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22-6-155
Section 22-6-155 Terms of contracts; cost evaluations. An initial contract between the Medicaid
Agency and a regional care organization shall be for three years, with the option for the
Medicaid Agency to renew the contract for not more than two additional one-year periods. The
Medicaid Agency shall obtain provider input and an independent evaluation of the cost savings,
patient outcomes, and quality of care provided by each regional care organization, and obtain
the results of each regional care organization's evaluation in time to use the findings to
decide whether to enter into another multi-year contract with the regional care organization
or change the Medicaid region's care-delivery system. (Act 2013-261, p. 686, §6; Act 2014-434,
p. 1598, §1.)...
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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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22-6-233
Section 22-6-233 Legislative findings; certification of collaborators; powers of Medicaid Agency;
state action immunity. (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 this goal, the Legislature declares its intent...
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22-6-150
Section 22-6-150 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) ALTERNATE CARE PROVIDER. A contractor, other than a regional care
organization, that agrees to provide a comprehensive package of Medicaid benefits to Medicaid
beneficiaries in a defined region of the state pursuant to a risk contract. (2) CAPITATION
PAYMENT. A payment the state Medicaid Agency makes periodically to a contractor on behalf
of each recipient enrolled under a contract for the provision of medical services. (3) CARE
DELIVERY SYSTEM. The manner in which the benefits and services set forth in the state Medicaid
plan are provided to Medicaid beneficiaries. (4) COLLABORATOR. A private health carrier, third
party purchaser, provider, health care center, health care facility, state and local governmental
entity, or other public payers, corporations, individuals, and consumers who are expecting
to collectively cooperate, negotiate, or contract with another...
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22-6-154
Section 22-6-154 Quality assurance committee; collection and publication of information. (a)
The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid Commissioner.
The members of the committee shall serve two-year terms. At least 60 percent of the members
shall be physicians who provide care to Medicaid beneficiaries served by a regional care organization.
In making appointments to the committee, the Medicaid Commissioner shall seek input from the
appropriate professional associations. (b) The committee shall identify objective outcome
and quality measures, including measures of outcome and quality for ambulatory care, inpatient
care, chemical dependency and mental health treatment, oral health care, and all other health
services provided by coordinated care organizations. Quality measures adopted by the committee
shall be consistent with existing state and national quality measures. The Medicaid Commissioner
shall incorporate these measures into...
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22-6-160
Section 22-6-160 Evaluation and report on long-term care system for Medicaid beneficiaries.
The Medicaid Agency shall decide which groups of Medicaid beneficiaries to include for coverage
by a regional care organization or alternate care provider. The Medicaid Agency, without the
approval of the Governor, shall not make a coverage decision that would affect Medicaid beneficiaries
who are directly served by another state agency. (Act 2013-261, p. 686, §11; Act 2015-322,
§1.)...
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22-21-294
Section 22-21-294 Certification of indigency; rules. Not later than October 1, 1979, the Department
of Human Resources shall adopt rules which provide a statewide eligibility standard to certify
residents of each county as indigent for the purposes of this article. These rules shall further
provide that certification as indigent for the purposes of this article may occur either prior
to a person's admission to a regional referral hospital, or subsequent to such admission for
an emergency condition, but in any event if a determination of whether a patient meets or
does not meet eligibility standards for certification as indigent for the purpose of this
article is not made within 90 days following written notification by the regional referral
hospital to the county of residence of the patient's admission to a regional referral hospital,
the patient shall be considered to have been a certified indigent patient upon admission.
A patient certified as indigent for the purpose of this article...
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22-6-220
Section 22-6-220 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) CAPITATION PAYMENT. A payment the state Medicaid Agency makes
periodically to the integrated care network on behalf of each recipient enrolled under a contract
for the provision of medical services pursuant to this article. (2) COLLABORATOR. A private
health carrier, third party purchaser, provider, health care center, health care facility,
state and local governmental entity, or other public payers, corporations, individuals, and
consumers who are expecting to collectively cooperate, negotiate, or contract with another
collaborator, or integrated care network in the health care system. (3) INTEGRATED CARE NETWORK.
One or more statewide organizations of health care providers, with offices in each regional
care organization region, that contracts with the Medicaid Agency to provide Medicaid benefits
to certain Medicaid beneficiaries as defined in subdivision (4) and...
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22-6-200
Section 22-6-200 Federal financial participation; contract for services. This article shall
be of no effect if federal financial participation under Title XIX of the Social Security
Act is not available to the Medicaid program for the purposes of this article at the approved
federal medical assistance percentage, established under Section 1905 of the Social Security
Act, for the applicable fiscal year, or in the event a contract for services between the PACE
program and the State of Alabama Medicaid Agency or Regional Care Organization is not executed
by September 30, 2014, and by the end of each subsequent state fiscal year thereafter. (Act
2014-126, p. 236, §11.)...
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22-6-13
Section 22-6-13 Medicaid benefits for county inmates and certain juveniles. (a) For the purposes
of this section, the following words have the following meanings: (1) COUNTY INMATE. Any person
being held in a public institution under the administrative control and responsibility of
the county sheriff and for whom the county is responsible for the provision of medical care.
The term includes a person in custody while awaiting arraignment or bond, a pretrial detainee,
a convicted person who is awaiting transfer to but has not otherwise become the responsibility
of the Department of Corrections, or a person serving his or her sentence in the county jail.
(2) INPATIENT. This term as defined in 42 C.F.R. § 435.1010, as may be amended. (3) JUVENILE.
Any child under the jurisdiction of the juvenile court who is detained in a public institution
and for whom the county is responsible for the provision of medical care pursuant to Section
12-15-108. (4) MEDICAL INSTITUTION. This term as defined...
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