SB459 Alabama 2014 Session

Under existing law, medical services to Medicaid beneficiaries are delivered on a managed care basis through regional care organizations or alternative care providers. The Medicaid Agency has established geographic Medicaid regions with at least one fully certified regional care organization providing medical care to Medicaid beneficiaries in the region directly or by contract with other providers

This bill would revise the membership of and eligibility requirements for the governing board of directors of a regional care organization

This bill would authorize the board of directors of a regional care organization to appoint an executive committee or other committees to take action as allowed by the governing documents of the organization

This bill would require each regional care organization to create a provider standards committee to review and develop performance standards and quality measures required of a provider by the organization, subject to the approval of the Medicaid Quality Assurance Committee

This bill would require the Medicaid Agency to, by rule, establish the minimum reimbursement rate for providers pursuant to certain methodologies and would require submission of the rates to the Centers for Medicare and Medicaid Services for approval

This bill would provide that all contracts of a regional care organization are subject to review by the Medicaid Agency, establish procedures for review of contract terms and provisions upon the request of dissatisfied providers, and require the Medicaid Agency to adopt rules regarding the review of agreements and contracts by the contract dispute committee

This bill would prohibit a regional care provider from excluding a provider from providing services to a Medicaid region if the provider is willing to meet the terms and conditions for participation established by the organization

This bill would also specify that all agreements and contracts of regional care organizations that have received probationary or final certification are subject to review or approval by the Medicaid Agency

Relating to the Medicaid Agency; to revise the membership of and eligibility requirements for the governing board of directors of a regional care organization; to authorize the board of directors of a regional care organization to appoint an executive committee and other committees to take certain authorized action; to provide for the membership of an executive committee; to require each regional care organization to create a provider standards committee to review and develop performance standards and quality measures; to provide for approval of the standards by the Medicaid Quality Assurance Committee; to require the Medicaid Agency to, by rule, establish the minimum reimbursement rate for providers pursuant to certain methodologies; to provide for the review of provider contracts by the Medicaid Agency; to establish procedures for the review of contracts upon the request of dissatisfied providers; to require the Medicaid Agency to adopt rules regarding the review of agreements and contracts by the contract dispute committee; to prohibit a regional care provider from excluding a provider from providing services to a Medicaid region if the provider is willing to meet certain criteria; to specify that all agreements and contracts of regional care organizations that have received probationary or final certification are subject to review or approval by the Medicaid Agency; and to further provide for the rulemaking authority of the Medicaid Agency in the administration of the Alabama Medicaid Program.