Department issues Request for Information (RFI) and upcoming provider changes

ATLANTA (April 28, 2026) — The Georgia Department of Community Health (DCH) is highly committed to administering the Medicaid program with integrity. Through the realignment of DCH’s fraud, waste, and abuse prevention system to better fit DCH’s current health care delivery models (fee-for-service and managed care), DCH hopes to increase cost avoidance and recovery of state and federal funds. DCH will gather information from vendors and revise processes and procedures for high-risk service categories to enhance program integrity.

DCH is soliciting information from vendors that can demonstrate delivery of a comprehensive pre-payment and post-payment review operation that provides state-of-the-art technologies, effective and efficient policies and processes, and expert staff to combat fraud, waste, and abuse to enhance cost avoidance and protect the fiscal integrity of the Georgia Medicaid program.

This request for information (RFI) will be issued as a means of technical discovery and information gathering. Full details on the RFI and how to submit information will be released in the coming weeks.

Additionally, DCH has identified Applied Behavioral Analysis (ABA) and Structured Family Caregiving (SFC) as high-risk service categories. In response, the Department intends to propose a series of policy and operational enhancements designed to strengthen program integrity, promote consistency, and support appropriate service delivery across the provider network.

Effective 7/1/2026, DCH proposes the following amended policies for Applied Behavioral Analysis (ABA) therapy: 

  • Additional prior authorization requirements 
  • Determination of Registered Behavioral Technician (RBT) oversight ratios based upon claims accuracy
  • Remote supervision of RBTs by a provider located within Georgia (or within 50 miles of the state border)
  • Requirements for agencies of a certain size to increase capacity to serve high-acuity members
  • Annual report on abandoned care to DCH each year
  • An increased emphasis on the prohibition of member solicitation

Effective 9/1/2026, DCH proposes the following amended policies for Structured Family Caregiving (SFC):

  • Requirement for caregiver certification and background check/fingerprint screenings
  • Compliance with Electronic Visit Verification 
  • Registered Nurse signoff on daily notes
  • National Committee for Quality Assurance accreditation and development of a caregiver training plan 

SFC Change of Ownership and expansion requests will be accepted beginning October 2026, and new providers will be accepted starting March 2027. Please note that, as a result of compliance with the new policies under SFC, providers in this space will be granted statewide service access. 

Full details of both sets of policy changes will be sent to applicable providers as Banner messages as final decisions are made.  

DCH recognizes that these changes represent a significant step forward in strengthening these programs and services, and our goal is to work collaboratively with providers to ensure clarity, readiness, and continued success in delivering high-quality care. Additional guidance and technical assistance opportunities will be shared in the coming months to support implementation.