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

Last reviewed: 2026-08-16

In Georgia, Respite Care Services provide essential short-term relief to unpaid primary caregivers, ensuring that individuals with disabilities or aging adults continue to receive safe, person-centered supervision and support. These services are primarily funded through Georgia's Medicaid Home and Community-Based Services (HCBS) waiver programs, including the New Options Waiver (NOW), Comprehensive Supports Waiver Program (COMP), Community Care Services Program (CCSP), and Service Options Using Resources in a Community Environment (SOURCE).

The single biggest structural barrier to entry for prospective respite providers in Georgia is the strict sequencing of licensure and network pre-qualification. Georgia does not issue a generic "respite license"; instead, an agency must first obtain a Private Home Care Provider (PHCP) license from the Department of Community Health (DCH) before a Medicaid enrollment application will even be accepted. Furthermore, to serve the developmental disability population under the NOW/COMP waivers, providers must pass a rigorous pre-qualification process and mandatory orientation through the Georgia Collaborative ASO before they are permitted to enroll with the Department of Behavioral Health and Developmental Disabilities (DBHDD).

1. Service Definition and Scope

Respite Care Services in Georgia are defined as temporary, substitute care provided to a waiver participant to relieve the usual unpaid family member or primary caregiver. The service ensures the participant's health and safety while the primary caregiver is unavailable due to planned absences, emergencies, or the need for routine relief.

The scope of service depends on the setting and the participant's Individual Service Plan (ISP). It can be delivered in the participant's own home (In-Home Respite) or in a licensed facility (Out-of-Home Respite). Services may include assistance with Activities of Daily Living (ADLs), supervision, and health monitoring, but cannot duplicate other authorized services.

• In-Home Respite: Delivered in the participant's residence by staff employed by a licensed Private Home Care Provider (PHCP).
• Out-of-Home Respite: Delivered in a licensed Personal Care Home (PCH) or Community Living Arrangement (CLA) for short-term overnight or day stays.
• Waiver Authorities: Authorized under Georgia's NOW, COMP, CCSP, and SOURCE Medicaid waiver programs.
• Service Limitations: Cannot be provided simultaneously with Community Living Support (CLS) for the same participant.
• Emergency Respite: Short-term service authorized for unavoidable circumstances, such as a family emergency or caregiver hospitalization.
• Capacity Limits: Out-of-home respite facilities are typically limited to serving no more than two to four waiver members simultaneously, depending on the specific waiver rules.

2. Regulatory and Oversight Agencies

Oversight of Respite Care Services in Georgia is bifurcated between the agency that licenses the physical business or facility and the agencies that administer the Medicaid waivers. Providers must maintain compliance with both regulatory bodies simultaneously.

The Department of Community Health (DCH) handles facility and agency licensure as well as overall Medicaid billing, while the Department of Behavioral Health and Developmental Disabilities (DBHDD) manages the specific waivers for individuals with intellectual and developmental disabilities.

• Licensing Agency: Georgia Department of Community Health (DCH) Healthcare Facility Regulation Division (HFRD) (https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation-hfr) issues PHCP and PCH licenses.
• Waiver Administrator: Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) (https://dbhdd.georgia.gov) administers the NOW and COMP waivers.
• Designating Entity: Georgia Collaborative ASO (https://www.georgiacollaborative.com) manages DBHDD provider enrollment, mandatory orientations, and pre-qualification.
• Medicaid Administrator: Georgia Department of Community Health (DCH) (https://dch.georgia.gov) oversees Medicaid enrollment and reimbursement.
• Medicaid Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov) is the system used for provider enrollment and claims processing.

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia imposes strict structural preconditions that block an applicant from enrolling as a Medicaid Respite Care provider if not met. The most critical gatekeeping prerequisite is that a provider cannot apply for Medicaid enrollment until they already hold the appropriate state license for the setting in which they intend to operate.

While Georgia explicitly does not require a Certificate of Need (CON) for behavioral health or standard HCBS respite agencies, access to the DBHDD waiver network is tightly controlled through a pre-qualification gatekeeper.

• Licensure Prerequisite: Applicants must possess an active Private Home Care Provider (PHCP) license from DCH HFRD before GAMMIS will accept a Medicaid enrollment application for in-home respite.
• Designation Access: To serve NOW/COMP waiver participants, providers must submit a Letter of Intent (LOI) and pass the pre-qualification checklist managed by the Georgia Collaborative ASO.
• Mandatory Orientation: Prospective DBHDD providers are structurally blocked from applying until they register for and attend a mandatory orientation session conducted by the Georgia Collaborative ASO.
• Certificate of Need (CON): Genuinely none exists; a CON is explicitly not required for behavioral health facilities or PHCP agencies in Georgia.
• NPI Requirement: Applicants must obtain a Type 2 National Provider Identifier (NPI) via NPPES prior to initiating the GAMMIS enrollment process.

4. Licensure and Certification Requirements

Georgia does not issue a distinct "Respite Care License." Instead, providers must obtain the license that corresponds to the setting and level of care they provide. For agency-based in-home respite, this is the Private Home Care Provider (PHCP) license.

For out-of-home respite, providers must license the physical building. This typically requires a Personal Care Home (PCH) permit if serving two or more adults. Both pathways require rigorous policy reviews and on-site inspections by DCH HFRD.

• In-Home Authority: Private Home Care Provider (PHCP) license, governed by Georgia Rules and Regulations 111-8-65.
• Out-of-Home Authority: Personal Care Home (PCH) permit, governed by Georgia Rules and Regulations 111-8-62.
• Application Portal: PHCP and PCH applications must be downloaded from the DCH HFRD forms page and submitted with the required documentation.
• Initial Inspection: DCH HFRD conducts an initial on-site survey to verify physical plant compliance (for PCH) or operational readiness (for PHCP) before issuing a permanent license.
• Exemptions: Narrow exemptions to PHCP licensure exist, but they generally do not apply to agencies intending to bill Medicaid HCBS waivers for respite.
• Change of Ownership: Licenses are not transferable; a change of ownership (CHOW) requires a new application and approval from DCH HFRD.

5. Medicaid Provider Enrollment

Once the prerequisite PHCP license or PCH permit is secured, and DBHDD pre-qualification is met (if applicable), the agency must enroll as a Medicaid provider through the Georgia Medicaid Management Information System (GAMMIS).

The enrollment process is managed by Gainwell Technologies on behalf of DCH. Providers must complete the Group/Billing Application Type and undergo credentialing verification.

• Enrollment Portal: Applications are submitted electronically via the GAMMIS Provider Enrollment Wizard (https://www.mmis.georgia.gov).
• Application Type: Agencies must select the Group/Billing Application Type during the GAMMIS enrollment process.
• Ownership Disclosure: Per 42 CFR 1002.3, applicants must disclose all individuals or entities with a 5% or greater ownership interest, as well as all managing employees.
• Application Fee: Providers are subject to the federally mandated Medicaid institutional provider application fee (approximately $709, updated annually) unless waived by Medicare enrollment.
• Credentialing Verification: DCH utilizes a Credentialing Verification Organization (CVO) to verify provider qualifications every 3 years.
• Revalidation: Enrolled providers must revalidate their Medicaid enrollment every 3 to 5 years through the GAMMIS portal to prevent termination.

6. Staffing, Training and Background Checks

Staff delivering respite care must meet specific qualifications based on the acuity of the participant and the tasks performed. Georgia distinguishes between companion/sitter tasks and personal care tasks (e.g., bathing, feeding).

All direct care staff must undergo strict background screening and complete state-mandated training before providing unsupervised care to vulnerable waiver participants.

• Background Checks: Mandatory fingerprint-based criminal history checks must be processed through the Georgia Applicant Processing Service (GAPS) for all owners, administrators, and direct care staff.
• Basic Qualifications: Direct care staff must possess current CPR and First Aid certification and provide evidence of a negative TB screening.
• Personal Care Competency: Staff performing ADL assistance must either hold an active CNA certification or pass a documented personal care competency evaluation administered by an RN.
• Supervision: A Registered Nurse (RN) must oversee personal care tasks, develop the care plan, and conduct periodic in-home supervisory visits.
• DBHDD Training: Staff serving NOW/COMP waiver participants must complete specific training on incident reporting, individual rights, and person-centered care per DBHDD standards.
• Administrator Qualifications: The agency administrator must meet the education and experience requirements outlined in the PHCP or PCH rules, typically requiring a degree or equivalent healthcare management experience.

7. Documentation, Policies and Records

Respite providers must maintain comprehensive operational policies and client records that comply with both DCH HFRD licensing rules and DBHDD/Medicaid provider manuals. Documentation must prove that services were delivered exactly as authorized.

Georgia mandates the use of Electronic Visit Verification (EVV) for all in-home personal care and respite services to combat fraud and ensure care delivery.

• Service Plan Alignment: All respite services must strictly follow the participant's Individual Service Plan (ISP) as authorized by the waiver case manager.
• EVV Mandate: Providers must utilize the Georgia EVV system (currently managed by Netsmart/Tellus) to electronically log the start time, stop time, and location of all in-home respite visits.
• Policy Manual: Agencies must maintain written policies covering caregiver relief, emergency response, infection control, client rights, and grievance procedures.
• Personnel Files: Must contain GAPS background clearance, TB test results, RN competency sign-offs, and annual training logs for every employee.
• Incident Reporting: Critical incidents (e.g., injuries, abuse allegations) must be reported to DCH HFRD and DBHDD within 24 hours of discovery.
• Record Retention: Client and billing records must be retained for a minimum of six years following the last date of service.

8. Billing, Rates and Claims

Respite Care Services are billed to Georgia Medicaid through the GAMMIS portal using specific HCPCS codes assigned by the waiver program. Providers must secure prior authorization before any services are delivered.

Reimbursement rates are established by DCH and DBHDD. Claims that do not match the authorized units or lack corresponding EVV data will be automatically denied.

• Prior Authorization: DCH or DBHDD must authorize respite services prior to delivery; authorizations are updated at least annually based on the ISP.
• Billing Increments: In-home respite is typically billed in 15-minute increments, while out-of-home facility respite may be billed at a daily (per diem) rate.
• Claims Submission: Claims are submitted electronically via the GAMMIS portal or through an approved EDI clearinghouse.
• EVV Claims Tie-In: In-home respite claims submitted to GAMMIS will be denied if they are not matched with compliant, verified visit data in the state's EVV system.
• Simultaneous Billing Prohibition: Providers cannot bill for Respite and Community Living Support (CLS) simultaneously for the same participant.
• Rate Schedules: Current reimbursement rates are published in the DBHDD and DCH provider manuals available on the GAMMIS public portal.

9. Approval Sequence and Timeline

Becoming a respite provider in Georgia is a sequential process that cannot be rushed. Because Medicaid enrollment requires a license, and DBHDD enrollment requires pre-qualification, providers must follow the steps in exact order.

The entire process from business formation to billing the first Medicaid claim typically takes between 6 and 12 months, depending on DCH survey schedules and ASO review times.

• Step 1: Register the business with the Georgia Secretary of State and obtain an EIN and Type 2 NPI (1-2 weeks).
• Step 2: Submit the PHCP or PCH license application to DCH HFRD and pass the initial on-site survey (3-6 months).
• Step 3: Attend the mandatory DBHDD orientation and submit the LOI/pre-qualification packet to the Georgia Collaborative ASO (1-2 months).
• Step 4: Submit the Medicaid provider enrollment application via the GAMMIS portal (30-60 days).
• Step 5: Complete EVV system onboarding and staff training (2-4 weeks).
• Step 6: Receive prior authorizations from case managers and begin service delivery.

10. Common Denials and Survey Findings

Applications and initial surveys frequently fail when providers attempt to bypass the sequential prerequisites or submit generic policies that do not cite Georgia-specific regulations.

DCH HFRD is highly rigorous during initial PHCP and PCH surveys, and GAMMIS enrollment will be swiftly denied if ownership disclosures are incomplete.

• Premature Enrollment: Submitting a GAMMIS Medicaid application before the DCH HFRD license is fully issued and active.
• Incomplete Ownership Disclosure: Failure to accurately list all individuals or entities with a 5% or greater ownership interest on the GAMMIS application.
• Generic Policies: Submitting purchased policy manuals to DCH HFRD that lack required citations to Georgia Rules and Regulations 111-8-65 or 111-8-62.
• Training Gaps: Personnel files missing documented RN competency sign-offs for staff assigned to perform personal care tasks during respite.
• EVV Non-Compliance: Claims denying because direct care staff failed to clock in/out using the EVV mobile application at the point of care.
• Background Check Failures: Allowing staff to provide care before the GAPS fingerprint background check has been fully cleared and documented.

11. Key Contacts and Resources

Prospective respite providers must rely on official state resources for the most current applications, fee schedules, and regulatory manuals. Bookmark these portals for ongoing compliance.

Always verify current waiver amendments and rate changes through the DCH and DBHDD official websites.

• DCH Healthcare Facility Regulation (HFRD): https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation-hfr
• DBHDD Provider Enrollment: https://dbhdd.georgia.gov/be-connected/applications-new-existing-providers/become-provider
• Georgia Collaborative ASO: https://www.georgiacollaborative.com
• GAMMIS Provider Portal: https://www.mmis.georgia.gov
• Georgia EVV Information: https://medicaid.georgia.gov/programs/all-programs/georgia-electronic-visit-verification-evv
• Georgia Secretary of State (Business Registration): https://sos.ga.gov

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