SB431 Alabama 2015 Session

Summary

Primary Sponsor

Greg J. Reed

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

SB431 creates a Medicaid long-term care delivery system in Alabama that uses statewide integrated care networks with risk-based contracts to serve elderly and disabled beneficiaries.

What This Bill Does

It requires evaluating the current long-term care system and then assigning certain Medicaid long-term care beneficiaries to one or more integrated care networks that are paid with capitated, risk-bearing contracts. The networks must have governing boards, an advisory committee, and meet solvency and quality rules, with data reporting and grievance and appeal processes. The plan includes phased implementation with rules by 2017, procurement by 2018, and service delivery under risk contracts by 2018, plus collaboration and anti-trust provisions to support the reform.

Who It Affects

• Medicaid beneficiaries eligible for long-term care services will be enrolled in integrated care networks and receive covered care through these networks, with access to an appeals process and performance reporting.
• Providers and collaborators (nursing homes, home- and community-based providers, physicians and other health entities, and private carriers) will contract with integrated care networks, must meet licensing and Medicaid provider requirements, and will be paid under network capitation rates established by the Medicaid Agency.

Key Provisions

• Creates one or more statewide integrated care networks that contract with the Medicaid Agency to provide Medicaid long-term care benefits under risk-based capitation payments.
• Establishes a governing board for each integrated care network with specific composition (risk-bearing and non-risk-bearing members), diversity requirements, and rules for vacancies and approval by the Medicaid Agency.
• Requires a citizens' advisory committee with beneficiary representation, meeting at least quarterly, to advise networks on efficiency and quality of care.
• Imposes solvency and financial reserve rules, with options to use irrevocable letters of credit from large banks to guarantee performance.
• Requires quality assurance provisions, data reporting (HIPAA-compliant), and publication of aggregated outcome and cost data; mandates independent evaluation of cost savings and quality of care.
• Contracts are two years with potential up to three one-year renewals; includes cost, patient outcomes, and quality evaluations to guide future contracting.
• Provides procedures for grievance and appeal rights for enrollees and providers, including state-level hearings and court review.
• Allows collaboration among public payers, private carriers, and providers with state action antitrust immunity and confidentiality protections for negotiations and data.
• Requires rate-setting for providers to ensure networks pay not less than historically paid rates and defines how rates are incorporated into actuarial models.
• Mandates implementation milestones: solvency rules by 2017, procurement by 2018, and network operation under risk contracts by late 2018, with ongoing certification and oversight.

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