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22-6-224
Section 22-6-224 Medicaid Agency to contract for medical care; enrollment; delivery of services;
reimbursement. (a) Subject to approval of the federal Centers for Medicare and Medicaid Services,
the Medicaid Agency shall enter into contracts with one or more integrated care networks to
provide, pursuant to a risk contract under which the Medicaid Agency makes a capitated payment,
medical care to Medicaid beneficiaries assigned to the integrated care network. The Medicaid
Agency may enter into a contract pursuant to this section only if, in the judgment of the
Medicaid Agency, care of Medicaid beneficiaries would be better, more efficient, and less
costly than under the then existing care delivery system. Pursuant to the contract, the Medicaid
Agency shall set capitation payments for the integrated care network. (b) The Medicaid Agency
shall enroll beneficiaries it designates into an integrated care network consistent with guidance
from the Center for Medicare and Medicaid Services. (c)...
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22-6-231
Section 22-6-231 Implementation of article. (a) The following timeline applies to implementation
of this article: (1) Not later than April 1, 2017, the Medicaid Agency shall establish integrated
care network rules setting forth solvency, governing board, network, and active supervision
requirements, as well as other requirements of the Medicaid Agency. (2) Not later than April
1, 2018, Medicaid Agency will initiate competitive procurement for the services of integrated
care network or networks. (3) Not later than October 1, 2018, one or more integrated care
networks certified by the Medicaid Agency shall begin to deliver services pursuant to a risk
bearing contract. (Act 2015-322, §13.)...
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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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22-6-229
Section 22-6-229 Termination of certification. (a) The Medicaid Agency shall establish by rule
the procedure for the termination of an integrated care network certification for non-performance
of contractual duty or for failure to meet or maintain standards or requirements provided
by this article or established by the Medicaid Agency as required by this article. (b) Termination
of an integrated care network certification shall follow the standard administrative process
with the right to a hearing before a hearing officer appointed by the Medicaid Agency. (Act
2015-322, §11.)...
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22-6-230
Section 22-6-230 Rates for contracting services; provider requirements. An integrated care
network shall contract with any willing nursing home, doctor, home and community waiver program,
or other provider to provide services through an integrated care network if the provider is
willing to accept the payments and terms offered comparable providers, where applicable, but
in no event less than amounts historically paid by the Medicaid Agency to comparable providers.
To the extent that the Medicaid Agency currently calculates and establishes provider-specific
rates for any provider category on an annualized basis, it shall continue to calculate and
establish such rates and the integrated care network shall be required to offer providers
from that category not less than their established rates. Any provider shall meet licensing
requirements set by law, shall have a Medicaid provider number, and shall not otherwise be
disqualified from participating in Medicare or Medicaid. (Act 2015-322,...
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22-6-20
Section 22-6-20 Legislative intent. The Legislature recognizes the increasing population of
our senior citizens and the importance of ensuring that each receives quality health care.
The Medicaid Agency of the State of Alabama, hereinafter referred to as "Medicaid",
shall have the power to enforce specific remedies to ensure compliance with OBRA. (Acts 1989,
No. 89-641, p. 1268, §1.)...
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22-12B-2
Section 22-12B-2 Board established; composition; meetings; powers. There is hereby established
the Alabama Mothers and Babies Indigent Care Trust Board to administer said fund. The board
shall consist of the Governor, who shall serve as ex officio chairman, the commissioner of
the Alabama Medicaid Agency, the Finance Director and the State Health Officer. The board
shall meet as necessary to carry out its duties, upon three days' notice to all board members.
The board shall have the power to transfer moneys from the trust fund to the Alabama Medicaid
Agency to carry out the purposes, intent and provisions of this chapter. The Medicaid Agency
may accept unconditional and unrestricted transfers of such moneys. The existence or availability
of this trust fund shall not reduce appropriations from the State General Fund. (Acts 1987,
No. 87-707, p. 1245, §2.)...
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22-4-2
Section 22-4-2 Definitions. When used in this article, the following terms shall have the following
meanings, respectively, unless a different meaning clearly appears from the context: (1) STATE
BOARD OF HEALTH. The statutory agency of the State of Alabama operative in the field of general
health matters and performing the duties and exercising the powers as set forth in the statutory
provisions relating thereto. (2) STATEWIDE HEALTH COORDINATING COUNCIL. The advisory council
established pursuant to this article which shall advise the State Board of Health on matters
relating to health planning and resource development. (3) HEALTH SYSTEMS AGENCY. An entity
which is organized and operated under the provisions of Title XV of the Public Health Service
Act (42 U.S.C. §§ 3001 et seq.) and is responsible for the health planning and development
in a health service area designated by the Governor. (4) HEALTH SERVICE AREA. A geographical
area designated by the Governor as being appropriate...
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22-11A-111
Section 22-11A-111 Definitions. For purposes of this article, the following terms shall have
the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2) BOARD.
The State Board of Health. (3) COUNCIL. The Health Care Data Advisory Council. (4) DATA. Patient
information submitted by health care facilities to the Department of Public Health necessary
to carry out the requirements of this article. The information required to be reported by
health care facilities to the department shall be based upon the Federal Centers for Disease
Control and Preventions National Healthcare Safety Network definitions of hospital-acquired
infections and the guidelines for reporting. (5) HEALTH CARE FACILITY. General, critical access,
and specialized hospitals licensed pursuant to Section 22-21-20. (6) HEALTH CARE FACILITY
ACQUIRED INFECTIONS. A localized or systemic condition that: a. Results from adverse reaction
to the presence of an infectious agent or agents or its toxins. b....
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22-6-120
Section 22-6-120 Legislative findings. The Legislature finds the following: (1) The availability
of appropriate pharmaceutical benefits to every Alabama citizen is a critical component to
the overall health of its population. (2) Alabama should strive to provide appropriate, safe,
effective, and cost-efficient pharmaceutical care to those who depend on health benefits through
state funded programs. (3) The Alabama Medicaid Agency should endeavor to manage the Medicaid
Pharmacy Program utilizing clinical management tools in a manner to foster optimal health
outcomes at reasonable costs. (4) State Medicaid programs and private insurance plans across
the country utilize preferred drug lists as an effective way to foster and encourage clinically
appropriate and safe use of pharmaceuticals in a cost-effective manner. (5) Based on the proven
effectiveness of preferred drug programs to foster appropriate use of drugs, it is in the
best interests of Alabama and its citizens for the Alabama...
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