HB585 Alabama 2015 Session

Summary

Primary Sponsor

April WeaverSenator

Republican

Session

Regular Session 2015

Title

Medicaid, long-term care services, delivery to elderly and disabled on managed care basis, intergrated care network established, Sec. 22-6-160 am'd.

Summary

This bill would move long-term care services for certain elderly and disabled Alabama Medicaid beneficiaries into statewide integrated care networks operated on a managed-care, risk-contract basis, with a governing board and a citizens' advisory committee.

What This Bill Does

It would create one or more statewide integrated care networks to deliver long-term care services to eligible Medicaid beneficiaries under capitation risk contracts. It would require a governing board and establish a citizens' advisory committee to provide oversight and input, including representation from beneficiaries and disability organizations. It would set financial solvency and reporting requirements, establish provider reimbursement rules, quality assurance and grievance/appeal processes, and create oversight and timelines for implementing the new system, including anti-trust collaboration protections.

Who It Affects

• Medicaid beneficiaries who are elderly or disabled and eligible for long-term care services would receive their care through integrated care networks and participate in advisory committee activities.
• Providers and organizations (nursing facilities, doctors, home- and community-based waiver providers, private health carriers, and collaborators) that deliver long-term care services would contract with integrated care networks, meet licensing and financial requirements, set and receive specified reimbursements, and be subject to governance, oversight, and reporting rules.

Key Provisions

• Establish statewide integrated care networks to deliver long-term care services to identified Medicaid beneficiaries under risk-based, capitated contracts.
• Create a governing board for each network with a specified mix of risk-bearing and non-risk-bearing members, plus diversity requirements and Medicaid Agency oversight for appointments and structure.
• Create a citizens' advisory committee with beneficiary representation and ties to disability and aging groups to advise the network and meet regularly.
• Impose solvency and financial reserve requirements, allow use of irrevocable letters of credit, and require actuarial soundness and regular financial reporting.
• Require networks to contract with providers at minimum established rates, ensure adequate provider networks, and set reimbursement methodologies with CMS involvement as needed.
• Implement quality assurance provisions, grievance and appeal processes, and provide for binding Medicaid Agency decisions with court appeal options.
• Provide state action antitrust immunity for collaboratives and networks, require collaboration certificates, and protect confidential information with limited disclosure.
• Set a multi-year contract framework with periodic evaluations to decide whether to renew or adjust the care-delivery system, and outline termination procedures for non-performance.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Medicaid