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.

Description

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.

Show more Show less

Subjects

Medicaid