7 AAC 43.1090. Provider certification and enrollment

(a) To be certified by the department as a provider of a home and community-based waiver service, the provider must meet the applicable certification criteria, including provider qualifications and program standards, set out in the department's Home and Community Based Waiver Services Certification Application Packet, revised as of February 12, 2004 and adopted by reference.

(b) The department will enroll the following provider types to provide home and community-based waiver services if the provider is certified by the department under (a) of this section as a provider of particular home or community-based waiver services, and if the provider has entered a medical provider agreement under 7 AAC 43.065:

(1) as a home and community-based services provider, for

(A) chore services provided under 7 AAC 43.1042;

(B) adult day services provided under 7 AAC 43.1043;

(D) residential habilitation services provided under 7 AAC 43.1046;

(E) supported employment services provided under 7 AAC 43.1047;

(F) intensive active treatment services provided under 7 AAC 43.1048;

(G) respite care services provided under 7 AAC 43.1049;

(H) transportation services provided under 7 AAC 43.1052;

(I) meals services provided under 7 AAC 43.1053; or

(J) environmental modification services provided under 7 AAC 43.1054;

(2) as a care coordination agency provider, for care coordination services;

(3) as a residential supported living services provider, for residential supported living services provided under 7 AAC 43.1044;

(4) as a durable medical equipment provider under 7 AAC 43.1900 - 7 AAC 43.1980, for specialized medical equipment and supplies provided under 7 AAC 43.1055, unless the department has awarded a contract to a particular provider to act as the single source of a particular item or procedure under 7 AAC 43.1900(m);

(5) as a private duty nursing provider under 7 AAC 43.456, for specialized private duty nursing services provided under 7 AAC 43.1051.

(1) without requiring certification, the department will enroll a contractor licensed under AS 08.18 as a home and community-based services provider, for environmental modification services provided under 7 AAC 43.1054, if the

(A) department determines that the contractor is in compliance with the applicable provisions of 7 AAC 43.1054; and

(B) contractor has entered a medical provider agreement under 7 AAC 43.065; and

(2) a provider of transportation that is enrolled under 7 AAC 43.500 - 7 AAC 43.530 to provide transportation under the Medicaid program need not be certified by the department in order to enroll under (b) of this section to provide transportation services under 7 AAC 43.1052.

(d) If a recipient plans to obtain services out of state, the recipient's care coordination agency provider must document that the recipient has chosen the out-of-state provider freely, and must have a written agreement with the out-of-state provider setting out the quality assurance responsibilities of the care coordination agency provider and the out-of-state provider. Payment will be made directly to the out-of-state provider.

History: Eff. 12/19/93, Register 128; readopt 8/7/96, Register 139; am 5/15/2004, Register 170; am 12/2/2005, Register 176; am 1/11/2006, Register 177

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.050

Editor's note: The Department of Health and Social Services's Home and Community Based Waiver Services Certification Application Packet, dated February 12, 2004 and adopted by reference in 7 AAC 43.1090, may be obtained by writing to the Department of Health and Social Services Division of Senior and Disabilities Services, P.O. Box 110680, Juneau, Alaska 99811-0680, or may be inspected at the office of the Division of Senior and Disabilities Services, 240 Main Street, Suite 602, Juneau, Alaska.

Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.1090 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.

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