Alaska home health agency license: HFLC rules, FTE-based fees and Medicare

What Alaska treats as a home health agency

Alaska licenses health and care businesses under one statute, the centralized licensing act in AS 47.32. Home health agencies are on its list at AS 47.32.010(b)(5), and AS 47.32.020 bars any listed entity from operating before it holds a license.⁠¹ The statute defines a home health agency as an organization that primarily provides skilled nursing in combination with physical therapy, occupational therapy, speech therapy or home health aide services, in a person’s home, an assisted living home or another residential setting.⁠¹

The facility rules narrow that definition in two ways. Under 7 AAC 12.500, the services must not be for the treatment of mental illness. Under 7 AAC 12.505(a), the agency must provide skilled nursing and at least one of four services: physical therapy, occupational therapy, speech therapy or home health aide services.⁠² Once that core is in place, you may add more services under a plan of care. 7 AAC 12.505(b) lists RN-supervised nursing care, respiratory therapy, medical social services, nutrition counseling, personal care and medical supplies other than drugs and biologicals.⁠²

HFLC’s application adds a condition that is easy to miss: skilled nursing “may not be contracted unless it is to cover vacations of regular staff or for specialized skills not routinely offered.” The agency must provide skilled nursing directly, plus one other recognized service, to qualify. If you contract skilled nursing, the form asks you to explain why.⁠⁸ An agency that plans to send contract nurses into every home will not fit Alaska’s model.

Businesses founders often confuse with this license:

• Personal care agencies. Non-medical personal care is not a licensed activity under AS 47.32. An agency needs certification under 7 AAC 125.060 only to be paid by Medicaid for personal care.⁠¹² A home health agency may also provide personal care, but only as an add-on to the skilled core.⁠²
• Hospice agencies. Hospice has its own license type and fee schedule under 7 AAC 12.⁠⁴ Under AS 47.32.020(b), an organization that runs both needs a separate license for each activity.⁠¹
• Tribal and IHS programs. A facility owned and operated by the Indian Health Service, or by a tribal organization under a self-governance funding agreement, does not have to obtain the license. It must still meet the licensure requirements.⁠³

If your plan is a residential setting rather than visits to homes, see the Alaska assisted living home license. Home health agencies may serve residents of licensed assisted living homes, and Alaska Medicaid counts an assisted living home as a place of residence for home health.⁠⁹

Medicare certification decides whether you can bill Medicaid

Under 7 AAC 125.300(a), Alaska Medicaid pays a home health agency only if it is (1) certified as a home health agency for Medicare where the services are provided, and (2) enrolled as a home health provider under 7 AAC 105.210.⁠⁹ HFLC’s program page says the same: to take part in Medicare, an agency has to meet federal requirements and be “separately certified and approved.”⁠⁷

That makes the federal freeze an Alaska problem as well as a Medicare one. CMS imposed a six-month nationwide moratorium on Medicare enrollment of home health agencies, effective May 13, 2026. During it, “no new HHAs or HHA branches or practice locations will be enrolled into Medicare” unless the Medicare contractor received the application before that date.⁠¹⁰ A change of ownership that would require a new initial enrollment is also covered.⁠¹⁰ CMS can extend the moratorium in six-month increments and must publish any extension in the Federal Register. The initial six months run to about November 13, 2026, and the notice found on October 12, 2026 is the only one on this moratorium; check the Federal Register for an extension before you plan around a date.⁠¹⁰ CMS left Medicaid moratoria to each state.⁠¹⁰ The Alaska sources reviewed on October 12, 2026 (7 AAC 125.300 and the Department of Health pages) mention no Alaska-specific home health enrollment moratorium. Ask Alaska Medicaid provider enrollment whether one applies before you file.

In practice, a new Alaska agency can get its state license during the freeze. It can serve private-pay, insurance and other non-Medicare, non-Medicaid patients, but it cannot bill Alaska Medicaid for home health until Medicare certification is possible.

Medicaid conditions to plan for once you are certified:⁠⁹

• Every service other than the first evaluation visit needs prior authorization. Authorization periods last no more than 60 days.
• Eligibility does not depend on homebound status, a need for institutional care or a need for skilled nursing. Medicaid may also pay when Medicare refuses because a dual-eligible patient is not homebound or does not need intermittent skilled nursing.
• “Intermittent or part-time” means no more than eight hours of care in a 24-hour period.
• An RN completes an initial assessment within 48 hours of referral and a comprehensive assessment, including a medication review, within five days of the start of care.
• Every claim must be backed by electronic visit verification data from the state’s EVV system or an approved one.
• Where no Medicare-certified agency serves a patient’s home, a rural health clinic may bill Medicaid for limited skilled nursing visits.

Fees, priced by headcount and locations

Alaska is unusual in setting home health fees by your total employee full-time equivalents (FTEs). The count includes staff at every branch and subunit, and each extra location adds its own fee.⁠⁴ On the application, you report FTEs, part-time staff and paid volunteers by discipline, so the fee you pay should match that staffing table.⁠⁸

Other charges in the same rule:⁠⁴⁠⁷

• Revisit fee: $150. You pay it for each extra onsite visit caused by failing to correct deficiencies, due within 30 days after the revisit.
• Relocation: $150. HFLC inspects the new location and charges the revisit fee.
• Adding a branch or subunit mid-cycle: $500 per new location, plus the FTE-based fee for any added FTEs.
• Other license modifications: $250.
• Change of administrative leadership: a notice form, no fee.
• Extending a provisional license for its one allowed extra period costs nothing.

All fees are nonrefundable, and state-owned facilities are exempt.⁠⁴ The application lets you pay by check made out to “State of Alaska – HFLC” or by credit card over the phone at 907-334-2400, option 3. For help working out your fee, call HFLC at 907-334-2483 or email [email protected].⁠⁸

The leadership structure the rules require

Before you file, you need an organization that matches 7 AAC 12.507-12.516, because the application asks you to name the people and attach an organizational chart.⁠²⁠⁸

• Governing body. It holds “full legal authority and fiscal responsibility” for the agency. It appoints the administrator and the advisory committee, adopts written bylaws and policies, provides adequate staff and equipment, and makes sure a program evaluation happens every year.⁠²
• Administrator. This person needs education, experience and knowledge related to home health, plus at least one year of overall administrative experience in home health care or a related home health program. The administrator must designate in writing who acts in their absence, report to the governing body at least once a year, and keep an annual operating budget and a three-year capital expenditure plan. Administrative and supervisory functions may not be delegated to another agency or organization.⁠²
• Director of clinical services. This must be a physician or RN. The director supervises all professional staff, takes part in hiring decisions for direct-care staff, makes sure staffing is sufficient, and is responsible for orientation, in-service training and the agency’s clinical policies.⁠²
• Professional advisory committee. Members are the administrator, a physician, an RN, a representative of one of your patient care services, and a consumer who is not an owner or employee. Each year the committee reviews your policies and quality improvement results and sends a written evaluation to the governing body.⁠² The application’s staffing table has a separate line for the “Physician on PAC.”⁠⁸

The application asks whether the administrator or clinical director also holds that role at another Alaska agency. If so, you must list those agencies and their license numbers.⁠⁸

Writing the policy manual HFLC reviews

HFLC’s initial licensing steps include sending “an electronic copy of all policies and procedures” with the application packet.⁠⁷ Under 7 AAC 12.531, written policies must cover at least these topics and be reviewed every year:⁠²

1. Scope and area

   Scope of services and geographic service area.

2. Patient flow

   Acceptance, transfer, discharge and continuing care.

3. Clinical practice

   Treatments and procedures by service, patient teaching, IV infusion and aseptic technique, patient safety assessment, and emergency care.

4. Coordination and records

   Coordination of services and clinical records.

5. Infection control

   Infection control practices and preventive maintenance of patient care equipment.

6. Personnel

   Qualifications, responsibilities and job descriptions.

7. Oversight

   Program evaluation, and how you supervise subunits and branch offices.

8. Patient protections

   Complaint investigation and resolution, advance directives, and abuse, neglect and mistreatment.

Some services need extra written content. If you offer parenteral or hyperalimentation therapy, 7 AAC 12.526 requires a defined scope and population, an emergency plan, and procedures for site care, biohazard disposal, blood products, infusion devices and pediatric dosing. Staff who give infusions need documented IV training.⁠² Every agency must also keep a separate area for processing and storing sterile supplies.⁠²

From application to biennial license

1. Complete the packet

   HFLC uses one form, the Home Health Agency State Licensure Application (revised 02/02/2024), for both initial and renewal licenses. You tick “Initial Provisional Licensing.”⁠⁸ The owner must sign and verify it, or two officers if the owner is a corporation, association or government unit. Under 7 AAC 12.610(b), the form must list the names and addresses of all owners, officers, directors, partners, members and principals.⁠³⁠⁸

2. Describe your service area by community

   The form says HFLC “will not accept descriptions such as ‘Southeast Alaska’ or ‘South Central Alaska’”. Name specific areas.⁠⁸

3. List contracts and services

   For each service, mark whether you provide it directly or by contract. Contracts must be available for HFLC to review at the licensure survey.⁠⁸ Under 7 AAC 12.563, each contract must be written and signed, must say that patients are accepted only by your agency, and must require the contractor to follow your policies.⁠²

4. Answer the background check and insurance questions

   The form asks whether you have a system for criminal background checks through the Alaska Background Check Program under AS 47.05 and 7 AAC 10.900-10.990. It also asks whether you carry malpractice insurance, and with which company.⁠⁸

5. Pay and submit

   Send the provisional fee with the packet. You can mail, hand-deliver, fax or email it to HFLC, 4601 Business Park Blvd., Bldg. K, Anchorage, AK 99503; fax (907) 334-2682.⁠⁸

6. Completeness review

   HFLC reviews the application for completeness within 30 days and returns incomplete ones for more information.⁠³

7. Onsite inspection

   Once the application is complete, HFLC inspects. By signing, the administrator attests that the agency is ready for an onsite inspection. If you are temporarily out of compliance but correcting it, HFLC can extend the review by 90 days.⁠³⁠⁸

8. Provisional license

   If you meet the requirements, HFLC issues a provisional license valid for up to one year. It can be extended once for up to another year.⁠¹⁠³

9. Biennial license

   Before the provisional license expires, HFLC inspects again. It then issues a biennial license if you comply, no ground for nonrenewal exists, and you have paid the biennial fee.⁠¹⁠⁴

Post the license in a conspicuous place. It cannot be transferred without the department’s approval.⁠¹

Staffing rules that shape your hiring

Home health aides. Each aide must be a nurse aide certified by the Alaska Board of Nursing, must not be listed on the nurse aide registry for abuse, neglect or misappropriation, and must have a valid background check unless a variance is granted.⁠² Aides must also pass a competency evaluation in 13 areas before they see patients, from vital signs and infection control to bed baths and safe transfers. They get documented orientation within two weeks of hire and 12 hours of in-service training each calendar year.⁠²

Supervision intervals. An RN or therapist visits the patient’s home at least every two weeks, and directly observes each aide at work at least every three months.⁠² When an LPN provides care, an RN reviews the plan of care and nursing services every two weeks. Physical and occupational therapists visit every two weeks to supervise assistants.⁠²

Professional qualifications. Nurses must be licensed under AS 08.68, and PTs, OTs and their assistants under AS 08.84. Speech therapists need ASHA’s Certificate of Clinical Competence. Dietitians must be registered with the Commission on Dietetic Registration. A medical social worker needs a master’s degree from a CSWE-accredited school and one year of health care experience.⁠²

Employee health and files. Your employee health program must screen and test new staff for tuberculosis, following CDC guidance, before their first day. You also need proof of hepatitis B vaccination. The rubella requirement in the same rule does not apply to home health agencies.⁠⁵ Each personnel file needs a job description, a license copy, a summary of education and experience, employee health records and background check evidence.⁠⁵

Training cycle. You must provide orientation and annual in-service training on policies, fire and home safety hazards, infection control, and ethics and confidentiality. You also need CPR training every two years for direct-care staff, training on HIV/AIDS, hepatitis and tuberculosis precautions at least every two years, and an annual performance evaluation for every employee.⁠²

Clinical records and quality checks surveyors look for

• Plans of care. Review each plan with the physician, APRN or PA at least every 62 days. The practitioner must sign it within 21 days after the start of care.⁠²
• Who you can accept. You may not accept a patient who lives in a hospital or nursing facility.⁠²
• Progress notes. Write them on the day of the visit and add them to the record within seven days. Send summary reports to the practitioner at least every 62 days.⁠²
• Record retention. Keep records for five years after discharge, or for minors, three years after the patient turns 21. Your policies must keep records safe even if the agency closes.⁠²
• Quality improvement. Each quarter, a multidisciplinary team reviews at least 10% of both active and closed records. Each patient’s record is also reviewed for every 62-day period of care.⁠²
• Patient rights. Give patients their rights orally and in writing before care begins, and let them see their record within two working days of a written request.⁠²
• Abuse reporting. Report suspected abuse, neglect, mistreatment or misappropriation within 24 hours.⁠² AS 47.32.200 also requires 24-hour notice to the department, followed by a written investigation report within five days.⁠¹

Branches, subunits and changes after licensing

Alaska’s rules separate two kinds of extra location. A branch serves part of the parent agency’s own geographic area. A subunit serves an area at a distance from the parent.⁠² The application describes a branch as sharing administration, supervision and services with the parent every day, and says a branch does not need its own license.⁠⁸ Both types appear on your license and carry their own fees.⁠⁴ HFLC surveys each subunit at least once a year, as it does the parent.⁠²

Notices under AS 47.32.200:⁠¹

• Address change: 14 days before the change.
• Relocation: 30 days before the move.
• Sale: no more than one day after signing the sale contract.
• Giving up the license: 20 days before the effective date.
• Staff criminal charges: within 24 hours of learning that an administrator or employee has been charged with or convicted of a barrier crime.

Renewal, inspection waivers and enforcement

Biennial licenses start on July 1 of an even-numbered year and expire on June 30 of the next even-numbered year. The cycle that began on July 1, 2026 ends on June 30, 2028.⁠³ AS 47.32.060 requires renewal applications at least 90 days before expiration. The department’s page puts the deadline before April 1 of even-numbered years.⁠¹⁠⁷ If HFLC has not finished its review when the license expires, the license is automatically extended for six months.⁠¹ The department’s renewal text refers to the “Hospice Licensing Application”, but its renewal link opens the same home health PDF as the initial application, which has a “Biennial Renewal License” box.⁠⁷⁠⁸ Confirm with HFLC that this form is the one it expects for renewal.

Accredited agencies can avoid one state survey per cycle. Under 7 AAC 12.925, an agency accredited by a nationally recognized organization may ask HFLC in writing to waive the biennial inspection. The request must include the accreditor’s latest survey report and any plan of correction. You need a new request each licensing period.⁠⁶⁠⁸ The waiver does not stop HFLC from investigating complaints.⁠⁶

Grounds for nonrenewal include false information, kickback or fee-splitting arrangements, and too few staff with the training to provide adequate care.⁠³ A person who intentionally or with criminal negligence breaks a health-and-safety provision of AS 47.32 or its rules commits a class B misdemeanor.⁠¹

No certificate of need

Alaska’s certificate of need law covers hospitals, psychiatric hospitals, skilled nursing and intermediate care facilities, kidney treatment centers, ambulatory surgical facilities and a few other facility types. Home health agencies are not on that list, so you do not need a certificate of need to open one.⁠¹¹ The department may only issue a license if you meet the AS 47.32 requirements and 7 AAC 12, and any other applicable statutes or regulations.⁠¹

Other Alaska licenses: assisted living home, child care center, child care home. Compare with other states under home health licenses.

Sources

1. 1
   Alaska State Legislature, AS 47.32, Centralized Licensing Checked 12 Oct 2026 · Back to text ↑
2. 2
   Alaska State Legislature, Alaska Administrative Code, 7 AAC 12.500-12.590, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Alaska State Legislature, Alaska Administrative Code, 7 AAC 12.610-12.611, Licensure; exemptions from licensure Checked 12 Oct 2026 · Back to text ↑
4. 4
   Alaska State Legislature, Alaska Administrative Code, 7 AAC 12.615, Facility fees Checked 12 Oct 2026 · Back to text ↑
5. 5
   Alaska State Legislature, Alaska Administrative Code, 7 AAC 12.605, 12.650 and 12.660, Background checks, employee health program, personnel Checked 12 Oct 2026 · Back to text ↑
6. 6
   Alaska State Legislature, Alaska Administrative Code, 7 AAC 12.925, Accredited entities Checked 12 Oct 2026 · Back to text ↑
7. 7
   Alaska Department of Health, Home Health Agencies (HHAs) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Alaska Department of Health, Health Facilities Licensing and Certification, Home Health Agency State Licensure Application (revised 02/02/2024) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Alaska State Legislature, Alaska Administrative Code, 7 AAC 125.300-125.399, Home health care services (Medicaid) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
11. 11
    Alaska State Legislature, AS 18.07.111, Certificate of need definitions Checked 12 Oct 2026 · Back to text ↑
12. 12
    Alaska State Legislature, Alaska Administrative Code, 7 AAC 125.060, Personal care services provider certification Checked 12 Oct 2026 · Back to text ↑

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