Crisis Placement Provider Agreement

The Department of Family and Community Services (DFCS), through the Division of The Alaska Psychiatric Institute, is soliciting eligible applicants to provide placement and/or care services to individuals with urgent and/or complex placement needs for the State of Alaska's Crisis Placement Program. In order to establish a provider agreement, an applicant must submit proof of eligibility and a signed provider agreement at any time to the following person: Josie Valliant, Grants Administrator Grants and Contracts PO Box 110650 Juneau, AK 99811-0650 fcs.fms.grants@alaska.gov Attachments: A. 7 AA 81, Grant Services for Individuals, Revised 6/23/06 B. Alaska Statues: B-1. AS 47.30.660; and B-2. AS 47.30.700-775 C. Privacy and Security Procedures for Providers D. Resolution for Alaska Natives Entities E. SOA DHSS HIPAA Business Associates