Q2 2025 Georgia Medicaid Manual Updates
No significant updates were made the Medicaid Autism Providers Manual this quarter. Some minor changes were made to the Authorization Request Cover Page [Appendix D], primarily related to school-based services.
Removed Skill acquisition exclusion from school plan guidance [Appendix D]
On page 46 of the manual, under the School Plan section, the following line was removed:
“Skill acquisition goals should not be implemented in this setting as the primary objective should be reducing maladaptive behaviors that impede the member’s ability to engage in academic tasks.”
This change provides greater flexibility for providers delivering services within public schools. By removing this restriction, clinicians are now able to incorporate skill acquisition goals as part of a comprehensive treatment plan, even in educational settings.
This marks an important shift—especially for clients transitioning from intensive, full-time programs to receiving support in public schools without one-on-one assistance. However, all existing requirements related to skill acquisition planning, data collection, and progress monitoring still apply and must be followed in accordance with the manual.
Added “for members enrolled in a public school” in section requestion IEP/EFSP/504 plan [Appendix D]
On page 44 the following underlined language was added:
“Does the member have and IEP, IFSP, and/or 504 Plan? (submission is optional unless school-based services are requested for members enrolled in a public school)”
This update reflects Georgia Medicaid’s continued effort to define the parameters for providing services within public school settings. As the Department of Community Health expands opportunities for service delivery in schools, it also continues to refine expectations—ensuring that public school systems actively participate and contribute to the coordination of care for eligible students.
Removed Advance nurse practitioner from providers authorized to provide ASD services. This was erroneously added during the manual reformat [Section 601.1.1]
In Section 601.1.1 of the manual (page 5), references to Advanced Nurse Practitioners as qualified providers for ASD services have been removed. The now-deleted language had incorrectly stated:
“601.1.1.2 Advanced Nurse Practitioner (with or without BCBA certification):
601.1.1.2.1 May be the enrolled QHCP 601.1.1.2.1 May supervise the work of BCaBAs and RBTs who implement behavior-analytic interventions”
According to the update, this content was erroneously included during a prior manual reformatting. This correction reaffirms that Advanced Nurse Practitioners—unless otherwise authorized under a different credential—are not permitted to serve as QHCPs or supervisors of behavior-analytic services under the ASD service guidelines.
Organizations should review their supervision structures to ensure alignment with the corrected policy and avoid assigning responsibilities outside of approved provider roles.
As I often emphasize in these manual update blogs, staying current with evolving payor expectations is not just about compliance—it’s about ensuring your clinical and operational practices reflect the highest standards. This includes regular review of updates and maintaining a permanent, organized archive of past versions.
Payors have, at times, audited services based on the most recent version of the manual, even when those services were delivered under older guidelines. Without proper documentation of past standards, it becomes difficult to justify decisions made in good faith. Keeping a historical record protects your organization, supports clinical decision-making, and demonstrates responsible leadership.
Take time to review these updates with both your clinical and administrative teams. Make sure your treatment planning, supervision structures, and documentation are aligned with the most current Medicaid guidelines.
Staying informed—and I mean truly informed—isn’t optional. It’s what sets ethical, forward-thinking providers apart. Let’s continue holding ourselves to that standard.
