Current through November 28, 2024
(a)
To receive payment for personal care services, an agency must be certified by
the department as a provider of personal care services. To be certified by the
department, an agency must
(1) submit an
application, in a format provided by the department; before submitting the
application for certification or application to renew certification, the
personal care services program administrator for that agency must attend the
personal care services agency training course provided by the
department;
(2) meet and comply
with the applicable standards of certification criteria, including provider
qualifications and program standards, set out in the department's
Personal Care Services and Community First Choice Personal Care
Services Provider Conditions of Participation, adopted by reference in
7
AAC 160.900;
(3) demonstrate to the department's
satisfaction that the program administrator, supervisors of personal care
assistants, and personal care assistants possess the requisite skills and
competencies necessary to meet the needs of the recipient population;
and
(4) comply with 7 AAC 105 - 7
AAC 160 (Medicaid coverage and payment), including enrolling in the Medicaid
program in accordance with
7
AAC 105.210.
(b) The department will certify a provider
who meets and complies with the standards of certification for a
(1) probationary certification of one year,
during which the department will not certify an additional service under
7
AAC 125.010-7 AAC
125.199, 7 AAC 127, and 7 AAC 130, or service location
beyond those approved at the beginning of the probationary certification
period, for
(A) a provider not previously
certified by the department; or
(B)
a renewing provider who does not meet the certification requirements to the
department's satisfaction under (a) of this section, or has committed an act or
omission that is grounds for sanction under
7
AAC 105.400, regardless of whether a sanction was
imposed; or
(2) standard
certification of
(A) two years for each
renewing provider that the department has determined met the probationary
certification requirements under (1) of this subsection in the immediately
preceding certification period; or
(B) a variable period of up to four years, to
be determined by the department's review of the provider's compliance with the
certification requirements under (a) of this section in the preceding
certification periods.
(c) Not later than 90 days before the
expiration of the provider's certification, the department will send to the
provider notice of the requirement to renew that certification. The provider
must submit a new certification application and all required documentation not
later than 60 days before the expiration date of the current
certification.
(d) A certified
personal care services provider under
7
AAC 125.010 -
7
AAC 125.199 shall comply with
7
AAC 125.010 -
7
AAC 125.199 and the requirements of
7
AAC 105.200 -
7
AAC 105.280. The department will determine compliance
through program monitoring, including audits, program reviews, and
investigations, that may take place at the provider's place of business or at
any site where services under
7
AAC 125.010 -
7
AAC 125.199 are provided. To assure compliance, the
department may
(1) request, in accordance
with 7 AAC 105.240, records related to
the services provided under
7
AAC 125.010 -
7
AAC 125.199; or
(2) take immediate custody of a provider's
original records, maintained in accordance with
7
AAC 105.230, if the department has reason to believe,
based on an audit, program review, or investigation, that those records are at
risk of alteration; once records are in the custody of the department, the
provider may make copies of those records only under the supervision of the
department.
(e) In
addition to the authority under
7
AAC 105.400 -
7
AAC 105.490 to take action in regard to certification,
the department will deny an initial application or an application to renew
certification if
(1) the provider fails to
submit a complete application under (a) of this section;
(2) the provider's certification, license, or
enrollment related to Medicaid or Medicare was denied, revoked, or
rescinded;
(3) the provider's name
appears on any state or federal exclusion list related to health care
services;
(4) the department has
documentation that indicates the provider is unable or unwilling to meet the
certification requirements of this section or any other Medicaid requirement
under 7 AAC 105 - 7 AAC 160;
(5)
the department has evidence that a provider's owner or administrator does not
operate honestly, responsibly, and in accordance with applicable laws in order
to maintain the integrity and fiscal viability of the medical assistance
program;
(6) based upon evidence
from an audit, provider review, or investigation, the department has probable
cause to believe that a provider's noncompliance with the Medicaid program or
7
AAC 125.010 -
7
AAC 125.199 causes immediate risk to the health,
safety, or welfare of a recipient or would be considered to be fraud, abuse, or
waste; or
(7) the provider has two
consecutive probationary certification periods under (b)(1) of this section and
is still not compliant to the department's satisfaction.
(f) If the department denies an initial
application or an application to renew certification, the department will send
written notice of the action and information regarding the provider's right to
appeal the decision under AS 44.64.
(g) The department may enter into a contract
under AS 36.30, a grant agreement, or another arrangement permitted by law,
with a provider or tribal health program that authorizes the provider or tribal
health program to provide personal care services to a specified group of
recipients or in a specific geographical area.
(h) A provider of personal care services
shall comply with the accounting, reporting, and cost survey requirements of
7
AAC 145.531 -
7
AAC 145.537.
Authority:AS
47.05.010
AS
47.07.030
