Georgia - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

In Georgia, Adult Companion Services provide non-medical supervision, socialization, and assistance with instrumental activities of daily living to ensure individuals can remain safely in their homes. These services are primarily funded through the state's Home and Community-Based Services (HCBS) waivers, specifically the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE) for the elderly and physically disabled, and the NOW/COMP waivers for individuals with intellectual and developmental disabilities.

The single biggest structural barrier to entry for new providers in Georgia is the bifurcated, strictly sequenced pre-approval process. Providers targeting the elderly (CCSP/SOURCE) cannot even apply for Medicaid enrollment until they first secure a Private Home Care Provider (PHCP) license from the Department of Community Health (DCH), a process taking months. Conversely, providers targeting the IDD population must pass a rigorous pre-qualification process through the Georgia Collaborative ASO—starting with a mandatory Provider Enrollment Forum and Letter of Intent—before DCH will accept their Medicaid application. Failing the DCH application at any point triggers a mandatory one-year lockout period before a provider can reapply.

1. Service Definition and Scope

Adult Companion Services in Georgia are defined as non-medical care, supervision, and socialization provided to a waiver participant who cannot safely be left alone. The service is designed to promote community integration and ensure safety, rather than to provide medical treatments or direct physical assistance with basic daily needs.

Because Georgia distinguishes between companion care and personal care, companion sitters are restricted from performing hands-on medical tasks or direct physical assistance with Activities of Daily Living (ADLs) like bathing or transferring. They may, however, assist with Instrumental Activities of Daily Living (IADLs) if those tasks are incidental to the primary companion role.

• Target Populations: Elderly and physically disabled adults (via CCSP/SOURCE waivers) and individuals with intellectual/developmental disabilities (via NOW/COMP waivers).
• Allowed Tasks: Light housekeeping, meal preparation, laundry, shopping, and socialization activities.
• Prohibited Tasks: Hands-on medical care, medication administration, and direct physical assistance with ADLs.
• Service Setting: Delivered in the participant's private residence or community settings, strictly excluding institutional or residential facility settings.
• Authorization Limits: Services must be explicitly detailed and authorized in the individual's care plan by an Area Agency on Aging (AAA) case manager or DBHDD support coordinator.

2. Regulatory and Oversight Agencies

Oversight of Adult Companion Services in Georgia is divided among several state agencies depending on the specific waiver program the provider operates under. The Georgia Department of Community Health (DCH) acts as the central Medicaid authority and licensing body.

Operational management of the waivers is delegated to specific divisions and departments, meaning providers must maintain compliance with both the central licensing authority and their specific waiver's operating agency.

• Georgia Department of Community Health (DCH): The state Medicaid agency responsible for managing the GAMMIS portal and overall Medicaid policy.
• Healthcare Facility Regulation Division (HFRD): The division within DCH that issues the Private Home Care Provider (PHCP) license and conducts compliance surveys.
• Department of Behavioral Health and Developmental Disabilities (DBHDD): Oversees the NOW and COMP waivers for individuals with intellectual and developmental disabilities.
• Georgia Collaborative ASO: The administrative services organization that manages the DBHDD provider enrollment and pre-qualification process.
• Division of Aging Services (DAS): Administers the CCSP waiver through local Area Agencies on Aging (AAAs) under the GAPP framework.

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia employs strict structural gates that block Medicaid enrollment applications until specific prerequisites are met. You cannot simply submit a GAMMIS application to become a companion provider; you must clear the preliminary hurdles dictated by your target waiver.

For CCSP/SOURCE, licensure is the gate. For NOW/COMP, DBHDD pre-qualification is the gate. Attempting to bypass these steps or submitting an incomplete application results in severe administrative penalties.

• PHCP Licensure Prerequisite: CCSP/SOURCE applicants must hold an active Private Home Care Provider (PHCP) license from DCH HFRD before a GAMMIS enrollment application will be accepted.
• DBHDD Mandatory Forum: NOW/COMP waiver applicants must attend a scheduled DBHDD Provider Enrollment Forum before they are permitted to submit a Letter of Intent.
• Georgia Collaborative Pre-Qualification: DBHDD applicants must pass a rigorous pre-qualification review and Regional Field Office site visit before applying to DCH.
• NPI Matching Requirement: Applicants must obtain an Organizational (Type 2) National Provider Identifier (NPI) that exactly matches the legal entity name on their PHCP license and IRS documentation.
• One-Year Lockout Penalty: If a DCH Medicaid application is denied for any reason, state policy mandates the applicant must wait one full year before submitting another application.

4. Licensure and Certification Requirements

Georgia does not issue a standalone "Companion Care" license. Instead, agencies providing these services must obtain a Private Home Care Provider (PHCP) license from the DCH Healthcare Facility Regulation Division (HFRD).

When applying for the PHCP license, agencies must specify the classes of service they intend to provide. To offer Adult Companion Services, the agency must be approved for the "Companion Sitter" service class.

• License Type: Private Home Care Provider (PHCP) license issued by DCH HFRD.
• Service Class Designation: Must specifically apply and be approved for the "Companion Sitter" classification on the PHCP application.
• Application Fees: Requires a non-refundable application fee based on the DCH Schedule of Licensure Activity Fees (historically scaling with agency size/type).
• Operational Policies: Must submit comprehensive policies covering client rights, emergency procedures, infection control, and complaint resolution with the application.
• Administrator Qualifications: The agency must designate a qualified administrator with documented experience in healthcare administration or business management to oversee operations.

5. Medicaid Provider Enrollment

Once the gatekeeping prerequisites (PHCP license or DBHDD pre-qualification) are met, providers must enroll in Georgia Medicaid through the Georgia Medicaid Management Information System (GAMMIS).

Enrollment requires absolute precision. Any mismatch between the provider's IRS documentation, NPI registry data, state license, and GAMMIS application will trigger an immediate rejection by HP Enterprise Services (HPES), the system administrator.

• Enrollment Portal: Applications must be submitted electronically through GAMMIS at mmis.georgia.gov.
• Program Selection: Providers must enroll under the GAPP (Georgia Aged and Physically Disabled) program for CCSP/SOURCE or the DBHDD network for NOW/COMP.
• Taxonomy Code: Must select the correct HCBS/Companion taxonomy code that aligns with the GAMMIS specialty designation.
• Financial Setup: Requires an established bank account for Electronic Funds Transfer (EFT) payments, verified by a bank letter matching the agency's legal name.
• Insurance Verification: Must upload proof of active commercial general liability insurance and, if applicable, worker's compensation insurance.

6. Staffing, Training and Background Checks

Direct care workers providing companion services in Georgia are classified as Companion Sitters. The state mandates strict background screening and initial training requirements before a worker can be placed in a waiver participant's home.

Agencies are responsible for maintaining continuous compliance with these standards, and personnel files are heavily scrutinized during DCH HFRD licensing surveys.

• Background Checks: Mandatory fingerprint-based criminal history checks via the Georgia Applicant Processing Service (GAPS) and enrollment in the state's Rap Back system.
• Initial Training: Companion Sitters must complete state-mandated orientation covering client rights, emergency response, universal precautions, and abuse/neglect reporting.
• CPR and First Aid: All direct care staff must hold current, hands-on (not strictly online) CPR and First Aid certifications.
• Tuberculosis Screening: Staff must have documented negative TB screening results prior to any direct client contact.
• Supervision Requirements: Agencies must designate a qualified supervisor to conduct and document regular performance evaluations and in-home supervisory visits.

7. Documentation, Policies and Records

Georgia Medicaid requires providers to maintain exhaustive documentation proving both the medical necessity of the service and the actual delivery of care. Records must be kept audit-ready at all times.

Failure to maintain proper documentation not only results in survey citations but can also trigger Medicaid payment clawbacks during post-payment reviews.

• Service Plans: Must maintain a current copy of the AAA or DBHDD-approved individualized care plan detailing the authorized companion hours and goals.
• Personnel Files: Must contain I-9s, GAPS background check clearances, CPR/First Aid cards, TB test results, and annual training certificates.
• Client Records: Must include signed service agreements, emergency contact information, and daily service logs detailing activities performed.
• Incident Reporting: Must follow strict protocols for reporting critical incidents (e.g., abuse, neglect, severe injury) to HCBS.IncidentReports@dch.ga.gov.
• Record Retention: All clinical and financial records must be securely retained for a minimum of five years, or longer if specified by the specific waiver manual.

8. Billing, Rates and Claims

Billing for Adult Companion Services in Georgia is entirely dependent on Electronic Visit Verification (EVV). The state uses NetSmart (formerly Tellus) as its designated EVV aggregator.

Claims are submitted through GAMMIS, but if the EVV data does not perfectly match the prior authorization and the submitted claim, GAMMIS will automatically deny the payment.

• EVV Mandate: Georgia requires the use of NetSmart (Tellus) for all Medicaid HCBS companion visits to capture clock-in/out times and location data.
• Billing Portal: All claims are processed through the GAMMIS portal (mmis.georgia.gov).
• Prior Authorization: Services cannot be billed without an active Prior Authorization (PA) loaded into GAMMIS by the referring case management agency.
• Billing Increments: Companion services are typically billed in 15-minute units using specific HCPCS codes (e.g., S5135) as defined by the waiver fee schedule.
• Claim Matching: EVV data (caregiver ID, client ID, duration, location) must perfectly align with the GAMMIS claim and PA parameters to avoid billing exceptions.

9. Approval Sequence and Timeline

Becoming a fully billing Adult Companion Services provider in Georgia is a lengthy, sequential process. Because steps cannot be completed concurrently, providers should plan for a 6 to 12-month timeline from initial application to first payment.

Delays in obtaining the PHCP license or passing the DBHDD pre-qualification are the most common bottlenecks in this timeline.

• Step 1: DBHDD Pre-qualification (NOW/COMP) or DCH PHCP Licensure (CCSP/SOURCE) (typically 3-6 months).
• Step 2: GAMMIS Medicaid Provider Enrollment application submission and HPES review (30-90 days).
• Step 3: Waiver-specific enrollment, such as signing provider agreements with local Area Agencies on Aging for CCSP (1-2 months).
• Step 4: NetSmart/Tellus EVV system registration and caregiver app onboarding (2-4 weeks).
• Step 5: Receipt of initial client referrals and loading of Prior Authorizations into GAMMIS (variable).

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently rejected for administrative errors, triggering the severe one-year lockout penalty. Precision during the application phase is critical.

Once operational, providers face DCH HFRD surveys where citations are most commonly issued for personnel file deficiencies and EVV non-compliance.

• Application Rejection: Mismatched legal names or addresses between the IRS EIN letter, NPI registry, PHCP license, and GAMMIS application.
• Lockout Penalty: Failing the DCH application review results in a mandatory one-year waiting period before a new application can be submitted.
• Survey Citation: Missing, lapsed, or online-only CPR/First Aid certifications in Companion Sitter personnel files.
• Survey Citation: Failure to document negative TB screenings prior to a caregiver's first client contact.
• Claim Denial: Submitting GAMMIS claims without matching NetSmart EVV data, or billing for hours outside the authorized PA parameters.

11. Key Contacts and Resources

Providers must navigate multiple state portals and help desks to maintain compliance and resolve billing issues. Keeping these contacts accessible is essential for daily operations.

Always refer to the official state portals for the most current provider manuals, fee schedules, and policy updates.

• DCH Provider Enrollment: 1-800-GEORGIA or (404) 656-4507 for GAMMIS application status and Medicaid enrollment questions.
• GAMMIS Portal: mmis.georgia.gov for Medicaid billing, prior authorizations, and provider enrollment.
• Georgia Collaborative ASO: georgiacollaborative.com for DBHDD provider enrollment, Letters of Intent, and pre-qualification.
• DCH HFRD: dch.georgia.gov/licensure-forms-applications for Private Home Care Provider (PHCP) licensing forms and fee schedules.
• NetSmart/Tellus EVV: The state-designated portal for EVV registration, caregiver training, and technical support.

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