How to start a hospice in Alaska

Alaska requires a Hospice agency license (volunteer, full-service/non-volunteer, or inpatient hospice facility); provisional, then biennial from Alaska Department of Health, Health Facilities Licensing & Certification to operate a hospice. Fee: Provisional license: volunteer in-home hospice $100; non-volunteer in-home hospice $250; inpatient hospice facility $250 + $75/bed; plus $100 per subunit. Biennial license/renewal: $200; $500; $500 + $150/bed; plus $200 per subunit.

License required

Yes

License

Hospice agency license (volunteer, full-service/non-volunteer, or inpatient hospice facility); provisional, then biennial

Issuing agency

Alaska Department of Health, Health Facilities Licensing & Certification

Fee

Provisional license: volunteer in-home hospice $100; non-volunteer in-home hospice $250; inpatient hospice facility $250 + $75/bed; plus $100 per subunit. Biennial license/renewal: $200; $500; $500 + $150/bed; plus $200 per subunit.

Renewal

Every 2 years · Biennial renewal fees: volunteer $200, non-volunteer $500, inpatient facility $500 + $150/bed, +$200 per subunit. Renewal application is due 90 days before the license expires.

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

AS 47.32; 7 AAC 10; 7 AAC 12 (fees at 7 AAC 12.615)

1. Complete the Volunteer / Full Services Hospice Agency State Licensure Application (signed by owner or two officers)
2. Pay the provisional licensure fee under 7 AAC 12.615
3. Set up criminal background checks through the Alaska Background Check Program (AS 47.05, 7 AAC 10.900-990)
4. Operate under a provisional license (extendable once, up to one year, without fee)
5. Obtain the biennial license and renew every two years, applying 90 days before expiration

Program

Alaska Medicaid (Alaska Medical Assistance)

Enrollment portal

Alaska Medicaid Health Enterprise portal (online provider enrollment)

Fiscal agent

HMS Gainwell (Gainwell Technologies) — provider enrollment and fiscal agent services; the Health Enterprise MMIS is a Conduent system

Application fee

Alaska requires group providers and sole proprietors to pay the application fee (with an attestation form) at enrollment and again at revalidation, subject to the federal exceptions; a hardship waiver can be requested with a justification letter and financial records. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Alaska applies pre- and post-enrollment site visits to moderate- and high-risk group providers and sole proprietors at enrollment, revalidation and service-location changes; the site-visit date feeds into the enrollment effective date. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Alaska sets each provider's revalidation timing by its risk level; providers that miss their due date have payments held until the revalidation is processed. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alaska Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Alaska Department of Health (decision by the commissioner)

Services covered

• hospitals (including psychiatric and tuberculosis hospitals)
• skilled nursing facilities / nursing home beds
• intermediate care facilities
• residential psychiatric treatment centers
• ambulatory surgical facilities
• kidney disease treatment centers / freestanding dialysis
• independent diagnostic testing facilities

Alaska certificate of need details →

State minimum wage

$14.00 an hour

Effective

2026-07-01

Scheduled increases

Rises to $15.00 on 2027-07-01 under Ballot Measure 1 (2024); annual inflation adjustments begin 2028-01-01.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

36 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

6 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

206,739 (as of Jun 1, 2026)