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22-6-151
Section 22-6-151 Regional care organizations; governing board of directors; citizen's advisory
committee; solvency and financial requirements; reporting; provider standards committee. (a)
A regional care organization shall serve only Medicaid beneficiaries in providing medical
care and services. (b) Notwithstanding any other provision of law, a regional care organization
shall not be deemed an insurance company under state law. (c)(1) A regional care organization
and an organization with probationary regional care organization certification shall have
a governing board of directors composed of the following members: a. Twelve members shall
be persons representing risk-bearing participants in the regional care organization or organization
with probationary certification. A participant bears risk by contributing cash, capital, or
other assets to the regional care organization. A participant also bears risk by contracting
with the regional care organization to treat Medicaid beneficiaries...
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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, the Medicaid Agency may enter into a contract pursuant to
this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries
would be better, more efficient, and less costly than under the then existing care delivery
system. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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22-6-226
Section 22-6-226 Review and approval of contracts; rules governing operation of integrated
care networks. (a) All provider contracts of an organization granted final certification as
an integrated care network shall be subject to review and approval of the Medicaid Agency.
(b)(1) If a provider is dissatisfied with any term or provision of the agreement or contract
offered by an integrated care network, the provider shall: a. Seek redress with the integrated
care network. In providing redress, an integrated care network shall afford the provider a
review by a panel composed of a representative of an integrated care network, the same type
of provider, and a representative of the citizens' advisory board appointed by the chair of
the advisory board. b. After seeking redress with an integrated care network, a provider or
an integrated care network who remains dissatisfied may request a review of such disputed
term or provision by the Medicaid Agency. The Medicaid Agency shall have 10 days...
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22-6-221
Section 22-6-221 Service by integrated care network; board of directors. (a) An integrated
care network shall serve only Medicaid beneficiaries in providing medical care and services.
For the purposes of this article, a beneficiary cannot be a member of both an integrated care
network and a regional care organization. (b) An integrated care network shall provide required
medical care and services to Medicaid beneficiaries and may coordinate care provided by or
through an affiliation of other health care providers or other programs as the Medicaid Agency
shall determine. (c) Notwithstanding any other provision of law, the integrated care network
shall not be deemed an insurance company under state law. (d)(1) An integrated care network
shall have a governing board of directors composed of the following members: a. Twelve members
shall be persons representing risk bearing participants. A participant bears risk by contributing
cash, capital, or other assets to the integrated care network....
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-221.htm - 2K - Match Info - Similar pages
22-22A-5
Section 22-22A-5 Powers and functions of department; representation of department by Attorney
General in legal actions. In addition to any other powers and functions which may be conferred
upon it by law, the department is authorized beginning October 1, 1982 to: (1) Administer
appropriate portions of Sections 9-7-10 through 9-7-20, which relate to permitting, regulatory
and enforcement functions; administer and enforce the provisions and execute the functions
of Chapter 28 of this title; Chapter 22 of this title; Article 2 of Chapter 23 of this title;
Chapter 30 of this title; appropriate portions of Article 1 of Chapter 27 of this title; Sections
22-24-1 through 22-24-11; Sections 22-25-1 through 22-25-15; and Sections 22-36-1 through
22-36-10. (2) Acting through the Environmental Management Commission, promulgate rules, regulations,
and standards in order to carry out the provisions and intent of this chapter; provided, however,
that prior to the promulgation of any state primary or...
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22-18-50
or procedures related to specific employees or other matters related to the Commission's internal
personnel practices and procedures; c. Current, threatened, or reasonably anticipated litigation;
d. Negotiation of contracts for the purchase or sale of goods, services, or real estate; e.
Accusing any person of a crime or formally censuring any person; f. Disclosure of trade secrets
or commercial or financial information that is privileged or confidential; g. Disclosure of
information of a personal nature where disclosure would constitute a clearly unwarranted
invasion of personal privacy; h. Disclosure of investigatory records compiled for law
enforcement purposes; i. Disclosure of information related to any investigatory reports prepared
by or on behalf of or for use of the Commission or other committee charged with responsibility
of investigation or determination of compliance issues pursuant to the Compact; or j. Matters
specifically exempted from disclosure by federal or member...
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16-44B-1
Commission may deem appropriate. The executive director shall serve as secretary to the Interstate
Commission, but shall not be a Member of the Interstate Commission. The executive director
shall hire and supervise such other persons as may be authorized by the Interstate Commission.
D. The Interstate Commission's executive director and its employees shall be immune from suit
and liability, either personally or in their official capacity, for a claim for damage to
or loss of property or personal injury or other civil liability caused or arising
out of or relating to an actual or alleged act, error, or omission that occurred, or that
such person had a reasonable basis for believing occurred, within the scope of Interstate
Commission employment, duties, or responsibilities; provided, that such person shall not be
protected from suit or liability for damage, loss, injury, or liability caused by the
intentional or willful and wanton misconduct of such person. 1. The liability of...
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22-6-159
Section 22-6-159 Implementation of article. (a) The following is the timeline for implementation
of this article: (1) Not later than October 1, 2013, the Medicaid Agency shall establish Medicaid
regions. (2) Not later than October 1, 2014, an organization seeking to become a regional
care organization shall have established a governing board and structure as approved by the
Medicaid Agency. An organization may receive probationary certification as a regional care
organization upon submission of an application for, and demonstration of, a governing board
acceptable to the Medicaid Agency. Probationary certification shall expire on October 1, 2016,
or a later date established by the Medicaid Agency. (3) Not later than April 1, 2015, an organization
with probationary regional care organization certification shall have demonstrated to Medicaid's
approval the ability to establish an adequate medical service delivery network. (4) Not later
than October 1, 2015, an organization with...
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27-31A-3.1
Section 27-31A-3.1 Risk retention groups to comply with governance standards. (a) By January
1, 2016, existing risk retention groups shall be in compliance with the governance standards
set forth in this section. New risk retention groups shall be in compliance with these standards
at the time of licensure. (b) The board of directors or board, as used in this section, means
the governing body of the risk retention group elected by the shareholders or members to establish
policy, elect or appoint officers and committees, and make other governing decisions. Director,
as used in this section, means a natural person designated in the articles of the risk retention
group, or designated, elected, or appointed by any other manner, name, or title to act as
a member of the board of directors. (c)(1) The board of directors of the risk retention group
shall have a majority of independent directors. If the risk retention group is a reciprocal,
then the attorney-in-fact would be required to adhere...
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16-5-8
Section 16-5-8 Review, coordination, establishment, etc., of programs; transfer of credits;
Articulation and General Studies Committee. (a)(1) The Commission on Higher Education is authorized
to review periodically all new and existing programs and units of instruction, research, and
public service funded by state appropriations at the state universities and colleges and to
share with the appropriate governing board, through the president of the institution, and
state Legislature, its recommendations. (2) As a part of its program review process, the commission
shall enforce, monitor, and report on minimum degree productivity standards for all existing
programs of instruction at public two-year and four-year institutions of higher education.
Productivity standards shall be based, primarily, but not exclusively, on the annual average
number of degrees conferred during a five-year period for senior institutions and a three-year
period for two-year institutions, as verified by the...
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