Alaska - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Alaska’s Department of Health, Division of Senior and Disabilities Services (SDS) certifies agencies to deliver Personal Care Services (PCS) and Community First Choice (CFC) PCS under regulation 7 AAC 125.060. Agencies must secure this SDS certification using form Cert-36 before they can enroll in the Alaska Medical Assistance Program to bill for hands-on assistance with activities of daily living.

The mandatory structural gate for new agencies is the approval of a qualified Program Administrator who must document at least one year of human services delivery experience and one year of supervisory experience, and who must complete the SDS-mandated personal care services agency training course within three months of hire. Providers choose between Agency-Based and Consumer-Directed service models, with Agency-Based requiring a designated Supervising Nurse to oversee care delivery.

1. Service Definition and Scope

In Alaska, Personal Care Services (PCS) and Community First Choice (CFC) PCS provide hands-on physical assistance, cueing, and supervision for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). These services are designed to prevent institutionalization and are delivered in the recipient's home or community.

Providers can operate under an Agency-Based model, where the agency hires, trains, and schedules the Personal Care Assistants (PCAs), or a Consumer-Directed model, where the recipient manages the PCA while the agency handles administrative and financial backing.

• Service Name: Personal Care Services (PCS) and Community First Choice (CFC) PCS
• Regulatory Citation: 7 AAC 125.010 through 7 AAC 125.199 (PCS) and 7 AAC 127.050 (CFC)
• Agency-Based Model: Requires a Supervising Nurse to oversee PCAs and manage recipient care plans
• Consumer-Directed Model: Recipient is responsible for training, scheduling, and supervising the PCA directly
• Covered Tasks: Bathing, dressing, transferring, toileting, eating, and light housekeeping directly related to the recipient's care

2. Regulatory and Oversight Agencies

The Alaska Department of Health (DOH) divides oversight between two primary divisions. The Division of Senior and Disabilities Services (SDS) handles the programmatic certification, training, and quality assurance for PCS providers.

The Division of Health Care Services (DHCS) manages the Medicaid state plan, while Conduent operates the Alaska Medical Assistance Program provider enrollment portal and MMIS for claims processing.

• Certifying Agency: Division of Senior and Disabilities Services (SDS) (https://health.alaska.gov/dsds/)
• Medicaid Authority: Division of Health Care Services (DHCS) (https://health.alaska.gov/dhcs/)
• Enrollment Portal: Alaska Medicaid Provider Portal (https://www.medicaidalaska.com)
• Licensing Alternative: Health Facilities Licensing and Certification (HFLC) for Home Health Agencies (https://health.alaska.gov/dhcs/Pages/hflc/default.aspx)

3. Gatekeeping Prerequisites: Who Can Even Apply

Alaska does not require a Certificate of Need or an RFP procurement to become a PCS provider, but it strictly gates application acceptance on the pre-qualification of the agency's Program Administrator. The agency must submit a Notice of Appointment or Change of Program Administrator Form (Cert-04) proving the administrator meets specific human services and supervisory experience thresholds.

Additionally, the agency must hold an active State of Alaska business license and secure commercial general liability, workers' compensation, and automobile insurance before submitting the Cert-36 application.

• Administrator Experience Gate: Program Administrator must have one year of full-time human services delivery experience plus one year of supervisory experience in a human services setting
• Administrator Training Gate: The Program Administrator must attend the SDS personal care services agency training course within three months of hire
• Business Licensure: Must hold an active State of Alaska business license prior to application
• Insurance Pre-requisite: Must provide Certificates of Insurance for General Liability, Workers Compensation, and Automobile coverage
• Model Selection: Must explicitly apply for either Agency-Based or Consumer-Directed certification (or both) on the initial application

4. Licensure and Certification Requirements

Standalone PCS providers do not require a Home Health Agency license from HFLC unless they also provide skilled nursing or therapy services. Instead, they must obtain PCS Provider Certification directly from SDS by submitting the Cert-36 application packet.

The certification process requires submission of comprehensive operational policies, an organizational chart, and a personnel list. Certifications must be renewed biennially, requiring a Quality Improvement Report (Cert-50).

• Application Form: Cert-36 PCS Provider Certification Application
• Administrator Form: Cert-04 Notice of Appointment or Change of Program Administrator
• Policy Submission: Must submit policies covering critical incident reporting, emergency response, restrictive interventions, and financial accountability
• Renewal Cycle: Certification must be renewed biennially
• Renewal Requirement: Must submit the Quality Improvement Report (Cert-50) with renewal applications

5. Medicaid Provider Enrollment

After receiving the SDS certification letter, the agency must enroll as a billing provider through the Alaska Medical Assistance Program portal. The enrollment links the agency's NPI and tax ID to their specific PCS taxonomy and SDS certification.

Individual Personal Care Assistants do not enroll as independent billing providers; they render services under the umbrella of the certified and enrolled PCS agency.

• System: Alaska Medicaid Health Enterprise Portal operated by Conduent
• Prerequisite: Must upload the active SDS PCS Certification approval letter during enrollment
• Provider Type: Enrolls as an atypical or standard agency provider depending on exact NPI usage for waiver services
• Individual Rendering Providers: PCAs are managed by the agency and do not bill Medicaid directly
• Revalidation: Medicaid enrollment must be revalidated every five years, separate from the biennial SDS certification

6. Staffing, Training and Background Checks

Alaska regulations (7 AAC 125.090 and 7 AAC 127.105) dictate strict qualifications for Personal Care Assistants. Agencies must ensure all PCAs pass a State of Alaska background check through the Department of Health Background Check Program (BCP) before having client contact.

Agency-Based providers must employ a Supervising Nurse (an Alaska-licensed RN) to conduct recipient assessments, develop care plans, and evaluate PCA competency.

• Background Check: Mandatory fingerprint-based check through the Alaska DOH Background Check Program (BCP)
• PCA Qualifications: Must meet standards outlined in 7 AAC 125.090, including CPR/First Aid certification
• Supervising Nurse: Agency-Based models require an active Alaska-licensed Registered Nurse
• Competency Evaluation: The agency must implement a process to evaluate whether the PCA provides quality care and identify skills needing development
• Incident Training: Staff must complete SDS Critical Incident Report Training and hold the corresponding certificate

7. Documentation, Policies and Records

SDS requires PCS agencies to maintain detailed records of service delivery, recipient support plans, and critical incidents. Agencies must coordinate with CFC care coordinators regarding support plans and amendments.

The Provider Conditions of Participation mandate specific written policies, including emergency response, evaluation of employees, and termination/transfer of provider services.

• Care Coordination: Must document coordination with the recipient’s care coordinator if the recipient is on a HCBS waiver
• Timesheets: Must maintain verifiable timesheets signed by the recipient or their representative confirming service delivery
• Critical Incidents: Must have a documented policy for and maintain logs of critical incident reporting to SDS
• Personnel Records: Must keep files containing background check clearances, CPR/First Aid cards, and competency evaluations
• Quality Improvement: Must maintain ongoing data collection to support the biennial Cert-50 Quality Improvement Report

8. Billing, Rates and Claims

PCS and CFC services are billed to the Alaska Medical Assistance Program using standard HCPCS codes on professional claims (CMS-1500 or 837P). Rates are established by the Department of Health and published in the SDS fee schedule.

Agencies must designate a specific individual responsible for billing Medicaid on their Cert-36 application and ensure claims strictly match the authorized units in the recipient's approved care plan.

• Billing System: Alaska Medicaid MMIS via Conduent
• Claim Format: 837P electronic or CMS-1500 paper claims
• Prior Authorization: Services must be prior-authorized by SDS based on the recipient's assessment and care plan
• Rate Setting: Fixed fee-for-service rates published in the Alaska DHCS/SDS Medicaid Fee Schedule
• Billing Contact: Must explicitly name the individual or contractor responsible for Medicaid billing on the Cert-36 form

9. Approval Sequence and Timeline

The approval sequence begins with establishing the business entity and hiring a qualified Program Administrator. The agency then submits the Cert-36 application packet, including all policies and the Cert-04 form, to SDS for review.

Once SDS approves the certification, the agency applies for Medicaid enrollment through Conduent. The entire process typically takes several months depending on SDS review queues and background check processing times.

• Step 1: Obtain Alaska Business License and commercial insurance
• Step 2: Hire Program Administrator and submit Cert-04 for SDS approval
• Step 3: Submit complete Cert-36 PCS Provider Certification Application with all policies
• Step 4: Administrator completes SDS training within 3 months of hire
• Step 5: Receive SDS Certification and apply for Medicaid Provider Enrollment via Conduent

10. Common Denials and Survey Findings

SDS frequently returns initial applications that are incomplete; applications missing required attachments like the organizational chart or insurance certificates are not reviewed and must be resubmitted in their entirety.

During audits or renewals, common findings include failure to maintain current background check clearances for PCAs, missing signatures on timesheets, and failure to submit the Cert-50 Quality Improvement Report.

• Incomplete Applications: Cert-36 packets missing the Cert-04, insurance, or policies are rejected without review
• Administrator Qualifications: Denials occur if the proposed Program Administrator lacks the required 1-year supervisory experience
• Background Checks: Citations for allowing PCAs to provide care before the BCP clearance is fully approved
• Care Plan Deviations: Billing for tasks or hours not explicitly authorized in the SDS-approved support plan
• Training Lapses: Failure of the Program Administrator to complete the mandatory SDS training within the 3-month window

11. Key Contacts and Resources

Prospective providers should regularly consult the Division of Senior and Disabilities Services (SDS) provider page for updated forms, training schedules, and certification guidance.

For billing and enrollment technical assistance, providers interact with Conduent, the fiscal agent for the Alaska Medical Assistance Program.

• Division of Senior and Disabilities Services (SDS): https://health.alaska.gov/dsds/
• SDS Provider Certification Page: https://health.alaska.gov/dsds/Pages/provider/default.aspx
• Alaska Medicaid Provider Enrollment (Conduent): https://www.medicaidalaska.com
• Division of Health Care Services (DHCS): https://health.alaska.gov/dhcs/
• Alaska Background Check Program (BCP): https://health.alaska.gov/dhcs/Pages/bcp/default.aspx

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