****Amendment #1 issued 3/25/16 serves to post a corrected Provider Agreement and extend the due date. The SDS Telehealth Reassessment Site Initiation Provider Agreement applicant pool has been corrected from a select group of rural census areas, to all rural applicants Statewide.  All applicants that previously downloaded the Telehealth Provider Agreement posted 2/25/16 will need to download and submit the corrected version posted 3/25/16.  Due to this change the submission deadline has been extended to 5/27/16.****

The Department of Health and Social Services is soliciting eligible applicants to host video teleconference (VTC) calls on behalf of the Division of Senior and Disabilities Services.  The Provider will conduct initial and annual assessments for Medicaid Waiver and Personal Care Assistance service participants who live in rural remote villages in which the local clinic maintains and operates VTC equipment.  Applicants should refer to the attached provider agreement, appendices and other attachments for additional information.

In order to establish a Provider Agreement, an applicant must submit proof of eligibility and a signed Provider Agreement to the following Person:

Alyssa Hobbs, Grants Administrator
Grants and Contracts Support Team
Department of Health & Social Services
P.O. Box 110650
Juneau, AK 99811-0650
PHONE: (907)465-1187
FAX: (907)465-8678
EMAIL: alyssa.hobbs@alaska.gov