reglab/housing_qa huggingface dataset:
AL Code § 22-6-193 (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 22-6-193 - Licensing Requirements; Promulgation of Rules.

Section 22-6-193Licensing requirements; promulgation of rules.  Each PACE provider providing services in a Class 2 municipality shall be licensed by the Department of Public Health which shall, from time to time, as it deems desirable, promulgate such reasonable rules as necessary to provide for the delivery of health care by the PACE provider in this state. (Act 2014-126, p. 236, §4.)
AL Code § 22-6-194 (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 22-6-194 - Privilege Assessment - Authorized on Business Activities of Certain Pace Program Providers.

Section 22-6-194Privilege assessment - Authorized on business activities of certain PACE program providers.  To provide further for the availability of indigent health care in a Class 2 municipality, there is levied and shall be collected as provided in this article a privilege assessment on the business activities of each provider of a PACE program with its principal place of business in a Class 2 municipality. The privilege assessment imposed by this article shall be in addition to all other taxes of any kind imposed by law and shall be at a rate of five percent of the net patient revenues of the organization. (Act 2014-126, p. 236, §5.)
AL Code § 22-6-195 (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 22-6-195 - Privilege Assessment - Payment; Disposition of Funds.

Section 22-6-195Privilege assessment - Payment; disposition of funds. (a) The assessment imposed by this article shall be due and payable to the department on or before the twentieth day of the month next succeeding the month in which the assessment accrues and, when collected, shall be paid by the department into the State Treasury. Payment by United States mail shall be timely if mailed in accordance with Section 40-1-45. When paid into the State Treasury, all such taxes shall be deposited to the credit of the Alabama Health Care Trust Fund or any successor fund administered by or on behalf of the Medicaid Agency. (b) The receipts from the assessment levied in this article shall be solely available for appropriation by the Legislature to the Medicaid Agency for use by the agency in accomplishing the purposes of this article. (Act 2014-126, p. 236, §6.)
AL Code § 22-6-196 (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 22-6-196 - Privilege Assessment - Failure to Pay.

Section 22-6-196Privilege assessment - Failure to pay. Any PACE provider that fails to pay the assessment levied by this article within the time required by this article shall pay, in addition to the assessment, a penalty of 10 percent of the amount of assessment due, together with interest thereon at the rate prescribed by Section 40-1-44, the penalty and interest to be assessed and collected as part of the taxes. Provided, however, the department, if a good and sufficient reason is shown, may waive or remit the penalty of 10 percent or a portion thereof. If payment is not received by the last day of the month, the department shall notify the Medicaid Agency which shall determine whether the PACE provider is a Medicaid provider, and if so, shall withhold the payment, interest, and penalty due from any reimbursement due the provider under the Medicaid program. The assessment levied by this article shall constitute a debt due the State of Alabama and may be collected by civil action in addition to the methods provided in this article. The department is empowered to assess, file liens, and collect the assessments levied by this article as prescribed in this article. (Act 2014-126, p. 236, §7.)
AL Code § 22-6-197 (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 22-6-197 - Privilege Assessment - Recordkeeping; Promulgation of Rules.

Section 22-6-197Privilege assessment - Recordkeeping; promulgation of rules.  (a) It shall be the duty of each PACE provider subject to this article to keep and preserve suitable books and records as may be necessary to determine the amount of assessment for which it is liable under this article. The books and records shall be kept and preserved for a period of not less than three years, and all books and records shall be open for examination during business hours by the department or its duly authorized agents. (b) All information secured pursuant to this article by the department shall be confidential, except that the department may provide such information to the Medicaid Agency as necessary for the proper administration of the Medicaid program, or for the department's proper administration of the assessment levied by this article. (c) The department, from time to time, as it deems desirable, shall promulgate reasonable rules as necessary to provide for the orderly and efficient administration of the assessment levied by this article. (Act 2014-126, p. 236, §8.)
AL Code § 22-6-198 (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 22-6-198 - Privilege Assessment - Use of Revenues; Reimbursements.

Section 22-6-198Privilege assessment - Use of revenues; reimbursements.  (a) The Medicaid Agency shall use the revenues from the assessment levied by this article in furtherance of the purposes of this article, provided that the uses shall be limited to those for which federal financial participation under Title XIX of the Social Security Act is available. (b) Any reimbursement due a PACE provider under the Medicaid program shall be paid in a timely fashion. If the amount payable is not in dispute and is not paid by the Medicaid Agency within 30 days of the due date, interest on the amount due shall be charged. The interest shall be the legal amount currently charged by the state. (Act 2014-126, p. 236, §9.)
AL Code § 22-6-199 (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 22-6-199 - Privilege Assessment - Reduction or Elimination of Revenues.

Section 22-6-199Privilege assessment - Reduction or elimination of revenues.  No revenues resulting from the assessment established by this article and applied to increases in covered services or reimbursement levels or other enhancements of the Medicaid program adopted by the Medicaid Agency as a result of revenues made available under the assessment levied by this article shall be subject to reduction or elimination while the assessment is in effect. (Act 2014-126, p. 236, §10.)
AL Code § 22-6-200 (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 22-6-200 - Federal Financial Participation; Contract for Services.

Section 22-6-200Federal financial participation; contract for services.  This article shall be of no effect if federal financial participation under Title XIX of the Social Security Act is not available to the Medicaid program for the purposes of this article at the approved federal medical assistance percentage, established under Section 1905 of the Social Security Act, for the applicable fiscal year, or in the event a contract for services between the PACE program and the State of Alabama Medicaid Agency or Regional Care Organization is not executed by September 30, 2014, and by the end of each subsequent state fiscal year thereafter. (Act 2014-126, p. 236, §11.)
AL Code § 22-6-221 (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 11 - Integrated Care.|Section 22-6-221 - Service by Integrated Care Network; Board of Directors.

Section 22-6-221Service by integrated care network; board of directors.  (a) An integrated care network shall serve only Medicaid beneficiaries in providing medical care and services. For the purposes of this article, a beneficiary cannot be a member of both an integrated care network and a regional care organization. (b) An integrated care network shall provide required medical care and services to Medicaid beneficiaries and may coordinate care provided by or through an affiliation of other health care providers or other programs as the Medicaid Agency shall determine.  (c) Notwithstanding any other provision of law, the integrated care network shall not be deemed an insurance company under state law. (d)(1) An integrated care network shall have a governing board of directors composed of the following members:  a. Twelve members shall be persons representing risk bearing participants. A participant bears risk by contributing cash, capital, or other assets to the integrated care network.  b. Eight members shall be persons who do not represent a risk bearing participant in the integrated care network and are not employed by a risk bearing participant.  c. A majority of the board may not represent a single provider. The Medicaid Agency may promulgate rules providing for the criteria and selection of risk bearing and non-risk bearing participants on the board of directors.  (2) Any provider represented on the governing board shall meet licensing requirements set by law, shall have a valid Medicaid provider number, and shall not otherwise be disqualified from participating in Medicare or Medicaid.  (3) The Medicaid Agency shall approve the members of the governing board and the board's structure, powers, bylaws, or other rules of procedure. No organization shall be granted integrated care network certification without approval. (4) Any vacancy on the governing board of directors in connection with non-risk bearing directors shall be filled in accordance with rules promulgated by the Medicaid Agency. A vacancy in a board of directors' seat held by a representative of a risk bearing participant as defined herein, shall be filled by a majority vote of the remaining directors of the integrated care network. Notwithstanding other provisions of this subsection, the Medicaid Commissioner shall fill a board seat left vacant for more than three months. (5) All appointing authorities for the governing board shall coordinate their appointments so that diversity of gender, race, and geographical areas is reflective of the makeup of the population served. (Act 2015-322, §3.)
AL Code § 22-6-222 (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 11 - Integrated Care.|Section 22-6-222 - Citizens' Advisory Committee.

Section 22-6-222Citizens' advisory committee.  There shall be a citizens' advisory committee constituted to advise the integrated care network on ways the integrated care network may be more efficient in providing quality care to Medicaid beneficiaries. In addition, the advisory committee shall carry out other functions and duties assigned to it by the integrated care network and approved by the Medicaid Agency. The committee shall meet all of the following criteria: (1) Be selected in a method established by the organization seeking to become an integrated care network, or established by an integrated care network, and approved by the Medicaid Agency. (2) At least 20 percent of its members shall be Medicaid beneficiaries or sponsors of Medicaid beneficiaries or, if the organization has been certified as an integrated care network, at least 20 percent of its members shall be Medicaid beneficiaries enrolled in the integrated care network, or their sponsor. (3) Include members who are representatives of organizations that are part of the Disabilities Leadership Coalition of Alabama or Alabama Arise, or their successor organizations, the Alabama chapter of AARP, the Alabama Disability Advocacy Program, the Disability Rights and Resources, The Arc of Alabama, and also include members who are non-at-risk providers that provide services to Medicaid beneficiaries through the integrated care network. (4) Be inclusive and reflect the racial, gender, geographic, and diversity of the population served. (5) Elect a chair. (6) Meet at least every three months. (Act 2015-322, §4.)
AL Code § 22-6-223 (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 11 - Integrated Care.|Section 22-6-223 - Solvency and Financial Requirements.

Section 22-6-223Solvency and financial requirements.  (a) An integrated care network shall meet minimum solvency and financial requirements as provided by the Medicaid Agency. The Medicaid Agency shall require the integrated care network, as a condition of certification or continued certification, to maintain minimum solvency and financial reserves. The Medicaid Agency shall hereafter promulgate rules setting forth requirements for minimum solvency, financial reserves, and other financial requirements of an integrated care network based on the number of integrated care networks that may be certified and based on actuarial soundness as determined by the Medicaid Agency. The Medicaid Agency shall allow for the requirements to be met through the submission of an irrevocable letter of credit in an amount equal to the financial reserves that would otherwise be required of the integrated care network, to guarantee the performance of the provisions of the risk contract. If an irrevocable letter of credit is used, it shall be issued by a federally or Alabama state chartered banking institution with assets in excess of four billion dollars ($4,000,000,000) and in a form approved by the Medicaid Agency. No assets of the integrated care network shall be pledged or encumbered in connection with the irrevocable letter of credit. (b) An integrated care network shall provide financial reports and information as required by the Medicaid Agency. (c) An integrated care network shall report all data as required by the Medicaid Agency, consistent with the federal Health Insurance Portability and Accountability Act (HIPAA). (Act 2015-322, §5.)
AL Code § 22-6-224 (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 11 - Integrated Care.|Section 22-6-224 - Medicaid Agency to Contract for Medical Care; Enrollment; Delivery of Services; Reimbursement.

Section 22-6-224Medicaid Agency to contract for medical care; enrollment; delivery of services; reimbursement.  (a) Subject to approval of the federal Centers for Medicare and Medicaid Services, the Medicaid Agency shall enter into contracts with one or more integrated care networks to provide, pursuant to a risk contract under which the Medicaid Agency makes a capitated payment, medical care to Medicaid beneficiaries assigned to the integrated care network. The Medicaid Agency may enter into a contract pursuant to this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries would be better, more efficient, and less costly than under the then existing care delivery system. Pursuant to the contract, the Medicaid Agency shall set capitation payments for the integrated care network. (b) The Medicaid Agency shall enroll beneficiaries it designates into an integrated care network consistent with guidance from the Center for Medicare and Medicaid Services.  (c) An integrated care network shall provide applicable Medicaid services to Medicaid enrollees directly or by contract with other providers. An integrated care network shall establish an adequate medical service delivery network as determined by the Medicaid Agency. The Medicaid Agency, pursuant to the Administrative Procedure Act, shall establish by rule the minimum reimbursement rate for providers. The minimum provider reimbursements shall be incorporated into the actuarially sound rate development methodology for an integrated care network. If necessary, the methodology and resulting rates shall be submitted to the Centers for Medicare and Medicaid Services for approval. (Act 2015-322, §6.)
AL Code § 22-6-225 (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 11 - Integrated Care.|Section 22-6-225 - Denial of Claims; Grievances and Appeals.

Section 22-6-225Denial of claims; grievances and appeals.  (a) The Medicaid Agency shall establish by rule procedures for safeguarding against wrongful denial of claims and addressing grievances of enrollees in an integrated care network.  (b) If a patient or the provider is dissatisfied with the decision of an integrated care network, the patient or provider may file a written notice of appeal to the Medicaid Agency. The Medicaid Agency shall adopt rules governing the appeal, which shall include a full evidentiary hearing and a finding on the record. The Medicaid Agency's decision shall be binding upon the integrated care network. However, a patient or provider may file an appeal in circuit court in the county in which the patient resides, or the county in which the provider provides services. (c) The Medicaid Agency shall by rule establish procedures for addressing grievances and appeals of the integrated care network. The appeal procedure shall include an opportunity for a fair hearing before an impartial hearing officer in accordance with the Administrative Procedure Act, Chapter 22 of Title 41. The state Medicaid Commissioner shall appoint one, or more than one, hearing officer to conduct fair hearings. After each hearing, the findings and recommendations of the hearing officer shall be submitted to the Commissioner, who shall make a final decision for the agency. Judicial review of the final decision of the Medicaid Agency may be sought pursuant to the Administrative Procedure Act. All costs related to development and implementation of the appeal procedure, including the provision of administrative hearings, shall be borne by the Medicaid Agency. The Medicaid Agency shall adopt rules for implementing this subsection in accordance with the Administrative Procedure Act. (Act 2015-322, §7.)
AL Code § 22-6-226 (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 11 - Integrated Care.|Section 22-6-226 - Review and Approval of Contracts; Rules Governing Operation of Integrated Care Networks.

Section 22-6-226Review and approval of contracts; rules governing operation of integrated care networks.  (a) All provider contracts of an organization granted final certification as an integrated care network shall be subject to review and approval of the Medicaid Agency. (b)(1) If a provider is dissatisfied with any term or provision of the agreement or contract offered by an integrated care network, the provider shall: a. Seek redress with the integrated care network. In providing redress, an integrated care network shall afford the provider a review by a panel composed of a representative of an integrated care network, the same type of provider, and a representative of the citizens' advisory board appointed by the chair of the advisory board. b. After seeking redress with an integrated care network, a provider or an integrated care network who remains dissatisfied may request a review of such disputed term or provision by the Medicaid Agency. The Medicaid Agency shall have 10 days to issue, in writing, its decision regarding the dispute. c. If the provider or an integrated care network is dissatisfied with the decision of the Medicaid Agency, the provider or an integrated care network may file an appeal only in the Montgomery County Circuit Court within 30 days of the decision. (c) The Medicaid Agency shall establish by rule requirements by which integrated care networks shall operate. In addition to the foregoing, the Medicaid Agency shall do all of the following: (1) Establish by rule the criteria for certification of an integrated care network. (2) Establish by rule the quality standards and minimum service delivery network requirements for an integrated care network to provide care to Medicaid beneficiaries. (3) Establish by rule and implement quality assurance provisions for an integrated care network. (4) Adopt and implement, at its discretion, requirements for an integrated care network concerning health information technology, data analytics, quality of care, and care quality improvement. (5) Conduct or contract for financial audits of an integrated care network. The audits shall be based on requirements established by the Medicaid Agency by rule or established by law. The audit of an integrated care network shall be conducted at least every three years or more frequently if requested by the Medicaid Agency. (6) Take any other action with respect to an integrated care network as may be required by federal Medicaid regulations or under terms and conditions imposed by the Centers for Medicare and Medicaid Services in order to assure that payments to an integrated care network qualify for federal matching funds. (Act 2015-322, §8.)
AL Code § 22-6-227 (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 11 - Integrated Care.|Section 22-6-227 - Quality Assurance Committee; Reporting Requirements.

Section 22-6-227Quality assurance committee; reporting requirements.  (a) The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid Commissioner to review the care rendered through the integrated care networks. The members of the committee shall serve two-year terms. The Medicaid Agency shall promulgate a rule establishing the membership and criteria to serve on the quality assurance committee.  (b) The Medicaid Agency shall continuously evaluate the outcome and quality measures adopted by the committee pursuant to this section. (c) 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. (d) 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 all of the following: (1) Quality measures. (2) Costs. (3) Outcomes. (4) Other information, as specified by the contract between the integrated care network and the Medicaid Agency, that is necessary for the Medicaid Agency to evaluate the value of health services delivered by an integrated care network. (Act 2015-322, §9.)