SB397 Alabama 2016 Session

Summary

Primary Sponsor

Greg J. Reed

Republican

Session

Regular Session 2016

Title

Medicaid Agency, regional care organization, full and probationary certification, time period extended, Secs. 22-6-156, 22-6-159, 22-6-162 am'd.

Summary

SB397 would give the Medicaid Agency power to extend regional care organization certification timelines and probationary status beyond 2016, and allow contracts with alternate providers if needed.

What This Bill Does

It lets the Medicaid Agency set a later date to obtain regional care organization certification and extend probationary status beyond October 1, 2016. It also allows the Agency to contract with alternate care providers if no regional care organization is certified or if one loses probationary status, and it may first offer opportunities to other regional organizations that meet quality criteria. The bill retains a milestone-based framework (financial solvency, service network, and readiness for risk contracts) with potential deadline extensions. Additionally, if a probationary RCO fails to gain full certification or loses probationary status, the organization must refund half of the Medicaid case-management payments received in the prior 12 months.

Who It Affects

• Regional care organizations and organizations seeking regional certification: deadlines for full certification and probationary status can be extended beyond October 1, 2016, giving them more time to meet requirements.
• The State Medicaid Agency and alternate care providers: the Agency gains authority to contract with alternate providers when needed, may require refunds if a probationary organization fails to certify, and can contract with more than one alternate provider if in the state's best interest.

Key Provisions

• Authorizes the Medicaid Agency to establish a later date for obtaining regional care organization certification and to extend probationary certification beyond October 1, 2016.
• Allows contracting with an alternate care provider in a Medicaid region if no RCO is certified, if an RCO loses probationary certification, or if no organization is certified by the extended date, with first offer to a different RCO meeting quality criteria.
• Permits the Agency to contract with more than one alternate care provider if it is in the state's best interest and there is a lack of suitable RCOs.
• Maintains a schedule of milestones (board establishment, solvency, network adequacy, readiness for risk contracts) with extensions possible by the Agency, and allows full certification if milestones are met by the extended date.
• If a probationary RCO fails to gain full certification or has probationary status terminated, the organization must refund half of the Medicaid case-management payments received in the previous 12 months.
• Effective date: the act becomes law on the first day of the third month after approval by the Governor.

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 Agency