***This amendment issued 5/14/21 serves to clarify what information may not be submitted as proof of federal tax ID. Please refer to the final page of the provider agreement.***

***This amendment issued on 10/16/20 serves to update the email address on this online public notice. All signed Provider Agreements and documentation demonstrating provider eligibility should be sent to HSS.FMS.Grants.Provider.Agreements@alaska.gov.***

The Department of Health & Social Services (DHSS) Division of Behavioral Health (DBH) is entering into Agreements under 7 AAC 81 with qualified Providers for the State of Alaska’s Youth Individualized Services Program (YISP) to provide community-based services and supports to Children and Youth (21and under) experiencing Severe Emotional Disturbance (SED) and/or Substance Use Disorder (SUD), who are at risk for out-of-home placement, residential or institutional care, in need of supports to transition to a lower level of care, or need assistance stabilizing during an emergent or ongoing crisis.

Please Note, this Provider Agreement will take effect November 1, 2020. Applicants should refer to the attached Provider Agreement, Appendices and Attachments for additional information. In order to establish a Provider Agreement, an applicant must submit Proof of Eligibility and the signed Provider Agreement to the following person:

Victoria Gibson, Grants Administrator
Grants and Contracts Support Team
P.O. Box 110650
Juneau, AK 99811-0650
Phone: (907)465-4738 Fax: (907)465-8678
Email: victoria.gibson@alaska.gov