Georgia - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Georgia, Personal Assistance Services are officially administered as Personal Support Services (PSS) under the state's Medicaid Home and Community-Based Services (HCBS) waivers, primarily the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE). These programs fund hands-on assistance with activities of daily living to keep elderly Georgians and adults with physical disabilities in their own homes rather than institutional settings.

The single biggest structural barrier to entry for new providers in Georgia is the strict sequential prerequisite of licensure: an applicant cannot even begin the Medicaid enrollment process or seek waiver approval until they have first successfully obtained a Private Home Care Provider (PHCP) license from the Georgia Department of Community Health (DCH). This creates a significant upfront investment of time and resources before any Medicaid billing can occur.

1. Service Definition and Scope

Georgia defines Personal Support Services (PSS) as hands-on assistance provided to individuals who require a nursing facility level of care but choose to remain in their communities. These services are funded under the Georgia Aged and Physically Disabled (GAPP) framework.

The scope of PSS is strictly limited to non-medical care. While caregivers may assist with instrumental tasks, the primary justification for the service must be the need for physical assistance with core daily activities.

• Target Population: Elderly Georgians (65+) and adults with physical disabilities who meet nursing facility level of care criteria.
• Primary Waivers: Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE).
• Covered ADLs: Hands-on assistance with bathing, dressing, grooming, mobility, transferring, and toileting.
• Covered IADLs: Meal preparation, light housekeeping, and medication reminders, provided these are incidental to the primary personal care tasks.
• Service Setting: The individual's private residence; services cannot be provided in institutional settings or while the client is hospitalized.

2. Regulatory and Oversight Agencies

Oversight of Personal Support Services in Georgia is divided among licensing, Medicaid administration, and waiver management entities. Providers must maintain compliance with multiple state divisions simultaneously.

The Department of Community Health (DCH) handles both the facility licensure and the financial/claims side of Medicaid, while the Department of Human Services (DHS) manages the aging population's waiver access.

• Licensing Authority: Georgia Department of Community Health (DCH), Healthcare Facility Regulation Division (HFRD) [https://dch.georgia.gov/divisionsoffices/hfrd].
• Medicaid Administration: DCH Medical Assistance Plans Division [https://dch.georgia.gov/divisionsoffices/medical-assistance-plans].
• Medicaid Portal: Georgia Medicaid Management Information System (GAMMIS) [https://www.mmis.georgia.gov/].
• Waiver Oversight (CCSP): Georgia Department of Human Services (DHS), Division of Aging Services (DAS) [https://aging.georgia.gov/].
• Local Coordination: Area Agencies on Aging (AAAs) [https://aging.georgia.gov/locations].

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia enforces strict sequential prerequisites for PSS providers. You cannot simply apply to be a Medicaid provider; you must clear specific regulatory gates before your application will be accepted by the state's systems.

While Georgia does not require a Certificate of Need (CON) for non-medical personal care, the licensure and local network requirements act as significant structural barriers.

• Licensure Prerequisite: An active Private Home Care Provider (PHCP) license from DCH HFRD is strictly required before a GAMMIS Medicaid enrollment application can be submitted.
• CON Exemption: Unlike skilled home health agencies, PHCP agencies providing only personal care and companion services are exempt from Georgia's Certificate of Need (CON) requirements (O.C.G.A. § 31-6).
• Waiver Network Access: CCSP providers must establish coordination agreements with regional Area Agencies on Aging (AAAs), which act as the gatekeepers for client referrals and case management.
• EVV Mandate: Providers must register and complete orientation with NetSmart (Tellus), Georgia's designated Electronic Visit Verification (EVV) system, before any Medicaid visits can be billed.
• Business Registration: Applicants must possess an active NPI, an IRS EIN, and a Georgia Secretary of State business registration prior to initiating the PHCP license application.

4. Licensure and Certification Requirements

To operate legally, agencies must obtain a Private Home Care Provider (PHCP) license from DCH HFRD under O.C.G.A. § 31-7-300 et seq. and Ga. Comp. R. & Regs. 111-8-65. This license is location-specific and must be renewed annually.

The licensure process involves a detailed application packet, policy review, and an on-site inspection to ensure the agency is prepared to deliver safe, compliant care.

• License Type: Private Home Care Provider (PHCP) license, specifically approved for the "Personal Care Tasks" service category.
• Application Portal: Applications are processed through the DCH Provider Education Portal and the HFRD licensure division.
• Administrator Requirements: The agency must designate a qualified administrator responsible for day-to-day operations, compliance, and record-keeping.
• Nursing Oversight: The agency must employ or contract with a Georgia-licensed Registered Nurse (RN) to conduct initial client assessments and supervise caregivers performing personal care tasks.
• Inspections: Agencies are subject to an initial on-site licensure inspection by HFRD prior to approval, followed by periodic unannounced surveys.

5. Medicaid Provider Enrollment

Once the PHCP license is secured, agencies must enroll as Medicaid providers through the Georgia Medicaid Management Information System (GAMMIS). This process is managed by Gainwell Technologies on behalf of DCH.

The enrollment wizard dictates the application path based on the provider type and specialty selected, requiring extensive demographic, ownership, and licensure disclosures.

• Enrollment Portal: GAMMIS Provider Enrollment Wizard at [https://www.mmis.georgia.gov/].
• Application Type: Agencies typically select the "Group/Billing" application type to affiliate rendering providers and manage agency-level claims.
• Tracking System: GAMMIS generates an Application Tracking Number (ATN) upon submission; this ATN is mandatory for checking status or speaking with Gainwell support.
• Required Documentation: Applicants must upload their active PHCP license, NPI confirmation, IRS EIN letter, and proof of commercial liability insurance.
• Financial Setup: Providers must submit bank account information to establish Electronic Funds Transfer (EFT) for Medicaid claim payouts.

6. Staffing, Training and Background Checks

Georgia mandates rigorous background screening and training standards for all direct-care staff under both PHCP rules and Medicaid waiver guidelines. The agency serves as the employer of record.

Compliance with these standards is heavily scrutinized during HFRD surveys, and lapses can result in immediate citations or suspension of Medicaid billing privileges.

• Background Checks: Mandatory fingerprint-based criminal background checks for all owners and direct access employees via the Georgia Long-Term Care Background Check Program (O.C.G.A. § 31-7-350).
• Age Requirement: All caregivers providing personal support services must be at least 18 years of age.
• Health Screenings: Staff must provide documentation of a negative TB test prior to any direct client contact.
• Certifications: Current CPR and First Aid certification is required for all direct-care staff before they can be assigned to a client.
• Competency Evaluation: The agency's RN supervisor must evaluate and document each caregiver's competency in specific personal care tasks prior to independent client assignment.

7. Documentation, Policies and Records

Comprehensive documentation is required to verify service delivery and maintain agency compliance. Both DCH HFRD and Medicaid auditors require records to be meticulously maintained and readily available.

Agencies must implement standardized policies for care planning, incident reporting, and electronic visit verification to meet state standards.

• Service Plan: An individualized care plan must be developed by the RN supervisor, detailing specific ADL/IADL tasks, frequency, and duration based on the waiver authorization.
• Personnel Files: Must contain background check clearance, TB test results, CPR/First Aid cards, and RN competency sign-offs for every caregiver.
• EVV Compliance: All personal care visits must be electronically logged in NetSmart (Tellus) with exact start/stop times and GPS location data.
• Incident Reporting: Agencies must maintain written policies for reporting adverse events, abuse, neglect, or exploitation to DCH and Adult Protective Services.
• Record Retention: Client and personnel records must be retained securely in accordance with Georgia Medicaid and HFRD regulations, typically for a minimum of five years.

8. Billing, Rates and Claims

Billing for PSS in Georgia is processed exclusively through GAMMIS and is strictly tied to prior authorizations and EVV data. The state utilizes specific HCPCS codes for waiver services.

Because Georgia utilizes a closed-loop system, any discrepancy between the authorized hours, the EVV log, and the submitted claim will result in automatic denial.

• Billing System: Claims are submitted electronically via the GAMMIS portal [https://www.mmis.georgia.gov/].
• EVV Integration: GAMMIS billing requires perfectly matching data from the NetSmart (Tellus) EVV system; claims without matching EVV records are rejected.
• Prior Authorization: Services must be prior-authorized by the CCSP or SOURCE case manager; billing cannot exceed the authorized hours.
• Payment Schedule: Approved claims are paid via direct deposit (EFT) by Georgia Medicaid, typically on a consistent weekly or bi-weekly cycle.
• Service Codes: Billing utilizes specific HCPCS codes designated for personal support services under the GAPP waivers, which dictate the hourly reimbursement rate.

9. Approval Sequence and Timeline

The end-to-end process from business formation to billing first claims in Georgia is lengthy due to sequential dependencies. Providers cannot run these applications concurrently.

Prospective agency owners should expect a minimum timeline of 4 to 6 months before they are fully authorized to accept and bill for Medicaid clients.

• Step 1: Business Formation & NPI acquisition (1-2 weeks).
• Step 2: PHCP License Application & Initial HFRD Survey (60-120 days, highly dependent on state surveyor backlog).
• Step 3: GAMMIS Medicaid Enrollment (30-90 days after complete application submission and ATN issuance).
• Step 4: Waiver Approval & AAA Coordination (30-60 days, often concurrent with or immediately following GAMMIS approval).
• Step 5: NetSmart EVV Setup & Training (1-2 weeks prior to the first scheduled patient visit).

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or failure to follow Georgia's strict sequential steps. HFRD surveys also routinely catch operational lapses.

Understanding these common pitfalls can save providers months of delays and prevent costly claim rejections.

• Premature Enrollment: GAMMIS applications submitted before the PHCP license is fully approved and issued are automatically denied.
• EVV Mismatches: Claims denied in GAMMIS because the NetSmart EVV data does not match the billed hours or the case manager's prior authorization.
• Background Check Lapses: HFRD survey citations for allowing caregivers to start work before the fingerprint background check officially clears.
• RN Oversight Failures: Citations for missing, incomplete, or late RN supervisory visits and initial client assessments.
• Incomplete ATN Tracking: Losing the GAMMIS Application Tracking Number (ATN), which makes it impossible to check enrollment status or respond to Gainwell's requests for information.

11. Key Contacts and Resources

Prospective providers must utilize official state portals for applications, regulations, and support. Always ensure you are accessing the official .gov domains for Georgia agencies.

Keep your ATN, NPI, and PHCP license numbers readily available when contacting state agencies or support desks.

• DCH Healthcare Facility Regulation Division (HFRD): [https://dch.georgia.gov/divisionsoffices/hfrd]
• GAMMIS Provider Portal & Enrollment: [https://www.mmis.georgia.gov/]
• Georgia Division of Aging Services (DAS): [https://aging.georgia.gov/]
• Gainwell Technologies (GAMMIS Support): 1-800-766-4456 (Reference your ATN on all calls).

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