Alaska - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Alaska, Medicaid Home and Community-Based Services (HCBS) case management is officially designated as Care Coordination. This service is the linchpin of Alaska’s waiver programs (including ALI, APDD, CCMC, IDD, and ISW), responsible for conducting assessments, developing the Person-Centered Support Plan (PCSP), referring participants to direct service providers, and conducting ongoing monitoring of the participant's health, safety, and service utilization.

The single biggest structural barrier to entry for this service in Alaska is the strict enforcement of Conflict-Free Case Management (CFCM) coupled with a mandatory, state-administered individual certification process. Alaska does not utilize a Request for Proposals (RFP) or Certificate of Need (CON) for this service, meaning the network is technically open. However, an agency cannot even apply for Medicaid enrollment until its individual care coordinators have passed the Alaska Division of Senior and Disabilities Services (SDS) training and exam, and the agency has proven structurally and financially that it does not provide direct waiver services (like residential habilitation or supported employment) to the same individuals it coordinates care for.

1. Service Definition and Scope

Care Coordination in Alaska is defined under the Alaska Administrative Code (7 AAC 130.238) as a service that assists participants in gaining access to needed waiver and other State Plan services, as well as medical, social, and educational resources. The Care Coordinator acts as the independent advocate and organizer of the participant's care.

The scope of work requires the provider to guide the participant through the initial and annual assessment processes, draft the PCSP, and maintain continuous contact to ensure services are delivered as authorized and remain appropriate for the participant's acuity level.

• Regulatory Authority: Governed by 7 AAC 130.238 (Care Coordination Services) and 7 AAC 130.240 (Care Coordinator Certification)
• Assessment Facilitation: Assisting the state or its designees in completing the Consumer Assessment Tool (CAT) or Uniform Needs Assessment
• PCSP Development: Drafting the Person-Centered Support Plan in collaboration with the participant and their chosen team
• Service Linkage: Identifying and referring the participant to qualified, enrolled Medicaid providers for direct care
• Ongoing Monitoring: Conducting required monthly or quarterly face-to-face and telephonic contacts to verify service delivery and participant welfare
• Incident Management: Reporting and following up on critical incidents involving the participant within state-mandated timeframes

2. Regulatory and Oversight Agencies

The oversight of Care Coordination in Alaska is bifurcated between the division that manages the HCBS waivers and certifies providers, and the division that handles Medicaid billing and claims.

Providers must maintain compliance with both entities, utilizing state-specific portals for certification maintenance, incident reporting, and claims submission.

• Alaska Department of Health (DOH): The umbrella state agency overseeing all Medicaid and public health programs (https://health.alaska.gov)
• Division of Senior and Disabilities Services (SDS): The operating agency for HCBS waivers that sets policy, approves PCSPs, and monitors care coordinators (https://health.alaska.gov/en/senior-and-disabilities-services)
• SDS Provider Certification & Compliance Unit: The specific unit within SDS responsible for reviewing applications, issuing provider certifications, and conducting compliance surveys (https://health.alaska.gov/en/senior-and-disabilities-services/provider-certification-and-compliance/)
• Alaska Medicaid (Division of Health Care Services): The division responsible for the financial administration of the Medicaid program and provider enrollment
• Alaska Medical Assistance Health Enterprise Portal: The state's Medicaid Management Information System (MMIS) used for provider enrollment and billing (https://www.medicaidalaska.com)

3. Gatekeeping Prerequisites: Who Can Even Apply

Alaska does not restrict Care Coordination through a Certificate of Need (CON), competitive procurement (RFP), or closed managed care networks. The state operates an open-enrollment fee-for-service model for HCBS waivers.

However, strict structural prerequisites block applications from moving forward. The most critical is the Conflict-Free Case Management (CFCM) mandate. Agencies that provide direct care services (like group homes or personal care) cannot provide care coordination to the same individuals, and SDS heavily scrutinizes business structures to prevent self-referral.

• Certificate of Need (CON): Not required for Care Coordination agencies in Alaska
• Procurement/RFP: None; this is an open-enrollment provider type for those who meet certification standards
• Conflict-Free Mandate: Applicant must submit a CFCM attestation and organizational chart proving they will not coordinate care for individuals to whom they provide direct services
• Alaska Business License: Must hold an active business license issued by the Alaska Division of Corporations, Business and Professional Licensing prior to application
• Background Check Clearance: The agency owner, administrator, and all care coordinators must clear the Alaska Background Check Program (BCP) before the SDS application is submitted
• Physical Presence: The provider must maintain a physical business address within the State of Alaska to facilitate participant meetings and state audits

4. Licensure and Certification Requirements

Alaska does not issue a traditional facility "license" for Care Coordination agencies. Instead, the state requires Provider Certification through the SDS Provider Certification & Compliance Unit, governed by 7 AAC 130.220.

Certification is a two-tiered process: the agency itself must be certified as a provider, and every individual performing the duties must hold an active Care Coordinator Certification from SDS.

• Agency Certification: Must submit the SDS Provider Certification Application with all required policies, procedures, and business documentation
• Individual Certification: Each care coordinator must apply for and receive individual certification under 7 AAC 130.240
• Mandatory Training: Individuals must complete the SDS-approved Initial Care Coordinator Training program before certification is granted
• Certification Exam: Candidates must pass the SDS Care Coordinator Certification Examination with a score of 80% or higher
• Renewal Timeframe: Provider certification and individual care coordinator certifications must be renewed every two years
• Continuing Education: Certified care coordinators must complete a minimum of 24 hours of approved continuing education during each two-year certification period

5. Medicaid Provider Enrollment

Once SDS Provider Certification is obtained, the agency must enroll as a billing provider with Alaska Medicaid. This is done exclusively online through the Alaska Medical Assistance Health Enterprise Portal.

Medicaid enrollment cannot be initiated until the SDS certification letter is in hand. The enrollment process links the agency's National Provider Identifier (NPI) to the state's MMIS for claims processing.

• Enrollment Portal: Applications must be submitted via the Alaska Medical Assistance Health Enterprise Portal (https://www.medicaidalaska.com)
• Provider Type: Must enroll under the specific provider type and specialty codes designated for HCBS Care Coordination
• Application Fee: Subject to the federal Medicaid/Medicare institutional provider application fee (approx. $709 for 2024), unless waived by proof of prior payment to Medicare or another state
• Required Attachments: Must upload the SDS Provider Certification letter, IRS W-9, and proof of liability insurance
• Site Visit: Subject to a pre-enrollment site visit by the state or its contractor as part of federal high-risk screening requirements
• Revalidation: Medicaid enrollment must be revalidated every five years, independent of the two-year SDS certification renewal

6. Staffing, Training and Background Checks

Alaska sets strict educational and experiential baselines for anyone acting as a Care Coordinator. Agencies cannot hire individuals who do not meet these minimums, as they will be rejected during the individual certification process.

All staff must clear the state's centralized background check system before having any contact with participants or accessing their protected health information.

• Education/Experience Track 1: Bachelor's degree in a human services field plus one year of full-time experience in human services
• Education/Experience Track 2: Registered Nurse (RN) licensed in Alaska plus one year of full-time experience in human services
• Education/Experience Track 3: High school diploma or equivalent plus four years of full-time experience in human services
• Background Check Program (BCP): Mandatory fingerprint-based clearance through the Alaska Department of Health BCP (7 AAC 10.900) prior to hire
• CPR and First Aid: Must maintain current certification in cardiopulmonary resuscitation (CPR) and basic first aid
• Mandated Reporter Training: Must complete state-approved training on reporting abuse, neglect, and exploitation of vulnerable adults and children

7. Documentation, Policies and Records

Care Coordination is a highly documented service. SDS auditors frequently review agency records to ensure that contacts are being made, plans are being updated, and participants are actively engaged in their care.

Agencies must maintain a comprehensive Policy and Procedure Manual that aligns with 7 AAC 130.220 and specific waiver conditions.

• Person-Centered Support Plan (PCSP): Must be updated annually or whenever the participant's needs change, using the SDS-mandated format
• Contact Notes: Detailed case notes for every telephonic and face-to-face contact, documenting the date, time, duration, and content of the interaction
• Critical Incident Reporting (CIR): Policies must dictate the immediate reporting of critical incidents to SDS via the Harmony data system within 24 hours
• Grievance Policy: Must maintain a documented participant grievance procedure, including how complaints are logged, investigated, and resolved
• HIPAA Compliance: Secure physical and electronic storage of all participant records, retaining them for a minimum of seven years
• Quality Assurance: Must implement an internal quality improvement program to periodically review case files for accuracy and compliance

8. Billing, Rates and Claims

Care Coordination services are billed on a fee-for-service basis through the Alaska Medical Assistance Health Enterprise Portal. Rates are standardized and published by the Department of Health.

Providers must ensure that an active Service Authorization (SA) is in place before billing; claims submitted without a matching SA in the MMIS will be automatically denied.

• Billing System: Claims are submitted electronically via the Health Enterprise Portal or through an approved clearinghouse using 837P transactions
• Procedure Codes: Typically billed using HCPCS code T1016 (Case management, each 15 minutes), though specific modifiers may apply based on the waiver
• Rate Schedule: Reimbursed according to the published Alaska Medicaid HCBS Fee Schedule (rates are uniform statewide, with no geographic differentials for this service)
• Service Authorization (SA): Billing is strictly tied to the units approved in the participant's SA; overbilling will result in recoupment
• Timely Filing: Claims must be submitted within 12 months of the date of service
• Third-Party Liability (TPL): Medicaid is the payer of last resort; providers must verify if the participant has other insurance that covers case management

9. Approval Sequence and Timeline

Becoming a fully enrolled Care Coordination agency in Alaska is a sequential process that cannot be rushed, largely due to the training and background check bottlenecks.

Prospective providers should plan for a 3 to 6-month runway from the initial business setup to the approval of their first Medicaid claim.

• Step 1: Business Setup & BCP (Weeks 1-4): Register the business in Alaska, obtain an NPI, and submit all staff through the Alaska Background Check Program
• Step 2: Training & Exam (Weeks 4-8): Staff complete the SDS Initial Care Coordinator Training and pass the certification exam
• Step 3: SDS Certification (Weeks 8-16): Submit the Provider Certification Application to SDS and await review, corrections, and final approval letter
• Step 4: Medicaid Enrollment (Weeks 16-20): Submit the enrollment application via the Health Enterprise Portal, pay the fee, and undergo screening
• Step 5: Harmony Access (Weeks 20-22): Request and receive access to the SDS Harmony system to begin managing participant records and PCSPs
• Total Timeline: Typically 4 to 6 months, heavily dependent on the availability of SDS training cohorts and state processing queues

10. Common Denials and Survey Findings

The SDS Provider Certification & Compliance Unit conducts routine and unannounced audits. Failure to maintain strict adherence to waiver rules frequently results in corrective action plans (CAPs) or decertification.

At the application stage, most delays are caused by incomplete policies or failure to properly document the required experience of the care coordinator candidates.

• CFCM Violations: Denials or decertification for steering participants to direct care agencies owned by the care coordinator's relatives or business partners
• Incomplete Background Checks: Allowing staff to begin training or work before the final BCP clearance is issued
• Lapsed Certifications: Failure to complete the required 24 hours of continuing education, resulting in the expiration of the individual care coordinator certification
• PCSP Delays: Audit findings for failing to submit the annual PCSP and assessment documents to SDS before the previous plan expires
• Inadequate Case Notes: Recoupment of funds due to billing for 15-minute units without corresponding, detailed contact notes justifying the time spent
• Missing Signatures: Failure to obtain the participant's signature on the PCSP or choice of provider forms

11. Key Contacts and Resources

Navigating the Alaska Medicaid and SDS landscape requires utilizing the correct state portals and helpdesks. Providers should bookmark these essential resources.

When in doubt regarding policy interpretations, providers should contact the SDS Provider Certification & Compliance Unit directly rather than relying on third-party advice.

• SDS Provider Certification & Compliance Unit: Email info@alaska.gov or call 907-269-3666 for certification questions (https://health.alaska.gov/en/senior-and-disabilities-services/provider-certification-and-compliance/)
• Alaska Medical Assistance Provider Enrollment: Call 800-770-5650 for Health Enterprise Portal assistance (https://www.medicaidalaska.com)
• Alaska Background Check Program (BCP): Manages all required fingerprinting and clearances (https://health.alaska.gov/dhcs/Pages/bcp/default.aspx)
• SDS Training Unit: Coordinates the mandatory Initial Care Coordinator Training and exams (https://health.alaska.gov/dsds/Pages/training/default.aspx)
• Alaska Division of Corporations, Business and Professional Licensing: For initial business registration (https://www.commerce.alaska.gov/web/cbpl/)

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