Georgia - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Georgia Department of Community Health (DCH) Healthcare Facility Regulation Division (HFRD) licenses Home Health Agencies to deliver intermittent skilled nursing, physical therapy, and home health aide services to patients in their residences. Approval to establish a new agency or expand a geographic service area requires securing a Certificate of Need (CON) from DCH, which is only granted when the state's numerical formula projects an unmet need of at least 500 patients in a designated health planning area.

Once licensed and Medicare-certified, agencies enroll in Georgia Medicaid through the GAMMIS portal under the Home Health provider type. Enrolled agencies must also complete centralized credentialing through the Council for Affordable Quality Healthcare (CAQH) to contract with Care Management Organizations (CMOs) like Peach State Health Plan and CareSource for managed care reimbursement.

1. Service Definition and Scope

Home Health Services in Georgia consist of part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse, alongside physical, occupational, or speech therapy, medical-social services, and home health aide services. These services must be delivered in the patient's residence under a written plan of care established and periodically reviewed by a physician.

The scope of practice is strictly defined by state licensure rules and federal Medicare Conditions of Participation, which Georgia Medicaid adopts for its service standards.

• Nursing Care: Services provided by a licensed RN or LPN under RN supervision, adhering to the Georgia Nurse Practice Act.
• Therapy Services: Physical, occupational, and speech therapy ordered by a physician to restore or maintain patient function.
• Home Health Aide: Part-time or intermittent personal care and basic health assistance supervised by an RN.
• Medical-Social Services: Patient counseling and resource coordination directed by a physician.
• Plan of Care: Written medical directives established by a physician that dictate the frequency and duration of all home health interventions.

2. Regulatory and Oversight Agencies

The Georgia Department of Community Health (DCH) serves as the primary regulatory authority for Home Health Agencies, managing both licensure and Medicaid enrollment. Within DCH, the Healthcare Facility Regulation Division (HFRD) conducts facility licensing, Medicare certification surveys, and complaint investigations.

Medicaid enrollment and claims processing are managed through the state's fiscal agent via the GAMMIS portal, while managed care credentialing is centralized through CAQH.

• Georgia Department of Community Health (DCH): Administers the state Medicaid program and oversees health care facility regulation (https://dch.georgia.gov).
• Healthcare Facility Regulation Division (HFRD): Issues state licenses and conducts Medicare and Medicaid certification surveys for home health agencies (https://dch.georgia.gov/divisionsoffices/hfrd).
• Georgia Medicaid Management Information System (GAMMIS): The official portal for Medicaid provider enrollment, claims submission, and policy manual access (https://www.mmis.georgia.gov).
• Council for Affordable Quality Healthcare (CAQH): Manages the centralized credentialing database required for Georgia Medicaid CMO network participation (https://proview.caqh.org).

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia strictly limits the establishment of new Home Health Agencies through its Certificate of Need (CON) program, governed by Ga. Comp. R. & Regs. R. 111-2-2-.32. An applicant cannot submit a licensure application without first obtaining a CON, which requires demonstrating a specific numerical unmet need in the proposed geographic service area.

The state calculates need based on population and utilization data. If the threshold is not met, the state will not accept applications for new agencies in that planning area.

• Certificate of Need (CON): Mandatory state approval required prior to establishing a new agency or expanding an existing geographic service area.
• Numerical Unmet Need Threshold: DCH must project a net unmet need of 500 or more patients in a planning area to authorize applications for a new home health agency.
• Expansion Threshold: Existing agencies seeking to expand must demonstrate an unmet need of at least 300 patients in the target planning area.
• Special Group Exception: CONs may be granted outside the standard formula if the applicant documents a projected need of at least 200 patients for special groups like medically fragile children or HIV/AIDS patients.
• County Service Mandate: Applicants must apply to serve 100 percent of the unmet numerical need in any single county they propose to enter; need cannot be divided among multiple applicants.

4. Licensure and Certification Requirements

Following CON approval, agencies must apply for a state license from the DCH Healthcare Facility Regulation Division (HFRD). Because Georgia Medicaid requires Home Health Agencies to be Medicare-certified, the agency must also undergo an initial certification survey conducted by HFRD on behalf of the Centers for Medicare & Medicaid Services (CMS).

Applicants must also demonstrate their intent to meet national accreditation standards and provide detailed community linkage plans.

• Licensure Application: Submitted to HFRD with proof of CON approval, ownership disclosures, and operational policies.
• Medicare Certification: Required for Medicaid enrollment; involves an initial survey by HFRD to verify compliance with federal Conditions of Participation.
• Accreditation Mandate: CON rules require new agencies to provide evidence of intent to meet accreditation requirements from bodies like The Joint Commission (TJC) or Community Health Accreditation Partner (CHAP).
• Community Linkage Plan: Applicants must submit a written plan demonstrating referral arrangements and working agreements with other local healthcare systems.
• Compliance History: The applicant and its parent organization must have no history of uncorrected conditional-level violations or Medicare/Medicaid fraud convictions.

5. Medicaid Provider Enrollment

Agencies enroll as Home Health providers through the GAMMIS Provider Enrollment Wizard. Because home health is categorized as an elevated risk service, applicants undergo stringent screening, including ownership disclosures and potential site visits.

Once approved by the state, providers must complete centralized credentialing to participate in the managed care networks that cover the majority of Georgia Medicaid beneficiaries.

• GAMMIS Portal: The online system where agencies submit the Medicaid provider enrollment application and upload supporting documents.
• National Provider Identifier (NPI): Agencies must obtain and link an active organizational NPI to their Medicaid application.
• Elevated Risk Screening: Home Health Agencies are subject to enhanced Medicaid screening protocols, which may include fingerprint-based criminal background checks for owners with 5 percent or more interest.
• Revalidation: Georgia Medicaid requires enrolled providers to revalidate their enrollment data every 3 to 5 years to maintain active billing status.
• CMO Credentialing: Providers must complete a centralized credentialing application via CAQH to participate in Care Management Organization networks like Peach State Health Plan and CareSource.

6. Staffing, Training and Background Checks

Home Health Agencies must maintain a qualified workforce capable of executing physician-ordered care plans. The agency must provide a written plan during the CON and licensure phases demonstrating its ability to recruit and retain appropriately licensed personnel in the target geographic area.

All clinical staff must hold current Georgia licenses, and aides must complete state-approved training and competency evaluations.

• Registered Professional Nurse (RN): Must hold an active, unencumbered license from the Georgia Board of Nursing to provide skilled care and supervise aides.
• Therapists: Physical, occupational, and speech therapists must be licensed by their respective Georgia state examining boards.
• Home Health Aides: Must complete a state-approved training program and competency evaluation before providing direct patient care.
• Physician Oversight: All clinical services must be delivered under a written plan of care established and periodically reviewed by a licensed physician.
• Background Screening: Agencies must conduct criminal history background checks on all patient-facing staff prior to employment.

7. Documentation, Policies and Records

HFRD and Medicaid regulations require agencies to maintain comprehensive clinical and administrative records. Documentation must clearly link the physician's orders to the specific interventions delivered during each home visit.

Agencies are also required to submit statistical data to the state annually to support ongoing health planning and CON need calculations.

• Plan of Care (CMS-485): The formal medical directive that outlines the patient's diagnoses, required services, frequency of visits, and rehabilitation potential.
• Visit Notes: Contemporaneous clinical documentation detailing the date, time, duration, and specific skilled interventions provided during each staff visit.
• Statistical Reporting: Agencies must agree to provide DCH with requested statistical data related to operations and patient volume, typically submitted via the Annual Home Health Services survey.
• Personnel Files: Must contain proof of current licensure, background check results, competency evaluations, and annual performance reviews.
• Quality Assessment: Agencies must implement a continuous quality improvement program that reviews clinical outcomes and patient satisfaction.

8. Billing, Rates and Claims

Home Health claims for fee-for-service Medicaid are processed through the GAMMIS portal, while managed care claims are submitted directly to the respective CMOs. Reimbursement is based on the Georgia Medicaid fee schedule for specific procedure codes related to nursing, therapy, and aide visits.

Prior authorization is frequently required for extended services beyond initial evaluation and treatment thresholds.

• Fee-for-Service Claims: Submitted electronically via the GAMMIS portal using standard institutional or professional claim formats depending on the specific service code.
• CMO Billing: Claims for members enrolled in Peach State Health Plan, CareSource, or Amerigroup must be routed through the specific CMO's clearinghouse.
• Prior Authorization: Many home health services, particularly extended therapy or aide visits, require prior approval from the Medicaid utilization management contractor or the member's CMO.
• Procedure Codes: Billing relies on standard HCPCS and CPT codes as defined in the DCH Provider Manual.
• Rate Setting: Reimbursement rates are established by DCH and published in the Home Health Services fee schedule available on the GAMMIS portal.

9. Approval Sequence and Timeline

The pathway to becoming a billing Home Health Agency in Georgia is lengthy due to the CON requirement. The process spans state health planning approval, facility licensure, Medicare certification, and finally Medicaid enrollment.

Providers should anticipate a multi-year process from the initial CON application to executing final CMO contracts.

• CON Application: The initial step, which can take 90 to 120 days for DCH review once a batching cycle or unmet need window opens.
• Licensure Submission: Following CON approval, the agency submits its state license application to HFRD, which typically takes 60 to 90 days to process.
• Initial Survey: HFRD conducts an on-site licensure and Medicare certification survey after the agency has admitted a minimum number of patients.
• Medicaid Enrollment: Submitted via GAMMIS after Medicare certification is secured; elevated risk screening can extend processing to several weeks.
• CMO Contracting: CAQH credentialing and network contracting with CMOs add an additional 60 to 120 days post-Medicaid approval.

10. Common Denials and Survey Findings

Applications are most frequently rejected at the CON stage due to a failure to prove numerical unmet need or adequately address the community linkage requirements. During HFRD surveys, deficiencies often center on incomplete clinical documentation or inadequate supervision of home health aides.

Medicaid enrollment delays are typically caused by mismatched data between the GAMMIS application and the CAQH profile.

• CON Need Failure: Denials occur when applicants apply for counties without a DCH-projected unmet need of at least 500 patients for new agencies or 300 for expansions.
• Incomplete CAQH Profiles: Medicaid CMO credentialing is frequently delayed due to expired liability insurance or mismatched practice addresses in the CAQH database.
• Plan of Care Deviations: Surveyors frequently cite agencies for delivering services that alter the frequency or scope of the physician's written plan of care without obtaining a new order.
• Aide Supervision Lapses: Failure of the RN to conduct and document the required on-site supervisory visits for home health aides every 14 days.
• Background Check Violations: Citations for allowing staff to provide direct patient care before the return of a clear criminal history background check.

11. Key Contacts and Resources

Providers must navigate multiple DCH divisions and contractor portals to maintain compliance. The GAMMIS portal and the DCH HFRD website are the primary hubs for policy manuals, fee schedules, and regulatory updates.

For managed care participation, providers must interact directly with the credentialing portals of the individual CMOs.

• DCH Healthcare Facility Regulation Division (HFRD): Oversees licensure and surveys (https://dch.georgia.gov/divisionsoffices/hfrd).
• Georgia Medicaid Management Information System (GAMMIS): Portal for enrollment, claims, and provider manuals (https://www.mmis.georgia.gov).
• CAQH ProView: Centralized credentialing portal required for Georgia Medicaid CMO networks (https://proview.caqh.org).
• Peach State Health Plan Provider Network: CMO contracting and credentialing information (https://www.pshpgeorgia.com/providers/become-a-provider.html).
• CareSource Georgia Providers: CMO contracting resources (https://www.caresource.com/ga/providers/education/become-caresource-provider/medicaid/).

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