Georgia Manuals Updates and CMO auth rules

The January 2026 manuals for Georgia Medicaid published some new details that needs to be noted.

Children's Intervention Services (CIS) had clarity added about a prescription needed for an evaluation:

Therapy evaluations including physical therapy, occupational therapy, and speech-language pathology evaluations do not require a referral or separate prescription from a physician in order to be initiated or performed. Licensed therapy providers may independently perform evaluations consistent with their professional scope of practice and applicable state licensure regulations. Therapy services will require a signed POC. (Rev. 01/2026)

There's been a lot of discussion about this topic in compared to Babies Can't Wait/Early Intervention as to getting the patient started with services to meet IFSP deadlines and evaluations.

CMO authorizations often have different rules. Currently (and yes this could change tomorrow):

• You can request an auth for a patient for 1 month with an unsigned Plan of Care, RX from pediatrician, and one of the following: IFSP/IEP/Attestation.

• You can request up to 1 month of services after an IFSP or IEP ends to continue services if the Plan of Care continues past the end date to enable the transition. Example: POC range is 6/1/25-12/1/25. IFSP range is 4/30/25-10/30/2025. The authorization can be requested as 6/1/2025-11/30/2025.

• If you have a new patient who is transitioning from another provider who performed an evaluation within the last 6 months but you want to see the patient before writing your Plan of Care and goals, you can submit an auth request with the Rx, previous evaluation report, letter of change request from parent, IFSP/IEP/Attestation to state you need 1-2 visits to work with the patient to develop your own POC.

  
  

ABA had lots of changes as we expected from announcements made at the November Medicaid conference. Newest manual reflects a template to follow for Plans of Care, along with a new detailed cover sheet for authorizations. Make sure you review the template before submitting a new authorization, as it could cause rejections on a long awaited auth. Changes were also made so that authorizations can be requested 90 days in advance, but make sure you have an updated evaluation within 2 months of the request before submitting.

Lastly, I'm often asked about eligibility and how it effects Medicaid members:

 Members who are terminated and later reinstated with a retroactive eligibility date do NOT qualify for retroactive PAs. Members who are approved for Katie Beckett with a retroactive eligibility date do NOT qualify for a retroactive PA.