Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-62 - REGIONAL CARE ORGANIZATIONS › Section 560-X-62-.26 - Active Supervision Of Regional Care Organizations

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Medicaid Agency shall actively
			 monitor and supervise each regional care organization's ("RCO") activities
			 including, but not limited to, key staffing, governance, provider services and
			 materials, network adequacy, claims processing and payment, solvency,
			 financial, care coordination, quality and/or utilization management, grievance
			 and appeals, enrollment requirements, administrative support, technical
			 infrastructure, compliance with reporting and legal requirements, the
			 collective negotiations, bargaining, cooperation, and collaboration described
			 in Section
			 22-6-150(4),
Code of Ala. 1975
, and any other activities determined
			 by the Agency. In addition to any other reports required by the Medicaid
			 Agency, each RCO shall submit an on-line periodic report to the Medicaid Agency
			 on the first business day of the months of June and December unless otherwise
			 specified by the Medicaid Agency.
(2) Each periodic report must contain the
			 information requested by the Medicaid Agency in order to allow the Medicaid
			 Agency to engage in appropriate state supervision in accordance with Section
			 22-6-163,
Code of Ala.
			 1975
, including the following information:
(a) A description of the RCO's activities
			 during the reporting period, including a description of what entities and
			 persons with whom the RCO engaged in collective negotiations, bargaining,
			 contracting, or cooperation during the reporting period and any material
			 decisions by the RCO's Board of Directors, Executive Committee, Citizens'
			 Advisory Committee, Provider Standards Committee, or management or managing
			 entity of the RCO;
(b) A
			 description of any concerns or problems encountered in the collaborative,
			 bargaining and contracting, operational, or administrative process during the
			 reporting period;
(c) A description
			 of the nature and scope of expected future activities of the RCO; and
(d) Information concerning any previously
			 unreported changes to the RCO's Board of Directors, Executive Committee,
			 Citizens' Advisory Committee, Provider Standards Committee or corporate
			 structure during the reporting period, including any changes in board or
			 committee membership, material changes in management services, agreements or
			 conflicts of interest policies, and any amendments or other changes to the
			 RCO's governing documents such as the RCO's articles of incorporation, articles
			 of formation, bylaws, operating agreement, certificate of formation and
			 policies or rules required by the Medicaid Agency;
(e) Information concerning contracts or
			 agreements the RCO entered into or terminated during the reporting
			 period;
(f) A description of any
			 material changes in the operations, performance, service delivery networks,
			 policies and procedures required by the Medicaid Agency or by law or the
			 financial condition of the organizations and of any substantial litigation
			 filed against the organization related to the delivery of healthcare services
			 or that could have a substantial adverse financial effect on the organization;
			 and
(g) Any additional information
			 the Medicaid Agency may request.