Governance and Project Management

Georgia has established a strong governance and project management structure, supported by a multidisciplinary team prepared to lead, coordinate, and sustain implementation of the GREAT Health Program. The Department of Community Health (DCH) will serve as the lead agency, working closely with the Department of Public Health (DPH), the State Office of Rural Health (SORH), the Department of Human Services (DHS), the Department of Behavioral Health and Developmental Disabilities (DBHDD), and the Georgia Board of Health Care Workforce (GBHCW) to ensure alignment across agencies and with external partners.

The financial and administrative management functions associated with the GREAT Health Program operations will be the responsibility of DCH and affiliated subcontractors and will include project initiation, planning, execution, monitoring and closeout. DCH, with partners and the CMS Project Officer, will develop processes to ensure appropriate and consistent communication, perform multiple tasks concurrently, complete tasks within narrow timeframes, and assure quality services.

In year one, DCH will hire fourteen new staff members to oversee statewide implementation and stakeholder coordination, including one rural health manager (RHM), three rural health specialists, three rural behavioral health specialists, three attorneys, one IT senior project manager, and three administrative assistants. These positions will be located at DCH to best collaborate with executive leadership and partner agencies. Additionally in year one, the State Office of Rural Health (SORH) will hire one rural health grant manager and three rural health grant specialists. These positions will work out of the SORH office in rural Georgia, ensuring direct availability of subject-matter experience and to further encourage community participation and buy-in. Lastly in year one, GBHCW will hire a Graduate Medical Education (GME) program manager and a data analyst. Positioning of new roles within the agencies can be seen in organizational charts provided in Attachments F-H.

As principal investigator of the project, the Medicaid Director will ensure all federal funding requirements are met and that DCH is adhering to the project as specified and approved by CMS. In addition, regular progress reports will be generated for distribution to CMS as agreed upon and in accordance with funder requirements.

The RHM, a subject matter expert and supervisor in health policy, will serve with the SORH as lead officials in assessing Georgia’s rural health needs. The RHM will supervise the new Medical Assistance Program Rural Health team for the policy oversight of all GREAT Health Program initiatives and oversee the overall policy implementation of the grant areas, ensuring alignment with the grant objectives. The RHM will manage the project’s strategic direction, maintain communication with key partners, and ensure timely and accurate reporting to CMS. This role will provide efficient execution of the project while meeting all Medicaid Policy compliance standards. This position will attend monthly calls with the CMS project and/or grants management specialists and be responsible for coordinating all aspects of the project to ensure successful outcomes. The RHM will report to the Director of Provider Services and supervise three rural health specialists. These specialists will direct policy and oversight for each assigned area of the GREAT Health Program, ensure compliance, and provide technical assistance to awardees. They will coordinate with grantees, contractors, and the SORH GREAT Health team to ensure continuity and consistency across the program and offices.

The rural health behavioral specialist team will provide direct policy and oversight for each position’s assigned area of the behavior health initiatives in the rural transformation grant (Building Bridges, Behavioral Health Assessment, Integrated Mobile Clinics, and others). The Medicaid division will maintain a direct partnership with partner organizations in implementation of behavioral health projects to ensure consistency with Medicaid policy, effective implementation, and desired outcomes. These positions will be supervised by the Director of Behavioral Health and Member Services, who is an experienced Licensed Clinical Social Worker (LCSW), with a master’s in healthcare administration.

Three administrative assistants will support the GREAT Health team by ensuring staff coordinate across offices and aiding in general office tasks needed when adding new staff members. Most importantly, these staff will be responsible for coordinating staff and sub-contractor schedules for milestone meetings and processing invoices for all expenses associated with the GREAT Health grants.

All positions listed above fall within the existing structure of the Medical Assistance Plans (MAP) Division within DCH, which focuses on Medicaid. Ultimate policy direction and division oversight will be provided by the Medicaid Director.

Two attorneys will provide primary direct contractual support to the subrecipient agreements and provider agreements that are referenced in this grant proposal. The proposal has the potential to add over 300 agreements (grants or subrecipient agreements) to the annual workload of the General Counsel’s office. The office presently has no capacity for the additional contract or grant reviews that are contemplated. An additional attorney will assist in record keeping to align with all privacy laws and state and federal government transparency statutes. Given the public interest in the program thus far and the volume of confidential and proprietary information the Department will handle through the course of these initiatives, particularly the rate setting process needed for executing the AHEAD model, additional legal support will allow RHT Program staff to focus on project coordination rather than open records requests.

An IT senior project manager will provide direct policy and connectivity support for the technology-based initiatives in the GREAT Health Program. While there are many grants to partner organizations for implementation, the DCH IT Senior Project Manager will work to ensure consistency with data sharing and security, interoperability, and desired outcomes. This position will have direct supervision from the Director of Information Technology.

At the SORH, the rural health grant manager will coordinate strategic planning and policy creation for the addition of up to 126 rural hospital grants for initiatives to address gaps in service delivery and preparation for the AHEAD transition for each hospital projected to participate. This manager will supervise three grant specialists, who will partner directly with the hospitals to ensure successful grant implementation and provide technical assistance directly to hospitals as needed. Grant specialists will be responsible for implementation and technical assistance to specific hospitals, as assigned by the manager. The SORH team currently administers similar grants on a smaller scale; these additional staff expand capacity of the office to include the 126 counties necessary for AHEAD operations.

Both DCH staff and SORH staff will be time-limited, benefits-eligible employee positions that are planned for transition to the AHEAD administration funds in year three of AHEAD, which is projected to be the first year without Rural Health Transformation funding.

The GME program manager at GBHCW, which is an administratively attached agency to DCH, will assist in strategic planning and implementation for GME and rural recruitment incentive grant programs for GREAT Health. This position will ensure expanded GME residency and fellowship slots are appropriately prioritized and lead the effort in coordinating between the agency and GME programs. The program manager will report to the Executive Director of the GBHCW and supervise the data analyst. The data analyst at the GBHCW will be an additional resource for data analytics and will assist in data gathering for healthcare workforce projects in the GREAT Health Program. Hospitals will need assistance with data analytics to expand the proposed GME slots by specialty and to assist with fellowship slots determination, physician specialty need prioritization, and physical recruitment.

DCH has policies and protocols in place for fiscal and quality assurance management of subcontractor services. These protocols include strict adherence to federal funding requirements, required project reporting format and timeline, and project budget tracking and specificity in invoicing. The Georgia Department of Administrative Services (DOAS) oversees contracts with the state on most matters and retains a list of approved contractors for a variety of purposes. DCH will utilize DOAS in procurements, as is state policy, to ensure fairness, appropriateness, and quality of fit. At the time of application, RSM and Deloitte are the professional services contractors identified for the GREAT Health Program. RSM will work in collaboration with DCH leadership and GREAT Health staff as an external grants manager, while Deloitte will provide actuarial evaluation and assessment. In collaboration with DOAS, DCH will select a Project Management Organization as the GREAT Health external project management organization according to state law and processes.

To ensure coordination in deploying funds, tracking milestones, and assessing project impact, a multisector collaborative, including DCH, DPH, SORH, and other involved state agencies, will be developed as the GREAT Health Advisory Council. The GREAT Health Advisory Council will comprise of representatives from each initiative-based workgroup and rural patients, guaranteeing that at least 60% of members represent rural entities to ensure community involvement in program governance. The GREAT Health Advisory Council will meet regularly, and meetings will provide a forum for sharing data, identifying challenges, and recommending adjustments for implementation and sustainability. Additionally, rural providers, patients, residents, and other rural entities will be part of initiative-based workgroups.

In the first year of the grant award, the GREAT Health Program leadership team will meet to adopt methods for shared decision-making, conflict resolution, internal and external communications, and other governance strategies necessary for effective operations.