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40-26B-77.1
Section 40-26B-77.1 Intergovernmental transfers to the Medicaid Agency. (a) Beginning on October
1, 2016, and ending on September 30, 2022, publicly owned and state-owned hospitals shall
begin making intergovernmental transfers to the Medicaid Agency. If the agency begins making
payments pursuant to Article 9 of Chapter 6 of Title 22, on or before September 30, 2019,
the amount of the intergovernmental transfers shall be calculated for each hospital using
a pro-rata basis based on the hospital's IGT contribution for FY 2018 in relation to the total
IGT for FY 2018. Total IGTs for any given fiscal year shall not exceed three hundred thirty-three
million, four hundred thirty-four thousand, and forty-eight dollars ($333,434,048) with the
exception of an adjustment as described in subsection (d) and to the extent adjustments are
required to comply with federal regulations or terms of any waiver issued by the federal government
relating to the state's Medicaid program. The total...
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40-26B-73
Section 40-26B-73 Hospital Assessment Account. (a)(1) There is created within the Health Care
Trust Fund referenced in Article 3 of Chapter 6 of Title 22 of a designated account known
as the Hospital Assessment Account. (2) The hospital assessments imposed under this article
shall be deposited into the Hospital Assessment Account. (3) If the Medicaid Agency begins
making payments under Article 9 of Chapter 6 of Title 22, while Act 2017-382 is in force,
the hospital intergovernmental transfers imposed under this article shall be deposited into
the Hospital Assessment Account. (b) Moneys in the Hospital Assessment Account shall consist
of: (1) All moneys collected or received by the department from privately operated hospital
assessments imposed under this article; (2) Any interest or penalties levied in conjunction
with the administration of this article; and (3) Any appropriations, transfers, donations,
gifts, or moneys from other sources, as applicable; and (4) If the Medicaid Agency...
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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-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-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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40-26B-80
Section 40-26B-80 Outpatient 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 fiscal year 2019 for outpatient services based upon
a fee for service and access payments or OPPS schedule. 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 2022, there shall be no retroactive adjustment to payments already made to hospitals
in accordance with the approved state plan. Should the Medicaid Agency implement OPPS, the
total amount budgeted (total base rate) for OPPS shall not be less than the total outpatient
UPL. 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 agency shall pay hospitals as a base amount
for fiscal year 2019 for outpatient services, based upon an...
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22-6-70
Section 22-6-70 Created. There is hereby created in the State Treasury a trust fund to be known
as the Medicaid Trust Fund. The trust fund shall be administered by a board of directors in
accordance with the provisions of this article. Funds received by the State of Alabama from
the following sources shall be deposited into the trust fund: (1) Tobacco revenues, as defined
by Section 41-10-622(9), designated by state law for the use and benefit of the Alabama Medicaid
Agency; (2) intergovernmental fund transfers received by the Alabama Medicaid Agency from
public hospitals and public nursing homes which, at the end of any fiscal year, have not been
expended or encumbered in accordance with the fiscal laws and procedures of the State of Alabama
and when the transfer to the Medicaid Trust Fund has been recommended by the Commissioner
of the Medicaid Agency and approved by the Director of Finance; and (3) any funds appropriated
to the Alabama Medicaid Agency from any source which, at the...
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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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13A-9-150
Section 13A-9-150 Public assistance fraud; penalties. (a) For the purposes of this section,
public assistance means money or property provided directly or indirectly to eligible persons
through programs of the federal government, the state, or any political subdivision thereof,
including any program administered by a public housing authority. (b) It shall be unlawful
for an individual or business entity to knowingly do any of the following: (1) Fail, by false
statement, misrepresentation, impersonation, or other fraudulent means, to disclose a material
fact used in making a determination as to the qualification of the person to receive public
assistance. (2) Fail to disclose a change in circumstances in order to obtain or continue
to receive any public assistance to which he or she is not entitled or in an amount larger
than that to which he or she is entitled. (3) Aid and abet another person in the commission
of the prohibitions enumerated in subdivisions (1) and (2). (4) Use,...
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33-12-5
Section 33-12-5 Powers, duties and functions. The powers, duties and functions of the agency
shall be as follows: (1) GENERALLY. The agency a. Shall have perpetual succession in its corporate
name. b. May sue and be sued in its corporate name. c. May adopt, use and alter a corporate
seal, which shall be judicially noticed. d. May enter into such contracts and cooperative
agreements with the federal, state and local governments, with agencies of such governments,
with private individuals, corporations, associations, trusts and other organizations as the
board may deem necessary or convenient to enable it to carry out the purposes of this chapter,
including the planned, orderly residential development of the area. e. May adopt, amend and
repeal bylaws. f. May appoint such managers, officers, employees, attorneys and agents as
the board deems necessary for the transaction of its business, fix their compensation, define
their duties, require bonds of such of them as the board may...
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