Georgia - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Georgia Department of Community Health (DCH) funds Non-Emergency Medical Transportation (NEMT) and waiver-specific transportation services through a bifurcated system of regional brokers and specific Home and Community-Based Services (HCBS) waiver programs. Providers seeking to transport Medicaid members to standard medical appointments must operate under the state's brokerage model, while those transporting individuals to community integration activities must enroll through specific waivers like the Comprehensive Supports Waiver Program (COMP) or the Community Care Services Program (CCSP).

Approval requires either securing a subcontract with a designated regional NEMT broker or passing the Department of Behavioral Health and Developmental Disabilities (DBHDD) open enrollment Letter of Intent (LOI) process before submitting a formal Medicaid application via the Georgia Medicaid Management Information System (GAMMIS). The pathway dictates the credentialing standards, reimbursement rates, and oversight authority governing the provider's daily operations.

1. Service Definition and Scope

In Georgia, Adult Health Transportation encompasses two distinct service models depending on the destination and funding source. State Plan NEMT covers transportation for eligible Medicaid members to and from Medicaid-reimbursable medical services, managed entirely by regional brokers.

Conversely, HCBS Waiver Transportation supports individuals enrolled in programs like COMP, NOW, or CCSP by providing transit to waiver-funded services, such as Adult Day Health or supported employment, fostering community integration outside of traditional medical appointments.

• State Plan NEMT: Transportation to standard medical appointments, managed exclusively by regional brokers rather than direct fee-for-service Medicaid.
• HCBS Waiver Transportation: Transportation to community-based waiver services, authorized under DBHDD or Division of Aging Services (DAS) care plans.
• Broker Regions: Georgia divides its NEMT network into five regions (North, Atlanta, Central, East, and Southwest) to manage provider networks.
• Modivcare: The designated NEMT broker managing specific regions, including the Central, East, and Southwest territories.
• Verida: The designated NEMT broker (formerly Southeastrans) managing the North and Atlanta regions.
• Excluded Services: Emergency transportation (ambulance services) falls outside NEMT and is billed directly to DCH.

2. Regulatory and Oversight Agencies

The Georgia Department of Community Health (DCH) serves as the single state Medicaid agency, holding the contracts with the regional NEMT brokers and overseeing the GAMMIS payment system. DCH delegates the daily management of the State Plan NEMT network to these brokers.

For waiver-based transportation, the Department of Behavioral Health and Developmental Disabilities (DBHDD) and the Division of Aging Services (DAS) act as the operating agencies, setting provider qualifications, conducting site visits, and approving applicants before they can enroll with DCH.

• Georgia Department of Community Health (DCH): The state Medicaid agency overseeing all funding and broker contracts (https://dch.georgia.gov).
• Department of Behavioral Health and Developmental Disabilities (DBHDD): Operates the COMP and NOW waivers and approves I/DD transportation providers (https://dbhdd.georgia.gov).
• Georgia Medicaid Management Information System (GAMMIS): The official portal for direct provider enrollment and fee-for-service claims (https://www.mmis.georgia.gov).
• Verida: The regional NEMT broker for the North and Atlanta regions (https://verida.com).
• Modivcare: The regional NEMT broker for the Central, East, and Southwest regions (https://www.modivcare.com).
• Division of Aging Services (DAS): Manages the CCSP waiver and conducts pre-enrollment training for aging service providers (https://aging.georgia.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia heavily restricts direct entry into the transportation provider network through structural prerequisites that vary by the target population. State Plan NEMT operates as a closed network where providers cannot enroll directly with Medicaid; they must be accepted as subcontractors by the regional brokers.

Waiver transportation is gated by strict operating history requirements and procurement windows. Applicants must navigate these specific agency gates before DCH will even review a Medicaid enrollment application.

• Broker Subcontracting Requirement: State Plan NEMT providers cannot enroll directly with DCH; they must apply to and be accepted into the network of Verida or Modivcare.
• DBHDD Open Enrollment Windows: COMP/NOW waiver transportation applicants must wait for a scheduled open enrollment period to submit a Letter of Intent (LOI) to the Georgia Collaborative ASO.
• CCSP Operating History: CCSP waiver applicants must have been in business providing the service for a minimum of 12 consecutive months prior to making an application.
• CCSP Pre-Enrollment Training: Mandatory, invitation-only training required before a CCSP application is accepted, requiring a $25 fee per person.
• Application Fee: A federal Medicaid application fee (approximately $709) applies to institutional and agency providers enrolling directly via GAMMIS.
• One-Year Denial Moratorium: If a DCH application is denied, DBHDD policy requires the applicant to wait one full year before submitting another LOI.

4. Licensure and Certification Requirements

Georgia does not issue a distinct "NEMT License" through the DCH Healthcare Facility Regulation (HFR) division. Because it is not a licensed facility type, providers must instead prove legal business authority and meet stringent commercial insurance and vehicle safety standards.

Waiver providers must obtain agency certification directly from the operating agency (DBHDD or DAS) by passing policy reviews and site inspections that verify compliance with waiver-specific transportation standards.

• Local Business License: Required from the city or county of operation to prove the legal right to conduct business in Georgia.
• Commercial Auto Insurance: High-limit liability coverage required by brokers and waivers (typically a minimum of $1,000,000 combined single limit).
• Vehicle Registration: All transport vehicles must be properly registered, tagged, and insured within the State of Georgia.
• HFR Exemption: NEMT is not a licensed facility type under the DCH Healthcare Facility Regulation division, exempting it from HFR licensure.
• DBHDD Certification: Waiver providers must pass a DBHDD Regional Field Office site visit to receive approval as an I/DD provider.
• Vehicle Inspections: Brokers require comprehensive physical inspections of all vehicles, verifying safety equipment like fire extinguishers and wheelchair tie-downs.

5. Medicaid Provider Enrollment

The enrollment process diverges based on the service model. Providers seeking to offer State Plan NEMT must complete the proprietary credentialing packets of Verida or Modivcare and do not use the state's enrollment portal for this service.

Providers approved for waiver transportation must complete the DCH Medicaid Provider Enrollment Application using the GAMMIS Enrollment Wizard, linking their agency to the specific waiver Category of Service (COS).

• GAMMIS Enrollment Wizard: The online portal used for DCH Medicaid enrollment after a provider receives DBHDD or DAS waiver approval.
• Broker Credentialing Packet: A separate, proprietary application submitted directly to Verida or Modivcare for State Plan NEMT participation.
• Category of Service (COS): Waiver providers must select the specific COS code for Transportation during the GAMMIS enrollment process.
• NPI Requirement: A Type 2 (Organization) National Provider Identifier is required for agency enrollment.
• EFT Enrollment: Mandatory Electronic Funds Transfer setup via GAMMIS for direct Medicaid payments for waiver services.
• Revalidation: Enrolled GAMMIS providers must revalidate their Medicaid enrollment every 3 to 5 years as prompted by DCH.

6. Staffing, Training and Background Checks

Drivers are the primary focus of staffing compliance, subject to rigorous safety, background, and training standards dictated by DCH broker contracts and DBHDD policies. Agencies must maintain active files proving continuous compliance for every driver.

Training requirements extend beyond basic driving skills, requiring specialized certifications in passenger assistance and emergency response to ensure the safety of vulnerable Medicaid members.

• Motor Vehicle Record (MVR): Annual MVR checks are required for all drivers, strictly prohibiting major violations such as DUIs.
• Criminal Background Check: Fingerprint-based background checks are required via the Georgia Applicant Processing Service (GAPS).
• Drug Testing: Pre-employment and random drug screening are mandatory for all NEMT drivers under broker contracts.
• CPR and First Aid: All drivers must hold current, in-person CPR and Basic First Aid certifications.
• Defensive Driving: Drivers must complete a certified defensive driving course before transporting any Medicaid members.
• Passenger Assistance Training: Specialized training required for drivers operating wheelchair vans or assisting members with mobility devices.

7. Documentation, Policies and Records

Transportation providers must maintain meticulous records of every trip, vehicle inspection, and driver qualification. Brokers utilize electronic routing and GPS tracking systems to monitor trip execution in real-time.

Waiver providers must adhere to DBHDD or DAS documentation standards, ensuring that transportation aligns with the member's individualized care plan and that all incidents are reported promptly.

• Trip Logs: Must include the member's signature, exact pickup and drop-off times, locations, and the driver's signature for every leg of the trip.
• Vehicle Maintenance Records: Daily pre-trip inspection logs and routine maintenance schedules must be documented and retained.
• Electronic Trip Routing: Broker providers must utilize the broker's designated routing and GPS tracking software for dispatch and compliance.
• Incident Reporting: DBHDD providers must use the HCBS Incident Reporting System for any accidents, injuries, or behavioral events during transit.
• Record Retention: All Medicaid, trip, and personnel records must be retained for a minimum of five years and made available for audit.
• Care Plan Alignment: Waiver transportation documentation must demonstrate that the trip supported a goal or service outlined in the member's care plan.

8. Billing, Rates and Claims

Reimbursement mechanisms depend entirely on the provider's enrollment pathway. State Plan NEMT providers are paid directly by Verida or Modivcare based on negotiated per-trip or per-mile rates established in their subcontracts.

Waiver transportation providers bill DCH directly through the GAMMIS web portal using specific HCPCS codes, adhering to the fee schedules published in the DBHDD or CCSP provider manuals.

• Broker Reimbursement: Paid directly by Verida or Modivcare based on contracted rates, independent of the DCH fee-for-service schedule.
• Waiver Billing: Claims are submitted through the GAMMIS web portal using the CMS-1500 format or electronic equivalent.
• HCPCS Codes: Common waiver billing codes include A0120 (Non-emergency transportation) or T2003 (Non-emergency transportation; encounter/trip).
• Prior Authorization: All State Plan NEMT trips must be pre-arranged and authorized by the regional broker before the trip occurs.
• Timely Filing: Claims submitted to GAMMIS must typically be filed within 6 months of the date of service to avoid denial.
• Electronic Remittance: GAMMIS provides Electronic Remittance Advice (ERA) detailing claim approvals, denials, and payment amounts.

9. Approval Sequence and Timeline

The timeline to become an operational provider varies drastically between the broker and waiver pathways. Broker credentialing is generally faster but depends on network need, while waiver enrollment is a multi-phase process that can take over a year.

Waiver applicants must successfully navigate the LOI phase, agency site visits, and final GAMMIS enrollment, with delays at any step significantly extending the timeline.

• Phase 1 (Waiver): Register for the New Provider Enrollment Forum and submit an LOI during a DBHDD open enrollment window (1-3 months).
• Phase 2 (Waiver): Submit the full DBHDD application and undergo a Regional Field Office site visit (3-6 months).
• Phase 3 (Waiver): Upon DBHDD approval, submit the DCH application via the GAMMIS Enrollment Wizard (30-90 days).
• Broker Pathway: Submit a credentialing packet to Verida or Modivcare, complete vehicle inspections, and execute a contract (60-120 days).
• CCSP Pathway: Complete 12 months of operating history, attend the $25 pre-enrollment training, and submit joint DAS/DCH applications.
• Final Activation: Providers receive a welcome letter and Medicaid provider number, allowing them to begin billing for authorized services.

10. Common Denials and Survey Findings

Applications are frequently rejected at the gatekeeping stage for failing to meet strict submission windows or operating history requirements. Once operational, providers face intense scrutiny over trip documentation and vehicle safety.

Audits by DCH, DBHDD, or the brokers frequently target missing signatures and lapsed driver credentials, leading to immediate recoupment of funds or suspension from the network.

• LOI Rejection: DBHDD will outright deny applications submitted outside the designated open enrollment periods or missing required attachments.
• Vehicle Inspection Failures: Brokers will deny credentialing if vehicles lack proper safety equipment, such as functional wheelchair tie-downs.
• Missing Signatures: A primary cause for recoupment during audits is the absence of member or driver signatures on trip logs.
• Insurance Lapses: Providers face immediate suspension from broker networks if their commercial auto insurance certificates expire.
• Unqualified Drivers: Citations and payment retractions occur when audits reveal drivers with expired CPR/First Aid or flagged MVRs transported members.
• Premature CCSP Application: DAS will reject CCSP applications if the agency cannot prove a full 12 months of prior operating history.

11. Key Contacts and Resources

Prospective providers must interact with multiple state systems and corporate portals depending on their chosen service model. The Georgia Collaborative ASO manages the front end of DBHDD waiver enrollment, while GAMMIS handles the back end.

For State Plan NEMT, providers must bypass state portals entirely and communicate directly with the provider relations departments of Verida or Modivcare.

• Georgia Medicaid Management Information System (GAMMIS): Portal for DCH enrollment and billing (https://www.mmis.georgia.gov).
• Department of Behavioral Health and Developmental Disabilities (DBHDD): Operating agency for COMP/NOW waivers (https://dbhdd.georgia.gov).
• Georgia Collaborative ASO: Manages DBHDD provider enrollment and LOI submissions (https://www.georgiacollaborative.com/providers/enrollment/).
• Verida: NEMT Broker for North and Atlanta regions (https://verida.com).
• Modivcare: NEMT Broker for Central, East, and Southwest regions (https://www.modivcare.com).
• Division of Aging Services (DAS): Operating agency for the CCSP waiver (https://aging.georgia.gov).

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