reglab/statecodes huggingface dataset:
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 3 - Health Care Trust Fund. › Section 22-6-32 - Unobligated Balance Not to Revert to General Fund but to Be Carried Forward.

Section 22-6-32
Unobligated balance not to revert to General Fund but to be carried forward.
Any unobligated balance in said fund shall not revert to the General Fund at the end of any fiscal year but shall be automatically carried forward and available to be appropriated by the Alabama Legislature in each succeeding fiscal year in said fund. Such appropriations shall be budgeted and allotted pursuant to Article 4 of Chapter 4 of Title 41. The existence or availability of moneys in this trust fund shall not reduce appropriations to the Alabama Medicaid Agency from the State General Fund below the amount appropriated for fiscal year 1992.
(Acts 1991, No. 91-125, p. 152, §3.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 4 - Obstetrics, Pediatrics, and Family Practice Financing and Insurance Premium Adjustments. › Section 22-6-40 - Medicaid Agency Authorized to Increase Financing and Adjust Insurance Premiums for Family Practitioners, Pediatricians and Obstetricians.

Section 22-6-40
Medicaid Agency authorized to increase financing and adjust insurance premiums for family practitioners, pediatricians and obstetricians.
The Legislature recognizes the shortage of and the decline in obstetrical care in the rural areas of the state and the hardship imposed on those who are required to travel many miles to obtain the necessary prenatal care and ultimately delivery at term. The Legislature further recognizes the high infant mortality rates that are attributed in part to inadequate care during pregnancy, delivery, and necessary care after delivery. The Legislature further recognizes that the reduction in available care and services is attributed in part to high liability insurance premiums. In recognizing the ability of the Alabama Medicaid Agency to maximize state revenues, it is the intent of the Legislature that the Alabama Medicaid Agency provide increased financing for family practitioners, pediatricians and obstetricians to increase availability of obstetrical services and to address the difference in existing insurance premiums and the amount required for obstetrical practice.
(Acts 1991, No. 91-596, p. 1099, §1.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 4 - Obstetrics, Pediatrics, and Family Practice Financing and Insurance Premium Adjustments. › Section 22-6-41 - Availability of Increased Financing.

Section 22-6-41
Availability of increased financing.
This financing shall be available to physicians in family practice, pediatrics and obstetrics who provide obstetrical services in rural and underserved areas.
(Acts 1991, No. 91-596, p. 1099, §2.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 4 - Obstetrics, Pediatrics, and Family Practice Financing and Insurance Premium Adjustments. › Section 22-6-42 - Administration of Financing Program; Establishment of Rules and Criteria for Alleviating Rural Problems and Reducing High Infant Mortality Rates.

Section 22-6-42
Administration of financing program; establishment of rules and criteria for alleviating rural problems and reducing high infant mortality rates.
The Alabama Medicaid Agency is hereby authorized to develop and administer the financing program and establish the appropriate rules necessary to promote new obstetrical services and set additional criteria necessary to alleviate the problems in the rural areas to reduce the high infant mortality rates.
(Acts 1991, No. 91-596, p. 1099, §3.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 6 - Medicaid Trust Fund. › Section 22-6-70 - Created.

Section 22-6-70
Created.
There is hereby created in the State Treasury a trust fund to be known as the Medicaid Trust Fund. The trust fund shall be administered by a board of directors in accordance with the provisions of this article. Funds received by the State of Alabama from the following sources shall be deposited into the trust fund: (1) Tobacco revenues, as defined by Section 41-10-622(9), designated by state law for the use and benefit of the Alabama Medicaid Agency; (2) intergovernmental fund transfers received by the Alabama Medicaid Agency from public hospitals and public nursing homes which, at the end of any fiscal year, have not been expended or encumbered in accordance with the fiscal laws and procedures of the State of Alabama and when the transfer to the Medicaid Trust Fund has been recommended by the Commissioner of the Medicaid Agency and approved by the Director of Finance; and (3) any funds appropriated to the Alabama Medicaid Agency from any source which, at the end of any fiscal year, have not been expended or encumbered in accordance with the fiscal laws and procedures of the State of Alabama and when the transfer to the trust fund has been approved by the Director of Finance and the Governor.
(Act 2000-772, p. 1768, §1.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 6 - Medicaid Trust Fund. › Section 22-6-71 - Board of Directors.

Section 22-6-71
Board of directors.
The Medicaid Trust Fund Board of Directors shall be composed of the Governor, who shall be its chairman; the Director of Finance, who shall be its vice-chairman; the Commissioner of the Alabama Medicaid Agency, who shall be its secretary; the Chairman of the Senate Finance and Taxation Committee-General Fund or his or her designee; and the Chairman of the House Ways and Means Committee-General Fund or his or her designee. The board shall meet at the call of the chairman. Any four members shall constitute a quorum for the purpose of transacting business. The proceedings of the board shall be reduced to writing by the secretary and signed by the chairman or vice-chairman and the secretary. The proceedings of the board shall be recorded in a substantially bound book and filed in the office of the secretary. Copies of such proceedings, when certified by the secretary, shall be received in all courts as prima facie evidence of the matters and things therein certified.
(Act 2000-772, p. 1768, §2.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 6 - Medicaid Trust Fund. › Section 22-6-72 - Duties of State Treasurer; Disposition of Funds.

Section 22-6-72
Duties of State Treasurer; disposition of funds.
The State Treasurer shall invest the funds in the trust fund on the direction of the board in investments which are eligible investments for the Alabama Trust Fund as authorized by Amendment No. 450 and Amendment No. 488 of the Constitution of Alabama of 1901. All interest earned on the investment of money in the trust fund shall be credited to the trust fund. The State Treasurer shall receive no fees or compensation for his or her work in complying with this provision. No funds may be transferred to the Medicaid Agency or expended by the board except as budgeted and allotted in accordance with the Budget Act and the Budget Management Act. Money contained in the trust fund at the end of any year shall not revert to the General Fund or any other fund in the State Treasury but shall remain in the trust fund until appropriated by the Legislature.
(Act 2000-772, p. 1768, §3.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 6 - Medicaid Trust Fund. › Section 22-6-73 - Powers of Board.

Section 22-6-73
Powers of board.
The board of directors of the trust fund shall have the following powers:
(1) To transfer funds in the trust fund, upon appropriation by the Legislature, to the Alabama Medicaid Agency for any purpose for which the Medicaid Agency may expend funds.
(2) To advise the State Treasurer on investments that may be made with trust fund assets.
(3) To make recommendations to the Governor and the Legislature as to the need for appropriations from the Medicaid Trust Fund to the Medicaid Agency.
(4) To advise the Governor and the Legislature on the continuing status of the tobacco revenues designated by state law for the use and benefit of the Alabama Medicaid Agency.
(Act 2000-772, p. 1768, §4.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-90 - Short Title.

Section 22-6-90
Short title.
This article shall be known as the "Medicaid Revenue Use Act."
(Act 2002-410, p. 1031, §1.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-91 - Definitions.

Section 22-6-91
Definitions.
For purposes of this article, the following words shall have the following meanings:
(1) HEALTHCARE SERVICES. Any services of the type for which the Medicaid Agency may reimburse a provider.
(2) PARTNERSHIP HOSPITAL PROGRAM. The Medicaid managed care program for the provision of inpatient care in this state.
(Act 2002-410, p. 1031, §2.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-92 - Use of Funds; Annual Certification.

Section 22-6-92
Use of funds; annual certification.
Any hospital or hospital system located in the State of Alabama that receives funds from the Medicaid Agency or from a partnership hospital program shall utilize all revenues received from either source only in connection with the provision of healthcare services. Within 30 days after the close of a hospital's or a hospital system's fiscal year, the hospital or hospital system shall certify in writing to the Medicaid Agency that it has complied with the requirements of this section during the past fiscal year. The certification shall be executed by the hospital's or hospital system's administrator or chief financial officer and may be made electronically.
(Act 2002-410, p. 1031, §3.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-93 - Transfer of Funds - Generally.

Section 22-6-93
Transfer of funds - Generally.
To the extent any hospital or hospital system transfers, directly or indirectly, funds to the Medicaid Agency, transfers by the hospital or hospital system in any fiscal period which may be determined on an annual or other reasonable periodic basis may not exceed the amount of revenues received by the hospital or hospital system from payors other than the Medicaid Agency or a partnership hospital program during that period.
(Act 2002-410, p. 1031, §4.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-94 - Transfer of Funds - Use by Medicaid Agency.

Section 22-6-94
Transfer of funds - Use by Medicaid Agency.
All funds transferred by a hospital or a hospital system from any payor source directly or indirectly to the Medicaid Agency shall be used by the Medicaid Agency to defer costs incurred in connection with either the provision of healthcare services, as provided in Section 22-6-92, or Medicaid-covered services to Medicaid-eligible beneficiaries.
(Act 2002-410, p. 1031, §5.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-95 - Transfer of Funds - Annual Certification.

Section 22-6-95
Transfer of funds - Annual certification.
At the time a hospital or hospital system transfers funds to the Medicaid Agency, or no less frequently than within 30 days after the close of the transferor hospital's or hospital system's fiscal year, the hospital or hospital system shall certify in writing to the Medicaid Agency that the funds transferred met the requirements of Section 22-6-93. In the case of an annual certification, the transferor hospital or hospital system shall certify that all the funds transferred during the hospital's or hospital system's past fiscal year met the requirements of Section 22-6-93. The certifications pursuant to this section shall be executed by the hospital's or hospital system's administrator or chief financial officer and may be made electronically. The Medicaid Agency shall determine that it has not sought federal matching funds on funds transferred to it by a hospital or hospital system that have not been certified by the transferor hospital or hospital system as provided for in this section.
(Act 2002-410, p. 1031, §6.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-96 - Transfer of Funds - Return of Uncertified Funds.

Section 22-6-96
Transfer of funds - Return of uncertified funds.
In the event a hospital or hospital system transfers funds to the Medicaid Agency and fails to certify that the funds transferred are in compliance with the requirements of Section 22-6-93, the Medicaid Agency shall return any portion of the funds not certified to the transferor hospital or hospital system no later than 90 days after the close of the transferor hospital's or hospital system's fiscal year.
(Act 2002-410, p. 1031, §7.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-97 - Transfer of Funds - Return of Noncomplying Funds.

Section 22-6-97
Transfer of funds - Return of noncomplying funds.
In the event a hospital or hospital system transfers funds to the Medicaid Agency and certifies that the funds transferred are in compliance with Section 22-6-93, but subsequently it is determined that the transfer was not in compliance, the Medicaid Agency shall return the transferred funds to the transferor hospital or hospital system. The transferor hospital or hospital system shall transfer to the Medicaid Agency funds that comply with the requirements of this article within 60 days of that determination, along with a certification that this transfer complies with the requirements of this article, to the extent that revenues from sources other than Medicaid are available to effect a transfer that complies with this article.
(Act 2002-410, p. 1031, §8.)
2023 Code of Alabama › Title 22 - Health, Mental Health, and Environmental Control. › Title 1 - Health and Environmental Control Generally. › Chapter 6 - Medicaid Program. › Article 7 - Medicaid Revenue Use Act. › Section 22-6-98 - Rules and Regulations.

Section 22-6-98
Rules and regulations.
The Commissioner of the Medicaid Agency may adopt and implement regulations as necessary to ensure compliance with this article.
(Act 2002-410, p. 1031, §9.)
2023 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 22-6-120 - Legislative Findings.

Section 22-6-120
Legislative findings.
The Legislature finds the following:
(1) The availability of appropriate pharmaceutical benefits to every Alabama citizen is a critical component to the overall health of its population.
(2) Alabama should strive to provide appropriate, safe, effective, and cost-efficient pharmaceutical care to those who depend on health benefits through state funded programs.
(3) The Alabama Medicaid Agency should endeavor to manage the Medicaid Pharmacy Program utilizing clinical management tools in a manner to foster optimal health outcomes at reasonable costs.
(4) State Medicaid programs and private insurance plans across the country utilize preferred drug lists as an effective way to foster and encourage clinically appropriate and safe use of pharmaceuticals in a cost-effective manner.
(5) Based on the proven effectiveness of preferred drug programs to foster appropriate use of drugs, it is in the best interests of Alabama and its citizens for the Alabama Medicaid Agency to develop and implement a preferred drug plan. The plan should include a preferred drug list, which should be based on in-depth clinical evaluations of drugs.
(6) Efficacy and safety considerations override all other considerations in the preferred drug decision making process.
(Act 2003-297, p. 697, §1.)
2023 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 22-6-121
Medicaid 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.)
2023 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 22-6-123
Considerations 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.)
2023 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 22-6-124
Confidentiality 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.)
2023 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 22-6-150
Definitions.
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.)
2023 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 22-6-152
Medicaid 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.)
2023 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 22-6-154
Quality 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.)
2023 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 22-6-155
Terms 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.)
2023 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 22-6-157
Termination 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.)
2023 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 22-6-158
Contracts 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.)
2023 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 22-6-159
Implementation 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.)
2023 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 22-6-160
Evaluation 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.)
2023 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 22-6-161
Evaluation 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.)
2023 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 22-6-162
Case-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.)
2023 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 22-6-164
Rulemaking 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.)
2023 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 22-6-165
Regional 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.)
2023 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 22-6-190
Applicability.
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.)
2023 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 22-6-191
Legislative 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.)
2023 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 22-6-192
Definitions.
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.)
2023 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 22-6-193
Licensing 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.)
2023 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 22-6-194
Privilege 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.)
2023 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 22-6-195
Privilege 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.)
2023 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 22-6-196
Privilege 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.)
2023 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 22-6-197
Privilege 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.)
2023 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 22-6-198
Privilege 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.)