Georgia - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Georgia Department of Community Health (DCH) and the Department of Behavioral Health and Developmental Disabilities (DBHDD) fund Skilled Respite Services primarily through the New Options Waiver (NOW), Comprehensive Supports Waiver Program (COMP), and the Elderly and Disabled Waiver Program (EDWP). The service delivers temporary relief to primary caregivers of individuals whose complex medical needs require interventions by licensed nursing staff.

Approval requires an agency to first secure a Private Home Care Provider (PHCP) license with a Nursing Services designation from the DCH Healthcare Facility Regulation (HFR) division before applying for Medicaid enrollment. Applicants targeting the NOW and COMP waivers must also pass DBHDD's pre-enrollment review, submit a Letter of Intent during a designated open enrollment window, and attend mandatory provider enrollment forums before gaining access to the GAMMIS portal.

1. Service Definition and Scope

In Georgia, Skilled Respite Service provides temporary relief to primary caregivers of Medicaid waiver participants who require medical care exceeding the scope of basic personal care. The service ensures the health and safety of the participant while the primary unpaid caregiver is unavailable.

Because the participant's needs are medical in nature, the service must be delivered by licensed nursing professionals. It can be provided in the participant's home or in a licensed facility, depending on the specific waiver authorization.

• Target Population: Medicaid waiver participants with complex medical needs requiring skilled nursing interventions.
• Delivery Setting: The participant's private residence or a DCH-licensed facility.
• Staffing Requirement: Must be delivered directly by a Registered Nurse (RN) or a Licensed Practical Nurse (LPN).
• Waiver Vehicles: Funded primarily through the NOW, COMP, and EDWP waivers.
• Service Limits: Capped at a specific number of hours or days annually, strictly dictated by the participant's approved Individual Service Plan (ISP).

2. Regulatory and Oversight Agencies

Oversight of Skilled Respite is divided between the agency that licenses the provider and the agencies that operate the specific Medicaid waivers. The Department of Community Health handles facility licensure and the Medicaid claims system.

The Department of Behavioral Health and Developmental Disabilities manages the IDD waivers, while the Division of Aging Services manages the aging and physical disability waivers.

• Licensing Authority: Georgia Department of Community Health (DCH) Healthcare Facility Regulation (HFR) division (https://dch.georgia.gov/healthcare-facility-regulation).
• IDD Waiver Operating Agency: Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) (https://dbhdd.georgia.gov/).
• Aging Waiver Operating Agency: Georgia Division of Aging Services (DAS) (https://aging.georgia.gov/).
• Medicaid Enrollment Portal: Georgia Medicaid Management Information System (GAMMIS) (https://www.mmis.georgia.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia strictly gates entry into its waiver programs through licensure prerequisites and closed enrollment windows. An agency cannot simply apply to be a Medicaid waiver provider without first holding the underlying state license.

For IDD waivers, DBHDD utilizes targeted procurement and open enrollment windows, meaning applications are only accepted at specific times of the year or when the state identifies a network need.

• Licensure Prerequisite: Applicants must hold an active Private Home Care Provider (PHCP) license from DCH HFR before initiating Medicaid enrollment.
• DBHDD Open Enrollment: NOW/COMP providers must apply during DBHDD's designated open enrollment windows or targeted Requests for Proposals (RFP).
• Letter of Intent (LOI): DBHDD requires the submission and approval of an LOI before a full waiver application is accepted.
• Mandatory Training: DBHDD applicants must attend a mandatory Provider Enrollment Forum prior to application submission.

4. Licensure and Certification Requirements

Georgia does not issue a distinct "Skilled Respite" license. Instead, agencies must obtain a Private Home Care Provider (PHCP) license from DCH HFR.

To provide skilled respite, the agency's PHCP license must specifically include the "Nursing Services" designation, which requires demonstrating appropriate RN oversight and clinical policies.

• License Type: Private Home Care Provider (PHCP) license.
• Service Designation: Must be approved for "Nursing Services" under the PHCP license.
• Application Fee: $500 initial application fee for PHCP licensure.
• Regulatory Citation: Rules and Regulations of the State of Georgia, Chapter 111-8-65 (Private Home Care Providers).
• On-Site Inspection: DCH HFR conducts an initial on-site survey prior to issuing the final license.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the GAMMIS portal. Providers must submit a Facility/Agency application and link it to their approved waiver operating agency.

For NOW/COMP providers, DCH will not process the GAMMIS application until DBHDD transmits a network approval tie-in notice.

• System: Georgia Medicaid Management Information System (GAMMIS).
• Application Type: Facility/Agency Provider Enrollment Application.
• Required Documentation: IRS Form 147-C or W-9, active PHCP license, and NPI number.
• DBHDD Tie-In: NOW/COMP applicants must have an approved DBHDD network application on file.
• Application Fee: The CMS-mandated Medicaid institutional application fee applies.

6. Staffing, Training and Background Checks

Because this service is skilled, all direct care must be provided by licensed nurses. Agencies must verify credentials through the Georgia Board of Nursing.

All patient-facing staff must undergo strict background checks through the state's centralized fingerprinting system.

• Direct Care Qualifications: Must hold an active, unencumbered Georgia RN or LPN license.
• Supervision: LPNs must be supervised by an RN in accordance with Georgia Board of Nursing regulations.
• Background Checks: Mandatory fingerprint-based background checks via the Georgia Criminal History Check System (GCHEXS).
• CPR/First Aid: All direct care staff must maintain current CPR and First Aid certification.
• TB Testing: Staff must have a negative Tuberculosis (TB) screening prior to client contact.

7. Documentation, Policies and Records

Providers must maintain comprehensive clinical records detailing the medical necessity and execution of skilled respite. Documentation must prove that the care provided matched the authorized level of need.

Agencies must also maintain policies for medical emergencies and situations where the primary caregiver does not return on time.

• Care Plan: Services must strictly follow the DBHDD or DAS approved Individual Service Plan (ISP).
• Nursing Notes: RN/LPN must document clinical observations, interventions, and medication administration for each shift.
• Service Logs: Must include date, start/stop times, staff signature, and caregiver signature verifying relief was provided.
• Emergency Procedures: Agency must maintain written policies for medical emergencies and caregiver unavailability.
• Record Retention: Medicaid records must be retained for a minimum of five years from the date of service.

8. Billing, Rates and Claims

Claims are submitted via the GAMMIS portal. Rates are established by DCH and DBHDD based on the specific waiver program and the practitioner level (RN vs. LPN).

Skilled respite cannot be billed without an active prior authorization matching the dates of service and the specific procedure codes.

• Billing Portal: GAMMIS web portal or via EDI 837P transactions.
• Procedure Codes: Typically billed using T1005 (Respite care services) with specific modifiers (e.g., TD for RN, TE for LPN).
• Prior Authorization: 100% of skilled respite hours require prior authorization (PA) from the waiver operating agency.
• Rate Structure: Reimbursed in 15-minute increments or per diem, strictly capped by the PA.
• Timely Filing: Claims must be submitted within 6 months of the date of service.

9. Approval Sequence and Timeline

The approval process is sequential and lengthy. An agency cannot begin the Medicaid enrollment phase until the DCH licensure phase is entirely complete.

For IDD waivers, the timeline is further extended by waiting for DBHDD open enrollment windows.

• Step 1: Submit PHCP application to DCH HFR (3-6 months for review and initial survey).
• Step 2: Submit LOI to DBHDD during an open enrollment window (1-2 months).
• Step 3: Complete DBHDD mandatory training and full network application (2-4 months).
• Step 4: Submit Medicaid enrollment application via GAMMIS (15-30 business days).
• Total Timeline: 8 to 14 months from initial PHCP application to active Medicaid billing status.

10. Common Denials and Survey Findings

Applications and surveys frequently fail due to incomplete documentation or operating outside the scope of the PHCP license.

DCH HFR surveyors strictly enforce background check compliance and nursing oversight requirements during initial and routine inspections.

• Licensure Denial: Failure to demonstrate RN oversight for the "Nursing Services" PHCP designation.
• Enrollment Rejection: Missing IRS 147-C letter or mismatched Tax ID information in GAMMIS.
• Survey Citation: Incomplete employee files, specifically missing GCHEXS background check clearances.
• Survey Citation: Inadequate nursing documentation or failure to follow the specific medical interventions in the ISP.
• Billing Denial: Submitting claims for dates of service before the GAMMIS effective date or without an active PA.

11. Key Contacts and Resources

Providers must interact with multiple state portals and divisions to maintain compliance and active enrollment.

Always refer to the official state agency websites for the most current provider manuals, fee schedules, and enrollment forms.

• DCH Healthcare Facility Regulation (HFR): https://dch.georgia.gov/healthcare-facility-regulation
• DBHDD Provider Enrollment: https://dbhdd.georgia.gov/becoming-provider
• Georgia Medicaid Management Information System (GAMMIS): https://www.mmis.georgia.gov/
• Georgia Division of Aging Services (DAS): https://aging.georgia.gov/
• Georgia Criminal History Check System (GCHEXS): https://gchexs.dch.ga.gov/

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