What do I do when a client’s care needs change or the plan has to change?
Do not change what caregivers do or how many hours they work on your own. Tell the care coordinator, document why the need changed, and wait for the updated authorization. Services outside the authorization may not be paid. Georgia ties payment to the authorized plan and units.
A change in needs usually means a change in the plan and the authorization. Payment follows the paper.
Steps:
- Write down what changed: a fall, a hospital stay, a new diagnosis, or new limits. Date it.
- Tell the nurse and the care coordinator the same day.
- Ask what they need from you, such as a nurse assessment or a new service plan.
- Do not exceed the authorized units. Georgia denies claims when units are used up or the dates fall outside the authorization.
- Wait for the updated authorization before you bill the new level.
- Update the service plan in your client file and share it with the caregivers.
A trade article warns that visits booked outside the authorization will not be reimbursed.
If there is an emergency, make sure the client is safe first, then document exactly what you did and why. Report incidents as the manual requires: within 24 hours or one business day for critical and non-critical incidents, and within two hours for severity 3 and above.
Ask the state how it handles urgent changes in your program.
Sources
- EDWP: CCSP and SOURCE General Services manual (Q3 July 2026) · Georgia DCH / GAMMIS
- Georgia Medicaid Common Denials webinar (Feb 2021) · Georgia DCH / GAMMIS
- So You Want to Bill Medicaid · Home Care magazine
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
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