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Alaska - Respite Care 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 Respite Care providers under 7 AAC 130.280 to deliver short-term relief across the state's Medicaid waivers, including the CCMC, ALI, APDD, and IDD programs. The service provides temporary relief to unpaid primary caregivers, ensuring the waiver participant maintains continuous supervision and support in their home or an approved facility.

Approval requires submitting the Cert-01 Waiver Services Provider Certification Application and securing an approved Program Administrator via form Cert-04 before an applicant can access the Alaska Medical Assistance Health Enterprise Portal for Medicaid enrollment. The state requires SDS certification to be fully completed and approved prior to initiating the Medicaid provider enrollment step.

1. Service Definition and Scope

In Alaska, Respite Care is defined under 7 AAC 130.280 as a service provided to individuals unable to care for themselves, furnished on a short-term basis to provide temporary relief to unpaid persons normally providing care. It can be delivered in the participant's home, the respite caregiver's home, or an approved non-private residential setting.

The service is available across multiple Home and Community-Based Services (HCBS) waivers, including the Complex Care Medical Children (CCMC) waiver, which currently operates without a waitlist. Respite cannot be billed concurrently with residential supported living or group home services where the facility is already paid for 24-hour care.

2. Regulatory and Oversight Agencies

The Alaska Department of Health (DOH) oversees the Medicaid program and HCBS waivers. Within DOH, the Division of Senior and Disabilities Services (SDS) is the primary operating agency responsible for certifying non-licensed respite agencies and managing waiver policy.

For facility-based respite (such as in an Assisted Living Home or Skilled Nursing Facility), the DOH Division of Health Care Services, Residential Licensing Unit handles facility licensure. Medicaid enrollment and claims processing are managed by Gainwell Technologies through the Alaska Medical Assistance Health Enterprise Portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

Alaska does not require a Certificate of Need (CON) for non-facility, in-home respite care agencies. There are currently no statewide moratoria, closed networks, or mandatory managed care subcontracting requirements blocking new in-home respite providers from applying.

However, a strict structural precondition exists: an applicant must designate a qualified Program Administrator using form Cert-04, and this individual must meet specific educational and experience requirements outlined in the Conditions of Participation. Furthermore, SDS certification is a mandatory prerequisite; the Medicaid enrollment application will be rejected if the provider does not already hold an active SDS certification.

4. Licensure and Certification Requirements

Providers seeking to offer in-home respite must apply for certification as an SDS Certified Respite Provider under 7 AAC 130.220. The application requires submission of the Cert-01 Waiver Services Provider Certification Application, along with specific service declarations for respite.

If the provider intends to offer respite in a facility setting, they must first obtain a State of Alaska license under AS 47.32 and 7 AAC 12.610 (for nursing facilities/hospitals) or 7 AAC 75 (for assisted living homes). SDS verifies provider qualifications every two years during the recertification process.

5. Medicaid Provider Enrollment

Once SDS certification is secured, providers must enroll through the Alaska Medical Assistance Health Enterprise Portal, managed by Gainwell Technologies. Providers must obtain a National Provider Identifier (NPI) prior to beginning the enrollment application.

Providers can enroll as an Individual Provider (sole proprietor) or a Group Provider. If enrolling as a group or incorporating, a Federal Tax Identification number and an application fee are required. Enrollment must be revalidated every three years.

6. Staffing, Training and Background Checks

All direct care workers and administrative staff with access to participants must clear a background check through the State of Alaska Background Check Program (BCP) before having contact with waiver participants. The agency must maintain an organizational chart detailing lines of authority from the owner down to direct care workers.

The Program Administrator must meet the minimum work experience and educational requirements specified in the Conditions of Participation. Direct care staff must complete Critical Incident Reporting training and maintain current CPR and First Aid certifications.

7. Documentation, Policies and Records

SDS requires applicants to submit specific policies and procedures with their Cert-01 application. Providers must not submit entire employee handbooks; only the specific policies required for Medicaid certification, clearly labeled, should be uploaded.

Required documentation includes a Certificate of Insurance, a business license, and a Quality Improvement Report (for renewal applications). Policies must address critical incident reporting, participant rights, and emergency response, adhering to the guidelines in the SDS Policy and Procedures Manual.

8. Billing, Rates and Claims

Respite services are billed to the Alaska Medical Assistance Health Enterprise Portal (MMIS). Providers can submit claims directly through the portal, via a clearinghouse, or using electronic health record software that supports EDI.

Rates for respite care are established by the DOH and published in the SDS rate schedule. Providers must ensure that claims are only submitted for authorized units reflected in the participant's SDS-approved Support Plan.

9. Approval Sequence and Timeline

The approval process is strictly sequential. The applicant must first establish their business entity and obtain an Alaska Business License. Next, they submit the Cert-01 application and Cert-04 to SDS for waiver certification.

Only after SDS issues the official certification can the provider apply for Medicaid enrollment through Gainwell Technologies. The entire process, from initial policy drafting to final MMIS enrollment, typically takes several months depending on the completeness of the application and SDS review queues.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied if the provider submits an entire, unedited employee handbook instead of the specific, separated policies requested by SDS. Failure to clearly label policies to match the application requirements will result in a return for corrections.

During surveys or recertification, common findings include failure to maintain current background check clearances for all staff, lapsed CPR/First Aid certifications, and billing for respite hours that exceed the authorized amount in the participant's Support Plan.

11. Key Contacts and Resources

The primary contact for certification questions is the SDS Provider Certification & Compliance Unit. They provide application guidance, forms, and technical assistance for prospective waiver providers.

For questions regarding the Medicaid enrollment application or portal access, providers should contact Gainwell Technologies Provider Enrollment.

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