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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....
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-221.htm - 2K - Match Info - Similar pages
35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/35-11-371.htm - 5K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/40-26B-82.htm - 5K - Match Info - Similar pages
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
36-1A-5
Section 36-1A-5 Participation limited to voluntary, charitable, health and human care federations
and agencies with a substantial local presence. (a) Participation in the Alabama State Employee
Combined Charitable Campaign shall be limited to voluntary, charitable, health and human care
federations and agencies with a substantial local presence that provide or support direct
health and welfare services to individuals or their families and meet the criteria set forth
in this section. "Substantial local presence" is defined as a facility, staffed
by professionals or volunteers, available to provide its services and open at least 15 hours
a week. Such services must be available to state employees in the local campaign community,
unless they are rendered to needy persons overseas. Such services must directly benefit human
beings, whether children, youth, adults, the aged, the ill and infirm, or the mentally or
physically handicapped. Such services must consist of care, research, or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-1A-5.htm - 4K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-226.htm - 3K - Match Info - Similar pages
29-2-105
Section 29-2-105 Coordination council - Composition; meetings; duties. (a) The committee shall
convene a council composed of the chair of the committee or his or her designee and the commissioner
or the commissioner's designee of each department of state government that administers services
to children, youth, and their families, including, but not limited to, the Department of Education,
the Department of Human Resources, the Department of Mental Health, the Department of Public
Health, the Medicaid Agency, the Department of Youth Services, the Department of Rehabilitation
Services, one member from the Alabama Association of County Directors of Human Resources appointed
by that organization, one member from the Alabama Residential Child Care Association appointed
by that organization, two members from the Alabama Foster Parent Association appointed by
that organization, one member from the Juvenile Court Judges Association appointed by that
organization, one guardian ad litem...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/29-2-105.htm - 3K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-3A-3.htm - 3K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-265.htm - 15K - Match Info - Similar pages
22-50-11
Section 22-50-11 Department - Additional and cumulative powers. The Department of Mental Health
is given hereby the following additional and cumulative powers through its commissioner: (1)
It is authorized and directed to set up state plans for the purpose of controlling and treating
any and all forms of mental and emotional illness and any and all forms of mental retardation
and shall divide the state into regions, districts, areas or zones, which need not be geographic
areas, but shall be areas for the purpose of establishing priorities and programs and for
organizational and administrative purposes in accordance with these state plans. (2) It is
designated and authorized to supervise, coordinate, and establish standards for all operations
and activities of the state related to mental health and the providing of mental health services;
and it is authorized to receive and administer any funds available from any source for the
purpose of acquiring building sites for, constructing,...
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