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 […]
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 […]
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 […]
Section 22-6-223 Solvency and financial requirements. (a) An integrated care network shall meet minimum solvency and financial requirements as provided by the Medicaid Agency. The Medicaid Agency shall require the integrated care network, as a condition of certification or continued certification, to maintain minimum solvency and financial reserves. The Medicaid Agency shall hereafter promulgate rules […]
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 […]
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 […]
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 […]
Section 22-6-227 Quality assurance committee; reporting requirements. (a) The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid Commissioner to review the care rendered through the integrated care networks. The members of the committee shall serve two-year terms. The Medicaid Agency shall promulgate a rule establishing the membership and criteria to serve […]
Section 22-6-228 Risk contracts. A risk contract between the Medicaid Agency and an integrated care network shall be for two years, with the option for Medicaid to renew the contract for not more than three additional one-year periods. The Medicaid Agency shall obtain provider input and an independent evaluation of the cost savings, patient outcomes, […]
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) […]
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 […]
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 […]
Section 22-6-232 Coverage of Medicaid beneficiaries by integrated care networks. (a) The Medicaid Agency shall determine by rule which groups of Medicaid beneficiaries to include for coverage by an integrated care network. The Medicaid Agency, without the approval of the Governor, shall not make a coverage decision that would affect Medicaid beneficiaries who are directly […]
Section 22-6-233 Legislative findings; certification of collaborators; powers of Medicaid Agency; state action immunity. (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 […]
Section 22-6-234 Advance directive for health care options. Any participant in the integrated care network system receiving long term care services shall be offered information regarding advance directive for health care options consistent with applicable Alabama state law. (Act 2015-322, §16.)
Section 22-6-235 Rulemaking authority. The Medicaid Agency shall adopt rules necessary to implement this article and to administer the Medicaid Program as provided in this article in a manner consistent with state and federal law, as well as any State Plan or State Plan Waiver approved by the Centers for Medicare and Medicaid Services. (Act […]
Section 22-6-236 Construction and application of §§22-6-220 through 22-6-234. All laws or parts of laws which conflict with this act are repealed. Notwithstanding the above, it is expressly declared that the provisions of Sections 22-6-220 to 22-6-234, inclusive, apply only to long-term care and integrated care networks as provided for in those sections. Therefore, Sections […]
Section 22-6-237 Exemption from certain fees and taxes. Any other provision of law to the contrary notwithstanding, integrated care networks as defined in this article are exempt from the payment of any and all state, county, and municipal license fees, including any business privilege or license tax heretofore or hereafter levied by the State of […]
