Managing Healthcare Compliance in Georgia

What does healthcare compliance in Georgia look like? Like all states, Georgia has its own distinct rules and regulations that compliance management teams must follow. Knowing how to skillfully navigate these intricacies will set you up for success.

Managing compliance in Georgia effectively requires healthcare organizations to establish comprehensive programming and systems for monitoring and interpreting regulatory changes, so that policies and procedures can be appropriately updated. Keep reading for resources, tips, and regulations unique to healthcare compliance in Georgia.

Georgia Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

• The Georgia Department of Public Health (DPH) plays a crucial role in safeguarding the health and well-being of Georgians. Through its various departments, such as the Office of Compliance, DPH ensures adherence to ethical standards, regulations, and policies to maintain quality care.
• The Department of Community Health (DCH) serves as the lead agency for Medicaid and PeachCare for Kids®, and also oversees the State Health Benefit Plan, Healthcare Facility Regulation Division and State Office of Rural Health.
• The Georgia Hospital Association (GHA) serves as a vital resource for healthcare institutions, supporting their efforts to provide quality care and improve patient outcomes. 
• The Medical Assistance Plans Division oversees Georgia’s Medicaid and PeachCare for Kids® programs. It ensures access to healthcare for low-income individuals and families, promoting equitable healthcare services.
• The Georgia Composite Medical Board (GCMD) oversees licensing requirements for medical providers in Georgia. 
• The Board of Professional Counselors, Social Workers, and Marriage and Family Therapists provides oversight and licensing for mental/behavioral health professionals in Georgia.

These agencies help maintain the integrity and quality of healthcare services in Georgia, protecting the public and promoting patient safety. The resources provided by these Georgia state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Georgia.

Regulations Unique to Georgia

To meet the standards of healthcare compliance in Georgia, there are a few additional regulations.

Health Information Privacy Laws

In Georgia, written patient authorization is required for certain uses and disclosures of protected health information (PHI). This includes instances such as applications for benefits under the Georgia Crime Victims Compensation Program, a state-level initiative. Further, Georgia HIPAA laws require written patient authorization for providers to disclose information regarding the diagnosis or treatment of HIV/AIDS, sexually transmitted diseases, drug and/or alcohol abuse, mental illness, and psychiatric treatment. These requirements are unique to Georgia. Providers must follow the state’s strict privacy laws to avoid costly repercussions for non-compliance.

Clinical Pain Management Regulations

In Georgia, pain management clinics are strictly regulated under the Georgia Pain Management Clinic Act, enforced since 2013 by the Georgia Composite Medical Board (GCMB). These regulations mandate that such clinics be properly licensed and owned by state-licensed physicians, with certain exceptions for clinics established before June 30, 2013. Georgia defines pain management clinics as those primarily treating chronic pain using Schedule II or III controlled substances, excluding those affiliated with licensed hospitals and other healthcare facilities. This regulatory framework ensures thorough background checks, compliance with legal standards, and aims to address the opioid crisis while providing necessary pain management services. Operating a pain management clinic without a license is a felony.

Medical Cannabis Regulations 

Healthcare organizations and providers in Georgia should be aware of the significant developments in the state’s medical cannabis program. Since the legalization of medical cannabis oil in 2015 and the introduction of Georgia’s Hope Act in 2019, licensed businesses can now cultivate marijuana, convert it into low-THC cannabis oil, and sell it in dispensaries they operate. This means increased accessibility for patients. In order to prescribe, qualified physicians must register through the Georgia Department of Public Health’s (DPH’s) secure Low THC Oil Registry. And before prescribing, providers need to know which medical conditions qualify a patient to receive a Low THC Cannabis Oil Card.

Tips To Manage Healthcare Compliance in Georgia

Effectively managing healthcare compliance in Georgia is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

• Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Georgia-approved training.
• Organize Policies By Requirement: Including “GA” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
• Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
• Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Georgia

In Georgia, the medical credentialing application process for healthcare providers is centralized and efficient, managed by the Department of Community Health’s Credentialing Verification Organization (CVO) since 2015. The process meets National Committee on Quality Assurance (NCQA) standards and is available via the Georgia Medicaid Management Information System (MMIS). It essentially streamlines credentialing and recredentialing for Medicaid providers, reducing administrative complexities and duplicated tasks. The process involves primary source verification and checks against federal and state exclusions databases. Additionally, the Georgia Primary Care Association (GPCA) assists Federally Qualified Health Centers (FQHCs) with credentialing, also meeting NCQA standards.

Meet Georgia Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Georgia. 

MedTrainer’s all-in-one compliance platform can streamline management of Georgia healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!