Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-62 - REGIONAL CARE ORGANIZATIONS › Section 560-X-62-.01 - Certificate in Order to Collaborate with other Entities, Individuals, or Regional Care Organizations

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Every
			 person or entity who is operating or may operate as a Collaborator shall
			 possess a certificate (Certificate to Collaborate) issued by the Medicaid
			 Agency qualifying such person or entity to collaborate as set forth in Section
			 22-6-163 of the
Code
			 of Ala. 1975
. A Collaborator is defined in Section
			 22-6-150(4) of
			 the
Code of Ala. 1975
, as: "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."
(2)
			 Every person or entity seeking a Certificate to Collaborate shall submit an
			 on-line application with the Medicaid Agency and must include the following
			 information in the application:
(a) The
			 applicant's name, business, occupation or medical specialty, principal address
			 and the name, mailing address, e-mail address, and telephone number of each
			 person authorized to receive notices and communications relating to the
			 application;
(b) The applicant's
			 National Provider Identifier (NPI) number(s), Medicaid ID number(s), Taxpayer
			 Identification Number(s) (TIN), Social Security Number (SSN) and any state
			 professional or facility license number(s);
(c) The name and address of each individual
			 who the applicant authorizes to collaborate on its behalf with other entities,
			 persons, or Regional Care Organizations (RCOs);
(d) Background information relating to the
			 applicant and each individual authorized to collaborate on its behalf,
			 including:
(i) whether the applicant or any
			 individual authorized to collaborate on its behalf is currently excluded or
			 suspended from the Medicare, Medicaid, or the Title XX services
			 program;
(ii) whether the applicant
			 or any individual authorized to collaborate on its behalf has ever pled guilty
			 to or been convicted of a criminal offense related to the applicant's or the
			 individual's involvement in any program under Medicare, Medicaid, or the Title
			 XX services program;
(iii) whether
			 the applicant or any individual authorized to collaborate on its behalf has
			 ever pled guilty, been convicted, or found liable in a criminal or civil
			 proceeding of engaging in any form of health care fraud or abuse;
(iv) whether the applicant or any individual
			 authorized to collaborate on its behalf has ever pled guilty, been convicted,
			 or found liable in a criminal or civil proceeding of engaging in any form of
			 anti-competitive conduct or other anti-trust violation;
(v) whether the professional license or
			 certification of the applicant or any individual authorized to collaborate on
			 its behalf is currently suspended or revoked; and
(vi) whether the applicant or any individual
			 authorized to collaborate on its behalf has ever pled guilty or been convicted
			 of a violation of the state or federal securities or insurance laws.
(e) Information whether the
			 applicant intends to help establish or develop a RCO, to enroll as a provider
			 with a RCO, or to engage in other activity.
(f) Identification of the Medicaid region(s)
			 in which the applicant intends to help establish or develop a RCO, to enroll as
			 a provider with a RCO, or to engage in other activity.
(g) Description of what entities and persons
			 with whom the applicant intends on collaborating or negotiating;
(h) Description of the expected effects of
			 the negotiated contract, including whether the negotiated contract is expected
			 to:
(i) result in improved quality of health
			 care services to Medicaid beneficiaries;
(ii) result in cost containment in providing
			 health care services;
(iii) result
			 in enhancements in technology; and
(iv) maintain competition in the health care
			 services market.
(i)
			 Certification by the applicant that all information entered on the application
			 is true, to the best of the applicant's knowledge, and (1) that the applicant
			 will bargain in good faith, (2) that such bargaining is necessary to identify
			 appropriate service delivery systems and reimbursement methods in order to
			 align incentives in support of integrated and coordinated health care delivery,
			 and (3) that such bargaining is necessary to provide quality health care to
			 Alabama citizens who are Medicaid eligible at the lowest possible
			 cost.