Current through November 28, 2024
(a) An individual
may not provide care coordination services unless
(1) the department certifies the individual
under this section;
(2) the
individual is enrolled in the Medicaid program under
7
AAC 105.210; and
(3) the individual is an owner of or employed
by a care coordination services provider agency certified under
7
AAC
130.220(a)(2).
(b) For the department to certify an employee
as a care coordinator,
(1) that employee must
(A) meet the applicable standards of
certification criteria, including the care coordination qualifications and
program standards set out in the department's
Care Coordinator
Certification Application, adopted by reference in
7
AAC 160.900; and
(B) meet the applicable standards of
certification criteria, including the care coordination qualifications and
program standards set out in the department's
Care Coordination
Services and long Term Services and Supports Targeted Case Management
Conditions of Participation, adopted by reference in
7
AAC 160.900; and
(2) the provider must certify in writing to
the department that the employee
(A) meets
and complies with the requirements of the department's
Care
Coordination Services and Long Term Services and Supports Targeted Case
Management Conditions of Participation, adopted by reference in
7
AAC 160.900;
(B) is employed by that provider;
and
(C) meets that provider's
employment standards to provide care coordination
services.
(c)
The department will certify a provider who meets and complies with the
standards of certification for a
(1)
probationary certification of one year 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 (b) 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 (b) of this section in the preceding
certification periods.
(d) Not later than 90 days before the
expiration of a care coordinator's certification, the department will send to
the care coordinator notice of the requirement to renew that certification. The
care coordinator must submit a new application for certification in accordance
with (b)(1)(A) of this section not later than 60 days before the expiration
date of the current certification.
(e) The department will deny certification of
an employee or renewal of a care coordinator's certification, or will decertify
a care coordinator if
(1) the individual
failed to submit a complete application in accordance with (b)(1)(A) of this
section so that it is received by the department not later than 30 days after
the date of any notice from the department that the application is
incomplete;
(2) the individual's
certification, license, or enrollment related to Medicaid or Medicare was
denied, revoked, or rescinded;
(3)
the individual's name appears on any state or federal exclusion list related to
health services;
(4) the department
has documentation that indicates that the individual
(A) is unable or unwilling to meet the
certification requirements of this section or any other Medicaid requirement
under 7 AAC 105 - 7 AAC 160; or
(B)
creates a risk to the health, safety, or welfare of a recipient;
or
(5) the individual has
two consecutive probationary certification periods under (c)(1) of this section
and is still not compliant to the department's
satisfaction.
(f) A care
coordinator may appeal, under
7
AAC 105.460, a decision by the department to
(1) deny the care coordinator's application
for certification, to renew certification, or for re-enrollment; or
(2) decertify the care
coordinator.
Authority:AS
47.05.010
AS 47.07.030
AS
47.07.040
