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22-6-223
Section 22-6-223 Solvency and financial requirements. (a) An integrated care network shall
meet minimum solvency and financial requirements as provided by the Medicaid Agency. The Medicaid
Agency shall require the integrated care network, as a condition of certification or continued
certification, to maintain minimum solvency and financial reserves. The Medicaid Agency shall
hereafter promulgate rules setting forth requirements for minimum solvency, financial reserves,
and other financial requirements of an integrated care network based on the number of integrated
care networks that may be certified and based on actuarial soundness as determined by the
Medicaid Agency. The Medicaid Agency shall allow for the requirements to be met through the
submission of an irrevocable letter of credit in an amount equal to the financial reserves
that would otherwise be required of the integrated care network, to guarantee the performance
of the provisions of the risk contract. If an irrevocable...
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22-6-228
Section 22-6-228 Risk contracts. A risk contract between the Medicaid Agency and an integrated
care network shall be for two years, with the option for Medicaid to renew the contract for
not more than three 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 an integrated care network, and obtain the results of an integrated care
network's evaluation in time to use the findings to decide whether to enter into another multi-year
contract with the integrated care networks or change the Medicaid care delivery system associated
with an integrated care network. (Act 2015-322, §10.)...
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22-6-225
Section 22-6-225 Denial of claims; grievances and appeals. (a) The Medicaid Agency shall establish
by rule procedures for safeguarding against wrongful denial of claims and addressing grievances
of enrollees in an integrated care network. (b) If a patient or the provider is dissatisfied
with the decision of an integrated care network, the patient or provider may file a written
notice of appeal to the Medicaid Agency. The Medicaid Agency shall adopt rules governing the
appeal, which shall include a full evidentiary hearing and a finding on the record. The Medicaid
Agency's decision shall be binding upon the integrated care network. However, a patient or
provider may file an appeal in circuit court in the county in which the patient resides, or
the county in which the provider provides services. (c) The Medicaid Agency shall by rule
establish procedures for addressing grievances and appeals of the integrated care network.
The appeal procedure shall include an opportunity for a fair...
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22-6-231
Section 22-6-231 Implementation of article. (a) The following timeline applies to implementation
of this article: (1) Not later than April 1, 2017, the Medicaid Agency shall establish integrated
care network rules setting forth solvency, governing board, network, and active supervision
requirements, as well as other requirements of the Medicaid Agency. (2) Not later than April
1, 2018, Medicaid Agency will initiate competitive procurement for the services of integrated
care network or networks. (3) Not later than October 1, 2018, one or more integrated care
networks certified by the Medicaid Agency shall begin to deliver services pursuant to a risk
bearing contract. (Act 2015-322, §13.)...
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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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45-2-261.62
Section 45-2-261.62 Planning and zoning advisory committee established; composition; purpose
and duties. (a) There is established the Fort Morgan Planning and Zoning Advisory Committee,
hereinafter referred to as the planning and zoning advisory committee, to be composed of the
following members: Two members appointed by the Baldwin County Commission from a list of not
less than four nominations by the Fort Morgan Civic Association, Inc.; and three members appointed
by the Fort Morgan Civic Association, Inc. All members shall be residents and registered voters
in the Fort Morgan District. All members shall serve a term of four years and may be reappointed
to succeeding terms. Members shall serve until a replacement is appointed and qualified. Any
vacancy on the committee shall be filled by the original appointing authority. Members shall
serve without compensation, but may be reimbursed for expenses in the performance of their
duties by the county. A member may be removed for cause by...
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2-27-6
Section 2-27-6 Pesticide Advisory Committee. (a) Creation. A pesticide advisory committee is
hereby created and established to consist of 13 members to be appointed from and by certain
agencies, departments, institutions, and organizations as provided in this section. The Pesticide
Advisory Committee's membership, their term of service, method of appointment, authority,
duties, and functions shall be as follows: (1) Two members from the School of Agriculture
and the Agricultural Experiment Station of Auburn University, to be appointed by its dean
and director; (2) Two members from the Cooperative Agricultural Extension Service of Auburn
University, to be appointed by its director; (3) Two members in the employ of the state Department
of Agriculture and Industries, to be appointed by its commissioner; (4) Two members in the
employ of the State Department of Public Health, to be appointed by the State Health Officer;
(5) Two members in the employ of the state Department of Conservation...
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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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22-6-157
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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22-6-150
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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