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Georgia - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

In Georgia, Case Management Services (often referred to as Support Coordination or Intensive Support Coordination) are funded primarily through the Comprehensive Supports (COMP) and New Options Waiver (NOW) programs, overseen by the Department of Behavioral Health and Developmental Disabilities (DBHDD). The service involves assessment, person-centered service planning, referral, and monitoring across the person’s full service package.

The most critical structural precondition for becoming a Support Coordination provider in Georgia is that DBHDD utilizes an open enrollment period and requires a Letter of Intent (LOI) process managed by the Georgia Collaborative ASO. Providers cannot simply apply at any time; they must wait for an open enrollment window, attend a mandatory New Provider Enrollment Forum, and submit an LOI. Only after the LOI is approved will the provider receive an invitation to submit a formal application.

1. Service Definition and Scope

Support Coordination Services in Georgia identify, coordinate, and oversee the delivery of services and supports to enhance the health, safety, and general well-being of waiver participants. This includes comprehensive assessment, person-centered service planning, referral to necessary resources, and ongoing monitoring of the individual's service package.

Georgia also offers Intensive Support Coordination (ISC) for individuals with complex medical or behavioral needs. Providers can apply to offer standard Support Coordination, Intensive Support Coordination, or both, but they must specify their intent during the LOI phase.

2. Regulatory and Oversight Agencies

The Department of Behavioral Health and Developmental Disabilities (DBHDD) is the operating agency responsible for the day-to-day management of the COMP and NOW waivers, including provider enrollment and certification. The Georgia Collaborative ASO administers the enrollment process on DBHDD's behalf.

The Department of Community Health (DCH) is the State Medicaid Agency, responsible for final Medicaid provider enrollment, assigning provider numbers, and managing the Medicaid Management Information System (MMIS) for claims and reimbursement.

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia strictly controls entry into the Support Coordination provider network through designated open enrollment periods. Providers cannot apply at will; they must wait for DBHDD to announce an open enrollment window.

During this window, prospective providers must first register for and attend a mandatory New Provider Enrollment Forum. Following attendance, they must submit a Letter of Intent (LOI). Only providers whose LOI is approved receive an invitation to submit a full application. Additionally, applicants must demonstrate a minimum of five years of business experience and oversight of 5 or more employees in the health care, behavioral health, or case management field.

4. Licensure and Certification Requirements

Georgia does not issue a distinct facility license specifically for Support Coordination agencies. Instead, providers must be certified by DBHDD as meeting the standards for a public or private provider agency.

While national accreditation (e.g., in case management services) is preferred and may be required for providers receiving $250,000 or more per year in DBHDD funding, it is not strictly required prior to submitting an LOI during open enrollment. Providers must maintain a valid Georgia business license.

5. Medicaid Provider Enrollment

Medicaid enrollment is a two-phase process. Providers must first be approved by DBHDD. Once DBHDD approves the application and completes any necessary site visits, the provider is notified to complete the online application with the Department of Community Health (DCH) via the GAMMIS portal.

The DCH application is processed through the GAMMIS Enrollment Wizard. Providers must pay an application fee as required by 42 CFR 455.460, unless exempt. If DCH denies the application, the provider must wait one year before reapplying during a subsequent open enrollment period.

6. Staffing, Training and Background Checks

Support Coordination agencies must meet specific staffing qualifications and experience requirements. The agency itself must have at least five years of experience serving individuals at risk due to medical, functional, and/or behaviorally complex conditions.

All providers must conduct and pay for criminal history background checks for their staff. DBHDD verifies compliance annually. Staff must also complete required orientation and ongoing training as specified in the COMP/NOW waiver service definitions.

7. Documentation, Policies and Records

Providers must submit comprehensive documentation during the application process, including a current resume or organizational chart, staffing information, and reference contact information to verify experience.

Agencies must maintain policies that ensure compliance with CMS Conflict-Free Case Management regulations. They must also utilize accounting systems, maintain payroll records, and generate service management and statistical reports.

8. Billing, Rates and Claims

Support Coordination and Intensive Support Coordination are Medicaid billable services reimbursed under the COMP and NOW waivers. Claims are processed through the GAMMIS system managed by DCH.

All waiver participant services require prior approval (PA) by DBHDD, which must be entered into MMIS. Claims will only pay according to the approved PA, and system edits control the amount and frequency of reimbursement. There is a single procedure code for both medical and behavioral Intensive Support Coordination.

9. Approval Sequence and Timeline

The approval sequence begins with attending the New Provider Enrollment Forum and submitting an LOI during an open enrollment window. DBHDD reviews early LOI submissions within 7 business days.

If the LOI is approved, the provider submits the full DBHDD application. Following DBHDD approval and a potential site visit, the provider applies to DCH via GAMMIS. The entire process spans several months, heavily dependent on the timing of the open enrollment periods.

10. Common Denials and Survey Findings

Applications are frequently denied at the LOI stage if the agency fails to meet the strict minimum experience requirements, such as lacking five years of business experience or oversight of 5 or more employees.

During ongoing monitoring, DBHDD and the Healthcare Facility Regulation Division (HFRD) conduct site visits and desk audits. Common compliance issues involve failing to adhere to person-centered planning requirements, conflict-free case management rules, or failing to maintain required background check documentation.

11. Key Contacts and Resources

Prospective providers should regularly monitor the Georgia Collaborative ASO and DBHDD websites for announcements regarding open enrollment periods and mandatory forums.

For specific questions regarding Intensive Support Coordination enrollment, providers can contact the DBHDD ISC team directly via email.

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