Section 7 AAC 125.060 - Personal care services agency certification and enrollment(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.Eff. 2/1/2010, Register 193; am 1/26/2012, Register 201; am 7/22/2017, Register 223, October 2017; am 10/1/2018, Register 227, October 2018; am 10/16/2022, Register 244, January 2023 Authority:AS 47.05.010
AS 47.07.030