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

Last reviewed: 2026-09-09

The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) and the Department of Community Health (DCH) authorize Transitional Assistance Services under the state's Home and Community-Based Services (HCBS) waiver programs, including the Comprehensive Supports Waiver Program (COMP) and the New Options Waiver (NOW). This service funds one-time set-up expenses, such as security deposits, utility activation fees, and essential furnishings, to transition Medicaid beneficiaries from institutional settings into community-based homes.

Prospective agencies must submit a Letter of Intent (LOI) to the Georgia Collaborative ASO exclusively during designated open enrollment windows and receive a formal invitation before submitting a DBHDD provider application. Agencies applying to serve Community Care Services Program (CCSP) waiver participants must also demonstrate a minimum of 12 consecutive months of operating history in the requested service line prior to application, and any DCH application denial mandates a mandatory one-year waiting period before a new LOI can be submitted.

1. Service Definition and Scope

In Georgia, Transitional Assistance Services (often categorized under Community Transition Services in waiver appendices) provide financial support for the one-time costs associated with establishing a community residence. The service is strictly limited to individuals transitioning from an institution, such as a nursing facility or intermediate care facility, into a private residence where they are responsible for their own living expenses.

The scope of the service covers concrete logistical and financial needs rather than ongoing direct care. It requires providers to coordinate the purchase and delivery of approved items and services, ensuring the participant's new home is safe, equipped, and ready for occupancy on the day of discharge.

• Target Population: Medicaid beneficiaries actively transitioning from an institutional setting to a private community residence under the NOW, COMP, or CCSP waivers.
• Covered Expenses: Security deposits, utility set-up fees, essential household furnishings, window coverings, and basic kitchen supplies.
• Non-Covered Expenses: Monthly rental or mortgage payments, ongoing utility charges, recreational items, and food.
• Service Limits: Capped at a specific lifetime maximum amount per participant as defined in the approved waiver appendix (historically around $3,000, subject to current DCH fee schedules).
• Coordination Requirement: Providers must work directly with the participant's Support Coordinator to ensure all purchases align with the approved transition plan.

2. Regulatory and Oversight Agencies

The Department of Community Health (DCH) serves as the State Medicaid Agency, holding ultimate authority over waiver funding, provider enrollment, and claims reimbursement. DCH manages the Medicaid Management Information System (GAMMIS) and sets the overarching policies for HCBS waivers.

The Department of Behavioral Health and Developmental Disabilities (DBHDD) operates the NOW and COMP waivers on a day-to-day basis. DBHDD conducts the initial provider screening, site visits, and certification reviews, utilizing the Georgia Collaborative ASO to manage the front-end enrollment phases.

• Department of Community Health (DCH): State Medicaid Agency responsible for final provider enrollment and reimbursement (https://dch.georgia.gov/).
• Department of Behavioral Health and Developmental Disabilities (DBHDD): Operating agency for NOW and COMP waivers, responsible for provider certification (https://dbhdd.georgia.gov/).
• Georgia Collaborative ASO: Contracted entity that manages the New Provider Enrollment Forums and processes Letters of Intent (https://www.georgiacollaborative.com/).
• Healthcare Facility Regulation (HFR): Division of DCH that issues licenses for direct care agencies, though not strictly required for standalone transition goods coordination (https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation).

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia employs a strictly gated enrollment process for DBHDD waiver providers, utilizing closed networks that only open during specific procurement windows. An applicant cannot simply submit a Medicaid enrollment application; they must first pass through the Georgia Collaborative ASO's screening process.

For providers seeking to operate under the Division of Aging Services (DAS) for the CCSP waiver, strict operational history requirements apply. These structural preconditions block any application from being reviewed if the agency does not meet the baseline tenure or apply during the correct timeframe.

• Open Enrollment Window: DBHDD only accepts Letters of Intent (LOI) during specific, published open enrollment periods; applications submitted outside these windows are rejected.
• New Provider Enrollment Forum: Mandatory attendance at a registration-only forum presented by the Georgia Collaborative ASO prior to submitting an LOI.
• Letter of Intent (LOI): The required initial screening document submitted to the Georgia Collaborative ASO to request an invitation to apply.
• Operating History Prerequisite: For CCSP enrollment, the provider agency must have been in business in the requested service line for a minimum of 12 consecutive months prior to application.
• One-Year Denial Moratorium: If the DCH application is denied at the final stage, the provider must wait one full year before submitting a new LOI in a subsequent enrollment period.

4. Licensure and Certification Requirements

Georgia does not issue a distinct facility or agency license specifically for "Transitional Assistance Services." Because this service primarily involves administrative coordination and purchasing rather than hands-on personal care, providers are approved through DBHDD certification rather than HFR licensure.

However, if the agency also intends to provide direct in-home care services (such as Community Living Support or Personal Support Services) alongside transition coordination, they must obtain a Private Home Care Provider (PHCP) license from DCH's Healthcare Facility Regulation division.

• DBHDD Certification: Required for all agencies providing services under the NOW and COMP waivers, focusing on the "Core Requirements for Providers."
• Business License: Proof of the legal right to conduct business in Georgia, such as a current city or county business license.
• Accreditation Threshold: Providers receiving $250,000 or more per year in DBHDD funding must be accredited by an approved national accrediting body.
• Surety Bond: Agencies acting as fiscal intermediaries or managing significant waiver funds must maintain a surety bond equal to or greater than the monetary value of accounts managed, minimum $250,000.
• PHCP License: Only required if the agency is simultaneously enrolling to provide direct personal care services alongside transition assistance.

5. Medicaid Provider Enrollment

After receiving DBHDD approval, agencies must complete the formal Medicaid enrollment process through the Georgia Medicaid Management Information System (GAMMIS) portal. This step establishes the agency's billing profile and assigns the official Medicaid provider number.

The GAMMIS Enrollment Wizard is a one-source application for fee-for-service Medicaid. Providers must upload their DBHDD approval letters, pay the required federal application fee, and sign the Medicaid Provider Agreement.

• GAMMIS Portal: The online system used to submit the DCH Medicaid provider application (https://www.mmis.georgia.gov/).
• Application Fee: Payment of the CMS-mandated application fee (42 CFR 455.460) is required unless exempted by prior payment to Medicare or another state.
• NPI Number: Providers must obtain and register a National Provider Identifier specific to their agency.
• Provider Agreement: Execution of the DCH Statement of Participation, legally binding the agency to Medicaid rules and reimbursement limits.
• EFT Enrollment: Mandatory setup of Electronic Funds Transfer for claims payment routing.

6. Staffing, Training and Background Checks

While Transitional Assistance Services do not require clinical nursing staff, the personnel coordinating the purchases and interacting with waiver participants must meet DBHDD's core training and background standards. The agency must maintain an organizational chart and detailed staffing information.

All owners, directors, and staff members must undergo rigorous background screening. DBHDD requires agencies to conduct and pay for these checks to ensure no individual with a disqualifying offense interacts with vulnerable populations.

• Criminal Background Check: Mandatory fingerprint-based background checks for all staff and owners prior to participant contact.
• New Provider Orientation: Agency leadership must attend DBHDD's New Provider Orientation upon approval of their DCH application.
• Basic Training: Staff must hold current CPR and First Aid certifications, even if primarily performing administrative coordination.
• Experience Verification: The agency must provide reference contact information to verify prior experience in coordinating services or managing funds.
• OIG Exclusion Screening: Monthly checks of all staff against the federal LEIE to ensure no excluded individuals are employed.

7. Documentation, Policies and Records

Because Transitional Assistance Services involve the expenditure of public funds for physical goods, documentation requirements are heavily focused on financial tracking and receipt retention. Providers must utilize robust accounting systems to track every dollar spent against the participant's authorized budget.

Agencies must maintain a comprehensive policy manual that aligns with DBHDD's Core Requirements. This includes policies on financial management, participant rights, and quality assurance.

• Expense Receipts: Original, itemized receipts for every item purchased must be retained and matched to the participant's transition plan.
• Transition Plan: A copy of the Support Coordinator's approved transition plan detailing the specific items authorized for purchase.
• Accounting System: Demonstrated use of an electronic accounting system capable of generating service management and statistical reports.
• Records Retention: All financial and participant records must be securely maintained for a minimum of six years following the service date.
• Quality Assurance Policy: Written procedures for ensuring purchased goods are delivered in working order and meet the participant's needs.

8. Billing, Rates and Claims

Reimbursement for Transitional Assistance Services is strictly controlled by Prior Approval (PA). The Support Coordinator must enter the PA into the Medicaid Management Information System (GAMMIS) before the provider can incur any expenses or submit a claim.

Claims are submitted electronically via the GAMMIS portal. The system is programmed with edits to control the amount and frequency of reimbursement, ensuring claims do not exceed the waiver participant's approved PA or the established Medicaid rate maximums.

• Prior Approval (PA): Absolutely required before any service is rendered or item purchased; claims will deny without a matching PA in GAMMIS.
• Electronic Claims: All billing must be submitted through the GAMMIS web portal using the designated HCBS procedure codes.
• Rate Maximums: Reimbursement is capped at the exact amount authorized in the PA, which cannot exceed the state's published fee schedule limits.
• Third-Party Liability: Medicaid is the payer of last resort; services are authorized only to the extent they are not available through another funding source.
• Timely Filing: Claims must be submitted within the DCH-specified timely filing window (typically 6 months from the date of service) to avoid denial.

9. Approval Sequence and Timeline

Becoming a provider is a sequential, multi-phase process that can take several months to over a year, depending on the timing of the open enrollment windows. An applicant cannot advance to the next phase until the previous entity grants explicit approval.

The process begins with the Georgia Collaborative ASO, moves to DBHDD for programmatic review and site visits, and concludes with DCH for final Medicaid enrollment and number assignment.

• Phase 1 (ASO): Register for and attend the New Provider Enrollment Forum, then submit the LOI during the open window.
• Phase 2 (DBHDD App): Upon invitation, submit the comprehensive DBHDD New Provider Application with all required policies and infrastructure documentation.
• Phase 3 (Site Visit): DBHDD Regional Field Office conducts an initial screening and site visit to review the organization and programs.
• Phase 4 (DCH App): Following DBHDD approval, complete the GAMMIS Enrollment Wizard application for DCH review.
• Phase 5 (Activation): DCH assigns the Medicaid provider number, and DBHDD notifies the provider to attend New Provider Orientation.

10. Common Denials and Survey Findings

Applications are most frequently rejected at the very beginning of the process due to failure to follow the strict gatekeeping rules. Submitting an LOI outside of the published open enrollment window or failing to attend the mandatory forum results in immediate rejection.

During post-enrollment audits, providers often face recoupments for failing to maintain exact financial documentation. Because this service reimburses physical goods, missing receipts or purchasing items not explicitly listed on the PA are major compliance violations.

• Out-of-Window LOI: Automatic rejection for submitting a Letter of Intent when the DBHDD enrollment period is closed.
• Insufficient History: Denial of CCSP applications for failing to prove 12 consecutive months of prior business operation.
• Missing Receipts: Recoupment of funds during audits due to the provider's inability to produce itemized receipts for transition purchases.
• Unapproved Purchases: Billing for items (like televisions or ongoing groceries) that are explicitly excluded from the service definition.
• No Prior Approval: Claim denials in GAMMIS because the provider executed purchases before the Support Coordinator entered the PA into the system.

11. Key Contacts and Resources

Providers must navigate multiple state portals and contractor websites to complete the enrollment process and maintain compliance. The Georgia Collaborative ASO is the primary contact for the initial LOI phase.

Once enrolled, GAMMIS becomes the central hub for billing, while DBHDD policy manuals dictate ongoing service standards.

• Georgia Collaborative ASO: Manages LOIs, enrollment forums, and initial application forms (https://www.georgiacollaborative.com/).
• DBHDD Provider Information: Central hub for waiver policies, provider manuals, and certification standards (https://dbhdd.georgia.gov/be-connected/applications-new-existing-providers/become-provider).
• GAMMIS Provider Portal: The DCH system for Medicaid enrollment, PA verification, and claims submission (https://www.mmis.georgia.gov/).
• DCH Healthcare Facility Regulation (HFR): Resource for agencies that also need to apply for a Private Home Care Provider license (https://dch.georgia.gov/divisionsoffices/healthcare-facility-regulation).

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