Current through February 27, 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
