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22-6-155
Section 22-6-155 Terms of contracts; cost evaluations. An initial contract between the Medicaid
Agency and a regional care organization shall be for three years, with the option for the
Medicaid Agency to renew the contract for not more than two 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 each regional care organization, and obtain
the results of each regional care organization's evaluation in time to use the findings to
decide whether to enter into another multi-year contract with the regional care organization
or change the Medicaid region's care-delivery system. (Act 2013-261, p. 686, §6; Act 2014-434,
p. 1598, §1.)...
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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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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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22-21-265
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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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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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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22-6-154
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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22-6-220
Section 22-6-220 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) CAPITATION PAYMENT. A payment the state Medicaid Agency makes
periodically to the integrated care network on behalf of each recipient enrolled under a contract
for the provision of medical services pursuant to this article. (2) 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
collaborator, or integrated care network in the health care system. (3) INTEGRATED CARE NETWORK.
One or more statewide organizations of health care providers, with offices in each regional
care organization region, that contracts with the Medicaid Agency to provide Medicaid benefits
to certain Medicaid beneficiaries as defined in subdivision (4) and...
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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-163.htm - 6K - Match Info - Similar pages
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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