Alaska - Day Habilitation Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Alaska Department of Health, Division of Senior and Disabilities Services (SDS) certifies Day Habilitation providers under 7 AAC 130.260 to serve participants enrolled in the state's Home and Community-Based Services (HCBS) waivers. Alaska does not issue a traditional facility license for Day Habilitation centers; instead, agencies must pass a pre-certification desk review and obtain an SDS Provider Certification before they are legally permitted to operate or bill for this service.

An applicant cannot submit a Medicaid enrollment application through the Alaska Medicaid Health Enterprise Portal until the SDS certification is fully approved and issued. This sequential requirement means all policies, facility diagrams, and administrator qualifications must be vetted and approved by SDS before the state's Medicaid fiscal agent will even accept the enrollment packet.

1. Service Definition and Scope

In Alaska, Day Habilitation services provide active teaching or training that assists the recipient to acquire, retain, or improve the self-help, socialization, and adaptive skills necessary to live independently and fully integrated in home and community-based settings. The service is designed to reinforce skills taught in school or therapy, or to mitigate the impact of a degenerative condition.

Services must be provided in a non-residential setting, though the state allows up to 10 percent of the total units of service approved for a plan year to be provided in residential settings or via distance delivery if justified in the support plan. The service cannot duplicate other waiver services or provide only companionship.

• Regulation Citation: 7 AAC 130.260
• Annual Limit: Maximum of 624 hours each year of all types of day habilitation services from all providers combined, unless an exception is approved
• Group Staffing Ratio: At least one direct service worker to not more than 2 to 5 recipients in a group activity
• Setting Restriction: Must be provided in a non-residential setting, with residential or distance delivery capped at 10 percent of annual units
• Prohibited Activities: Cannot replace services eligible under the Individuals with Disabilities Education Act or Rehabilitation Act
• Required Assistance: Providers must assist recipients with walking, eating, toileting, and personal hygiene as needed

2. Regulatory and Oversight Agencies

The Alaska Department of Health (DOH) oversees the Medicaid program, with specific waiver operations delegated to the Division of Senior and Disabilities Services (SDS). SDS is responsible for reviewing provider applications, issuing certifications, and conducting ongoing compliance surveys.

Medicaid provider enrollment and claims processing are managed through the Alaska Medical Assistance Program, utilizing the state's fiscal agent portal.

• Certifying Agency: Alaska Division of Senior and Disabilities Services (SDS) (https://health.alaska.gov/dsds/)
• Enrollment Portal: Alaska Medicaid Provider Enrollment (https://www.medicaidalaska.com/)
• Oversight Department: Alaska Department of Health (https://health.alaska.gov/)
• Regulatory Code: Alaska Administrative Code (AAC) Title 7 (https://law.alaska.gov/doclibrary/doclib.html)

3. Gatekeeping Prerequisites: Who Can Even Apply

Alaska operates an open enrollment model for Day Habilitation services, meaning there are no closed networks, moratoria, or competitive procurement (RFP) requirements to become a provider. There is genuinely no Certificate of Need (CON) required for this service in Alaska.

The mandatory structural precondition is obtaining SDS Provider Certification prior to Medicaid enrollment. An agency cannot apply for a Medicaid provider number until SDS has reviewed their policies, administrator qualifications, and facility details, and issued a formal certification.

• Certificate of Need: None required for Day Habilitation in Alaska
• Network Status: Open enrollment; no closed networks or moratoria
• Prerequisite Approval: SDS Provider Certification must be obtained before Medicaid enrollment is accepted
• Managed Care Contracting: Not applicable; Alaska operates a fee-for-service model for these waivers

4. Licensure and Certification Requirements

Because Alaska does not issue a traditional facility license for Day Habilitation, providers must complete the SDS Provider Certification process. This involves submitting a comprehensive application packet that includes specific state forms, facility diagrams, and operational policies.

Providers must submit a Service Declaration form specific to the services they intend to provide, along with proof of local building or use permits for their facility.

• Administrator Form: Cert-04 Notice of Appointment or Change of Program Administrator
• Policy Form: Cert-37 Policy Assurances Form
• Facility Documentation: Building or Use Permit required for the physical location
• Space Documentation: Floor Diagram Showing Square Footage required for the facility
• Service Declaration: Must submit the specific Service Declaration form for the intended waiver services

5. Medicaid Provider Enrollment

Once SDS Certification is granted, the agency must enroll as a billing provider with the Alaska Medical Assistance Program. This is done entirely online through the Alaska Medicaid Provider Enrollment Portal.

Providers must pay the standard federal application fee (or provide proof of payment to Medicare or another state) and undergo screening based on their categorical risk level.

• Enrollment System: Alaska Medicaid Provider Enrollment Portal
• Application Fee: Subject to the federally established CMS application fee for institutional providers
• Revalidation: Providers must revalidate their Medicaid enrollment every 5 years
• Self-Audit Requirement: Providers must conduct a self-audit every two years and repay any overpayments

6. Staffing, Training and Background Checks

Alaska's Day Habilitation Conditions of Participation mandate specific age, education, and experience requirements for both Program Administrators and Direct Service Workers. All staff must pass comprehensive criminal background checks before providing services.

Administrators must possess a specific knowledge base regarding the habilitative needs of the population and the applicable SDS laws and policies.

• Administrator Age: Must be at least 21 years of age
• Administrator Education: Bachelor of Arts or Bachelor of Science degree, or equivalent experience
• Administrator Experience: One year of full-time experience in a human services setting with management responsibilities
• Direct Worker Age: Must be at least 18 years of age
• Direct Worker Education: High school diploma or general education development (GED) diploma
• Background Checks: Comprehensive criminal background check required for all staff prior to service delivery

7. Documentation, Policies and Records

SDS requires providers to develop and submit a specific set of operational policies during the certification process. These policies must align with the state's Conditions of Participation and waiver regulations.

Providers must maintain detailed records, including direct service case notes and critical incident reports, to justify the services billed and ensure participant safety.

• Required Policy: Critical Incident Reporting
• Required Policy: Restrictive Intervention
• Required Policy: Person-Centered Practice
• Required Policy: Medication Management
• Required Policy: Independence and Inclusion
• Record Retention: Must maintain current and prior year assessments and support plans

8. Billing, Rates and Claims

Day Habilitation services are billed to the Alaska Medical Assistance Program using specific HCPCS procedure codes and modifiers that denote the waiver and service type. Claims are submitted through the state's MMIS portal.

Rates are established by the Department of Health and published in the SDS fee schedule. Providers must ensure that billed units do not exceed the authorized amounts in the participant's support plan.

• Billing System: Alaska Medicaid Health Enterprise Portal
• Prior Authorization: Services must be explicitly approved in the recipient's support plan prior to delivery
• Unit Limit: Hard cap of 624 hours annually unless a specific exception is documented and approved
• Rate Publication: Rates are published in the official SDS HCBS Fee Schedule

9. Approval Sequence and Timeline

The approval process is strictly sequential. An agency must first prepare its facility, hire a qualified administrator, and draft all required policies to submit the SDS Certification packet.

Only after SDS conducts its review and issues the certification can the agency apply for Medicaid enrollment. The entire process from initial policy drafting to active billing status typically takes several months.

• Step 1: Secure facility and obtain local building/use permits
• Step 2: Appoint qualified Program Administrator and submit Cert-04
• Step 3: Submit complete SDS Provider Certification packet including all policies
• Step 4: Receive approved SDS Provider Certification
• Step 5: Submit Medicaid enrollment application via the state portal
• Step 6: Receive Medicaid provider number and begin service delivery

10. Common Denials and Survey Findings

Applications for SDS Certification are frequently delayed or denied due to incomplete policy submissions or failure to provide required facility documentation, such as floor plans with square footage.

During ongoing compliance surveys, common findings include inadequate documentation of staff training, missing background checks, and failure to submit critical incident reports within the required timeframes.

• Application Delay: Missing or incomplete Policy Assurances Form (Cert-37)
• Application Delay: Failure to provide a floor diagram showing square footage
• Survey Finding: Direct service workers lacking required high school diploma or GED documentation
• Survey Finding: Billing for services that exceed the 624-hour annual limit without prior approval
• Survey Finding: Failure to maintain required 1:2 to 1:5 staffing ratios during group activities

11. Key Contacts and Resources

Prospective providers should rely on the official Alaska Department of Health websites for the most current forms, fee schedules, and regulatory updates.

The SDS Provider Certification team and the Medicaid Provider Enrollment helpdesk are the primary points of contact for navigating the approval process.

• SDS Provider Certification: https://health.alaska.gov/dsds/Pages/provider/default.aspx
• Medicaid Provider Enrollment Portal: https://www.medicaidalaska.com/
• Alaska Department of Health: https://health.alaska.gov/
• Service Authorizations Info: https://health.alaska.gov/en/education/service-authorizations

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