Notice of Proposed Amendments of Five 1915(c) Medicaid Waivers

The Department of Health, Division of Senior and Disabilities Services (SDS) is requesting comment from recipients, waiver service providers, and other stakeholders on five of Alaska’s 1915(c) home and community-based service waiver amendments before they are submitted to the Centers for Medicare and Medicaid Services (CMS).

The amended waivers are:

1. Alaskans Living Independently (ALI)
2. Adults with Physical and Developmental Disabilities (APDD)
3. Children with Complex Medical Conditions (CCMC)
4. People with Intellectual and Developmental Disabilities (IDD)
5. Individualized Supports Waiver (ISW)

For the ISW, the state updated and reorganized the language to mirror the language in the state’s other approved waivers. The state’s processes have stayed the same for all waivers, aside from the changes listed below. This list of changes can be found in the “Purpose of the Amendment” section of each waiver amendment. 

The proposed amendments include the following changes:

Main:

• IDD and ISW:
  • Transition plan moving from the Inventory for Client and Agency Planning (ICAP) assessment tool to the Developmental Disability Assessment Tool for Children (DDAT-C) and the Developmental Disability Assessment Tool (DDAT); both new tools are standardized and validated by interRAI.

Appendix A:

• ISW:
  • Updated and reorganized language.

Appendix B:

• APDD and ALI:
  • Added “Assessment” to the assessment tool name: Alaska Home Care Assessment Tool.

• IDD and ISW:
  • Revised language to clarify level of care terminology;
• ISW:

• Described the state’s process to transition from the Inventory from the Inventory for Client and Agency Planning (ICAP) to the Developmental Disability Assessment Tool for Children (DDAT-C) and the Developmental Disability Assessment Tool (DDAT); and
• Specified the qualifications of individuals who perform reassessments.
• Updated and reorganized language;
• Updated safeguard language to align with current practice;
• Updated selection of entrants to the waiver language to align with current practice; and 
• Updated eligibility groups served to align with current practice. 

Appendix C:

• APDD, CCMC, and IDD:
  • Reorganized the residential habilitation service definition and updated the residential habilitation service’s specialized provider specifications to align with current practice.
• ISW:
  • Updated and reorganized service definitions and provider specifications language to reflect current regulatory requirements and to mirror the language in the state’s other approved waivers;
  • Changed Adult Host Home to match statutory name: Host Home Care Service;
  • Added Host Care Home license as a type of Respite service provider;
  • Clarified remote/telehealth delivery of waiver services language to align with current practice;
  • Clarified which services can be provided by a legally responsible individual or relative; and
  • Specified the state’s option to provide services in acute care hospitals to align with current practice.

• ISW:
  • Updated and reorganized language; and
  • Updated safeguard language to align with current practice.

• ALI, APDD, CCMC, IDD, and ISW:
  • Updated language to align with the Office of Administrative Hearings’ processes.
• ISW:
  • Updated and reorganized language; and
  • Updated grievance policy to comply with Federal Access Rule.

• ISW:
  • Updated and reorganized language;
  • Changed the name of "behavioral support plan" to "restrictive intervention plan" to allow for inclusion of modifications to the settings rule; and
  • Added information for medication management in licensed foster homes.

• ISW:
  • Updated and reorganized language; and
  • Added additional task committees listed.

• ALI, APDD, CCMC, and IDD:
  • Depending upon which services the waiver offers, updated the rate setting methodology for Specialized Private Duty Nursing (SPDN) and/or Nursing Oversight and Care Management (NOCM).
• ISW:
  • Updated and reorganized language;
  • Updated to include all audits performed by the state; and
  • Updated care coordination rate setting methodology to align with current practice and mirror the language in the state’s other approved waivers.

• ALI, APDD, and IDD: 
  • Updated the SPDN rate.

SDS will accept public comment on the proposed amendments until 5:00 p.m. on December 21, 2026. Please send written comments to Ellen Hackenmueller at ellen.hackenmueller@alaska.gov or at 1835 Bragaw Street Suite 350, Anchorage, AK 99508.

Once the comments have been reviewed and necessary changes are incorporated into the proposed amendments, SDS will submit them to the Centers for Medicare and Medicaid (CMS).

If you need accommodation in order to review the proposed waiver amendments, please contact Ellen Hackenmueller at ellen.hackenmueller@alaska.gov.