Georgia - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Georgia, services for individuals with intellectual and developmental disabilities (I/DD) are primarily delivered through the New Options Waiver (NOW) and the Comprehensive Supports Waiver Program (COMP). These Medicaid Home and Community-Based Services (HCBS) waivers provide a full continuum of care, ranging from community access and supported employment to in-home personal care and 24-hour residential support in licensed facilities.

The single biggest structural barrier to entry in Georgia is the bifurcated, closed-network approval process. Applicants cannot simply submit a Medicaid enrollment application; they must wait for a specific open enrollment window, attend a mandatory forum, submit a Letter of Intent to a contracted Administrative Services Organization, and pass a rigorous Phase 1 policy and site review by the Department of Behavioral Health and Developmental Disabilities (DBHDD) before they are even permitted to apply to the Department of Community Health (DCH) for a Medicaid ID.

1. Service Definition and Scope

Georgia's I/DD services are designed to provide community-based alternatives to institutional care (such as ICF/IID facilities). The NOW waiver supports individuals who live independently or with family, while the COMP waiver is designed for individuals requiring more intensive, out-of-home residential support.

The service array covers habilitation, personal care, and specialized supports. Providers must be specifically approved for each distinct service they intend to offer, and reimbursement is tied directly to the participant's authorized Individual Service Plan (ISP).

• Community Access: Group and individual services designed to help participants acquire, retain, or improve self-help, socialization, and adaptive skills in community settings.
• Supported Employment: Assistance with obtaining and maintaining competitive employment in integrated work settings, including job coaching.
• Community Residential Alternative (CRA): 24-hour residential support provided in licensed Community Living Arrangements (CLAs) or Personal Care Homes (PCHs).
• Community Living Support (CLS): Individually tailored supports provided in the participant's own or family home to promote independence.
• Respite Services: Short-term relief for primary caregivers, provided in-home or out-of-home, billed in 15-minute or daily increments.
• Specialized Medical Equipment: Funding for adaptive equipment, vehicle adaptations, and home modifications to ensure accessibility.

2. Regulatory and Oversight Agencies

I/DD waiver services in Georgia are co-managed by two primary state departments and a contracted Administrative Services Organization (ASO). Navigating the system requires interacting with all three entities at different stages of the enrollment and billing lifecycle.

DBHDD handles day-to-day operations, clinical policy, and initial provider vetting, while DCH holds the ultimate Medicaid authority, manages the claims system, and handles facility licensure.

• Operating Agency: Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) (https://dbhdd.georgia.gov) manages waiver operations, provider certification, and regional field offices.
• Medicaid Authority: Georgia Department of Community Health (DCH) (https://dch.georgia.gov) oversees the Medicaid state plan, waiver funding, and final provider enrollment.
• Enrollment Administrator: Georgia Collaborative ASO (https://www.georgiacollaborative.com) processes DBHDD provider enrollment applications, Letters of Intent, and site visits on behalf of the state.
• Licensing Body: DCH Healthcare Facility Regulation (HFR) (https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation) issues facility-specific licenses required for certain waiver services.
• Claims Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov) processes all prior authorizations and Medicaid claims.

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia strictly controls the influx of new I/DD providers. You cannot submit a Medicaid application without prior DBHDD approval, and DBHDD only accepts applications during specific periods or based on regional network adequacy needs.

The initial gatekeeping phase is managed by the Georgia Collaborative ASO and requires mandatory pre-application steps. Failure to follow this exact sequence, or a denial at the DCH stage, triggers a mandatory one-year lockout period.

• Open Enrollment Windows: DBHDD restricts new provider applications to specific open enrollment periods; applications are not accepted on a rolling basis.
• Mandatory Forum: Prospective providers must attend a DBHDD Provider Enrollment Forum prior to submitting any documentation or applications.
• Letter of Intent (LOI): Following the forum, applicants must submit an LOI to the Georgia Collaborative ASO during the designated open window.
• DBHDD Phase 1 Approval: Applicants must pass DBHDD's policy review and site visit before being authorized to apply to DCH for Medicaid enrollment.
• One-Year Lockout Rule: If the DCH Medicaid application is denied in Phase 2, the applicant must wait one full year before restarting Phase 1 in a subsequent enrollment period.
• Host Home Subcontracting: Host Home/Life-Sharing providers cannot enroll directly as independent Medicaid providers; they must subcontract under an existing, approved DBHDD CRA provider per DBHDD Policy 02-704.

4. Licensure and Certification Requirements

Georgia does not issue a single generic I/DD Provider License. Instead, providers receive a DBHDD Certification for waiver services. However, if the provider operates a physical facility or provides nursing services, specific DCH HFR licenses are required.

Providers must secure these HFR licenses before DBHDD will approve them for the corresponding residential or nursing waiver services. Operating without the correct HFR license is grounds for immediate denial.

• DBHDD Certification: Required for all NOW/COMP providers, focusing on compliance with the DBHDD Provider Manual for Community Developmental Disability Services (Policy 02-1202).
• Personal Care Home (PCH) Permit: Required from DCH HFR (Rules 111-8-62) for agencies providing out-of-home residential or daily respite services to two or more adults.
• Community Living Arrangement (CLA) License: Required from DCH HFR for agencies operating group homes specifically tailored for individuals with I/DD.
• Private Home Care Provider (PHCP) License: Required from DCH HFR for agencies providing skilled nursing or certain in-home personal care services.
• Host Home Approval: Unlicensed private homes providing CRA services must be inspected and approved by their sponsoring DBHDD-enrolled agency, not directly by HFR.

5. Medicaid Provider Enrollment

Once DBHDD issues Phase 1 approval, the provider is notified to complete the Phase 2 online application with the Department of Community Health (DCH). This step officially registers the agency as a billing provider.

This process is conducted entirely through the GAMMIS portal. DCH verifies ownership, background checks, and DBHDD authorization before issuing a Medicaid Provider ID.

• System: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov).
• Application Type: Providers typically enroll as a Group/Billing entity under the specific HCBS Waiver taxonomy.
• Application Fee: Must pay the federal Medicaid application fee (approximately $732 for 2024) unless waived by Medicare or another state's Medicaid program.
• Ownership Disclosure: Must disclose all individuals or entities with 5 percent or greater ownership and all managing employees per 42 CFR 1002.3.
• DBHDD Notification: Upon DCH approval, DBHDD is notified and sends the provider an email regarding mandatory New Provider Orientation.

6. Staffing, Training and Background Checks

DBHDD enforces strict personnel requirements to ensure the safety of vulnerable adults. All direct support professionals (DSPs) and management must meet baseline education and background standards.

Training must align with DBHDD Core Requirements and specific NOW/COMP waiver standards, with documentation maintained in individual personnel files.

• Background Checks: All owners, directors, and direct care staff must undergo fingerprint-based criminal background checks via the Georgia Applicant Processing Service (GAPS).
• DSP Qualifications: Direct Support Professionals must have a high school diploma or GED, a valid driver's license, and CPR/First Aid certification.
• Developmental Disability Professional (DDP): Agencies must employ or contract with a DDP (e.g., a licensed clinician or degree-holding professional with I/DD experience) to oversee service planning.
• Initial Training: Staff must complete DBHDD-mandated training modules, including crisis intervention, recipient rights, and incident reporting, before working independently.
• OIG Exclusion Checks: Providers must screen all employees and contractors against the federal LEIE and state exclusion lists monthly.

7. Documentation, Policies and Records

Providers must maintain comprehensive administrative and clinical records that comply with the DBHDD Provider Manual (Policy 02-1202).

The Georgia Collaborative ASO and DBHDD Regional Field Offices conduct routine audits to ensure policies are actively implemented and records are current.

• Individual Service Plan (ISP): Providers must maintain a copy of the participant's current ISP, developed by the Support Coordinator, detailing authorized services and goals.
• Incident Management Policy: Must have written protocols for reporting critical incidents to DBHDD within 24 hours via the state's incident management system.
• Financial Viability: Must provide proof of financial stability, such as a line of credit or a surety bond (e.g., $250,000 required for financial management service providers).
• Change of Information: Providers must notify the DBHDD Provider Enrollment Unit, DCH, and Support Coordination agencies within 10 calendar days of any address or payee changes.
• Subcontractor Data: Must maintain and provide DBHDD with data on all subcontractors providing direct member care.

8. Billing, Rates and Claims

Reimbursement for NOW and COMP waiver services is strictly fee-for-service, based on rates established by DCH and DBHDD.

Providers cannot bill for services until a Prior Authorization (PA) is approved and loaded into the GAMMIS system. Claims submitted without a matching PA will be denied.

• Prior Authorization (PA): All waiver services require PA by DBHDD, which is entered into GAMMIS. Claims will deny if they exceed the PA limits.
• Billing Portal: Claims are submitted electronically via the GAMMIS web portal (https://www.mmis.georgia.gov) or through an approved clearinghouse.
• Rate Schedule: DCH publishes the NOW/COMP rate schedule, which dictates the maximum allowable reimbursement for 15-minute, daily, or monthly service units.
• Electronic Visit Verification (EVV): In-home personal care and community living support services require EVV compliance using the state-mandated system to capture visit data.
• Timely Filing: Claims must generally be submitted within 6 months of the date of service to avoid denial for timely filing.

9. Approval Sequence and Timeline

Becoming a DBHDD provider is a lengthy, multi-phase process that typically takes 6 to 12 months from the initial forum to final Medicaid enrollment.

Delays often occur during the site visit phase or if HFR licensure is required but not yet obtained by the applicant.

• Step 1: Attend the mandatory DBHDD Provider Enrollment Forum.
• Step 2: Submit the Letter of Intent (LOI) to the Georgia Collaborative ASO during an open enrollment window.
• Step 3: Submit the full DBHDD Phase 1 application and required policies (reviewed within 60-90 days).
• Step 4: Pass the DBHDD site visit and obtain any necessary DCH HFR licenses (timeline varies, 3-6 months).
• Step 5: Submit the Phase 2 DCH Medicaid application via GAMMIS (processed in 30-60 days).
• Step 6: Receive DBHDD final approval email and attend New Provider Orientation.

10. Common Denials and Survey Findings

Applications are frequently rejected at the LOI or Phase 1 stage due to incomplete documentation or failure to follow DBHDD's strict formatting rules.

Post-enrollment, providers face corrective action plans (CAPs) if they fail quality reviews conducted by the HCBS Waiver Quality Unit.

• Premature DCH Application: Applying in GAMMIS before receiving official Phase 1 approval from DBHDD results in immediate denial and a 1-year lockout.
• Missing HFR Licensure: Attempting to enroll for residential or nursing services without the prerequisite PCH, CLA, or PHCP license.
• Inadequate Policies: Submitting generic policy manuals that do not specifically reference DBHDD rules, the NOW/COMP waivers, or Georgia incident reporting timelines.
• Unapproved Locations: Billing for services provided at a site that has not passed a DBHDD site visit or HFR inspection.
• Lapsed Background Checks: Failing to complete GAPS fingerprinting for all required staff prior to the start of service delivery.

11. Key Contacts and Resources

Providers must navigate multiple state portals and manuals to maintain compliance. Bookmarking these resources is essential for successful enrollment and operation.

The DBHDD Regional Field Offices are the primary point of contact for day-to-day operational issues and crisis response once enrolled.

• DBHDD Provider Enrollment: https://dbhdd.georgia.gov/be-connected/applications-new-existing-providers
• Georgia Collaborative ASO: https://www.georgiacollaborative.com/providers/enrollment/
• DCH Medicaid Provider Portal (GAMMIS): https://www.mmis.georgia.gov
• DCH Healthcare Facility Regulation (HFR): https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation
• DBHDD Provider Manuals (Policy 02-1202): https://dbhdd.georgia.gov/be-connected/community-provider-manuals
• Georgia Medicaid HCBS Waivers Info: https://medicaid.georgia.gov/programs/all-programs/waiver-programs

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