Current through November 28, 2024
(a) Except as specified in (j) of this
section, to receive payment for Community First Choice services under
7
AAC 127.040, a provider must enroll in the Medicaid
program under
7
AAC 105.210 and must be certified under this section.
To be certified by the department, a provider must
(1) submit an application and meet and comply
with the applicable standards of certification criteria, including
(A) the 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, if the provider seeks certification to
provide personal care services; or
(B) the provider qualifications and program
standards applicable to chore services under
7
AAC 127.087 and set out in the department's
Provider Conditions of Participation for Home and Community-Based
Waiver Services and Community First Choice Chore Services, adopted by
reference in
7
AAC 160.900, if the provider seeks certification to
provide chore services; and
(2) for each service under
7
AAC 127.040 that the provider plans to offer, comply
with the
(A) provisions of this chapter
applicable to each service; and
(B)
conditions of participation applicable to that service, adopted by reference in
7
AAC 160.900.
(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, this chapter, 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 a 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
provider under this chapter shall comply with this chapter and the requirements
of 7 AAC 105.200 -
7
AAC 105.280. The department will determine compliance
through 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 this chapter are provided. The department will conduct
compliance reviews under
7
AAC 125.190, and may
(1) request, in accordance with
7
AAC 105.240. records related to the services provided
under this chapter; 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 of a provider agency as a provider of Community First Choice
services if
(1) the provider fails to submit
a complete application under (a) of this section so that it is received by the
department not later than 30 days after the date of notice from the department
that the application is incomplete;
(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 the owner or administrator of a provider
agency 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 this chapter 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 of a provider, the
department will send, not later than 14 business days after the date of the
decision, written notice of the action and information regarding the provider's
right to appeal the decision under AS 44.64.
(g) Notwithstanding the provisions of this
section, if the department has reasonable cause to believe that the health,
safely, or welfare of a recipient is at risk, the department may immediately
suspend or revoke a provider's certification. If the department immediately
suspends or revokes certification under' this subsection, the department will
(1) give the provider initial notice, oral
or written, of the suspension or revocation of certification, including
information regarding the right to appeal; if no one is present to receive the
notice, the department will post the notice on the main entrance to the
building in which the provider agency is located; and
(2) not later than 14 business days after the
date of the suspension or revocation of certification issue a formal report
that includes information related to the action taken, the reason for the
action, and the right to appeal.
(h) The department may enter into a contract
under AS 36.30, a grant agreement, or another arragement permitted by law, with
a provider or tribal health program authorizing that provider or tribal health
program lo provide Community First Choice services to a specific group or in a
specific geographical area.
(i) A
provider of Community First Choice services shall comply with the accounting,
reporting, and cost survey requirements of
7
AAC 145.531 -
7
AAC 145.537.
(j) A provider certified under
7
AAC 130.220(a)(1) and enrolled in the
Medicaid program under
7
AAC 105.210 may render and receive payment for chore
services provided in accordance with
7
AAC 127.087.
Authority:AS
47.05.010
AS 47.07.030
AS 47.07.036
AS 47.07.040