Providers of Waiver Services (SDS)

This includes Provider Agencies, Direct Service Professionals, Care Coordinators, and Legally Responsible Individuals (LRI.)

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Description of Flexibilities Affected

Important Update Regarding Legally Responsible Individuals (LRI)
The Centers for Medicare and Medicaid Service (CMS) announced this week that states can opt to apply for a new 1115 Covid-19 demonstration waiver that includes extending the flexibility to allow legally responsible individuals (LRIs) to serve as paid providers of Medicaid state plan personal care services for six months beyond the end of the federal Public Health Emergency (PHE).  

The Alaska Department of Health has applied to CMS for permission to continue this flexibility for services provided May 12, 2023, through November 11, 2023.

When approved, it will align with the current flexibility for LRIs to be paid to provide certain Medicaid waiver services (day habilitation, residential habilitation in home supports and supported living, and respite) consistent with the previously-approved Appendix K waiver amendments.   

Providers may continue using the flexibility pending CMS approval. The state will hold providers harmless in the highly unlikely situation that CMS does not approve the state’s 1115 Covid-19 demonstration waiver.   

The following flexibilities will end on May 11, 2023 (end of PHE):

  • Proof of First Aid and Cardiopulmonary Resuscitation (FA/CPR)
    • As of May 11, 2023, proof of First Aid and Cardiopulmonary Resuscitation (FA/CPR) will again be required for all DSPs (providing State Plan and waiver services). However, the Conditions of Participation for Personal Care Services and Community First Choice Personal Care Services have been amended to remove the hands-on skills check requirement for CPR, allowing all FA/CPR training to now be obtained entirely on-line.
  • Flexibility to receive additional Chore services due to COVID.
    • SDS will not authorize additional Chore hours due to COVID after May 11, 2023. If more hours are needed, an amendment requesting the increase should be filed.
  • Verbal Attestations
    • After May 11, 2023, signatures will be required. Please see the FAQ for more information.
  • Medical Documentation with Applications (Home and Community Based Waiver, Community First Choice, and Personal Care Services).
    • Medical records, Qualifying Diagnosis Certification (QDC), and Verification of Diagnosis (VOD) will be required for all applications submitted on or after May 11, 2023.
    • Best practices for requesting medical records:
      • Make requests to providers in advance to allow providers at least 10 business days to process requests.
      • Only request and submit medical records that support and document the applicant’s diagnosis and needed supports.
      • If Care Coordinators or Personal Care Administrators cannot get medical records from providers prior to an application deadline, they should file a centralized report that will be routed to the Quality Assurance Unit. Provide details about the dates and times that records were requested from the provider in the report.
      • Centralized Reporting
      • To request technical assistance or for further guidance on this subject, contact SDS at
  • Additional payment of monthly Targeted Case Management supporting Infant Learning Programs.
    • Providers can submit one final billing for two units of TCM in April 2023, since TCM is a monthly unit. Please direct questions to Susan Kessler.
  • For personal care services, Community First Choice personal care and chore services, and long term services and supports targeted case management services:
    • Allowing these services to be provided in alternative settings.
    • Allowing these services to be provided via telehealth (using distance delivery technology), except as permitted in 7 AAC 110.635.
    • Allowing these services to be provided without the direct support professional (DSP) employee to have proof of First Aid and Cardiopulmonary Resuscitation (FA/CPR) on file.

    The following flexibilities will continue until November 11, 2023:

    • Legally Responsible Individuals (LRI)
      • Flexibility to pay legally responsible individuals to provide state plan and waiver services.

    SDS E-Alert: Medicaid Telehealth Flexibilities Extended

    April 26, 2023
    SDS shares the following message that was sent out recently via Remittance Advice by the Division of Health Care Services concerning continuation of telehealth delivery until pending amendments to telehealth regulations are finalized.

    "The Department of Health is pleased to announce that, following consultation with the Alaska Department of Law, the decision has been made, consistent with HB 265 which was enacted in 2022, to extend Medicaid telehealth flexibilities beyond May 11, 2023, until proposed regulations are effective. The Division of Health Care Services, Medicaid Operations Unit, will issue additional information in the coming days to ensure that providers are aware of all federal and state requirements."

    NOTE: Telehealth flexibilities for certain 1915(c) waiver services are approved by CMS via Appendix K through November 11, 2023. After that, SDS will implement regulations made effective date September 18, 2022, that have been superseded by CMS’ Appendix K approval. The pending regulations amendments include the content of the September 19, 2022, amendments on telehealth delivery of certain HCBS services.


    CLARIFICATION: Use of electronic signatures

    • All current or potential recipients and providers may use electronic signatures to sign official SDS documents submitted by any method. Approval via signature (whether original or electronic) is different from approval via attestation. Attestations are allowed only while the Appendix K flexibilities approved by CMS remain in effect (November, 2023).
    • For more detail, please read theSDS Director's Memo on Use of Electronic Signatures and reviewthe latest information post on the SDS Director Communications page.

    Short Support Plan Guidance 

    The Appendix K Short Support Plan form will be retired as of June 30, 2023, and will not be accepted after that date. SDS is developing a permanent Short Support Plan form and process. SDS will provide additional information and training on this topic in the near future.