Sheila Marie Alexander

This document outlines the renewal and amendment of the Independent Care Waiver Program (ICWP) for the Georgia Department of Community Health, covering the period from July 2026 to June 2031. The plan aims to ensure continuity of long-term services and support for adults with severe physical disabilities or traumatic brain injury, preserving independence and autonomy. Key updates include increasing individual cost caps, significantly expanding waiver slots, formally integrating the Determination of Need-Revised (DON-R) screening, adding telehealth assurances, and incorporating HCBS Settings Rule requirements to strengthen fiscal stewardship, enhance service access, and ensure ongoing federal compliance.

This document is a renewal application for the Independent Care Waiver Program (ICWP) by the State of Georgia, designed to furnish Home and Community-Based Services (HCBS) to Medicaid beneficiaries. The program targets individuals aged 21-64 with significant physical disabilities or traumatic brain injury, requiring nursing home or hospital level of care, to enable them to live in the community and avoid institutionalization. Key objectives include delivering quality and cost-effective services, facilitating transitions from institutional settings, ensuring participant engagement in care decisions, and offering options for self-directed services. The renewal incorporates updates to the HCBS Transition Plan, cost neutrality figures, increased individual cost caps, expanded waiver slots, new Determination of Need screening requirements, and assures compliance with Telehealth and HCBS Final Settings Rule requirements.

The Georgia rural health transformation program, also known as the great health program, is led by the Georgia Department of Community Health. This strategic initiative outlines five key pillars: transforming for a sustainable health system via value-based care models such as the AHEAD model, strengthening the continuum of care, improving healthcare access for rural residents, fostering a highly skilled healthcare workforce, and leveraging technology for innovation in care delivery. The program's vision is to create healthier rural populations, ensure access to local high-quality care, achieve financially sustainable rural hospitals, and advance healthcare through new systems, technology, and a patient-centered approach.

The board meeting commenced with a roll call. Key discussions included the approval of the minutes from the October 9th meeting. A primary agenda item involved the final adoption of a proposed rate increase for Babies Can't Wait service coordinators, effective October 10, 2025, stemming from House Bill 68 passed in the 2025 legislative session. The presenters detailed the current and new reimbursement rates for specific service codes (T2022 and 96110) and the associated fiscal year cost impacts for 2026 and 2027. A public hearing and comment period for this rate increase yielded no oral or written comments. Additionally, an informational update was provided regarding the alignment with CMS federal requirements under the Consolidated Appropriations Act of 2022 concerning third-party liability payment of claims, which had already received CMS approval on September 9, 2025. The meeting concluded with well wishes for the upcoming Thanksgiving holiday.

The meeting focused on providing an update regarding the Rural Health Transformation Program, which was included in HR1 and is referred to as the Great Health Program, involving $50 billion over five years for states that apply. The committee discussed the condensed timeline for application submission and anticipated award notifications. Key discussion points included the five initiatives of the program: transforming for a sustainable health system, strengthening the continuum of care, connecting to care to improve healthcare access, growing a highly skilled healthcare workforce, and leveraging technology for healthcare innovation. Specific attention was given to the first initiative, which involves creating a value-based care model based on the AHEAD model from CMS, impacting 86 eligible rural hospitals across the state. The presentation also detailed plans for a three-year pre-implementation window, including assessments and funding for hospitals to expand service lines and prepare for value-based care participation, mitigating risk during the learning phase. A board member raised concerns about the focus being solely on primary care versus specialty care, and presenters clarified that while primary care, including behavioral health, is a heavy emphasis, other initiatives will support areas like specialist recruitment and infrastructure upgrades.