Georgia - Autism Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Georgia Medicaid covers Applied Behavior Analysis under the service name Adaptive Behavior Services (ABS) for members under age 21 through the EPSDT benefit, administered by the Department of Community Health (DCH). The state enrolls Board Certified Behavior Analysts (BCBAs) to provide these services upon recommendation by a licensed physician or practitioner.

Approval requires enrolling as a Group/Billing provider through the Georgia Medicaid Management Information System (GAMMIS) and subsequently credentialing with the Georgia Families Care Management Organizations (CMOs). A structural precondition for group enrollment is that the applicant must first establish a Payee Medicaid ID and affiliate individually credentialed rendering providers recognized by the Georgia Composite Medical Board.

1. Service Definition and Scope

Adaptive Behavior Services (ABS) in Georgia encompass assessment and treatment provided to Medicaid members in accordance with Early and Periodic Screening, Diagnostic and Treatment (EPSDT) standards. The service is designed to prevent the progression of Autism Spectrum Disorder (ASD), prolong life, and promote physical and mental health.

Services must be recommended by a licensed physician or other licensed practitioner of the healing arts acting within their scope of practice under state law. Interventions are delivered by Board Certified Behavior Analysts (BCBAs) and credentialed technicians.

• Service Name: Adaptive Behavior Services (ABS)
• Target Population: Medicaid members under age 21 with a documented DSM-V diagnosis of ASD
• Diagnostic Prerequisite: Diagnosis must be from a licensed physician, psychologist, or other licensed professional designated by the Medical Composite Board
• Covered Modalities: Comprehensive behavioral assessments, individualized treatment planning, and direct one-on-one ABA therapy
• Delivery Settings: Natural environments including home, school, and community settings, as well as specialized clinic environments

2. Regulatory and Oversight Agencies

The Department of Community Health (DCH) Medical Assistance Plans Division serves as the primary state Medicaid agency, overseeing the GAMMIS portal and the Georgia Families managed care program. DCH sets the overarching policy for Adaptive Behavior Services under the EPSDT benefit.

For providers also delivering services under the NOW and COMP waivers, the Department of Behavioral Health and Developmental Disabilities (DBHDD) manages day-to-day operations. The Healthcare Facility Regulation Division (HFRD) licenses physical healthcare facilities, though standalone ABA clinics typically operate under professional licensure exemptions rather than facility licenses.

• Medicaid Agency: Department of Community Health (DCH) Medical Assistance Plans Division (https://medicaid.georgia.gov)
• Waiver Operating Agency: Department of Behavioral Health and Developmental Disabilities (DBHDD) (https://dbhdd.georgia.gov)
• Facility Licensing: Healthcare Facility Regulation Division (HFRD) (https://dch.georgia.gov/divisionsoffices/hfrd)
• Medicaid Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov)
• Managed Care Program: Georgia Families (https://medicaid.georgia.gov/programs/all-programs/georgia-families)

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia does not require a Certificate of Need (CON) or Facility Need Review for standard outpatient Adaptive Behavior Services clinics. However, access to the majority of the Medicaid population requires contracting with the Georgia Families Care Management Organizations (CMOs), which operate closed or restricted networks based on regional network adequacy.

Before a group application can be submitted in GAMMIS, the entity must possess an existing Payee Medicaid ID. Furthermore, the agency cannot enroll as a standalone entity without affiliating at least one fully credentialed rendering provider (BCBA) who meets the state's professional designation requirements.

• Group Enrollment Prerequisite: Must possess an existing Payee Medicaid ID before submitting the Group/Billing Application Type in GAMMIS
• Rendering Provider Affiliation: Must affiliate fully credentialed rendering providers (BCBAs) during the initial group enrollment process
• Managed Care Contracting: Must secure network contracts with Georgia Families CMOs (e.g., CareSource, Peach State Health Plan) to serve the EPSDT population
• Diagnostic Gate: Services cannot be authorized without a DSM-V diagnosis of ASD from a Medical Composite Board-designated professional
• Waiver Allocation: For NOW/COMP waiver services, providers must respond to DBHDD procurement or open enrollment windows, distinct from standard ABS enrollment

4. Licensure and Certification Requirements

Georgia does not issue a distinct 'ABA Agency' or 'Autism Clinic' facility license through HFRD. Instead, the state regulates the service through the professional credentialing of the individuals delivering the care, specifically requiring Board Certified Behavior Analysts (BCBAs).

The Georgia Composite Medical Board oversees the professional designation required for Medicaid enrollment. Paraprofessionals delivering direct line therapy must hold active Registered Behavior Technician (RBT) certification under the supervision of the enrolled BCBA.

• Facility Licensure: Exempt from HFRD facility licensure unless operating a residential or adult day center
• Professional Designation: BCBAs must be recognized and designated by the Georgia Composite Medical Board
• Lead Analyst Certification: Must hold active Board Certified Behavior Analyst (BCBA) status from the BACB
• Technician Certification: Direct care staff must hold Registered Behavior Technician (RBT) credentials
• Supervision Standard: RBTs must practice under the direct, ongoing supervision of a licensed/certified BCBA per BACB guidelines

5. Medicaid Provider Enrollment

Providers must enroll through the Georgia Medicaid Management Information System (GAMMIS) using the Provider Enrollment Wizard. Agencies must select the Group/Billing Application Type and enter their group information.

During this process, the agency must enter its existing Payee Medicaid ID on the Payee panel and affiliate its rendering providers. GAMMIS serves as the primary web portal for tracking application status and managing provider files.

• Enrollment Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov)
• Application Type: Group/Billing Application Type via the Provider Enrollment Wizard
• Payee Requirement: Must enter an existing Payee Medicaid ID on the Payee panel
• Affiliation Step: Must affiliate rendering providers (BCBAs) directly within the group application
• Application Fee: Subject to the standard ACA institutional provider application fee unless waived by Medicare enrollment

6. Staffing, Training and Background Checks

All personnel providing Adaptive Behavior Services must meet strict background check and training requirements. Georgia mandates fingerprint-based criminal background checks for all direct care staff interacting with vulnerable populations.

Agencies must maintain personnel files documenting BACB certification, CPR/First Aid training, and ongoing supervision logs. The clinical director must be a fully credentialed BCBA responsible for all treatment plan approvals.

• Background Checks: Fingerprint-based criminal history checks required for all direct care staff
• Clinical Director: Must be a BCBA in good standing with the BACB and recognized by the state
• Direct Care Staff: RBTs must maintain active certification and complete required annual training
• Safety Training: Mandatory CPR, First Aid, and crisis de-escalation training for all client-facing staff
• Supervision Logs: Must maintain documented supervision hours matching BACB requirements for RBTs

7. Documentation, Policies and Records

Providers must maintain comprehensive clinical and administrative records subject to audit by the DCH Program Integrity Unit. The Program Integrity Unit conducts random sample reviews of enrolled providers annually.

Documentation must include the initial DSM-V diagnostic report, individualized treatment plans, detailed session notes, and critical incident reports. Direct Service Providers are required to report incidents to DCH via the HCBS Incident Reporting System.

• Diagnostic Record: Must retain the DSM-V ASD diagnosis from a licensed physician or psychologist
• Treatment Plan: Individualized plan detailing EPSDT medical necessity, goals, and baseline metrics
• Session Notes: Contemporaneous documentation of each encounter, including start/stop times and specific interventions
• Incident Reporting: Mandatory submission of critical incidents to the DCH HCBS Incident Reporting System
• Audit Compliance: Records must be available for the DCH Program Integrity Unit's annual 56% random sample review

8. Billing, Rates and Claims

Adaptive Behavior Services are billed using standard Category III CPT codes for ABA. Claims for the EPSDT population are primarily submitted to the respective Georgia Families CMO rather than straight Medicaid FFS.

Prior authorization is universally required before initiating treatment. Providers must submit the BCBA's assessment and treatment plan to the CMO's utilization management department to secure authorized units.

• Billing System: GAMMIS for FFS claims; individual CMO portals (e.g., CareSource, Peach State) for managed care claims
• Assessment Code: 97151 (Behavior identification assessment) billed by the BCBA
• Treatment Code: 97153 (Adaptive behavior treatment by protocol) billed for RBT direct services
• Prior Authorization: Required for all treatment hours, submitted via the member's specific CMO portal
• Fee Schedule: Published in the GAMMIS provider portal under Provider Manuals and Fee Schedules

9. Approval Sequence and Timeline

The approval sequence begins with securing professional certification and Medical Composite Board recognition for the lead BCBAs. Once individual credentials are in place, the agency establishes a Payee Medicaid ID.

The agency then submits the Group/Billing application in GAMMIS, affiliating the rendering providers. Following GAMMIS approval, the agency must undergo credentialing and contracting with each Georgia Families CMO, a process that can take several months.

• Step 1: Obtain BACB certification and Georgia Composite Medical Board recognition for rendering BCBAs
• Step 2: Establish a Payee Medicaid ID for the billing entity
• Step 3: Submit the Group/Billing Application in GAMMIS and affiliate rendering providers (30-60 days)
• Step 4: Receive active Georgia Medicaid ID and welcome letter
• Step 5: Submit credentialing applications to Georgia Families CMOs (e.g., CareSource, Peach State) (90-120 days)

10. Common Denials and Survey Findings

Applications in GAMMIS are frequently delayed or denied due to missing rendering provider affiliations or incorrect Payee Medicaid IDs. The system requires exact matching of NPIs and tax identification numbers.

During post-payment audits by the DCH Program Integrity Unit, common findings include missing session notes, lapsed RBT certifications, and failure to submit a Corrective Action Plan when requested. CMO claims are often denied for lack of prior authorization or out-of-network status.

• Enrollment Denial: Failure to enter an existing Payee Medicaid ID on the Payee panel in GAMMIS
• Affiliation Errors: Submitting a group application without successfully affiliating active rendering providers
• Audit Finding: Missing or incomplete contemporaneous session notes during Program Integrity reviews
• Claim Denial: Billing for services provided by an RBT whose certification has lapsed
• Authorization Denial: Initiating services before receiving formal prior authorization from the CMO

11. Key Contacts and Resources

Providers should utilize the GAMMIS portal for all fee-for-service enrollment, billing, and manual updates. The DCH Medical Assistance Plans Division provides overarching policy guidance for the ABS program.

For managed care contracting, providers must contact the network relations departments of the individual Georgia Families CMOs. DBHDD regional offices handle inquiries related to the NOW and COMP waivers.

• GAMMIS Provider Portal: https://www.mmis.georgia.gov
• DCH Medical Assistance Plans: https://medicaid.georgia.gov
• DBHDD Waiver Programs: https://dbhdd.georgia.gov
• CareSource Georgia: https://www.caresource.com
• Peach State Health Plan: https://www.pshpgeorgia.com

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