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How many nursing hours will GAPP approve for my child?
There is no fixed number. Georgia Medicaid sets your child’s hours from the medical need their physician documents, and the documentation is where hours are won or lost. Here is how the decision actually works.
The short answer
GAPP hours are decided one child at a time by the GAPP Medical Review Team at Alliant Health Solutions, which reviews requests for Georgia Medicaid. No agency sets the number, and no diagnosis comes with a set number of hours. Two children with the same diagnosis can be approved for very different hours, because what is being reviewed is the care each child needs, not the name of the condition.
Be careful with any agency that promises you a number of hours before your child’s case has been reviewed. It is not theirs to promise.
What the decision is based on
What the paperwork needs to show
Reviewers are deciding how much skilled care is medically necessary. In our experience the requests that hold up describe the care the way it actually happens in your home:
- Which skilled tasks your child needs, such as suctioning, trach care, ventilator management, tube feedings, medications or seizure rescue.
- How often each one happens, including overnight.
- How quickly things can change, and what a nurse has to watch for and act on.
- Why those tasks need a trained nurse rather than a caregiver.
“Needs a lot of care” does not get hours. “Suctioned every one to two hours around the clock, with desaturations overnight” is the kind of detail a reviewer can work with.
How approved hours work
Hours are approved per week, and they add up to a monthly total on the authorization. The agency gives you a Letter of Notification that shows the hours approved and how long the approval lasts, and you sign it. Within that approval, you and the agency decide together when the hours are used: day shifts, overnights, or a mix around school and work.
Each request covers up to six months, and reviewers can approve a shorter period. So your child’s hours are looked at again at least twice a year.
When your child’s needs change
If your child’s condition changes, the agency submits a change request. When a child gets sicker or comes home from the hospital needing more, the request goes in with signed physician orders, an updated plan of treatment, the hospital discharge summary or recent progress notes that state the hours being asked for. Georgia’s manual asks for a change request within five days of a change in condition, and those requests are reviewed within five days once the information is complete.
It works in the other direction too. When a child improves, for example after decannulation or weaning off the ventilator, that change has to be reported and hours can come down. Nurses also assess over time whether hours should taper.
Renewals, and why nurses’ notes matter
A renewal is due 30 days before the current approval ends. A late renewal starts from the day the complete packet is received, and there is no coverage for the gap in between. Every renewal includes the last three months of nurses’ notes, so the notes your nurses write every shift are the evidence for your child’s next approval.
If you disagree with the hours
The determination letter is sent to you by certified mail, and it explains your options. You have 30 calendar days from the date of that letter to ask Alliant Health Solutions to reconsider. If you are still not satisfied after the reconsideration, you can ask for a hearing before an administrative law judge within 30 days of the final letter.
Letters go to the address Medicaid has on file, so make sure DFCS has your current address.
Nursing hours and personal care hours
GAPP can approve two kinds of hours. Skilled nursing hours are delivered by an RN or LPN. Personal care support hours cover hands-on daily care, and under the Family Caregiver Option a parent can sometimes be paid for them. Skilled nursing hours can be shared between two GAPP agencies if you want that; personal care hours cannot. What GAPP covers explains the difference in more detail.
What HeartPath does, and does not do
We do the nursing assessment, build and submit the request, track the review, and keep change requests and renewals on time so your child’s hours are not interrupted by a missed deadline. We do not decide your child’s hours, and we will not promise you a number. Georgia Medicaid decides.
Questions families ask
How many nursing hours does GAPP approve?
There is no set number. Georgia Medicaid's GAPP Medical Review Team, run by Alliant Health Solutions, sets hours for each child from the medical need the physician documents. Two children with the same diagnosis can be approved for very different hours.
Who decides how many GAPP hours my child gets?
The GAPP Medical Review Team at Alliant Health Solutions, on behalf of Georgia Medicaid. The agency builds and submits the request and the physician orders the care, but neither one decides the hours.
How long does a GAPP approval last?
Each request covers up to six months, and reviewers can approve a shorter period. Renewals are due 30 days before the approval ends and need the last three months of nurses' notes.
Can we get more hours if our child's needs change?
Yes, if the need is documented. The agency submits a change request with signed physician orders, an updated plan of treatment, a hospital discharge summary or recent progress notes that state the hours requested.
Can GAPP hours go down?
Yes. When a child improves, for example after decannulation or weaning off the ventilator, the change has to be reported and hours can be reduced.
What if we disagree with the hours approved?
The determination letter comes by certified mail. You have 30 calendar days from its date to ask Alliant Health Solutions to reconsider, and if you are still not satisfied you can ask for a hearing before an administrative law judge within 30 days of the final letter.
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Check eligibility Call 678-459-2590HeartPath Home Care is an approved provider for the Georgia Pediatric Program. We are not a government agency, and this page is not an official publication of the Georgia Department of Community Health or Georgia Medicaid. It is a plain-language guide for families. Eligibility for GAPP, Medicaid and Katie Beckett is determined solely by Georgia Medicaid and the state agencies that administer them, based on your child's documented medical needs. Program rules and figures change.