Potential ccsp provider Information



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Potential CCSP Provider Information



Community Care Services Program (DHS/DAS CCSP)

http://www.aging.dhr.georgia.gov

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

Heart of GA/Altamaha

River Valley Regional Commission

Middle GA Regional Commission


Norma Ivey 404-657-5320 Northwest GA Regional Commission

Southern GA Regional Commission

Southwest GA
James Woodruff 404-657-5305 Atlanta Regional Commission

GA Mountains

Northeast GA

Southern Crescent

Tarrian Grant 404-657-5306 Coastal Regional Commission

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Potential CCSP Provider Information, cont’d




Georgia Health Partnership (DCH DMA Medicaid)

http://www.ghp.georgia.gov
State License or Permit Information

DCH Healthcare Facility Regulation Division


Questions about Personal Care Home (PCH): ALS-F, ALS-G

General Information 404-657-4076


Questions about Private Home Care Providers (PHC) or Home Health: PSS, HDS

General Information 404-657-5550


Long-Term Care Section 404-657-5850
Complaint Intake

800-878-6442 or 404-657-5726 and 5728



http://www.ors.dhr.georgia.gov
DCH CCSP Medicaid (waiver for aged and disabled)

Nancy Dubas 404-657-7211

E-mail address ndubas.dch.ga.gov
Medicaid Provider Manuals

Select Provider Information tab, go to Documents & Forms box. Select View Full List:

Part I Policies & Procedures for Medicaid/ Peachtree for Kids; CCSP General Manual; and, CCSP service specific manuals
DCH SOURCE

Nancy Dubas 404-657-7211

E-mail address ndubas.dch.ga.gov
DCH Other Waivers

ICWP (waiver for physical disabilities) Bessie Barnes 404-657-9321

MRWP/CHSS (waiver for developmentally disabled) 404-463-8037
General DCH or Medicaid Questions

404-651-9976


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August 2009
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