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22-6-226
Section 22-6-226 Review and approval of contracts; rules governing operation of integrated
care networks. (a) All provider contracts of an organization granted final certification as
an integrated care network shall be subject to review and approval of the Medicaid Agency.
(b)(1) If a provider is dissatisfied with any term or provision of the agreement or contract
offered by an integrated care network, the provider shall: a. Seek redress with the integrated
care network. In providing redress, an integrated care network shall afford the provider a
review by a panel composed of a representative of an integrated care network, the same type
of provider, and a representative of the citizens' advisory board appointed by the chair of
the advisory board. b. After seeking redress with an integrated care network, a provider or
an integrated care network who remains dissatisfied may request a review of such disputed
term or provision by the Medicaid Agency. The Medicaid Agency shall have 10 days...
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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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16-47-240
Section 16-47-240 Alabama Rural Hospital Resource Center. (a) The University of Alabama at
Birmingham shall establish the Alabama Rural Hospital Resource Center. (b) The purpose of
the resource center is to facilitate access to high quality care for rural Alabamians and
improve their health by increasing the viability and capabilities of eligible hospitals at
no or minimal cost to those hospitals. (c) For the purposes of this section, the following
terms shall have the following meanings: (1) ELIGIBLE HOSPITAL. A nonprofit or public rural
hospital. (2) RESOURCE CENTER. The Rural Hospital Resource Center of the University of Alabama
at Birmingham. (3) RURAL. Located in one of the following: a. An area designated as a shortage
area as defined in 42 C.F.R. § 491.5(c) and (d); or b. A rural area as defined by the Federal
Office of Rural Health Policy. (d) The resource center shall do all of the following: (1)
Hire necessary staff that is inclusive and reflects the racial, gender,...
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40-26B-26
Section 40-26B-26 Reduction of revenues; reimbursement computations; quality incentive program.
THIS SECTION WAS AMENDED BY ACT 2020-147 IN THE 2020 REGULAR SESSION, EFFECTIVE MAY 18, 2020.
THIS IS NOT IN THE CURRENT CODE SUPPLEMENT. (a) No revenues resulting from the privilege assessment
established by this article and applied to increases in covered services or reimbursement
levels or other enhancements of the Medicaid program shall be subject to reduction or elimination
while the privilege assessment is in effect. (b) Every nursing facility participating in the
Medicaid program in the State of Alabama shall be reimbursed according to the reimbursement
methodology contained in Chapter 560-X-22 of the Alabama Medicaid Agency Administrative Code
(Supp. 12/31/95) on January 31, 1998, which methodology is incorporated by reference herein,
except that the following shall apply: (1) The ceiling for the operating cost center described
in Title 560-X-22-.06 (2)(a) of the Alabama Medicaid...
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45-49-171.41
Section 45-49-171.41 Mobile County Indigent Care Board authorized. At the determination of
the county commission, there may be hereby established the Mobile County Indigent Care Board,
hereinafter referred to as the board, whose composition and duties shall be as follows: (1)
The county commission may appoint a Mobile County Indigent Care Board which shall consist
of three members who are duly qualified electors of Mobile County, but no member of such board
shall be employed by any hospital. Of the members of the board first appointed under this
section, one shall be appointed for a term of one year, one shall be appointed for a term
of three years, and one shall be appointed for a term of five years. Thereafter, their successors
shall be appointed for terms of five years and may be appointed to succeed themselves as members
of the board. The county commission shall appoint all members to the board. In the event the
county commission does not appoint the board, the duties and...
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22-32-1
Section 22-32-1 Enactment of Southeast Interstate Low-Level Radioactive Waste Management Compact.
The Southeast Interstate Low-Level Radioactive Waste Management Compact is hereby enacted
into law and entered into by the State of Alabama with any and all states legally joining
therein in accordance with its terms, in the form substantially as follows: SOUTHEAST INTERSTATE
LOW-LEVEL RADIOACTIVE WASTE MANAGEMENT COMPACT Article I. Policy and Purpose There is hereby
created the Southeast Interstate Low-Level Radioactive Waste Management Compact. The party
states recognize and declare that each state is responsible for providing for the availability
of capacity either within or outside the state for the disposal of low-level radioactive waste
generated within its borders, except for waste generated as a result of defense activities
of the federal government or federal research and development activities. They also recognize
that the management of low-level radioactive waste is handled most...
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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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22-6-159
Section 22-6-159 Implementation of article. (a) The following is the timeline for implementation
of this article: (1) Not later than October 1, 2013, the Medicaid Agency shall establish Medicaid
regions. (2) Not later than October 1, 2014, an organization seeking to become a regional
care organization shall have established a governing board and structure as approved by the
Medicaid Agency. An organization may receive probationary certification as a regional care
organization upon submission of an application for, and demonstration of, a governing board
acceptable to the Medicaid Agency. Probationary certification shall expire on October 1, 2016,
or a later date established by the Medicaid Agency. (3) Not later than April 1, 2015, an organization
with probationary regional care organization certification shall have demonstrated to Medicaid's
approval the ability to establish an adequate medical service delivery network. (4) Not later
than October 1, 2015, an organization with...
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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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22-6-221
Section 22-6-221 Service by integrated care network; board of directors. (a) An integrated
care network shall serve only Medicaid beneficiaries in providing medical care and services.
For the purposes of this article, a beneficiary cannot be a member of both an integrated care
network and a regional care organization. (b) An integrated care network shall provide required
medical care and services to Medicaid beneficiaries and may coordinate care provided by or
through an affiliation of other health care providers or other programs as the Medicaid Agency
shall determine. (c) Notwithstanding any other provision of law, the integrated care network
shall not be deemed an insurance company under state law. (d)(1) An integrated care network
shall have a governing board of directors composed of the following members: a. Twelve members
shall be persons representing risk bearing participants. A participant bears risk by contributing
cash, capital, or other assets to the integrated care network....
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