Georgia - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Respite Care Services in Georgia are funded through the New Options Waiver (NOW), Comprehensive Supports Waiver Program (COMP), and the Community Care Services Program (CCSP), requiring a Private Home Care Provider (PHCP) license from the Department of Community Health (DCH) for in-home delivery. The service provides short-term relief to unpaid primary caregivers, ensuring continuous supervision and support for the waiver participant.

To bill for this service under the CCSP waiver, an agency must hold its PHCP license for a minimum of nine months before submitting a Medicaid enrollment application during the March or September open enrollment windows. DBHDD waiver enrollment for NOW and COMP requires submitting a Letter of Intent during designated procurement periods and passing a pre-enrollment site visit.

1. Service Definition and Scope

In Georgia, Respite Care Services provide brief periods of support and supervision for individuals with intellectual, developmental, or physical disabilities when the primary unpaid caregiver is absent or needs relief. Services can be delivered in the individual's home or in an approved out-of-home setting.

The scope of tasks includes companion sitting, assistance with activities of daily living (ADLs), and basic supervision to ensure health and safety. It does not replace skilled nursing care unless specifically authorized under a medical model.

• In-Home Respite: Delivered in the waiver participant's family residence by a licensed PHCP agency.
• Out-of-Home Respite: Delivered in a licensed Personal Care Home (PCH) or other DCH-approved facility.
• Task Scope: Includes meal preparation, light housekeeping, bathing assistance, and general supervision.
• Limitations: Cannot be provided by a spouse or the primary caregiver themselves.

2. Regulatory and Oversight Agencies

Oversight of Respite Care Services is split between the agency that licenses the physical business and the agencies that administer the Medicaid waivers. DCH handles facility and agency licensure, while DBHDD and DCH manage the specific waiver programs.

Providers must maintain compliance with both the licensing body's rules and the specific waiver program's provider manuals.

• Department of Community Health (DCH): https://dch.georgia.gov
• Healthcare Facility Regulation Division (HFRD): https://dch.georgia.gov/divisionsoffices/hfrd
• Department of Behavioral Health and Developmental Disabilities (DBHDD): https://dbhdd.georgia.gov
• Georgia Medicaid Management Information System (GAMMIS): https://www.mmis.georgia.gov

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia enforces strict structural prerequisites that block applications from being submitted or reviewed if not met. Providers cannot simply apply for Medicaid enrollment at any time.

The most rigid requirements involve mandatory operating history under a state license and restricted application windows.

• Nine-Month Rule: CCSP applicants must hold a DCH PHCP license for at least nine (9) months prior to the month of application.
• Open Enrollment Windows: DCH accepts CCSP waiver applications only twice a year, in March and September.
• DBHDD Letter of Intent: NOW/COMP providers must submit a Letter of Intent (LOI) to DBHDD during specific open enrollment periods.
• CCSP Provider Consult: Mandatory consultation with the regional Area Agency on Aging (AAA) is required before a CCSP application is accepted.

4. Licensure and Certification Requirements

Georgia does not issue a specific "Respite Care License." Instead, agencies providing in-home respite must obtain a Private Home Care Provider (PHCP) license from DCH HFRD.

If a provider wishes to offer out-of-home respite, they must license the physical location as a Personal Care Home (PCH) or similar regulated facility.

• License Type: Private Home Care Provider (PHCP) license issued by DCH HFRD for in-home services.
• Out-of-Home License: Personal Care Home (PCH) license required for facility-based respite delivery.
• Rule Citation: Ga. Comp. R. & Regs. 111-8-65 governs PHCP operations.
• Application Fee: The PHCP initial application fee is typically $500, submitted to DCH.

5. Medicaid Provider Enrollment

Once licensed and past the prerequisite gates, providers enroll in Medicaid through the GAMMIS portal. Enrollment requires linking the agency's NPI to the specific waiver program (NOW, COMP, or CCSP).

Providers must also register for and implement the state's Electronic Visit Verification (EVV) system for all in-home personal care and respite services.

• System: Georgia Medicaid Management Information System (GAMMIS).
• NPI Requirement: A Type 2 Organizational NPI from NPPES is required.
• Application Fee: An institutional Medicaid application fee (approximately $709) is required unless waived by Medicare enrollment.
• EVV Registration: Mandatory integration with Georgia's EVV system for in-home respite claims.

6. Staffing, Training and Background Checks

Direct support professionals providing respite must meet qualifications set by both DCH HFRD (for the PHCP license) and DBHDD (for waiver compliance).

Agencies must maintain strict personnel files demonstrating competency, background clearance, and ongoing education.

• Background Checks: Fingerprint-based background checks via the Georgia Applicant Processing Service (GAPS) are mandatory.
• CPR/First Aid: All direct care staff must hold current, hands-on CPR and First Aid certification.
• Training Modules: DBHDD requires specific training on person-centered planning, incident reporting, and abuse/neglect.
• Competency: Staff must pass documented competency evaluations for companion/sitter or personal care tasks before serving clients.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that satisfy DCH licensing surveyors and Medicaid waiver auditors. Documentation must prove that services were delivered exactly as authorized.

Policies must cover client rights, emergency preparedness, and critical incident reporting.

• Service Plan Alignment: Care delivered must align exactly with the DBHDD or CCSP approved Individual Service Plan (ISP).
• EVV Records: Electronic capture of clock-in/out times, location, and specific tasks performed is required.
• Incident Reporting: Critical incidents must be reported to DBHDD or DCH within 24 hours of discovery.
• Personnel Files: Must contain GAPS clearance, TB screening results, and annual training logs.

8. Billing, Rates and Claims

Respite services are billed to Georgia Medicaid through the GAMMIS portal using specific HCPCS codes assigned by the waiver program.

Services cannot be billed without prior authorization from the participant's waiver case manager or support coordinator.

• Portal: Claims are submitted electronically through the GAMMIS portal.
• Codes: Billed using specific HCPCS codes (e.g., S5150 or S5151) depending on the waiver and duration.
• Prior Authorization: 100% of respite services require prior authorization on file in GAMMIS.
• Unit Measurement: Typically billed in 15-minute increments for in-home, or per diem for out-of-home care.

9. Approval Sequence and Timeline

Becoming a CCSP respite provider takes over a year due to the mandatory operating history requirement. DBHDD timelines vary based on when the state opens procurement windows.

Providers must sequence their licensing, operating period, and Medicaid enrollment perfectly to avoid application rejection.

• Step 1: Obtain PHCP license from DCH HFRD (typically takes 3-6 months).
• Step 2: Operate the agency for 9 months (for CCSP) or await a DBHDD LOI window.
• Step 3: Attend the mandatory AAA Provider Consult (for CCSP).
• Step 4: Submit Medicaid enrollment via GAMMIS during the March or September window.

10. Common Denials and Survey Findings

Applications are frequently denied for failing to meet the strict gatekeeping timelines. During surveys, DCH and DBHDD commonly cite providers for documentation and background check failures.

Maintaining continuous compliance is critical to avoiding recoupment of Medicaid funds.

• Premature Application: Applying for CCSP before reaching the 9-month PHCP licensure mark results in automatic denial.
• Incomplete GAPS: Allowing direct care staff to work before fingerprint clearance is finalized.
• EVV Non-Compliance: Failure to capture required data points in the EVV system, leading to claim denials.
• Training Deficiencies: Missing annual CPR/First Aid renewals or DBHDD-mandated training modules in staff files.

11. Key Contacts and Resources

Providers should rely on official state portals and manuals for the most current regulations, rates, and application windows.

Regional Area Agencies on Aging (AAAs) and the Georgia Collaborative ASO are also critical partners in the enrollment process.

• DCH HFRD Forms and Applications: https://dch.georgia.gov/divisionsoffices/hfrd
• DBHDD Community Provider Manuals: https://dbhdd.georgia.gov/be-connected/community-provider-manuals
• GAMMIS Provider Portal: https://www.mmis.georgia.gov
• Georgia Collaborative ASO (NOW/COMP Portal): https://www.georgiacollaborative.com

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