22-6-157
Section 22-6-157 Termination of regional care organization certification. (a) The Medicaid Agency shall establish by rule the procedure for the termination of a regional care organization certification or probationary regional care organization certification for non-performance of contractual duty or for failure to meet or maintain benchmarks, standards, or requirements provided by this article or established by the Medicaid Agency as required by this article. (b) Termination of a regional care organization certification or probationary certification shall follow the standard administrative process, with the right to a hearing before a hearing officer appointed by the Medicaid Agency. (Act 2013-261, p. 686, §8.)...
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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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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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22-6-156
Section 22-6-156 Contracts with alternate care providers. The Medicaid Agency may contract with an alternate care provider in a Medicaid region only under the terms of this section: (1) If a regional care organization failed to provide adequate service pursuant to its contract, or had its certification terminated, or if the Medicaid Agency could not award a contract to a regional care organization under the terms of Section 22-6-153, or if no organization had been awarded a regional care organization certificate by October 1, 2016, or a later date established by the Medicaid Agency if an extension is determined, in the Medicaid Agency's sole discretion, to be in the best interest of the state, then the Medicaid Agency shall first offer a contract, to resume interrupted service or to assume service in the region, under the conditions of Section 22-6-153 to any other regional care organization that Medicaid judged would meet its quality criteria. (2) If by October 1, 2014, no...
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22-6-162
Section 22-6-162 Case-management services. The Medicaid Agency may contract for case-management services with an organization that has been granted by the Medicaid Agency a probationary regional care organization certification. If the agency has contracted with such an organization, and that organization on or before October 1, 2016, or a later date established by the Medicaid Agency, has failed to gain full regional care organization certification or has had its probationary certification terminated, then that organization shall refund half the payments, made by the Medicaid Agency to the organization for case-management services, paid over the previous 12 months. (Act 2013-261, p. 686, §13; Act 2016-377, §1.)...
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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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22-6-229
Section 22-6-229 Termination of certification. (a) The Medicaid Agency shall establish by rule the procedure for the termination of an integrated care network certification for non-performance of contractual duty or for failure to meet or maintain standards or requirements provided by this article or established by the Medicaid Agency as required by this article. (b) Termination of an integrated care network certification shall follow the standard administrative process with the right to a hearing before a hearing officer appointed by the Medicaid Agency. (Act 2015-322, §11.)...
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40-26B-82
Section 40-26B-82 Effectiveness and cessation. (a) The assessment imposed under this article shall not take effect or shall cease to be imposed and any moneys remaining in the Hospital Assessment Account in the Alabama Medicaid Program Trust Fund shall be refunded to hospitals in proportion to the amounts paid by them if any of the following occur: (1) Expenditures for hospital inpatient and outpatient services paid for by the Alabama Medicaid Program for fiscal years 2020, 2021, and 2022, are less than the amount paid during fiscal year 2017. Reimbursement rates under this article for fiscal years 2020, 2021, and 2022, are less than the rates approved by CMS in Sections 40-26B-79 and 40-26B-80. (2) The Medicaid Agency makes changes in its rules that reduce hospital inpatient payment rates, outpatient payment rates, or adjustment payments, including any cost settlement protocol, that were in effect on September 30, 2019. (3) The inpatient or outpatient hospital access payments required...
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22-6-163
Section 22-6-163 Legislative findings; rules; collaboration; approval of agreements and contracts; state action immunity; confidentiality of records; additional duties. (a) The Legislature declares that collaboration among public payers, private health carriers, third party purchasers, and providers to identify appropriate service delivery systems and reimbursement methods in order to align incentives in support of integrated and coordinated health care delivery is in the best interest of the public. Collaboration pursuant to this article is to provide quality health care at the lowest possible cost to Alabama citizens who are Medicaid eligible. The Legislature, therefore, declares that this health care delivery system affirmatively contemplates the foreseeable displacement of competition, such that any anti-competitive effect may be attributed to the state's policy to displace competition in the delivery of a coordinated system of health care for the public benefit. In furtherance of...
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27-60-2
Section 27-60-2 Interstate Insurance Product Regulation Compact. The State of Alabama hereby agrees to the following interstate compact known as the Interstate Insurance Product Regulation Compact: ARTICLE I. PURPOSES. The purposes of this compact are, through means of joint and cooperative action among the compacting states: 1. To promote and protect the interest of consumers of individual and group annuity, life insurance, disability income, and long-term care insurance products; 2. To develop uniform standards for insurance products covered under the compact; 3. To establish a central clearinghouse to receive and provide prompt review of insurance products covered under the compact and, in certain cases, advertisements related thereto, submitted by insurers authorized to do business in one or more compacting states; 4. To give appropriate regulatory approval to those product filings and advertisements satisfying the applicable uniform standard; 5. To improve coordination of...
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