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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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22-6-232
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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22-6-222
Section 22-6-222 Citizens' advisory committee. There shall be a citizens' advisory committee
constituted to advise the integrated care network on ways the integrated care network may
be more efficient in providing quality care to Medicaid beneficiaries. In addition, the advisory
committee shall carry out other functions and duties assigned to it by the integrated care
network and approved by the Medicaid Agency. The committee shall meet all of the following
criteria: (1) Be selected in a method established by the organization seeking to become an
integrated care network, or established by an integrated care network, and approved by the
Medicaid Agency. (2) At least 20 percent of its members shall be Medicaid beneficiaries or
sponsors of Medicaid beneficiaries or, if the organization has been certified as an integrated
care network, at least 20 percent of its members shall be Medicaid beneficiaries enrolled
in the integrated care network, or their sponsor. (3) Include members who are...
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22-6-227
Section 22-6-227 Quality assurance committee; reporting requirements. (a) The Medicaid Agency
shall create a quality assurance committee appointed by the Medicaid Commissioner to review
the care rendered through the integrated care networks. The members of the committee shall
serve two-year terms. The Medicaid Agency shall promulgate a rule establishing the membership
and criteria to serve on the quality assurance committee. (b) The Medicaid Agency shall continuously
evaluate the outcome and quality measures adopted by the committee pursuant to this section.
(c) The Medicaid Agency shall utilize available data systems for reporting outcome and quality
measures adopted by the committee and take actions to eliminate any redundant reporting or
reporting of limited value. (d) The Medicaid Agency shall publish the information collected
under this section at aggregate levels that do not disclose information otherwise protected
by law. The information published shall report all of the...
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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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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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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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22-21B-3
Section 22-21B-3 Definitions. The following words and terms shall have the meanings ascribed
to them in this section, unless otherwise required by their respective context: (1) CONSCIENCE.
The religious, moral, or ethical principles held by a health care provider. (2) DISCRIMINATION.
Discrimination includes, but is not limited to: Hiring, termination, refusal of staff privileges,
refusal of board certification, demotion, loss of career specialty, reduction of wages or
benefits, adverse treatment in the terms and conditions of employment, refusal to award any
grant, contract, or other program, or refusal to provide residency training opportunities.
(3) HEALTH CARE PROVIDER. Any individual who may be asked to participate in any way in a health
care service, including, but not limited to: A physician, physician's assistant, nurse, nurse's
aide, medical assistant, hospital employee, clinic employee, nursing home employee, pharmacist,
researcher, medical or nursing school faculty, student,...
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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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45-37-171.44
Section 45-37-171.44 Ability to pay fees; increase in costs and fees; funding. No person shall
be denied any service because that person, or if a minor, the parent or legal guardian of
such person, is unable to pay the fee for such service established pursuant to this subpart.
The determination of a person's ability to pay shall be made in confidence and under circumstances
that will protect the dignity of the person receiving the service. Using any appropriate standards
of ability to pay for health care provided by the United States Government or any agency thereof,
the Jefferson County Board of Health may establish a sliding fee scale based on a person's
ability to pay. Any provision of this subpart to the contrary notwithstanding, this subpart
shall not be interpreted or applied to authorize any increase in the fees, if any, that any
person may be required to pay for any examination, treatment, vaccination, inoculation, or
other health care service of any kind that, as of September...
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