HOME HEALTH SERVICES PROVIDER IN GEORGIA

DELIVERING SKILLED NURSING, THERAPY, AND PERSONAL CARE SERVICES TO INDIVIDUALS IN THE COMFORT OF THEIR OWN HOMES

Home Health Services in Georgia provide medically necessary clinical care, therapeutic interventions, and supportive assistance to individuals with disabilities, chronic illnesses, or post-acute medical needs. These services are authorized under Georgia’s Medicaid State Plan, certain HCBS waiver programs, and Medicare, ensuring individuals receive high-quality care at home, promoting health, safety, and independence.

1. GOVERNING AGENCIES

Agency: Georgia Department of Community Health (DCH) — Healthcare Facility Regulation Division (HFRD)

Role: Licenses Home Health Agencies and monitors compliance with state and federal standards

Agency: Georgia Department of Community Health (DCH) — Medicaid Division

Role: Oversees Medicaid enrollment, service authorization, and reimbursement for Home Health Services

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight for Medicare- and Medicaid-certified Home Health Agencies, ensuring compliance with Conditions of Participation (CoPs)

2. HOME HEALTH SERVICE OVERVIEW

Home Health Services include skilled medical and rehabilitative care provided on an intermittent basis to individuals who are homebound or require clinical support at home.

Approved providers may deliver:

• Skilled Nursing (e.g., medication management, wound care, IV therapy, chronic disease management)

• Physical Therapy (PT) services (e.g., mobility training, strength building)

• Occupational Therapy (OT) services (e.g., ADL skill training, adaptive techniques)

• Speech-Language Pathology services (e.g., communication support, swallowing therapy)

• Medical Social Worker services (e.g., psychosocial assessments, resource referrals)

• Certified Home Health Aide services (e.g., personal care, basic health monitoring under nurse supervision)

Services must be prescribed by a physician, documented in a comprehensive care plan, and periodically reviewed for medical necessity and participant progress.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Georgia Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Obtain Home Health Agency License through DCH’s Healthcare Facility Regulation Division (HFRD)

• Complete Medicare certification (optional but required for dual Medicare/Medicaid billing)

• Maintain general liability, professional liability, and workers’ compensation insurance

• Employ qualified clinical staff, including RNs, PTs, OTs, SLPs, and HHAs

• Develop clinical policies and procedures compliant with Medicare Conditions of Participation and Georgia regulations

4. DCH PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit application for Home Health Agency License to HFRD

• Prepare for a Pre-Licensure Survey, including policies, facility readiness, and staff credentialing

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, licensure application materials, operational policies, and clinical protocols

• Provide documentation of quality assurance programs, infection control plans, and emergency preparedness systems

Licensure Survey and Certification:

• Undergo HFRD licensure inspection

• Undergo CMS Certification Survey if seeking Medicare participation

Medicaid Enrollment:

• Upon licensing and (if applicable) Medicare certification, complete Medicaid enrollment through the Georgia Medicaid Management Information System (GAMMIS)

• Configure billing codes for Home Health Services under Medicaid and Medicare

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Georgia Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Home Health Agency License (DCH HFRD)

• Medicare Certification (optional but recommended)

• Proof of insurance coverage

• DCH and CMS-Compliant Policy & Procedure Manual including:

  • Participant intake, physician order, and care planning protocols

  • Skilled nursing, therapy services, and home health aide service delivery procedures

  • Medication management and infection control procedures

  • Emergency preparedness, evacuation, and continuity of care plans

  • HIPAA confidentiality, participant rights, and grievance handling policies

  • Staff credentialing, background checks, and competency verification

  • Quality Assurance and Performance Improvement (QAPI) program

  • Medicaid billing, service authorization tracking, and audit readiness systems

6. STAFFING REQUIREMENTS

Role: Administrator / Director of Nursing (DON)

Requirements: Active Georgia RN license; experience managing home health or healthcare operations; background screening clearance

Role: Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)

Requirements: Active Georgia licensure; CPR certification; home health experience preferred

Role: Physical Therapists (PTs) / Occupational Therapists (OTs) / Speech-Language Pathologists (SLPs)

Requirements: Georgia professional licensure in respective discipline; background screening clearance

Role: Certified Home Health Aides (HHAs)

Requirements: Completion of a state-approved Home Health Aide program; background screening clearance

All staff must complete:

• HIPAA confidentiality, participant rights, and abuse prevention training

• Emergency response and infection control training

• Annual competency assessments and continuing education

• Specialized home health documentation and care plan compliance training

7. MEDICAID PROGRAMS

Home Health Services in Georgia are covered under:

• Medicaid State Plan (for individuals meeting homebound and skilled need criteria)

• Elderly and Disabled Waiver Program (EDWP) (for personal support extensions)

• Georgia Pediatric Program (GAPP) (for medically fragile children)

Approved providers may deliver:

• Skilled Nursing Visits

• Therapy Visits (PT, OT, ST)

• Medical Social Work Visits

• Home Health Aide Services under RN supervision

8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Licensing Application

Timeline: 1–2 months

Phase: Facility Setup, Staff Hiring, and Pre-Licensure Survey

Timeline: 3–6 months

Phase: CMS Certification (if applicable) and Medicaid Enrollment

Timeline: 3–6 months (can overlap with licensing phase)

Phase: Medicaid Billing System Setup and Program Launch

Timeline: 1–2 months

9. CONTACT INFORMATION

Georgia Department of Community Health (DCH) — Healthcare Facility Regulation Division (HFRD)

Website: https://dch.georgia.gov/divisionsoffices/hfrd

Georgia Department of Community Health (DCH) — Medicaid Division

Website: https://dch.georgia.gov/

Georgia Medicaid Management Information System (GAMMIS)

Website: https://www.mmis.georgia.gov/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — GEORGIA HOME HEALTH SERVICES PROVIDER

WCG supports healthcare agencies, clinical organizations, and entrepreneurs in launching Medicaid- and Medicare-compliant Home Health Services under Georgia’s State Plan and HCBS programs.

​​​​​​​​​​​​​​​​​​​​Scope of Work:

• Business registration and EIN/NPI setup

• Home Health Agency licensing and Medicare/Medicaid certification assistance

• Development of Home Health Services Policy & Procedure Manual

• Staff credentialing templates and participant intake documentation

• Medicaid billing system configuration and claims management

• Website, domain, and email setup

• Care planning, skilled nursing documentation, and therapy service tracking templates

• Emergency preparedness, infection control, and QAPI program development

• Quality assurance systems for compliance monitoring

• Community networking and referral building strategies

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