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

Last reviewed: 2026-09-09

The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) and the Department of Community Health (DCH) jointly approve providers of Adult Companion Services under the New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP). Applicants must navigate a dual-enrollment process, submitting separate applications to DBHDD for programmatic certification and to DCH for Medicaid billing authorization.

Approval requires passing a DBHDD initial screening and site visit before DCH will issue a Medicaid provider number through the GAMMIS portal. Agencies projecting $250,000 or more in annual waiver revenue face a strict mandate to obtain national accreditation from an approved accrediting body, while smaller agencies must maintain DBHDD certification based on the Core Requirements for Providers.

1. Service Definition and Scope

In Georgia's NOW and COMP waivers, Adult Companion Services provide non-medical supervision and socialization that let an adult remain safely in the community. These services are designed to assist individuals with intellectual and developmental disabilities in participating in community activities and maintaining their independence.

The service excludes medical care and is distinct from personal care or skilled nursing. It focuses on prompting, cueing, and supervising rather than hands-on physical assistance.

• Target Population: Adults with intellectual or developmental disabilities enrolled in NOW or COMP waivers
• Service Focus: Non-medical supervision, socialization, and community integration
• Exclusions: Hands-on medical care, nursing services, and emergency dental services
• Delivery Setting: The participant's home or community settings
• Authorization: Requires prior approval (PA) entered into the Medicaid Management Information System (MMIS)

2. Regulatory and Oversight Agencies

Two primary state agencies govern Adult Companion Services in Georgia. The Department of Behavioral Health and Developmental Disabilities (DBHDD) operates the NOW and COMP waivers, conducting provider screening, site visits, and certification.

The Department of Community Health (DCH) serves as the State Medicaid Agency, holding ultimate authority over Medicaid provider enrollment, rate setting, and claims reimbursement through the GAMMIS system.

• Operating Agency: Georgia Department of Behavioral Health and Developmental Disabilities (https://dbhdd.georgia.gov/)
• State Medicaid Agency: Georgia Department of Community Health (https://dch.georgia.gov/)
• Enrollment Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov/portal/PubAccess.Enrollment/tabId/26/Default.aspx)
• Eligibility Review Partner: Alliant-Georgia Medical Care Foundation (GMCF) (https://www.gmcf.org)

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia operates continuous, open enrollment for all willing and qualified providers of NOW and COMP waiver services. There is no Certificate of Need (CON) requirement or closed network moratorium for Adult Companion Services.

However, applicants must meet strict infrastructure and financial thresholds. Agencies must demonstrate the capacity to meet DBHDD Core Requirements and, depending on revenue size, secure national accreditation.

• Open Enrollment: The state maintains continuous, open enrollment for willing and qualified providers
• Dual Application Mandate: Must submit simultaneous applications to DBHDD and DCH
• Revenue-Based Accreditation: Providers receiving $250,000 or more per year must be accredited by an approved accrediting body
• Small Provider Certification: Providers receiving less than $25,000 per year must be certified by DBHDD
• Business Licensure: Must hold a current Georgia business license as required by city or county

4. Licensure and Certification Requirements

Georgia does not issue a distinct "Adult Companion Agency" license. Instead, providers are authorized through DBHDD certification and DCH Medicaid enrollment. The certification process focuses on the "Core Requirements for Providers" of developmental disability services.

DBHDD conducts an initial site visit to review the organization's infrastructure, policies, and programs. Technical assistance may be provided during this phase before a recommendation is sent to DCH.

• Certification Standard: DBHDD Core Requirements for Providers
• Site Visit: Mandatory initial screening and site visit conducted by DBHDD
• Accreditation Alternative: National accreditation required for agencies billing over $250,000 annually
• Professional Licensing: Copies of current Georgia provider agency or professional licenses must be submitted if applicable
• Infrastructure Review: DBHDD evaluates organizational charts, staffing information, and basic qualifying information

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the GAMMIS Provider Enrollment Wizard. Providers must complete all steps online, including uploading supporting documentation and paying the required application fee.

DCH will only assign a Medicaid provider number after receiving a recommendation for approval from DBHDD. The application is automatically saved after each step in the GAMMIS portal.

• Enrollment System: GAMMIS Provider Enrollment Wizard
• Application Fee: Required under 42 CFR 455.460 for institutional providers, unless a hardship exception is granted
• Rejection Window: Applications lacking the fee or hardship letter may be rejected within 30 days of submission
• DBHDD Recommendation: DCH requires a formal approval recommendation from DBHDD before issuing a provider number
• Appeals: Providers have the right to appeal if the DCH application is denied

6. Staffing, Training and Background Checks

Agencies must ensure all direct support professionals providing Adult Companion Services meet DBHDD qualifications. This includes passing comprehensive criminal history background checks.

Providers must submit current resumes, organizational charts, and reference contact information for verification of experience during the application process.

• Background Checks: Mandatory criminal history background checks for all direct care staff
• Staffing Documentation: Must submit current resume or organizational chart and staffing information with the application
• Experience Verification: Reference contact information required to verify agency and staff experience
• Education Records: Copy of degree, diploma, or official transcript required for qualified professionals
• Annual Verification: All providers receive annual verification through DBHDD

7. Documentation, Policies and Records

Providers must maintain extensive documentation to comply with DBHDD and DCH standards. This includes service management records, statistical information, and detailed payroll systems.

All participant services require prior approval (PA) by DBHDD, and providers must ensure claims match the approved PA exactly.

• Application Copies: Two copies of each application (DBHDD and DCH) must be submitted for review
• Prior Approval (PA): All waiver participant services require PA entered into the Medicaid MIS
• Incident Reporting: Must utilize the HCBS Incident Reporting System for adverse events
• Financial Records: Must utilize accounting systems and maintain a payroll system
• Death Reporting: DBHDD provides DCH a quarterly report of all consumer deaths, requiring provider compliance in reporting

8. Billing, Rates and Claims

Reimbursement for Adult Companion Services is managed by DCH through the GAMMIS system. Claims are paid according to the waiver participant's approved Prior Approval (PA).

System edits control the amount and frequency a provider can be reimbursed. Rates are established by DCH and cannot exceed the published Medicaid fee schedule.

• Billing System: GAMMIS (Georgia Medicaid Management Information System)
• Claim Basis: All claims pay according to what is on the participant's approved PA
• System Edits: Programmed controls limit the amount and frequency of reimbursement
• Rate Assignment: DCH Medicaid Program Specialist authorizes rates upon approval
• Third-Party Liability: Services are authorized only to the extent they are not available through another third-party source

9. Approval Sequence and Timeline

The approval sequence begins with the submission of dual applications to DBHDD and DCH. DBHDD conducts the initial screening and site visit.

If DBHDD approves the infrastructure and programmatic elements, they forward a recommendation to DCH. DCH then processes the Medicaid enrollment and assigns a provider number.

• Step 1: Submit applications via DBHDD website and GAMMIS portal
• Step 2: DBHDD conducts initial screening and site visit
• Step 3: DBHDD submits recommendation and documents to DCH Medicaid Program Specialist
• Step 4: DCH reviews application fee and Medicaid requirements
• Step 5: DCH assigns Medicaid provider number and notifies the provider

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation or failure to pay the required application fee within the 30-day window.

During site visits, DBHDD often cites providers for inadequate policies regarding criminal background checks or failure to meet the Core Requirements for Providers.

• Fee Omission: Rejection within 30 days for missing the 42 CFR 455.460 application fee
• Infrastructure Failure: Denial by DBHDD for failing the initial site visit or lacking required policies
• Background Check Gaps: Citations for incomplete or missing criminal history checks on staff
• PA Mismatch: Claims denied in GAMMIS for not matching the approved Prior Approval (PA)
• Program Integrity: Medicaid's Program Integrity Unit may investigate and sanction providers for billing anomalies

11. Key Contacts and Resources

Prospective providers should utilize the official state portals for application submission and policy review. The DBHDD and DCH websites host the necessary manuals and forms.

For technical assistance with the GAMMIS portal, providers can access help directly within the Enrollment Wizard.

• DBHDD Provider Information: https://dbhdd.georgia.gov/
• DCH Medicaid Information: https://dch.georgia.gov/
• GAMMIS Provider Enrollment: https://www.mmis.georgia.gov/portal/PubAccess.Enrollment/tabId/26/Default.aspx
• NOW/COMP Waiver Info: https://georgia.gov/now-and-comp
• Eligibility Partner (GMCF): https://www.gmcf.org

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