Section 7 AAC 130.238 - Certification of care coordinators(a) An individual may not provide care coordination services unless (1) the department certifies the individual under this section;(2) the individual is enrolled in the Medicaid program under 7 AAC 105.210; and(3) the individual is an owner of or employed by a care coordination services provider agency certified under 7 AAC 130.220(a)(2).(b) For the department to certify an employee as a care coordinator, (1) that employee must (A) meet the applicable standards of certification criteria, including the care coordination qualifications and program standards set out in the department's Care Coordinator Certification Application, adopted by reference in 7 AAC 160.900; and(B) meet the applicable standards of certification criteria, including the care coordination qualifications and program standards set out in the department's Care Coordination Services and long Term Services and Supports Targeted Case Management Conditions of Participation, adopted by reference in 7 AAC 160.900; and(2) the provider must certify in writing to the department that the employee (A) meets and complies with the requirements of the department's Care Coordination Services and Long Term Services and Supports Targeted Case Management Conditions of Participation, adopted by reference in 7 AAC 160.900;(B) is employed by that provider; and(C) meets that provider's employment standards to provide care coordination services.(c) The department will certify a provider who meets and complies with the standards of certification for a(1) probationary certification of one year for(A) a provider not previously certified by the department; or(B) a renewing provider who does not meet the certification requirements to the department's satisfaction under (b) of this section, or has committed an act or omission that is grounds for sanction under 7 AAC 105.400, regardless of whether a sanction was imposed; or(2) standard certification of(A) two years for each renewing provider that the department has determined met the probationary certification requirements under (1) of this subsection in the immediately preceding certification period; or(B) a variable period of up to four years, to be determined by the department's review of the provider's compliance with the certification requirements under (b) of this section in the preceding certification periods.(d) Not later than 90 days before the expiration of a care coordinator's certification, the department will send to the care coordinator notice of the requirement to renew that certification. The care coordinator must submit a new application for certification in accordance with (b)(1)(A) of this section not later than 60 days before the expiration date of the current certification.(e) The department will deny certification of an employee or renewal of a care coordinator's certification, or will decertify a care coordinator if (1) the individual failed to submit a complete application in accordance with (b)(1)(A) of this section so that it is received by the department not later than 30 days after the date of any notice from the department that the application is incomplete;(2) the individual's certification, license, or enrollment related to Medicaid or Medicare was denied, revoked, or rescinded;(3) the individual's name appears on any state or federal exclusion list related to health services;(4) the department has documentation that indicates that the individual (A) is unable or unwilling to meet the certification requirements of this section or any other Medicaid requirement under 7 AAC 105 - 7 AAC 160; or(B) creates a risk to the health, safety, or welfare of a recipient; or(5) the individual has two consecutive probationary certification periods under (c)(1) of this section and is still not compliant to the department's satisfaction.(f) A care coordinator may appeal, under 7 AAC 105.460, a decision by the department to (1) deny the care coordinator's application for certification, to renew certification, or for re-enrollment; or(2) decertify the care coordinator.Eff. 7/1/2013, Register 206; am 7/1/2015, Register 214, July 2015; am 10/1/2018, Register 227, October 2018; am 10/16/2022, Register 244, January 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040