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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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22-6-163
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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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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22-6-150
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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22-6-200
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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22-6-95
Section 22-6-95 Transfer of funds - Annual certification. At the time a hospital or hospital
system transfers funds to the Medicaid Agency, or no less frequently than within 30 days after
the close of the transferor hospital's or hospital system's fiscal year, the hospital or hospital
system shall certify in writing to the Medicaid Agency that the funds transferred met the
requirements of Section 22-6-93. In the case of an annual certification, the transferor hospital
or hospital system shall certify that all the funds transferred during the hospital's or hospital
system's past fiscal year met the requirements of Section 22-6-93. The certifications pursuant
to this section shall be executed by the hospital's or hospital system's administrator or
chief financial officer and may be made electronically. The Medicaid Agency shall determine
that it has not sought federal matching funds on funds transferred to it by a hospital or
hospital system that have not been certified by the transferor...
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40-26B-60
Section 40-26B-60 Definitions. (a) For the purposes of this article the following words have
the following meanings unless the context clearly indicates otherwise: (1) DISPROPORTIONATE
SHARE HOSPITAL. A hospital meeting the requirements of Section 1923 of the Social Security
Act and other criteria adopted by the Alabama Medicaid Agency in its state plan for medical
assistance under Title XIX of the Social Security Act. (2) FISCAL YEAR. An accounting period
of 12 months beginning on the first day of the first month of the state fiscal year. (3) HOSPITAL.
A facility, which is licensed as a hospital under the laws of the State of Alabama, provides
24-hour nursing services, and is primarily engaged in providing, by or under the supervision
of doctors of medicine or osteopathy, inpatient services for the diagnosis, treatment, and
care or rehabilitation of persons who are sick, injured, or disabled. (4) PUBLICLY-OWNED HOSPITAL.
A hospital created and operating under the authority of a...
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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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26-10D-5
Section 26-10D-5 State prohibited from discriminating against child care service providers
under certain conditions. (a) The state may not refuse to license or otherwise discriminate
or take an adverse action against any child placing agency that is licensed by or required
to be licensed by the state for child placing services on the basis that the child placing
agency declines to make, provide, facilitate, or refer for a placement in a manner that conflicts
with, or under circumstances that conflict with, the sincerely held religious beliefs of the
child placing agency provided the agency is otherwise in compliance with the requirements
of the Alabama Child Care Act of 1971, Chapter 7, Title 38, and the Minimum Standards for
Child Placing Agencies. (b) If a child placing agency under subsection (a) declines to make,
provide, facilitate, or refer for a child placement, the decision of the child placing agency
may not limit the ability of another child placing agency to make, provide,...
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22-6-92
Section 22-6-92 Use of funds; annual certification. Any hospital or hospital system located
in the State of Alabama that receives funds from the Medicaid Agency or from a partnership
hospital program shall utilize all revenues received from either source only in connection
with the provision of healthcare services. Within 30 days after the close of a hospital's
or a hospital system's fiscal year, the hospital or hospital system shall certify in writing
to the Medicaid Agency that it has complied with the requirements of this section during the
past fiscal year. The certification shall be executed by the hospital's or hospital system's
administrator or chief financial officer and may be made electronically. (Act 2002-410, p.
1031, §3.)...
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