Georgia - Residential Care Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) funds 24-hour residential habilitation through the Comprehensive Supports Waiver Program (COMP) under the service name Community Residential Alternative (CRA). Providers delivering this service must hold a physical site license from the Department of Community Health (DCH) as either a Community Living Arrangement (CLA) or a Personal Care Home (PCH) before they can bill Medicaid.

Prospective CRA providers must secure a DBHDD Letter of Support by passing the DBHDD New Provider Enrollment process, which is restricted to specific open enrollment windows and regional needs assessments, before applying for Medicaid enrollment via the Georgia Medicaid Management Information System (GAMMIS). Applications submitted outside of these designated procurement windows or without the required DBHDD sponsorship are rejected.

1. Service Definition and Scope

In Georgia, 24-hour residential care for individuals with intellectual and developmental disabilities is defined as Community Residential Alternative (CRA) services. This service is funded primarily through the COMP waiver and includes assistance with activities of daily living, personal care, and habilitation training delivered in a licensed residential setting.

Medicaid waiver funds cover the cost of the care and supervision provided by direct support professionals. Room and board costs are explicitly excluded from Medicaid reimbursement and must be paid through the resident's personal income, such as SSI.

• Service Name: Community Residential Alternative (CRA)
• Funding Authority: Comprehensive Supports Waiver Program (COMP)
• Target Population: Individuals with intellectual and developmental disabilities requiring 24-hour support
• Licensure Types: Community Living Arrangement (CLA) or Personal Care Home (PCH)
• Included Supports: Habilitation, supervision, and personal care assistance
• Excluded Costs: Room and board expenses are not covered by Medicaid

2. Regulatory and Oversight Agencies

The Georgia Department of Community Health (DCH) serves as the state Medicaid agency and houses the Healthcare Facility Regulation Division (HFRD), which issues the physical site licenses for residential facilities. DCH also manages the GAMMIS portal for provider enrollment and claims.

The Department of Behavioral Health and Developmental Disabilities (DBHDD) operates the COMP waiver, manages the provider network, conducts the initial provider enrollment vetting, and performs ongoing programmatic quality reviews.

• Licensing Authority: Georgia Department of Community Health (DCH), Healthcare Facility Regulation Division (HFRD) [https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation]
• Waiver Operator: Department of Behavioral Health and Developmental Disabilities (DBHDD) [https://dbhdd.georgia.gov]
• Medicaid Agency: Georgia Department of Community Health (DCH) [https://dch.georgia.gov]
• Enrollment Portal: Georgia Medicaid Management Information System (GAMMIS) [https://www.mmis.georgia.gov]

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia strictly controls the entry of new CRA providers through a needs-based procurement model managed by DBHDD. Providers cannot simply obtain a DCH license and enroll in Medicaid; they must be selected by DBHDD to join the waiver network.

DBHDD periodically opens enrollment windows based on regional capacity needs. Prospective providers must complete mandatory pre-enrollment training and submit a Letter of Intent (LOI) during these specific windows to be considered for a DBHDD Letter of Support.

• Network Access: DBHDD New Provider Enrollment is restricted to specific open enrollment periods based on regional capacity needs
• Required Training: Applicants must complete the DBHDD Pre-Enrollment Provider Training before submitting a Letter of Intent (LOI)
• Agency Sponsorship: A DBHDD Letter of Support is required before DCH will process the Medicaid provider enrollment application
• Licensure Prerequisite: Applicants must obtain a DCH HFRD license (CLA or PCH) prior to finalizing DBHDD approval

4. Licensure and Certification Requirements

Before delivering CRA services, the physical location must be licensed by DCH HFRD. Providers typically license their sites as either a Community Living Arrangement (CLA) or a Personal Care Home (PCH), depending on the specific population and facility size.

The licensure process involves a detailed review of architectural plans, fire safety approvals, and an initial on-site survey to ensure compliance with state physical plant and safety regulations.

• CLA Regulation: Ga. Comp. R. & Regs. R. 290-9-37 governs Community Living Arrangements
• PCH Regulation: Ga. Comp. R. & Regs. R. 111-8-62 governs Personal Care Homes
• Application Fee: DCH requires a non-refundable application fee that varies by facility size
• Fire Safety: Approval from the local Fire Marshal or State Fire Marshal is required for the physical building

5. Medicaid Provider Enrollment

Once DBHDD approval and DCH licensure are secured, providers must formally enroll in the Georgia Medicaid program using the GAMMIS Provider Enrollment Wizard. This step links the provider's credentials to the MMIS for billing purposes.

Providers must pay the federal Medicaid application fee and undergo screening based on their categorical risk level. Enrollment must be revalidated periodically to maintain active billing status.

• System: GAMMIS Provider Enrollment Wizard
• Application Fee: Subject to the federal Medicaid application fee unless waived or previously paid to Medicare
• Revalidation: Providers must revalidate enrollment every 3 to 5 years as mandated by 42 CFR 455.414
• Category of Service: Must enroll under the specific COS code for COMP Waiver CRA services

6. Staffing, Training and Background Checks

Georgia requires rigorous background screening and training for all staff working in CRA settings. Direct care staff must clear the Georgia Criminal Background Check System (GCHEXS) before having any direct contact with residents.

Agencies must also employ or contract with a Developmental Disabilities Professional (DDP) to oversee habilitation plans. Unlicensed staff who assist with medications must be trained under the state's Proxy Caregiver rules.

• Background Checks: All direct care staff must clear the Georgia Criminal Background Check System (GCHEXS)
• Director Qualifications: Must have a designated Developmental Disabilities Professional (DDP) meeting DBHDD credential standards
• Training: Staff must complete CPR, First Aid, and DBHDD-mandated crisis intervention training prior to independent client contact
• Proxy Caregivers: Unlicensed staff administering medications must be trained and checked off under the Proxy Caregiver rules (Chapter 111-8-100)

7. Documentation, Policies and Records

CRA providers must maintain comprehensive records that align with both DCH licensure rules and DBHDD waiver policies. The Individual Service Plan (ISP) is the central document driving all care and billing.

Providers are required to use state-mandated systems for reporting critical incidents and must keep detailed logs of resident admissions, discharges, and personal funds.

• Individual Service Plan (ISP): Must maintain the DBHDD-approved ISP detailing habilitation goals
• Incident Reporting: Critical incidents must be entered into the DBHDD Incident Management System (IMS) within 24 hours
• Admission/Discharge Log: Facilities must maintain a continuous log of all resident movements per DCH rules
• Financial Records: Must maintain separate accounting for resident personal funds and room/board payments

8. Billing, Rates and Claims

CRA services are billed on a per-diem basis through the GAMMIS portal. Rates are not uniform; they are tiered based on the assessed needs of the individual resident.

DBHDD uses the Health Risk Screening Tool (HRST) and the Supports Intensity Scale (SIS) to determine the appropriate rate tier for each individual. All claims must match an active Prior Authorization in GAMMIS.

• Billing System: Claims are submitted via the GAMMIS web portal using standard EDI 837P or direct data entry
• Rate Structure: CRA rates are tiered based on the individual's Health Risk Screening Tool (HRST) and Supports Intensity Scale (SIS) scores
• Prior Authorization: All CRA claims require an active Prior Authorization (PA) generated from the approved ISP
• Billing Cycle: Claims are typically submitted monthly or bi-weekly for per-diem residential services

9. Approval Sequence and Timeline

Becoming a CRA provider in Georgia is a sequential, multi-agency process that cannot be expedited. Providers must clear DBHDD's programmatic gates before DCH will issue a license or Medicaid number.

The entire process from attending the pre-enrollment training to receiving the final Medicaid provider number typically takes 9 to 18 months, heavily dependent on DBHDD's open enrollment schedule.

• Step 1: Attend DBHDD Pre-Enrollment Training and submit Letter of Intent during an open window
• Step 2: Submit full DBHDD Provider Application and receive conditional approval
• Step 3: Apply for and obtain DCH HFRD licensure (CLA or PCH) for the physical site
• Step 4: Submit Medicaid Enrollment via GAMMIS with DBHDD Letter of Support and DCH License
• Timeline: The end-to-end process typically takes 9 to 18 months depending on DBHDD enrollment windows and DCH survey schedules

10. Common Denials and Survey Findings

Applications are most frequently denied at the very beginning of the process if a provider attempts to submit a DBHDD application outside of a published open enrollment window or fails to demonstrate regional need.

During DCH licensure surveys and DBHDD quality reviews, citations often stem from inadequate documentation of staff credentials or medication administration errors.

• Application Denial: Submitting a DBHDD application outside of a published open enrollment window
• Survey Citation: Failure to properly document medication administration records (MAR) or proxy caregiver competencies
• Survey Citation: Incomplete or missing GCHEXS background clearance for direct care staff prior to hire date
• Billing Denial: Submitting claims without a matching, active Prior Authorization in GAMMIS

11. Key Contacts and Resources

Prospective providers should regularly monitor the DBHDD and DCH websites for announcements regarding open enrollment windows, policy manual updates, and training schedules.

The GAMMIS portal is the central hub for all final Medicaid enrollment actions and ongoing claims submission.

• DBHDD Provider Enrollment: [https://dbhdd.georgia.gov/be-supported/become-dbhdd-provider]
• DCH Healthcare Facility Regulation: [https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation]
• GAMMIS Provider Portal: [https://www.mmis.georgia.gov]
• Georgia State Rules and Regulations: [https://rules.sos.ga.gov]

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