SB459 Alabama 2014 Session

Summary

Primary Sponsor

Greg J. Reed

Republican

Co-Sponsors

Paul BussmanDel MarshJ.T. Waggoner

Session

Regular Session 2014

Title

Medicaid, Regional Care Organizations, membership and eligibility of board of directors revised, appointment of executive committee, creation of provider standards committee, establishment of minimum reimbursement rates by the Medicaid Agency, review of provider contract terms, rulemaking authority of the Medicaid Agency, Secs. 22-6-151, 22-6-153, 22-6-155, 22-6-158, 22-6-163, 22-6-164 am'd.

Summary

SB459 updates Alabama's Medicaid program by creating regional care organizations with governance and oversight reforms, adding provider standards and financial requirements, and expanding contract review and dispute processes.

What This Bill Does

It changes how regional care organizations are governed by revising board composition, creating an executive committee and other committees, and requiring a provider standards committee to develop performance and quality rules. It requires the Medicaid Agency to set minimum provider reimbursement rates, review provider contracts, and establish grievance and appeal processes for enrollees and providers. It creates a contract dispute committee to fairly review disputed contract terms and sets rules for contract reviews of probationary or final certified organizations. It strengthens the Medicaid Agency's rulemaking, financial oversight (solvency, audits), and collaboration rules that could provide immunity from certain anti-trust laws for state-approved collaborations.

Who It Affects

• Medicaid beneficiaries enrolled in regional care organizations would experience changes in how their care networks are organized and how they can appeal or challenge decisions.
• Regional care organizations, risk-bearing participants, and other providers (physicians, hospitals, optometrists, pharmacists) face new board structures, committees, minimum solvency and reimbursement rules, contract review and dispute processes, and greater Medicaid Agency oversight.

Key Provisions

• Redefined governing board composition for regional care organizations (12 risk-bearing participants; 8 non-risk participants including medical professionals, PCPs, optometrist, pharmacist; community representatives).
• Authority for the board to form an executive committee and other committees; executive committee must include representation of at-risk providers; at least one physician on committees; reports back to board.
• Creation of a provider standards committee to set performance standards and quality measures, with standards approved by the Medicaid Quality Assurance Committee; 60% of provider standards committee members must be physicians; chair is regional medical director.
• Establishment of minimum financial reserves (restricted reserves of $250,000 or 25% of expenditures, plus $2.5 million capital/surplus); option to post a performance bond for risk contracts.
• Mandatory review of provider contracts by the Medicaid Agency; new procedures for contract disputes with a contract dispute committee; binding decisions.
• Grievance and appeal procedures for enrollees and providers, including immediate appeal to a medical director, peer review by regional physicians, and appellate review by the Medicaid Agency or court.
• Rulemaking authority for certification processes, network requirements, quality standards, health IT and data analytics, and audits (every three years or as needed).
• Collaboration provisions allowing state action immunity from antitrust laws for approved collaborations; requirement for certificates to collaborate; confidentiality protections for collaboration records.

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