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

Last reviewed: 2026-09-09

Georgia regulates in-home hands-on assistance with activities of daily living under the Private Home Care Provider (PHCP) license, issued by the Department of Community Health (DCH) Healthcare Facility Regulation Division. Under Medicaid, these services are typically billed as Personal Support Services (PSS) through the Elderly and Disabled Waiver Program (EDWP) or the NOW/COMP waivers for individuals with developmental disabilities.

Approval requires a sequential process beginning with securing the PHCP license, which mandates a physical office location and a comprehensive policy review. Once licensed, agencies must apply through the Georgia Medicaid Management Information System (GAMMIS) and secure a waiver-specific contract or approval from the operating agency, such as the Department of Behavioral Health and Developmental Disabilities (DBHDD) or the regional Area Agency on Aging (AAA), which often restrict new network entrants to specific procurement windows.

1. Service Definition and Scope

In Georgia, personal assistance services fall under the regulatory definition of "Personal Care Tasks" within the Private Home Care Provider framework. These services involve hands-on assistance with activities of daily living in the client's residence.

The state strictly differentiates personal care from companion/sitter services (which do not involve hands-on care) and skilled nursing services. Agencies must be explicitly licensed to provide the personal care service tier.

• Regulatory Citation: Georgia Rules and Regulations Chapter 111-8-65 (Private Home Care Providers)
• Covered Tasks: Assistance with bathing, feeding, toileting, ambulation, and transferring
• Excluded Tasks: Medical services, nursing services, physical therapy, and medical social services
• Setting Requirement: Services must be delivered in the client's own home, not in a licensed personal care home or hospital

2. Regulatory and Oversight Agencies

The Department of Community Health (DCH) is the primary umbrella agency, handling both facility licensure and Medicaid administration. Its Healthcare Facility Regulation Division (HFRD) issues the foundational PHCP license.

For waiver-specific oversight, the Department of Behavioral Health and Developmental Disabilities (DBHDD) manages the NOW and COMP waivers, while DCH Medical Assistance Plans oversees the Elderly and Disabled Waiver Program (EDWP).

• Licensing Agency: DCH Healthcare Facility Regulation Division (https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation)
• Medicaid Enrollment Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov)
• Waiver Operating Agency (I/DD): Department of Behavioral Health and Developmental Disabilities (https://dbhdd.georgia.gov)
• Waiver Operating Agency (Aging): DCH Medical Assistance Plans (https://dch.georgia.gov/divisionsoffices/medical-assistance-plans)

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia requires all Medicaid personal care providers to hold an active Private Home Care Provider (PHCP) license before a Medicaid enrollment application will be processed. There is no standalone Medicaid enrollment for this service without the underlying DCH license.

Additionally, access to specific Medicaid waivers is gated by the operating agencies. For example, EDWP (CCSP/SOURCE) and NOW/COMP waivers frequently utilize closed networks or require providers to respond to specific Requests for Proposals (RFPs) or open enrollment periods, meaning a licensed agency cannot automatically bill Medicaid without waiver-level network admission.

• Licensure Prerequisite: Active PHCP license from DCH HFRD is required prior to GAMMIS enrollment
• Physical Location: Must maintain a physical business office in Georgia (or within 50 miles of the border for out-of-state agencies)
• Waiver Network Access: Enrollment in specific waivers (e.g., NOW/COMP) requires DBHDD network approval and is subject to regional need and procurement cycles
• Application Fee: Medicaid enrollment requires a federal application fee (or proof of payment to Medicare/another state) unless exempt

4. Licensure and Certification Requirements

To obtain a PHCP license, applicants must submit a detailed application to DCH HFRD, including comprehensive policies and procedures, organizational charts, and proof of qualified administration.

The state conducts an initial review of the paper application and policies. Once approved, a provisional license is issued, allowing the agency to begin serving clients, followed by an on-site initial survey to grant full licensure.

• Application Form: DCH PHCP Initial Licensure Application
• Administrator Qualifications: Must designate a qualified full-time administrator to oversee daily operations
• Policy Submission: Must submit complete operational policies, including client rights, infection control, and emergency procedures
• Initial Survey: An on-site inspection is conducted after the provisional license is issued and active clients are being served

5. Medicaid Provider Enrollment

Once the PHCP license is secured, the agency must enroll as a Medicaid provider using the GAMMIS Provider Enrollment Wizard. The application requires uploading the DCH license, business documentation, and ownership disclosures.

Providers must select the specific Category of Service (COS) codes that correspond to the waivers they intend to serve, which triggers routing to the appropriate waiver operating agency for final approval.

• System: GAMMIS Provider Enrollment Wizard
• Required Documents: Active PHCP license, IRS W-9, National Provider Identifier (NPI), and ownership disclosure forms
• Application Fee: Subject to the CMS-mandated institutional provider application fee during initial enrollment and revalidation
• Revalidation: Providers must revalidate their Medicaid enrollment every 3 to 5 years as directed by DCH

6. Staffing, Training and Background Checks

Direct care staff providing personal care tasks must meet strict training and background screening requirements before providing hands-on care. Agencies are responsible for maintaining these records in personnel files.

Georgia mandates fingerprint-based criminal background checks through the Georgia Criminal History Check System (GCHEXS) for all owners, administrators, and direct care employees.

• Background Checks: Mandatory fingerprinting via GCHEXS prior to client contact
• Health Screening: Staff must have a TB screening upon hire and annually thereafter
• Certifications: Current CPR and First Aid certification required for all direct care staff
• Supervision: Personal care tasks must be supervised by a Registered Nurse (RN) who conducts periodic in-home evaluations

7. Documentation, Policies and Records

PHCP regulations require agencies to maintain comprehensive client records, including initial assessments, individualized service plans, and daily service logs detailing the specific tasks performed.

Service plans must be developed in conjunction with the client or their representative and must be updated whenever the client's condition changes or at least annually.

• Service Plan: Must be established within a specified timeframe after admission and detail all personal care tasks to be provided
• Supervisory Visits: RN must conduct and document in-home supervisory visits according to the schedule dictated by the waiver or PHCP rules
• Service Logs: Caregivers must document the date, start/stop times, and specific tasks completed for every shift
• Record Retention: Client and personnel records must be retained for a minimum of five years after discharge or termination

8. Billing, Rates and Claims

Medicaid claims for personal support services are submitted electronically through the GAMMIS portal or to the respective Care Management Organizations (CMOs) if applicable.

Georgia requires the use of Electronic Visit Verification (EVV) for all Medicaid-funded personal care services to capture the time, location, and delivery of care in real-time.

• EVV Mandate: Providers must use the state-sponsored EVV system (Netsmart/Tellus) or an approved alternate vendor
• Billing Portal: GAMMIS Web Portal for fee-for-service claims
• Prior Authorization: All waiver services require prior authorization from the care coordinator or operating agency before billing
• Rate Setting: Rates are established by DCH and published in the specific waiver provider manuals on GAMMIS

9. Approval Sequence and Timeline

The end-to-end process to become a fully billing Medicaid personal care provider in Georgia typically takes 6 to 12 months, heavily dependent on DCH HFRD application processing times.

The sequence is strictly linear: establish the business, obtain the PHCP license, apply for Medicaid enrollment via GAMMIS, and finally secure waiver-specific network approval.

• Phase 1: PHCP License Application review by DCH HFRD (typically 60-90 days)
• Phase 2: Issuance of Provisional License and commencement of private-pay services
• Phase 3: GAMMIS Medicaid Enrollment application processing (30-60 days)
• Phase 4: Waiver network approval and EVV system onboarding

10. Common Denials and Survey Findings

Licensure applications are frequently delayed or denied due to incomplete policy manuals that do not specifically address Georgia's PHCP rule requirements, or failure to properly complete the GCHEXS background checks.

During initial and routine surveys, HFRD commonly cites agencies for missing RN supervisory visits, incomplete caregiver personnel files (missing CPR/TB records), and failure to follow the written service plan.

• Application Denial: Generic policies that do not cite or align with Georgia Rule 111-8-65
• Survey Citation: Lapsed CPR, First Aid, or TB screenings in staff files
• Survey Citation: Failure to document RN supervisory visits at the required intervals
• Enrollment Rejection: Failure to pay the Medicaid application fee or submit required ownership disclosures

11. Key Contacts and Resources

Prospective providers should regularly consult the DCH HFRD website for the most current licensure applications and the GAMMIS portal for Medicaid provider manuals and enrollment updates.

For waiver-specific questions, providers must contact the respective operating agency (DBHDD for developmental disabilities, or the local AAA for aging services).

• DCH HFRD Licensure: https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation
• GAMMIS Provider Portal: https://www.mmis.georgia.gov
• DBHDD Provider Network: https://dbhdd.georgia.gov/be-connected/licensure-information
• Georgia EVV Information: https://dch.georgia.gov/electronic-visit-verification-evv

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