22-19-123
Section 22-19-123 Adherence to quality assurance standards. Any person providing any service
pertaining to the acquisition and/or transportation of donor organs, bones and tissues retrieved
in Alabama, shall strictly adhere to and follow the established quality assurance standards
of proficiency and fitness and measures and procedures as established and promulgated by the
chairman. (Acts 1986, No. 86-225, p. 329, §4.)...
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22-6-232
Section 22-6-232 Coverage of Medicaid beneficiaries by integrated care networks. (a) The Medicaid
Agency shall determine by rule which groups of Medicaid beneficiaries to include for coverage
by an integrated care network. 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. (b) Notwithstanding subsection (a), the current Medicaid long-term
care programs shall continue as currently administered by the Medicaid Agency until one or
more integrated care networks are fully operational and has entered into a risk contract as
provided herein. (Act 2015-322, §14.)...
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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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22-6-156
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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22-6-229
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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43-2-697
Section 43-2-697 Notice to Medicaid Agency of appointment as personal representative or filing
of petition under Section 43-2-692. (a) The personal representative, or person filing to initiate
a proceeding in accordance with the Alabama Small Estates Act, Division 10 of this article,
shall give notice of his or her appointment, or the filing of a petition in accordance with
Section 43-2-692, to the Medicaid Agency. The notice shall include all of the following information:
(1) The full legal name of the deceased. (2) The date of birth of the deceased. (3) The date
of death of the deceased. (4) The Social Security number of the deceased. (5) The marital
status of the deceased at the time of death. (6) The name, address, and phone number of the
spouse of the deceased, if applicable. (7) The court in which a probate estate has been opened.
(8) The probate case number. (9) The date on which letters testamentary or letters of administration
were issued by the probate court. (10) The name,...
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22-6-161
Section 22-6-161 Evaluation and report on dental care program for Medicaid beneficiaries. (a)
The Medicaid Agency, with input from dental care providers, shall conduct an evaluation of
the existing dental care program for Medicaid beneficiaries and, on October 1, 2015, shall
report the findings of the evaluation to the Legislature and Governor. (b) Notwithstanding
the above, the current Medicaid dental care programs shall continue as currently administered
by the Medicaid Agency until the end of the fiscal year when the evaluation required in subsection
(a) is reported to the Legislature and the Governor. (Act 2013-261, p. 686, §12.)...
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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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22-2-7
Section 22-2-7 Annual report to Legislature by state committee; requests by same for information.
The State Committee of Public Health and the State Board of Health shall be accountable to
the Legislature of Alabama and shall make an annual report to the Legislature. The Legislature,
or any committee thereof, may, from time to time, request certain information from the State
Board of Health and the State Committee of Public Health, and both groups are hereby directed
to lend their full cooperation in response to these requests. (Acts 1973, No. 762, p. 1141,
§6.)...
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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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