SB340 Alabama 2013 Session

Summary

Primary Sponsor

Greg J. Reed

Republican

Session

Regular Session 2013

Title

Medicaid Agency, delivery of medical services to Medicaid eligible persons through regional care organizations, organization of a quality assurance committee, contracts with alternative care providers under limited circumstances, authorized

Summary

This bill creates a managed Medicaid system in Alabama using regional care organizations and alternate care providers with new governance, financial, and oversight rules.

What This Bill Does

It requires Medicaid to deliver services through regional care organizations or alternate care providers under risk contracts with capitation payments. It creates governing boards with a specified mix of risk bearing participants, medical professionals, and community representatives, plus a citizen advisory committee, all subject to approval by the Medicaid Agency. It sets solvency and financial reserve requirements and allows a performance bond option, while establishing a quality assurance committee to develop and monitor outcome and quality measures. It outlines enrollment of beneficiaries, provides choice or assignment to organizations, and creates grievance and appeal processes, along with provider network requirements and plans to evaluate long-term and dental care.

Who It Affects

• Medicaid beneficiaries who will be enrolled in regional care organizations or alternate care providers, with options to choose an organization and access to grievance and appeal processes.
• Hospitals, doctors, clinics, pharmacists, optometrists, and other health care providers and organizations that may contract with regional care organizations or alternate care providers and must meet network, licensing, and quality requirements.

Key Provisions

• Geographic Medicaid regions established and each region must support at least two regional care organizations or alternate care providers; contracts are risk based with capitated payments.
• Governing boards for regional care organizations to include 12 risk bearing participants and 8 non risk bearing members (including 5 medical professionals, 3 community representatives, and a voting structure with physician input), with diversity requirements and approval by the Medicaid Agency.
• Creation of a quality assurance committee appointed by the Medicaid Commissioner, with at least 60 percent of members who are physicians; development and annual updating of objective outcome and quality measures; measures incorporated into contracts and publicly reported in aggregate.
• Financial requirements for regional care organizations include minimum reserves (250,000 restricted or 25 percent of expenditures, plus 2.5 million in capital/surplus) or a qualifying performance bond; need for regular financial reporting and audits.
• Enrollment and provider network rules require beneficiaries to be enrolled in a regional care organization, allow choice, require adequate medical service networks, and permit contracts with willing providers who meet licensing and Medicaid/Medicare participation rules.
• Comprehensive grievance and appeal procedures from immediate medical director decisions to peer review and the Medicaid Agency, with hearings and final agency decisions and costs borne by the Medicaid Agency.
• Collaboration and state action immunity provisions to allow collaboration among public payers, private carriers, and providers; requires certificates to collaborate, formal rules, confidentiality protections, and potential intervening by the Medicaid Agency to facilitate negotiations.
• Independent evaluation of cost savings, patient outcomes, and quality of care by each regional care organization; benchmarks and performance used to decide contract renewals or changes in care delivery systems; long-term and dental care program evaluations due by October 1, 2015.
• phased implementation timeline with milestones for region establishment, probationary certification, network readiness, solvency and readiness for risk contracts, and potential replacement by alternate care providers if regional care organizations fail to meet terms.

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Medicaid Agency