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

Last reviewed: 2026-08-15

In Georgia, Transitional Assistance Services (TAS) are provided primarily under the New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP) administered by the Department of Behavioral Health and Developmental Disabilities (DBHDD). This service covers one-time, non-recurring set-up expenses—such as security deposits, utility activation fees, and basic furnishings—to help Medicaid members transition from institutional settings, like an ICF/IID, into their own community-based homes.

The single biggest structural barrier to entry for this service in Georgia is DBHDD's network need gatekeeping. A provider cannot simply apply to Medicaid to offer this service; they must wait for the Georgia Collaborative ASO to announce an open enrollment window or targeted Request for Proposals (RFP) based on geographic network shortages, attend a mandatory New Provider Enrollment Forum, and secure a formal DBHDD approval letter before the Department of Community Health (DCH) will even accept a Medicaid enrollment application.

1. Service Definition and Scope

Transitional Assistance Services in Georgia are designed to remove financial barriers for individuals moving from institutional care to community living. Under the NOW and COMP waivers, this service acts as a financial pass-through and coordination benefit rather than direct medical care.

The service is strictly capped and limited to essential household setup. It cannot be used for ongoing living expenses, making it a highly specialized administrative function often performed by Support Coordination agencies or dedicated transition providers.

• Target Population: Medicaid members transitioning from an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) or nursing facility to a private community residence.
• Covered Expenses: Security deposits, utility set-up fees, essential household furnishings, window coverings, and moving expenses.
• Excluded Costs: Monthly rental payments, ongoing utility charges, food, recreational items (e.g., televisions), and home modifications.
• Service Cap: Expenditures are capped at a lifetime maximum per waiver participant as defined in the current DBHDD NOW/COMP policy manual.
• Delivery Model: Providers act as purchasing agents and coordinators, procuring the approved items on behalf of the member and billing Medicaid for reimbursement.

2. Regulatory and Oversight Agencies

Oversight of Transitional Assistance Services is divided between the state's Medicaid authority and the behavioral health operating agency. Because the service is funded through HCBS waivers, programmatic rules are dictated by the waiver operator.

The actual vetting, credentialing, and quality monitoring of providers are outsourced to a third-party administrative services organization.

• Department of Community Health (DCH): The state Medicaid agency responsible for final GAMMIS enrollment, MMIS claims payment, and federal waiver compliance.
• Department of Behavioral Health and Developmental Disabilities (DBHDD): The operating agency for the NOW and COMP waivers that sets service policies and determines network need.
• Georgia Collaborative ASO: The administrative services organization contracted by DBHDD to manage provider enrollment, credentialing, and quality reviews.
• Healthcare Facility Regulation (HFR): A division of DCH that oversees facility licensure; while they do not license TAS directly, they regulate the residential settings members may move into.

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia heavily restricts new NOW/COMP provider enrollment based on geographic and service-specific network adequacy. You cannot submit a GAMMIS application for TAS without first clearing DBHDD's structural prerequisites.

Failure to follow the exact sequence of DBHDD's enrollment phases will result in immediate rejection of any application submitted to the state.

• Network Need Open Enrollment: DBHDD only accepts Letters of Intent (LOI) during specific open enrollment windows published by the Georgia Collaborative ASO, or via targeted RFPs when a shortage is identified.
• New Provider Enrollment Forum: Mandatory registration and attendance at a DBHDD/Georgia Collaborative ASO New Provider Enrollment Forum is required before an LOI will be accepted.
• National Accreditation: DBHDD requires providers to be fully accredited by CARF, CQL, TJC, or COA, or submit proof of initiating the accreditation process, depending on the provider's existing tier and service mix.
• DBHDD Letter of Approval: DCH will automatically deny any GAMMIS enrollment application for NOW/COMP waiver services that lacks a formal, unexpired DBHDD approval letter.
• Existing Licensure Prerequisite: If the provider is also offering bundled residential or personal care services, they must hold a DCH Private Home Care Provider (PHCP) license before applying for waiver enrollment.

4. Licensure and Certification Requirements

Because Transitional Assistance Services are administrative and financial pass-through services rather than direct medical or personal care, Georgia does not require a specific facility license (such as a Private Home Care Provider license) from DCH HFR to provide TAS alone.

Instead of a state license, authorization to provide this service is achieved through DBHDD programmatic certification and passing the Georgia Collaborative ASO's pre-enrollment review.

• HFR Licensure Exemption: No DCH Healthcare Facility Regulation license is required strictly for the provision of Transitional Assistance Services.
• DBHDD Programmatic Certification: Providers must pass the Georgia Collaborative ASO's pre-enrollment site visit and policy review to receive DBHDD certification.
• Business License: A standard Georgia city or county commercial business license is required for the agency's physical office location.
• Secretary of State Registration: The agency must be registered and in good standing as a corporate entity (LLC, Inc., etc.) with the Georgia Secretary of State.

5. Medicaid Provider Enrollment

After securing DBHDD approval, providers must formally enroll in the Georgia Medicaid Management Information System (GAMMIS). This step activates the provider's billing ID.

Effective July 2025, Georgia Medicaid enforces strict Group/Billing Enrollment requirements for all billing providers, requiring precise matching of corporate and tax identities.

• GAMMIS Portal: Applications must be submitted online via the MMIS Georgia Gov Provider Enrollment Wizard.
• Application Type: Applicants must select the Group/Billing Application Type to establish the agency as a billing entity.
• Required Attachments: The application must include the DBHDD approval letter, an EFT Agreement, a W-9 form, and a Power of Attorney for Payee (POA).
• Application Fee: Payment of the federal Medicaid/Medicare application fee (approximately $709) is required unless waived via proof of existing Medicare enrollment.
• Revalidation: Georgia requires Medicaid providers to revalidate their enrollment every 3 to 5 years; failure to revalidate results in suspension from GAMMIS.

6. Staffing, Training and Background Checks

While TAS does not involve direct nursing care, the staff coordinating the transitions must meet DBHDD's strict developmental disability training and background check standards.

Agencies must maintain comprehensive personnel files proving that all transition coordinators have cleared state and federal background checks before interacting with members.

• Criminal Background Checks: Mandatory fingerprint-based background checks through the Georgia Applicant Processing Service (GAPS) are required for all patient-facing staff.
• OIG/SAM Exclusions: Agencies must conduct monthly screenings of all owners, managing employees, and staff against federal and state exclusionary lists.
• DBHDD Core Training: Staff must complete DBHDD-mandated training modules, including the HCBS Settings Rule, incident reporting, and the rights of individuals with I/DD.
• Staff Qualifications: Transition coordinators typically must hold a bachelor's degree in a human services field or possess equivalent documented experience working with developmental disabilities.

7. Documentation, Policies and Records

TAS providers must maintain rigorous financial and programmatic records, as this service involves purchasing goods and services with public funds on behalf of Medicaid members.

Auditors will look for a direct paper trail linking the member's authorized service plan to the exact receipts for the items purchased.

• Individual Service Plan (ISP): All TAS expenditures must be explicitly authorized in the member's DBHDD-approved ISP prior to purchase.
• Receipts and Invoices: Providers must retain original, itemized receipts and paid invoices for all purchased goods (e.g., deposits, furniture) for auditing purposes.
• Transition Plan: A documented plan must be kept in the member's file outlining the timeline, purchased items, and coordination steps for the move.
• Record Retention: Georgia Medicaid requires all financial, programmatic, and personnel records to be retained for a minimum of six years.

8. Billing, Rates and Claims

Transitional Assistance Services are billed through GAMMIS using specific HCBS waiver procedure codes. The service operates on a cost-reimbursement model rather than a flat fee-for-service rate.

Providers are reimbursed for the actual cost of the approved items and deposits, up to the waiver's authorized cap, provided all prior authorizations are in place.

• Prior Authorization: Claims will automatically deny if the service is not prior-authorized in the GAMMIS system based on the member's ISP.
• Billing System: Claims must be submitted electronically via the GAMMIS web portal or through an approved EDI clearinghouse.
• Reimbursement Model: Billed as a pass-through cost; providers submit claims for the exact dollar amount of the approved items purchased.
• Procedure Codes: Services must be billed using the specific NOW/COMP waiver HCPCS codes designated for Transitional Assistance/Community Transition in the DBHDD manual.

9. Approval Sequence and Timeline

The end-to-end process for becoming a TAS provider in Georgia is lengthy due to DBHDD's phased gatekeeping steps. Providers should expect the process to take 6 to 12 months.

Delays frequently occur during the ASO review phase or if the GAMMIS application contains mismatched tax information.

• Step 1: Register for and attend the DBHDD New Provider Enrollment Forum (1 day).
• Step 2: Submit a Letter of Intent (LOI) during a designated open enrollment window (typically a 30-day window).
• Step 3: Submit the full DBHDD application to the Georgia Collaborative ASO (reviewed in 60-90 days).
• Step 4: Complete the ASO pre-enrollment site visit and policy review (30-60 days).
• Step 5: Receive the DBHDD Approval Letter and submit the GAMMIS Medicaid enrollment application (45-60 days for DCH processing).

10. Common Denials and Survey Findings

Applications and claims are frequently denied for administrative errors or failure to follow DBHDD's strict financial documentation rules.

Because TAS involves purchasing goods, the most common audit findings relate to missing receipts or buying items not explicitly covered by the waiver.

• Gatekeeping Denial: Submitting a GAMMIS application without the required DBHDD approval letter results in immediate rejection by DCH.
• Name Mismatches: GAMMIS enrollment denials frequently occur when the legal business name on the W-9, EFT Agreement, and application do not match exactly.
• Unapproved Purchases: Audit findings and recoupments occur when providers bill TAS for non-covered items (e.g., televisions, ongoing rent) not authorized in the ISP.
• Missing Receipts: DBHDD will demand recoupment of funds during audits if the provider cannot produce original, itemized receipts for the transition purchases.

11. Key Contacts and Resources

Providers must interact with multiple state portals and agencies to maintain compliance, receive authorizations, and submit claims.

Familiarity with these specific entities is essential for navigating Georgia's HCBS waiver system.

• Georgia Collaborative ASO: Manages DBHDD provider enrollment, credentialing, and the New Provider Enrollment Forum (georgiacollaborative.com).
• DBHDD: The operating agency for the NOW and COMP waivers, responsible for policy and network need (dbhdd.georgia.gov).
• GAMMIS Portal: The MMIS Georgia Gov site for Medicaid provider enrollment, prior authorizations, and claims submission (mmis.georgia.gov).
• DCH Provider Enrollment: Handles the final issuance of Medicaid IDs, application fee processing, and revalidation (dch.georgia.gov).

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