reglab/housing_qa huggingface dataset:
AL Code § 22-6-121 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 8 - Medicaid Preferred Drug Plan.|Section 22-6-121 - Medicaid Pharmacy and Therapeutics Committee - Composition; Meetings.

Section 22-6-121Medicaid Pharmacy and Therapeutics Committee - Composition; meetings. (a) The Alabama Medicaid Agency shall utilize a Medicaid Pharmacy and Therapeutics Committee within the agency for the purpose of advising and assisting Medicaid in the development of a preferred drug plan pursuant to 42 U.S.C. §1396r-8. (b) The Medicaid Pharmacy and Therapeutics Committee shall be comprised and consist of three clinical pharmacists licensed to practice in the State of Alabama and at least five physicians licensed to practice medicine in the State of Alabama. Physician members will be appointed by the Medicaid Commissioner from a list of at least two nominees for each position submitted by the Medical Association of the State of Alabama. Clinical pharmacist members will be nominated by the Alabama Pharmacy Association and appointed by the Medicaid Commissioner. Members of the Medicaid Pharmacy and Therapeutics Committee should be enrolled Medicaid providers and have experience developing or practicing under a preferred drug list. It is further provided that the committee shall reflect the racial, gender, geographic, urban/rural, and economic diversity of the state. A report shall be made annually to the Legislature detailing the extent to which this provision has been implemented. (c) Members of the Medicaid Pharmacy and Therapeutics Committee will serve staggered two-year terms and may be reappointed to the committee for additional terms. (d) The Medicaid Pharmacy and Therapeutics Committee shall meet at least quarterly and may meet at other times as needed and called by the Medicaid Commissioner and committee chairman. Meetings of the Medicaid Pharmacy and Therapeutics Committee responsible for recommending classes of drugs to the Medicaid Commissioner for inclusion in the Medicaid Preferred Drug Plan shall meet the requirements of the State's open meetings law and documents relating to a recommendation made by the committee to limit access to a drug shall be available under the open records law. (Act 2003-297, p. 697, §2.)
AL Code § 22-6-123 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 8 - Medicaid Preferred Drug Plan.|Section 22-6-123 - Considerations for Inclusions on Preferred Drug List; Review; Adoption of List.

Section 22-6-123Considerations for inclusions on preferred drug list; review; adoption of list. (a) Drugs will be considered for the Medicaid preferred drug list based on clinical efficacy, side effect profiles, appropriate usage, and cost effectiveness. (b) The Medicaid Pharmacy and Therapeutics Committee shall perform a thorough review of relevant clinical and medical considerations, including, but not limited to: Medicaid Drug Utilization Review (DUR) data; Surveillance Utilization Review (SUR) data; potential abuse, misuse, or inappropriate use in prescribing and/or dispensing patterns; inconsistency with FDA approved labeling, inconsistency with uses recognized in the American Hospital Formulary Service Drug Information, and the American Medical Association Drug Evaluations, or the U.S. Pharmacopoeia Dispensing Information. (c) The Medicaid Pharmacy and Therapeutics Committee shall recommend and the Medicaid Agency shall adopt an initial Medicaid preferred drug list not later than three months after June 18, 2003. Until Medicaid adopts the preferred drug list required by this article, Medicaid shall continue to use its existing voluntary preferred drug list and prior authorization program. Drugs that currently require Medicaid prior authorization shall not be subject to review for inclusion on the preferred drug list and shall continue to require prior authorization unless the Medicaid Pharmacy and Therapeutics Committee recommends and the Medicaid Commissioner approves changing the requirement. (d) Medicaid recipients may appeal prior authorization decisions using the Medicaid fair hearing process administered by the Alabama Medicaid Agency. Physicians may appeal prior authorization decisions to Medicaid's Medical Directors. (Act 2003-297, p. 697, §4.)
AL Code § 22-6-124 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 8 - Medicaid Preferred Drug Plan.|Section 22-6-124 - Confidentiality of Information.

Section 22-6-124Confidentiality of information. Notwithstanding any other law to the contrary, all information and documents containing trade secrets, proprietary information, rebate amounts for individual drugs or individual manufacturers, percentage of rebates for individual drugs or manufacturers, and manufacturer's pricing which are contained in records of the State Medicaid Agency and its agents shall be confidential and shall not be a public record for purposes of Section 41-13-1. (Act 2003-297, p. 697, §5.)
AL Code § 22-6-150 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-150 - Definitions.

Section 22-6-150Definitions. For the purposes of this article, the following words shall have the following meanings:  (1) ALTERNATE CARE PROVIDER. A contractor, other than a regional care organization, that agrees to provide a comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of the state pursuant to a risk contract. (2) CAPITATION PAYMENT. A payment the state Medicaid Agency makes periodically to a contractor on behalf of each recipient enrolled under a contract for the provision of medical services. (3) CARE DELIVERY SYSTEM. The manner in which the benefits and services set forth in the state Medicaid plan are provided to Medicaid beneficiaries.  (4) COLLABORATOR. A private health carrier, third party purchaser, provider, health care center, health care facility, state and local governmental entity, or other public payers, corporations, individuals, and consumers who are expecting to collectively cooperate, negotiate, or contract with another collaborator or regional care organizations in the health care system. (5) LONG-TERM CARE. Medicaid-funded nursing facility services or services in intermediate care facilities for the developmentally disabled, or home- and community-based support services provided to individuals who might otherwise require such services, or such other long-term care services as the Medicaid Agency may determine by rule.  (6) MEDICAID AGENCY. The Alabama Medicaid Agency or any successor agency of the state designated as the "single state agency" to administer the medical assistance program described in Title XIX of the Social Security Act. (7) MEDICAID BENEFICIARY. Anyone determined by the Medicaid Agency to be eligible for Medicaid. (8) QUALITY-ASSURANCE PROVISIONS. Specifications for assessing and improving the quality of care provided by a regional care organization or an alternative care plan. (9) REGIONAL CARE ORGANIZATION. An organization of health care providers that contracts with the Medicaid Agency to provide a comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of the state and that meets the requirements set forth in this article. (10) RISK CONTRACT. A contract under which the contractor assumes risk for the cost of the services covered under the contract and incurs loss if the cost of furnishing the services exceeds the payments under the contract.  (Act 2013-261, p. 686, §1.)
AL Code § 22-6-152 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-152 - Medicaid Regions.

Section 22-6-152Medicaid regions. The Medicaid Agency shall establish by rule geographic Medicaid regions in which a regional care organization or alternate care provider may operate, which together shall cover the entire state. Each Medicaid region, according to an actuary working for Medicaid, shall be capable of supporting at least two regional care organizations or alternate care providers.  (Act 2013-261, p. 686, §3.)
AL Code § 22-6-154 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-154 - Quality Assurance Committee; Collection and Publication of Information.

Section 22-6-154Quality assurance committee; collection and publication of information. (a) The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid Commissioner. The members of the committee shall serve two-year terms. At least 60 percent of the members shall be physicians who provide care to Medicaid beneficiaries served by a regional care organization. In making appointments to the committee, the Medicaid Commissioner shall seek input from the appropriate professional associations. (b) The committee shall identify objective outcome and quality measures, including measures of outcome and quality for ambulatory care, inpatient care, chemical dependency and mental health treatment, oral health care, and all other health services provided by coordinated care organizations. Quality measures adopted by the committee shall be consistent with existing state and national quality measures. The Medicaid Commissioner shall incorporate these measures into regional care organization contracts to hold the organizations accountable for performance and customer satisfaction requirements. (c) The committee shall adopt outcome and quality measures annually and adjust the measures to reflect the following: (1) The amount of the global budget for a regional care organization. (2) Changes in membership of the organization. (3) The organization's costs for implementing outcome and quality measures. (4) The community health assessment and the costs of the community health assessment conducted by the organization. (d) The Medicaid Agency shall continuously evaluate the outcome and quality measures adopted by the committee pursuant to this section. (e) The Medicaid Agency shall utilize available data systems for reporting outcome and quality measures adopted by the committee and take actions to eliminate any redundant reporting or reporting of limited value. (f) The Medicaid Agency shall publish the information collected under this section at aggregate levels that do not disclose information otherwise protected by law. The information published shall report, by regional care organizations, all of the following: (1) Quality measures. (2) Costs. (3) Outcomes. (4) Other information, as specified by the contract between the regional care organization and the Medicaid Agency, that is necessary for the Medicaid Agency to evaluate the value of health services delivered by a regional care organization. (Act 2013-261, p. 686, §5.)
AL Code § 22-6-155 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-155 - Terms of Contracts; Cost Evaluations.

Section 22-6-155Terms of contracts; cost evaluations. An initial contract between the Medicaid Agency and a regional care organization shall be for three years, with the option for the Medicaid Agency to renew the contract for not more than two additional one-year periods. The Medicaid Agency shall obtain provider input and an independent evaluation of the cost savings, patient outcomes, and quality of care provided by each regional care organization, and obtain the results of each regional care organization's evaluation in time to use the findings to decide whether to enter into another multi-year contract with the regional care organization or change the Medicaid region's care-delivery system. (Act 2013-261, p. 686, §6; Act 2014-434, p. 1598, §1.)
AL Code § 22-6-157 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-157 - Termination of Regional Care Organization Certification.

Section 22-6-157Termination of regional care organization certification.  (a) The Medicaid Agency shall establish by rule the procedure for the termination of a regional care organization certification or probationary regional care organization certification for non-performance of contractual duty or for failure to meet or maintain benchmarks, standards, or requirements provided by this article or established by the Medicaid Agency as required by this article. (b) Termination of a regional care organization certification or probationary certification shall follow the standard administrative process, with the right to a hearing before a hearing officer appointed by the Medicaid Agency.  (Act 2013-261, p. 686, §8.)
AL Code § 22-6-158 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-158 - Contracts With Service Providers.

Section 22-6-158Contracts with service providers. A regional care organization shall contract with any willing hospital, doctor, or other provider to provide services in a Medicaid region if the provider is willing to accept the payments and terms offered comparable providers. Any provider shall meet licensing requirements set by law, shall have a Medicaid provider number, and shall not otherwise be disqualified from participating in Medicare or Medicaid.  (Act 2013-261, p. 686, §9.)
AL Code § 22-6-159 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-159 - Implementation of Article.

Section 22-6-159Implementation of article. (a) The following is the timeline for implementation of this article: (1) Not later than October 1, 2013, the Medicaid Agency shall establish Medicaid regions. (2) Not later than October 1, 2014, an organization seeking to become a regional care organization shall have established a governing board and structure as approved by the Medicaid Agency. An organization may receive probationary certification as a regional care organization upon submission of an application for, and demonstration of, a governing board acceptable to the Medicaid Agency. Probationary certification shall expire on October 1, 2016, or a later date established by the Medicaid Agency. (3) Not later than April 1, 2015, an organization with probationary regional care organization certification shall have demonstrated to Medicaid's approval the ability to establish an adequate medical service delivery network. (4) Not later than October 1, 2015, an organization with probationary regional care organization certification shall have demonstrated to Medicaid's approval that it has met the solvency and financial requirements for a regional care organization as outlined in this article. (5) On October 1, 2016, or a later date established by the Medicaid Agency, an organization with probationary regional care organization certification shall demonstrate to Medicaid's approval that it is capable of providing services pursuant to a risk contract. (b) The timeline and benchmarks in subsection (a) shall not preclude an organization from meeting the timelines and benchmarks at an earlier date. (c) Failure to meet and maintain any one of the benchmarks in subdivisions (2) to (5), inclusive, shall constitute grounds for termination of a probationary regional care organization certification or full regional care organization certification. The Medicaid Agency shall award full regional care organization certification to an organization with probationary regional care organization certification if the organization timely meets each of those benchmarks. Failure by an organization to timely meet one or more of those benchmarks shall not prevent the Medicaid Agency, at its sole discretion, from granting full regional care organization certification to the organization as long as it has met all of those benchmarks by October 1, 2016, or a later date established by the Medicaid Agency. (Act 2013-261, p. 686, §10; Act 2016-377, §1.)
AL Code § 22-6-160 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-160 - Evaluation and Report on Long-Term Care System for Medicaid Beneficiaries.

Section 22-6-160Evaluation and report on long-term care system for Medicaid beneficiaries. The Medicaid Agency shall decide which groups of Medicaid beneficiaries to include for coverage by a regional care organization or alternate care provider. The Medicaid Agency, without the approval of the Governor, shall not make a coverage decision that would affect Medicaid beneficiaries who are directly served by another state agency. (Act 2013-261, p. 686, §11; Act 2015-322, §1.)
AL Code § 22-6-161 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-161 - Evaluation and Report on Dental Care Program for Medicaid Beneficiaries.

Section 22-6-161Evaluation and report on dental care program for Medicaid beneficiaries.  (a) The Medicaid Agency, with input from dental care providers, shall conduct an evaluation of the existing dental care program for Medicaid beneficiaries and, on October 1, 2015, shall report the findings of the evaluation to the Legislature and Governor. (b) Notwithstanding the above, the current Medicaid dental care programs shall continue as currently administered by the Medicaid Agency until the end of the fiscal year when the evaluation required in subsection (a) is reported to the Legislature and the Governor. (Act 2013-261, p. 686, §12.)
AL Code § 22-6-162 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-162 - Case-Management Services.

Section 22-6-162Case-management services. The Medicaid Agency may contract for case-management services with an organization that has been granted by the Medicaid Agency a probationary regional care organization certification. If the agency has contracted with such an organization, and that organization on or before October 1, 2016, or a later date established by the Medicaid Agency, has failed to gain full regional care organization certification or has had its probationary certification terminated, then that organization shall refund half the payments, made by the Medicaid Agency to the organization for case-management services, paid over the previous 12 months. (Act 2013-261, p. 686, §13; Act 2016-377, §1.)
AL Code § 22-6-164 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-164 - Rulemaking Authority.

Section 22-6-164Rulemaking authority. The Medicaid Agency may adopt rules necessary to implement this article and to administer the Alabama Medicaid Program in a manner consistent with state and federal law, as well as any state plan approved by the Centers for Medicare and Medicaid Services. (Act 2013-261, p. 686, §15; Act 2014-434, p. 1598, §1.)
AL Code § 22-6-165 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 9 - Delivery of Medical Services.|Section 22-6-165 - Regional Care Organizations Exempt From Certain License Fees.

Section 22-6-165Regional care organizations exempt from certain license fees. Any provision of law to the contrary notwithstanding, regional care organizations, as defined in Section 22-6-150, are exempt from the payment of any and all state, county, and municipal license fees, including any business privilege or license tax heretofore or hereafter levied by the State of Alabama or any county or municipality of the state. The exemptions provided by this section shall not extend to the individual health care providers who are members of the regional care organization. (Act 2015-349, §1.)
AL Code § 22-6-190 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 10 - Pace Program in Class 2 Municipality.|Section 22-6-190 - Applicability.

Section 22-6-190Applicability. This article shall apply only in a Class 2 municipality and would provide for a federal Program for All Inclusive Care for the Elderly (PACE program) with its principal place of business in a Class 2 municipality to contribute to the Alabama Health Care Trust Fund. (Act 2014-126, p. 236, §1.)
AL Code § 22-6-191 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 10 - Pace Program in Class 2 Municipality.|Section 22-6-191 - Legislative Intent.

Section 22-6-191Legislative intent.  The intent of this article is to allow the only PACE provider in the State of Alabama to continue to provide services to nursing home eligible patients as the PACE program provides treatment to patients for fewer federal and state taxpayer dollars than other programs existing in the state. The Legislature declares that this article is broad-based in nature as the assessment herein is imposed on all health care or services in the class of providers and is uniformly imposed across all providers. The Legislature further declares that the entire PACE industry in Alabama exists only in Class 2 municipalities. The Legislature further recognizes that a Class 2 municipality bill is a general bill under the Alabama Constitution. (Act 2014-126, p. 236, §2.)
AL Code § 22-6-192 (2021)
2021 Code of Alabama|Title 22 - Health, Mental Health, and Environmental Control.|Title 1 - Health and Environmental Control Generally.|Chapter 6 - Medicaid Program.|Article 10 - Pace Program in Class 2 Municipality.|Section 22-6-192 - Definitions.

Section 22-6-192Definitions. For the purposes of this article, the following words have the following meanings: (1) DEPARTMENT. The State Department of Revenue. (2) FISCAL YEAR. An accounting period of 12 months beginning on the first day of the first month of the state fiscal year. (3) MEDICAID PROGRAM. The medical assistance program as established in Title XIX of the Social Security Act and as administered in the State of Alabama by the Medicaid Agency pursuant to executive order and Title 560 of the Alabama Administrative Code. (4) PACE PROVIDER. PACE means a provider under the federal Program for All Inclusive Care for the Elderly operated by a public, private, nonprofit, or proprietary entity, as permitted by federal law as defined at 42 C.F.R. §460.6, as amended and supplemented. (Act 2014-126, p. 236, §3.)