Medical Coordination Program

Program Location: 
Atlanta, GA
Payer Type: 

The Georgia Department of Community Health plans to implement a Medicaid Medical Coordination Program for Medicaid members who are aged, blind or disabled (ABD) as identified by members’ Categories of Aid. This voluntary enrollment program will organize and integrate clinical management processes for the designated population and will assist in locating, coordinating and monitoring medical care and other services. All members will receive core medical coordination services including member education and access to a 24-hour nurse line. Members with chronic conditions, behavioral health conditions, co-morbidities, or other complex diagnoses and who are identified as in need of additional supports may receive intensive medical coordination services, which are specialized services provided to members with complex health care needs. Members identified to receive intensive medical coordination services will be formally assigned to a medical home. Members may voluntarily select or the vendor may assign members to a medical home. The vendor will determine if the member has a primary source of care that is participating in the Medical Coordination Program, and if so, assign the member to that provider.

Payment Model: 

Payment will include a case management fee and a bonus/incentive payment not to exceed 5% of the total FFS payment for services provided. 

Last updated April 2019
Go to top