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22-6-230
Section 22-6-230 Rates for contracting services; provider requirements. An integrated
care network shall contract with any willing nursing home, doctor, home and community waiver
program, or other provider to provide services through an integrated care network if the provider
is willing to accept the payments and terms offered comparable providers, where applicable,
but in no event less than amounts historically paid by the Medicaid Agency to comparable providers.
To the extent that the Medicaid Agency currently calculates and establishes provider-specific
rates for any provider category on an annualized basis, it shall continue to calculate and
establish such rates and the integrated care network shall be required to offer providers
from that category not less than their established rates. Any provider shall meet licensing
requirements set by law, shall have a Medicaid provider number, and shall not otherwise be
disqualified from participating in Medicare or Medicaid. (Act 2015-322,...
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40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall
have the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible
hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient.
(2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying
any non-Medicare inpatient stay into groups for the purposes of payment. (3) 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. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification
in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned
hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated
care provided by publicly owned hospitals and hospitals...
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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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22-21-265
Section 22-21-265 Certificates of need - Required for new institutional health service.
(a) On or after July 30, 1979, no person to which this article applies shall acquire, construct,
or operate a new institutional health service, as defined in this article, or furnish or offer,
or purport to furnish a new institutional health service, as defined in this article, or make
an arrangement or commitment for financing the offering of a new institutional health service,
unless the person shall first obtain from the SHPDA a certificate of need therefor. Notwithstanding
any provisions of this article to the contrary, those facilities and distinct units operated
by the Department of Mental Health, and those facilities and distinct units operating under
contract or subcontract with the Department of Mental Health where the contract constitutes
the primary source of income to the facility, shall not be required to obtain a certificate
of need under this article. (b) Notwithstanding all other...
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16-44B-1
Section 16-44B-1 Compact. ARTICLE I PURPOSE It is the purpose of this compact to remove
barriers to education success imposed on children of military families because of frequent
moves and deployment of their parents by: A. Facilitating the timely enrollment of children
of military families and ensuring that they are not placed at a disadvantage due to difficulty
in the transfer of education records from the previous school district(s) or variations in
entrance/age requirements. B. Facilitating the student placement process through which children
of military families are not disadvantaged by variations in attendance requirements, scheduling,
sequencing, grading, course content or assessment. C. Facilitating the qualification and eligibility
for enrollment, educational programs, and participation in extracurricular academic, athletic,
and social activities. D. Facilitating the on-time graduation of children of military families.
E. Providing for the promulgation and enforcement of...
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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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22-6-229
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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22-6-150
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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22-6-151
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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