Ga. Medicaid Part II Policies & Procedures for Hospital Services § 603

In addition to the general conditions of participation which apply to all providers in the Medicaid

Program as outlined in Part I, the following conditions apply to hospitals:

603.1. The Hospital must be currently licensed under the provisions of state law and must not be

operated primarily for the care and treatment of patients with mental disease or special

disorders such as, but not limited to, alcoholism or drug abuse

603.2. The Hospital must meet Title XVIII Standards for Medicare participation as currently

determined or be certified as eligible for participation.

The Hospital must operate a utilization review program in compliance with a

603.3. Utilization Review Plan approved by the state.

603.4. When a Hospital provides medical treatment to a member for injury, disability, disease or

sickness resulting from accidents or other possible tortuous conduct, the Division must be

notified. Please refer to Section 303.5 of Part I Policies and Procedures for

Medicaid/PeachCare for Kids.

Third Party Administration

Division of Medical Assistance Plans

P. O. Box 38439

Atlanta, Georgia 30334

603.5. “Hill-Burton” Hospitals are required to comply with Hill-Burton regulations

603.6. The Hospital must develop written policies and procedures on advance directives in

compliance with Section 1902 (a) (57) of the Social Security Act. (See Section 901)

603.7. In accordance with the Mammography Quality Standards Act (MQSA) of 1992, P.L. 102-

539, when a hospital provides mammography services, the facility is required to submit a

copy of the Food and Drug Administration (FDA) letter of certification that identifies the

mammography certification number. The hospital must notify the Division of any change in

certification status. Notification should be mailed to:

Gainwell Technology

Provider Enrollment

Post Office Box 105200

Tucker, Georgia 30085-5201

The Hospital must timely and accurately report to the Georgia Comprehensive Cancer

Registry certain information on cancer patients who receive hospital services at the

hospital in accordance with the Georgia Comprehensive Registry Policy and Procedure

Manual (Cancer Registry Manual).

603.8. For any provider billing outpatient laboratory procedures, agree to the rules regarding

enrollment, Clinical Lab Improvement Act certification, reimbursement, and adhere to the

policies in the Part II, Policies and Procedures for Independent Laboratory Services and the

Schedule of Maximum Allowable Payments for Clinical Laboratory and Anatomical

Pathology Services.