Select Programs, CCSP to access the Pre-Enrollment Technical Assistance Packet and view the Annual Report.
Provider agency must have been in business for which application is being made a
minimum of 12 consecutive months. CCSP does not guarantee client referrals. Clients have choice of providers.
Pre-Enrollment Technical Assistance Training Packet
In order to schedule attendance at a training, mail the Pre-Enrollment CCSP Technical Assistance Registration Form, attachments, and a check or money order of $25.00 (per person) made payable to the DAS General Training Trust Fund to:
Georgia Department of Human Resources
Division of Aging Services/CCSP
Two Peachtree Street, NW, Suite 9.405
Atlanta, Georgia 30303-3142
Note: CCSP PSS, HDS, and ALS-G applicant agency must also submit a current, non-restricted permit issued by ORS. ERS applicant must submit a Low Voltage Contractor License issued by Secretary of State, if applicable.
The CCSP Medicaid Provider Enrollment Application and the DCH Medicaid Application are distributed at the CCSP Pre-Enrollment Training.
[Location DCH Medicaid application: Select Provider Information tab, go to Documents & Forms box and select ‘View Full List’. Download Provider Enrollment Application Package and, if appropriate, Disclosure of Ownership and Control Interest Statement. Complete and submit to CCSP with the CCSP Provider Enrollment Application.
DO NOT submit to DCH Medicaid.]
CCSP State Provider Specialists: Ruth Davis 404-657-5309 Central Savannah River Area Regional Commission