.

I requested a mass adjustment of SOURCE claims for dates for service from July 2016 through June 2017, so you should see these adjusted on your RA by the end of September.  You can now submit an adjustment on any SOURCE claims for dates for service of 7/1/2017 or after at the new rate.  When you submit the adjustment on each claim, make sure you change the total amount billed to reflect the new rates, which are attached.

I requested a mass adjustment of CCSP claims for dates of service from July 2016 through February 2017, which you should see on your RA by the end of September.  I will request adjustment of CCSP claims for March 2017 through the current month when Mediware completes the update of the ADH SAFs in Harmony.  Again, don’t begin billing the new rates for CCSP until you hear from me.

Thanks for your tremendous patience during this process.  Have a great day.”

Tom Underwood

GA Dept of Community Health

Medicaid Division

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Generally adult day care is not a wealth building business.  However, every added nickel they can earn is surely deserved, if only for how they help keep families together and medically fragile people stable in their own neighborhoods.

Give us your thoughts.

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