Teleassessment

Many statewide providers have partnered with the Division of Senior and Disabilities Services (“SDS”) to provide access to audio, visual, or data communication methods for teleassessments. An assessment is required to determine if an individual is eligible for Home and Community Based Waiver Services (HCBW), Community First Choice Services (CFC), and Personal Care Services (PCS).

SDS assessors conduct either a teleassessment or an in-person assessment, to determine eligibility based on the level of care needed.
Individuals receiving Home and Community Based Waiver Services, and Community First Choice Services are assessed annually. People receiving Personal Care Services are re-evaluated from a random drawing of PCS recipients annually or in the event of a qualifying material change. Both assessments and ongoing evaluations, as well as other follow-up meetings, can be completed by SDS using teleassessment.

Our What to Expect from SDS Teleassessment Brochure explains the process. Teleassessments save travel costs and are also not affected by bad weather, which often delays in-person assessments in rural Alaska.

Provider partners

1. Aleutian Pribilof Islands Association
2. Bristol Bay Health Corp.
3. Cordova Community Medical Center
4. Eastern Aleutian Tribes
5. Hope Community Resources
6. Maniilaq Association
7. Norton Sound Health Corp.
8. Providence Valdez Counseling Center
9. South Peninsula Behavioral Health
10. Yukon Kuskokwim Health Corp.

Provider Agreement Information

• Provider Agreements general Regulation - 7 AAC 81
• Telehealth Provider Agreement Questions and Answers
• Protocols for Telehealth Assessment
• Video Conferencing Requirements

Please note that all the forms displayed here are strictly to be used as a sample reference.

Provider Agreement Contact Information:

Anna Ramirez
Grants Administrator III
DOH FMS Grants & Contracts
PO Box 110650
Juneau, AK 99811-0650
Phone: 907-465-5079 (On Wednesdays Only)
Fax: 907-465-8678
Anna.Ramirez@alaska.gov

Note: If you would like to be one of our Telehealth Providers, please contact Anna Ramirez at Anna.Ramirez@alaska.gov for a copy of Telehealth Provider Agreement documents.

Provider Reimbursement

• Facilitation Site Fee Invoice Sample
• Telehealth Invoice Questions and Answers

Please note that all the forms displayed here are strictly to be used as a sample reference and not as an official form to apply.

Important Notes for Applicants and Forms for Applicants

If you are a Care Coordinator or a Personal Care Services Agency for a client that would like to have a teleassessment or, you received a communication from the SDS notifying you of that possibility, please make sure to turn in the following documents with your client’s application:

• TELE 01 - Environmental Questionnaire
• TELE-02 Consent for Teleassessment
• A legible and clear copy of your client’s picture ID

1. These documents are required for all applications requesting a CAT teleassessment.
2. If you are a Personal Care Services Agency – please upload all the documents listed above through Harmony using note type: “consumer application” and note sub type: “telehealth submitted”.
3. If you are a Care Coordinator – please send all the documents listed above through DSM using the original e-mail you received from the Division of Senior and Disabilities Services.

Contact

Teleassessment Coordinator
1835 Bragaw Street, Suite 350
Anchorage, AK 99508
Tel: 907-269-3666
Fax: 907-269-3689
Toll Free: 1-800-478-9996
DSDSTelehealth@alaska.gov