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40-26B-83
Section 40-26B-83 State plan amendment. (a) There is established the Hospital Services
and Reimbursement Panel to advise in the development of and approve any state plan amendment
which involves hospital services or reimbursement to be submitted to the Centers for Medicare
and Medicaid Services. (1) The panel shall consist of six members and be constituted in the
following manner: a. The Commissioner of the Alabama Medicaid Agency. b. Three members to
be appointed by the Governor from a list of 10 names submitted by the Alabama Hospital Association.
The hospital members appointed shall represent the diverse ownership type of hospitals in
the state. c. Two members to be appointed by the Governor. (2) All panel members shall be
residents of Alabama and the composition of the board shall reflect the racial, gender, geographic,
urban/rural, and economic diversity of the state. The panel shall meet within 30 days subsequent
to May 15, 2009, to elect a chair and establish procedures...
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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-75
Section 40-26B-75 Quarterly notice and collection. (a)(1) The annual assessment imposed
under this article shall be due and payable on a quarterly basis during the first 15 business
days of each quarter. (2) Notwithstanding subdivision (1), the installment payment of an assessment
imposed by this article shall not be due and payable until: a. The department issues the written
notice required by this article stating that the payment methodologies to privately operated
hospitals required under this article have been approved by the Centers for Medicare and Medicaid
Services and the waiver under 42 C.F.R. §433.68 for the assessment imposed by this article,
if necessary, has been granted by the Centers for Medicare and Medicaid Services, or if approval
for the State Plan Amendment and the waiver under 42 CFR §433.68 for the assessment imposed
by this article, if necessary, is delayed for any reason, the payment shall be recalulated
by Medicaid upon actual approval; and b. The 30-day...
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40-26B-87
Section 40-26B-87 Exclusion from State General Fund. The Commissioner of the Alabama
Medicaid Agency is hereby directed to specifically exclude from the Plan Amendment submitted
to the Centers for Medicare and Medicaid Services regarding the Hospital Assessment Program
any language or calculations that would incur liability to the State General Fund. (Act 2009-549,
p. 1454, §3.)...
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40-26B-71
Section 40-26B-71 Assessment. (a) For state fiscal years 2020, 2021, and 2022, an assessment
is imposed on each privately operated hospital in the amount of 6.00 percent of net patient
revenue in fiscal year 2017, which shall be reviewed and updated annually, subject to limitations
in this article on the use of funds in the Hospital Assessment Account. The assessment is
a cost of doing business as a privately operated hospital in the State of Alabama. Annually,
the Medicaid Agency shall make a determination of whether changes in federal law or regulation
have adversely affected hospital Medicaid reimbursement during the most recently completed
fiscal year, or a reduction in payment rates has occurred. If the agency determines that adverse
impact to hospital Medicaid reimbursement has occurred, or will occur, the agency shall report
its findings to the Chair of the House Ways and Means General Fund Committee who shall propose
an amendment to this article during any legislative session...
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40-26B-81
Section 40-26B-81 Medicaid hospital access payments. (a) If the Medicaid Agency begins
making payments pursuant to Article 9 of Chapter 6 of Title 22, on or before September 30,
2019, to preserve and improve access to hospital services, for hospital inpatient and outpatient
services rendered on or after October 1, 2018, the agency shall consider the published inpatient
and outpatient rates as defined in Sections 40-26B-79 and 40-26B-80 as the minimum payment
allowed. (b) If the Medicaid Agency does not begin making payments pursuant to Article 9 of
Chapter 6 of Title 22, on or before September 30, 2019, the aggregate hospital access payment
amount is an amount equal to the upper payment limit, less total hospital base payments determined
under this article. All publicly, state-owned, and privately operated hospitals shall be eligible
for inpatient and outpatient hospital access payments for fiscal years 2020, 2021, and 2022,
as set forth in this article. (1) In addition to any other...
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40-26B-79
Section 40-26B-79 Inpatient Medicaid base payments. If the Medicaid Agency begins making
payments pursuant to Article 9 of Chapter 6 of Title 22, on or before September 30, 2019,
the agency shall pay hospitals as a base amount for state fiscal year 2019, for inpatient
services an APR-DRG payment that is equal to the total modeled UPL submitted and approved
by CMS during fiscal year 2019. If the agency begins making payments pursuant to Article 9
of Chapter 6 of Title 22, on a date other than the first day of fiscal year 2019, there shall
be no retroactive adjustment to payments already made to hospitals in accordance with the
approved state plan. If approved by CMS, the agency shall publish the APR-DRG rates for each
hospital prior to September 30, 2018. If the agency does not begin making payments pursuant
to Article 9 of Chapter 6 of Title 22, on or before September 30, 2022, the agency shall pay
hospitals as a base amount for fiscal years 2020, 2021, and 2022, the total inpatient...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive
denials, adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health
benefit plan that issues or renews any policy of accident or health insurance providing benefits
for medical or hospital expenses for its insured persons shall pay for services rendered by
Alabama health care providers within 45 calendar days upon receipt of a clean written claim
or 30 calendar days upon receipt of a clean electronic claim. If the insurer, health service
corporation, or health benefit plan is denying or pending the claim, the insurer, health service
corporation, or health benefit plan shall, within 45 calendar days for a written claim and
30 calendar days for an electronic claim, notify the health care provider or certificate holder
of the reason for denying or pending the claim and what, if any, additional information is
required to process the claim. Any undisputed portion of the claim...
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases
shall have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health.
(2) ENROLLEE. An individual who has contracted for or who participates in coverage under an
insurance policy, a health maintenance organization contract, a health service corporation
contract, an employee welfare benefit plan, a hospital or medical services plan, or any other
benefit program providing payment, reimbursement, or indemnification for health care costs
for the individual or the eligible dependents of the individual. (3) PROVIDER. A health care
provider duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system
for prospective and concurrent review of the necessity and appropriateness in the allocation
of health care resources and services given or proposed to be given to an individual within
this state. The term does not include elective requests for clarification of...
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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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