reglab/statecodes huggingface dataset:
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.04 - Admission Criteria

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Admission is limited to ventilator-dependent and/or qualified tracheostomy
			 residents.
(2) The
			 ventilator-dependent resident and/or qualified tracheostomy resident must meet
			 the current nursing facility level of care criteria established by
			 Medicaid.
(3) All of the following
			 criteria must be present in order for a resident to be considered
			 ventilator-dependent:
(a) The resident is not
			 able to breathe without a volume ventilator with a backup.
(b) The resident uses the ventilator seven
			 days per week.
(c) The resident has
			 a tracheostomy.
(d) The resident
			 requires daily respiratory therapy intervention, i.e., oxygen therapy,
			 tracheostomy care, chest physiotherapy or deep suctioning. These services must
			 be available 24 hours a day.
(e)
			 The resident must be medically stable and not require acute care services. A
			 Registered Nurse or Licensed Practical Nurse must be readily available and have
			 primary responsibility of the unit at all times.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.05 - Enrollment Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) All
			 nursing facilities that desire to receive a supplemental fee-for-service
			 payment for providing services to ventilator-dependent and/or qualified
			 tracheostomy Medicaid residents must execute an Addendum to the current Nursing
			 Facility Provider Agreement with the Alabama Medicaid Agency.
(2) The nursing facility must complete a
			 Medicaid enrollment application to serve ventilator-dependent and/or qualified
			 tracheostomy residents. The application must include the number of beds
			 designated to serve ventilator-dependent residents and/or qualified
			 tracheostomy residents.
Author:
Marilyn F. Chappelle, Director, Long
				  Term Care Division
Statutory Authority:
State Plan; Title XIX,
				  Social Security Act; and 42 CFR Section 401, et seq., Section
				  483.75
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.06 - Nursing Facility Participation Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
In addition to the requirements described in Rule No. 560-X-.63
				-.05 above, the nursing facility that desires to receive a supplemental
				fee-for-service payment for ventilator-dependent and/or qualified tracheostomy
				residents must:
(1) Be enrolled as a
			 Medicaid-certified facility.
(2)
			 Meet all of the federal and state regulations governing nursing
			 facilities.
(3) Meet the federal
			 and state physical plant requirements and all life safety standards for nursing
			 facilities including, an alternate power source to prevent interruption of the
			 ventilator in the event of a power outage.
(4) Ensure that a Registered Nurse or
			 Licensed Practical Nurse has primary responsibility for the unit and is readily
			 available at all times.
(5) Ensure
			 that in-house respiratory services are provided by a licensed Respiratory
			 Therapist 24 hours a day for ventilator-dependent residents and/or qualified
			 tracheostomy residents.
(6) Provide
			 a program of initial training and ongoing in-service training for direct care
			 staff.
(7) Ensure that any attempts
			 to wean a resident be documented in the resident's record. The nursing facility
			 must notify the Medicaid Agency within 14 days from the date the resident is
			 successfully weaned and is no longer in need of either ventilator care or
			 qualified tracheostomy treatment. No additional reimbursement will be issued to
			 the provider after the resident has been successfully weaned for 14 days and is
			 no longer in need of either ventilator care or qualified tracheostomy
			 treatment.
(8) Ensure that
			 physician visits are conducted in accordance with the federal regulations for
			 nursing facilities.
(9) Maintain
			 separate staffing records for the Respiratory Therapy staff that provides care
			 for the ventilator-dependent and/or qualified tracheostomy residents.
(10) Report any change of condition, such as
			 weaning from ventilators, transfers, discharges, re-hospitalizations and
			 deaths.
(11) Make available the
			 resident record for review by the Medicaid Agency every twelve months to
			 determine if the resident continues to meet the ventilator-dependent and/or
			 qualified tracheostomy care criteria.
(12) Not accept a ventilator-dependent and/or
			 qualified tracheostomy resident if any of the following situations exists:
(a) Termination of the nursing facility's
			 Medicaid certification is imminent; or
(b) The nursing facility is a Special Focus
			 Facility, under review by CMS, the Alabama Department of Public Health, or the
			 Alabama Medicaid Agency.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.07 - Nursing Facility Quality Standards

Current through Register Vol. 42, No. 9, June 28, 2024
The nursing facility must meet the following quality standards
				established by the Alabama Medicaid Agency:
(1) Staffing levels that correlate with the
			 number of ventilator-dependent residents.
(2) Respiratory therapy staff available
			 in-house 24 hours a day-employee or contractual.
(3) Staff knowledge: At least one full-time
			 professional staff member who has completed a course in the care of
			 ventilator-dependent and tracheostomy individuals.
(4) Ongoing training
(a) All staff providing care to
			 ventilator-dependent and tracheostomy residents must receive training in the
			 provision of ventilator care and tracheostomy care by a licensed Respiratory
			 Therapist or a physician who is a Board Certified Pulmonologist.
(b) Annual in-service training is required
			 and must be conducted by a Respiratory Therapist or a physician who is a Board
			 Certified Pulmonologist.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.08 - Quality Of Care

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Each
			 nursing facility must ensure that the necessary care and services to attain or
			 maintain the highest practicable physical, mental and psychosocial well-being
			 are provided to the resident, in accordance with the comprehensive assessment
			 and plan of care.
Author:
Marilyn F. Chappelle, Director, Long
				  Term Care Division
Statutory Authority:
State Plan; Title XIX,
				  Social Security Act; 42 CFR Section 401, et seq. and Section 483.25.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.09 - Limitations

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Alabama
			 Medicaid Agency will not limit participation to any nursing facility that
			 desires to provide services to ventilator-dependent or qualified tracheostomy
			 residents unless the following conditions exist:
(a) Termination of the nursing facility's
			 Medicaid certification is imminent; or
(b) The nursing facility is a Special Focus
			 Facility, under review by CMS, the Alabama Department of Public Health or the
			 Alabama Medicaid Agency.
(c) The
			 nursing facility does not meet the requirements established by the Department
			 of Public Health and the Medicaid Agency to serve residents who are
			 ventilator-dependent or in need of qualified tracheostomy services.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.10 - Reimbursement And Payment Limitations

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The nursing facility daily per diem rate
			 will continue to be made in accordance with Chapter 22,
Nursing
			 Facility Reimbursement
of the Alabama Medicaid Administrative
			 Code.
(2) The request for
			 additional reimbursement for a ventilator-dependent or qualified tracheostomy
			 resident must be submitted to the Alabama Medicaid Agency in writing for prior
			 approval. Each request must include the pertinent sections of the most current
			 Minimum Data Set (MDS) Resident Assessment and attending physician
			 documentation of the medical condition of the ventilator-dependent or qualified
			 tracheostomy resident. The MDS sections must include, but are not limited to:
			 Section I - Active Diagnoses; Section J - Health Conditions; and Section 0 -
			 Special Treatments, Procedures, and Programs.
(3) The nursing facility will be reimbursed
			 the daily per diem rate determined for the nursing facility plus an additional
			 daily payment for the ventilator-dependent or qualified tracheostomy
			 resident.
(4) The supplemental
			 fee-for-service payment will be $120 and indexed annually in accordance with
			 the cost of living increases as prescribed under Rule No.
			 560-X-22-.07.
(5) The total payment to the nursing facility
			 will be the daily per diem rate plus the supplemental fee-for-service
			 payment.
(6) In computing the daily
			 per diem rate, (i) costs for supplies directly associated with providing
			 ventilator-dependent or qualified tracheostomy care and (ii) salary, benefits,
			 and payroll taxes or contract expenses associated with engaging respiratory
			 therapists shall be excluded as allowable costs.
(7) No additional amount above the current
			 nursing facility rate will be allowed for the resident until it is determined
			 that both the resident and the nursing facility meet the requirements described
			 in this chapter and prior authorization is issued by the Medicaid
			 Agency.
(8) The supplemental
			 fee-for-service payments will be approved for 12-month intervals.
Author:
Marilyn F. Chappelle, Director, Long
				  Term Division
Statutory Authority:
State Plan; Title XIX,
				  Social Security Act; and 42 CFR Section 401, et seq., Section 483.75.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-63 - VENTILATOR-DEPENDENT AND QUALIFIED TRACHEOSTOMY CARE › Section 560-X-63-.11 - Claim Filing Limitations

Current through Register Vol. 42, No. 9, June 28, 2024
For claim filing limitations refer to Alabama Medicaid
				Administrative Code, Rule No.
				560-X-1-.17.
Author:
Marilyn F. Chappelle, Director, Long
				  Term Care Division
Statutory Authority:
State Plan, Title XIX,
				  Social Security Act;
				  42 CFR Section
				  447.45, et
				  seq.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.01 - Certificate In Order To Collaborate With Other Entities, Individuals, Or Integrated Care Networks (Repealed)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, Section
				  22-6-220 et seq.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.02 - Active Supervision Of Collaborations (Repealed)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-220 et seq.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.03 - Governing Board Of Directors

Current through Register Vol. 42, No. 9, June 28, 2024
(1) An Integrated Care Network (ICN) shall
			 have a governing board of directors composed of the following members:
(a) Sixty percent (60%) of the members shall
			 be persons representing risk-bearing participants in the ICN. A participant
			 bears risk by contributing cash, capital, or other assets to the ICN. At least
			 half of the risk-bearing participants shall be long-term health care or medical
			 providers, or representatives thereof, (herein referred to as "Provider
			 Members") who serve or will serve Medicaid beneficiaries enrolled in the ICN.
			 Provider Members must collectively contribute cash, capital, or other assets
			 approved by the Medicaid Agency to satisfy at least fifty percent (50%) of the
			 minimum financial reserves and capital or surplus requirements established by
			 the Medicaid Agency.
(b) Forty
			 percent (40%) of the members shall be persons who do not represent a
			 risk-bearing participant in the ICN and are not employed by a risk bearing
			 participant. At least four of these members must be Provider Members who serve
			 or will serve Medicaid beneficiaries enrolled in the ICN. The non-risk bearing
			 participants must be comprised as follows:
1.
			 At least twenty (20%) of the members shall be appointed by long-term care
			 and/or disability advocacy groups (including but not limited to Disabilities
			 Leadership Coalition of Alabama, Alabama Arise, AARP, Alabama Disabilities
			 Advocacy Program, Disability Rights and Resources, and Arc of
			 Alabama).
2. Two members shall be
			 appointed by the Medical Association of the State of Alabama, or its successor
			 organization; and
3. One member
			 shall be the chair of the citizens' advisory committee established pursuant to
			 Alabama Medicaid Administrative Code Rule
			 560-X-64-.04.
(c) The ICN shall adopt policies
			 and procedures, subject to the review and/or approval of the Medicaid Agency,
			 that ensures gender, race, and geographic diversity in the composition of the
			 governing board.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.04 - Citizens' Advisory Committee

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A citizens' advisory committee (CAC)
			 shall advise an integrated care network (ICN) on ways it may be more efficient
			 in providing quality care to Medicaid beneficiaries. In addition, a CAC shall
			 carry out other functions and duties assigned to it by the ICN and approved by
			 the Medicaid Agency. Each ICN shall have a CAC, which membership shall be
			 inclusive and reflect the racial, gender, geographic, urban/rural, and economic
			 diversity of the population served. The committee shall meet all of the
			 following criteria:
(a) Be selected in a
			 method established by the ICN and approved by the Medicaid Agency.
(b) At least 20 percent of its members shall
			 be Medicaid beneficiaries enrolled in the integrated care network, or the
			 Medicaid beneficiary's sponsor. It shall be the ICN's sole responsibility to
			 obtain all necessary approvals, consents or waivers from Medicaid beneficiaries
			 and to comply with all applicable laws regarding privacy and confidentiality
			 related to such information before providing it to the Medicaid
			 Agency.
(c) 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 Disabilities Advocacy Program, the
			 Disability Rights and Resources, the Arc of Alabama, and also include members
			 who are non-at-risk providers that provider services to Medicaid beneficiaries
			 through the integrated care network.
(d) Elect a chair.
(e) Meet at least every three
			 months.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.05 - ICN Quality Assurance Committee. (REPEALED)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §
										22-6-227; 42 CFR Part 438.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.07 - Service Delivery Network Requirements For Integrated Care Networks

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definitions -
			 As referenced in this Chapter of the Alabama Medicaid Administrative Code the
			 following terms shall be defined as follows:
(a)
Care Management Organization
			 (CMO)
is defined as an organization providing case management for the
			 1915(c) waivers enrolled in the ICN program in accordance with Rule
			 560-X-64-.17 (e.g. AAAs and other
			 agencies currently providing HCBS Case Management.)
(b)
Nursing Facility
as
			 defined in Rule
			 560-X-10-.01.
(c)
Service Delivery Network
is defined as one that ensures enrollees have access to a network of
			 appropriate providers that is sufficient to provide adequate access to all
			 enrollees of the ICN.
1. The ICN must
			 establish prior to the ICN Program implementation and maintain thereafter an
			 adequate amount and appropriate geographic distribution of Nursing Facilities
			 and CMOs, as required to appropriately service its enrollees, provide choice of
			 providers to enrollees, and facilitate timely and effective care transitions
			 and community participation. To satisfy this adequacy requirement, the ICN must
			 have:
(i) Coordination agreements with at
			 least fifty percent (50%) of the Medicaid Nursing Facilities' total licensed
			 beds in the State.
(ii) Contracts
			 with at least seventy-five percent (75%) of the CMOs in the State.
2. The ICN must establish
			 agreements with the Alabama Department of Mental Health (ADMH) to ensure that
			 each ICN establishes and maintains a collaboration to address the needs of
			 enrollees who have mental illnesses and substance abuse disorders.
3. The ICN must establish agreements with the
			 Alabama Department of Human Resources (ADHR) to ensure that each ICN
			 establishes and maintains a collaboration to assist with prevention, reporting,
			 and investigation activities of Adult Protection Services.
4. The ICN must establish agreements with the
			 Alabama Department of Senior Services (ADSS) to ensure that each ICN
			 establishes and maintains an adequate network for HCBS Waiver Case Management
			 activities.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.08 - Active Supervision Of Organizations With Probationary Certification (Repealed)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-220 et seq.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.09 - Information And Marketing Requirements For Enrollees And Potential Enrollees

Current through Register Vol. 42, No. 9, June 28, 2024
(1) As
			 used in this rule, the following terms have the meanings set forth below:
(a) Enrollee means a Medicaid beneficiary
			 enrolled as a member of an Integrated Care Network (ICN).
(b) Large Print means printed in a font size
			 no smaller than 18 point.
(c)
			 Limited English Proficient (LEP) means Enrollees and Potential Enrollees who do
			 not speak English as their primary language and who have a limited ability to
			 read, write, speak or understand English. LEP individuals may be eligible to
			 receive language assistance for a particular type of service, benefit or
			 encounter.
(d) Potential Enrollee
			 means a Medicaid beneficiary subject to mandatory enrollment in an ICN or who
			 may voluntarily be required to enroll as a member of an ICN.
(e) Prevalent means those non-English
			 languages determined to be spoken by a significant number or percentage of
			 Enrollees and Potential Enrollees that are limited English proficient. The
			 following languages are defined as Prevalent:
1. Spanish or Spanish Creole;
2. Korean;
3. Chinese;
4. Vietnamese;
5. Arabic;
6. German;
7. French;
8. Gujarati;
9. Tagalog;
10. Hindi;
11. Laotian;
12. Russian;
13. Portuguese;
14. Turkish; and
15. Japanese.
(f) Readily Accessible means electronic
			 information and services which comply with modern accessibility standards such
			 as section 508 guidelines, section 504 of the Rehabilitation Act and W3C s Web
			 Content Accessibility Guidelines (WCAG) 2.0 AA and successor
			 versions.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.11 - Hazardous Financial Condition and Insolvency (Repealed)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-220 et seq.; 42 C.F.R. Part
				  438.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.12 - Probationary Certification Of Organizations Seeking To Become Integrated Care Networks (Repealed)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-150, et
				  seq.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.13 - Conflict Of Interest Policy For Directors And Officers Of Integrated Care Networks

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 Integrated Care Network (ICN) shall adopt a conflict of interest policy for
			 directors and officers. The conflict of interest policy shall require all
			 directors and officers to conduct their activities as directors or officers so
			 that they do not advance or protect their own interests, or the interests of
			 others with whom they have a private or professional relationship, in a way
			 that is detrimental to the interests of, or to, the ICN, and the conflict of
			 interest policy shall provide for the removal of any director or officer whose
			 conduct violates such policy, unless a remedial action shall be sufficient to
			 bring the director or officer into compliance with the policy. The conflict of
			 interest policy shall require each director and officer to disclose in a
			 written statement all employments, associations, commitments and financial
			 interests that may currently exist or may have previously existed within the
			 preceding two (2) years or that they reasonably expect to arise in the future,
			 on the part of the director or officer, or his or her immediate family member,
			 including spouse, dependents, adult children and their spouses, parents,
			 spouse's parents, siblings and their spouses, that could reasonably be
			 perceived, directly or indirectly, as a conflict of interest with the ICN or
			 organization with probationary ICN certification. The statement shall also
			 disclose whether the director or officer or his or her immediate family member
			 as described in the preceding sentence is a current or former employee of,
			 consultant with, or lobbyist for the Medicaid Agency or with any individual or
			 entity (including subcontractors) providing enrollment broker or choice
			 counseling services on behalf of the Medicaid Agency. Each director and officer
			 shall file such disclosure statement with the ICN's or organization's board of
			 directors and the Medicaid Agency on an annual basis.
(2) The conflict of interest policy must
			 also:
(a) Require each director or officer to
			 disclose relevant financial interests and potential conflicts of
			 interest
(b) Provide a procedure
			 satisfactory to the Medicaid Agency to determine whether an actual or potential
			 conflict of interest exists and set forth a process satisfactory to the
			 Medicaid Agency to address any potential conflicts of interest that
			 arise;
(c) Address remedial action
			 for directors or officers that fail to comply with the policy; and
(d) Require that the board of directors of
			 the organization be responsible for enforcement of the conflict of interest
			 policy and maintain minutes, disclosures of potential conflicts and other
			 related documents, which will be subject to review by the Medicaid Agency,
			 describing potential conflicts of interests and the action taken by the
			 directors.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.14 - Right to Terminate Certificates of Probationary and Fully Certified Integrated Care Networks (Repealed)

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-220 et
				  seq.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.16 - ICN Covered Population

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The following groups of eligible Medicaid
			 beneficiaries shall be included for coverage by an integrated care network
			 (ICN):
(a) Individuals that meet the current
			 admission criteria for nursing facility care as described in Alabama Medicaid
			 Administrative Code Rule
			 560-X-10-.10 and who are
			 receiving nursing facility services in accordance with Alabama Medicaid
			 Administrative Code Rule
			 560-X-10-.04(1);
(b) Individuals that meet the eligibility
			 criteria for the Home and Community-Based Services for the Alabama Community
			 Transition (ACT) Waiver in accordance with Alabama Medicaid Administrative Code
			 Rule 560-X-44-.02; and
(c) Individuals that meet the eligibility
			 criteria for the Home and Community-Based Services for the Elderly and Disabled
			 Waiver in accordance with Alabama Medicaid Administrative Code Rule
			 560-X-36-.02.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.17 - ICN Covered Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 The following services must be covered for Medicaid recipients who are enrolled
			 in an integrated care network (ICN):
(a)
			 Direct Home and Community-Based Service Case Management for the Alabama
			 Community Transition (ACT) Waiver in accordance with Alabama Medicaid
			 Administrative Code Rule
			 560-X-44-.04;
(b) Direct Home and Community-Based Service
			 Case Management for the Elderly and Disabled in accordance with Alabama
			 Medicaid Administrative Code Rule
			 560-X-36-.04; and
(c) Primary care case management services,
			 which include the location, coordination, and monitory of primary health care
			 services, in addition to one or more of the following, as specified by the
			 Medicaid Agency:
1. Provision of intensive
			 telephonic or face-to-face case management, including operation of a nurse
			 triage advice line.
2. Development
			 of enrollee care plans.
3.
			 Execution of contracts with and/or oversight responsibilities for the
			 activities of FFS providers in the FFS program.
4. Provision of payments to FFS providers on
			 behalf of the State.
5. Provision
			 of enrollee outreach and education activities.
6. Operation of a customer service call
			 center.
7. Review of provider
			 claims, utilization and practice patterns to conduct provider profiling and/or
			 practice improvement.
8.
			 Implementation of quality improvement activities including administering
			 enrollee satisfaction surveys or collecting data necessary for performance
			 measurement of providers.
9.
			 Coordination with behavioral health systems/ providers.
10. Coordination with long-term services and
			 supports systems/providers.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.18 - Sanctions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Bases for
			 Imposition of Sanctions on ICNs. The Medicaid Agency may impose sanctions on an
			 integrated care network ("ICN") if the Medicaid Agency determines in its sole
			 discretion that the ICN has violated any applicable federal or state law or
			 regulation, the Alabama Medicaid State Plan, the risk contract between the
			 Medicaid Agency and the ICN and the exhibits thereto (the "risk contract"), any
			 policies, procedures, written interpretations, or other guidance of the
			 Medicaid Agency, or for any other applicable reason described in 42 C.F.R. Part
			 438, Subpart I or the risk contract, including but not limited to a
			 determination by the Medicaid Agency that an ICN acts or fails to act as
			 follows:
(a) fails substantially to provide
			 medically necessary services that the ICN is required to provide, under law or
			 under its risk contract, to an enrollee covered under the risk
			 contract;
(b) imposes on enrollees
			 premiums or charges that are in excess of the premiums or charges permitted
			 under the Alabama Medicaid program;
(c) acts to discriminate among enrollees on
			 the basis of their health status or need for health care services (including
			 termination of enrollment or refusal to reenroll a recipient, except as
			 permitted under the Alabama Medicaid program, or any practice that would
			 reasonably be expected to discourage enrollment by recipients whose medical
			 condition or history indicates probable need for substantial future medical
			 services);
(d) misrepresents or
			 falsifies information that it furnishes to the Medicaid Agency or to the
			 Centers for Medicare and Medicaid Services (CMS);
(e) misrepresents or falsifies information
			 that it furnishes to an enrollee, potential enrollee, or health care
			 provider;
(f) distributes directly,
			 or indirectly through any agent or independent contractor, marketing materials
			 that have not been approved in writing by the Medicaid Agency or that contain
			 false or materially misleading information;
(g) fails submit a corrective action plan
			 that is acceptable to the Medicaid Agency within the time period specified by
			 the Medicaid Agency's written notice or does not implement or complete the
			 corrective action within the established time period;
(h) violates, as determined by the Medicaid
			 Agency, any requirement of sections 1903(m), 1932, or 1905(t) of the Social
			 Security Act or any implementing regulations; or
(i) violates, as determined by the Medicaid
			 Agency, any applicable requirement of the Alabama Code or the Alabama Medicaid
			 Administrative Code.
Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-64 - INTEGRATED CARE NETWORKS › Section 560-X-64-.19 - Readiness Assessment Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Integrated Care Network (ICN) shall
			 be subject to a readiness assessment period before it may begin providing
			 services to enrollees.
(2) The ICN
			 must demonstrate readiness, to the Medicaid Agency's satisfaction, as specified
			 in the risk contract.
(3) The
			 Medicaid Agency will provide a readiness assessment tool detailing the
			 requirements necessary to demonstrate an ICN's readiness. The Medicaid Agency
			 will conduct a readiness review which will include desk and onsite reviews of
			 information submitted by the ICN.
(4) All requested documentation, information
			 and/or demonstrations must be submitted or conducted as specified by the
			 Medicaid Agency. The Medicaid Agency may require additional documentation or
			 updates to submissions throughout the readiness assessment period.
(5) The ICN shall produce or provide timely,
			 convenient, and free access at reasonable business hours at the office(s) of
			 the ICN to all books, records, accounts, papers, documents, and electronic and
			 other recordings in its possession or control relating to the matter related to
			 the readiness assessment, including as applicable the property, assets,
			 business and affairs of the ICN.
(6) The ICN shall make private office space
			 available to the Medicaid Agency and/or its designee for the duration of any
			 onsite review without cost to the Medicaid Agency and/or its
			 designee.
(7) Only after an ICN has
			 demonstrated, in the Medicaid Agency's sole discretion, readiness may it begin
			 providing services pursuant to its contract with the State to
			 enrollees.
Author:
Stephanie Lindsay, Administrator,
				  Administrative Procedures Office
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-6-220 et
				  seq.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.01 - Department Of Mental Health And Mental Retardation

Current through Register Vol. 42, No. 9, June 28, 2024
The Department of Mental Health and Mental Retardation is a
				department of state government as provided by
Code of Ala.
				1975
, §
								22-50-2,
				and is composed of the state mental health and mental retardation commissioner
				and such divisions and administrative sections as the mental health and mental
				retardation commissioner may direct.
Author:
Division of Mental Retardation,
				DMH/MR
Statutory Authority:
Code of Ala.
				  1975
, §
										22-50-2.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.02 - Rule Defined

Current through Register Vol. 42, No. 9, June 28, 2024
The term rule is defined to be any rule, policy, regulation or
				order establishing standards for the admission, diagnosis, care and treatment
				of persons receiving mental health or mental retardation services.
Author:
Division of Mental Retardation,
				DMR/MR
Statutory Authority:
Code of Ala.
				  1975
,
				  22-50-1.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.03 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
Patients
. Those persons afflicted with mental or
			 emotional illness and residing in a state operated hospital or residential
			 facilities operated by the Mental Illness Division.
(2)
Residents
.
			 Individuals residing in a 24 hour-a-day residential facility, who are afflicted
			 with mental, emotional illness, substance abuse/dependency or mental
			 retardation.
(3)
Clients
. Those individuals seen on an outpatient basis
			 and/or those persons identified as receiving or needing services for mental
			 retardation or substance abuse/dependency.
(4)
Department
. The
			 Alabama Department of Mental Health and Mental Retardation.
(5)
Mental Retardation
			 Services
. Evaluation for, amelioration of, habilitation for,
			 prevention of, and research into the causes of mental retardation.
(6)
Board
. Board of
			 Trustees for the Department of Mental Health and Mental Retardation.
(7)
Mental Health
			 Services
. Diagnosis of, treatment of, rehabilitation for,
			 follow-up care of, prevention of and research into the causes of all forms of
			 mental or emotional illness.
(8)
Substance Abuse/Dependency Services
. Assessment of,
			 diagnosis of, treatment of, rehabilitation for, follow-up care of, prevention
			 of and research into the causes of substance abuse/dependency.
Author:
Division of Mental Retardation,
				DMH/MR
Statutory Authority:
Code of Ala.
				  1975
, § 20-50-2.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.04 - Agency Head

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Mental
			 Health and Mental Retardation Commissioner is the agency head of the
			 department.
(2) On May 1, 1984, a
			 bill was signed into law which renamed the Department of Mental Health to the
			 Department of Mental Health and Mental Retardation. Additional provisions of
			 the newly enacted law had the effect of abolishing the Mental Health Board and
			 creating a Board of trustees to be composed of sixteen (16) members as follows:
(a) The governor, the commissioner of mental
			 health and mental retardation, the lieutenant governor and the speaker of the
			 house of representatives shall be ex-officio members of such board of trustees.
			 The remaining twelve (12) members shall be appointed by the governor, one (1)
			 from each of the congressional districts and the remainder from the state at
			 large.
One of the state at large positions shall be selected from
				nominations offered by the Association for Retarded Citizens of Alabama and one
				(1) of the state at large positions shall be selected from nominations offered
				by the Mental Health Association of Alabama. All appointed trustees shall have
				demonstrated a concern for the programs and services provided by the Department
				of Mental Health and Mental Retardation and should represent a balance of
				primary interest areas or expertise.
(b) The governor shall be chairman of the
			 board of trustees and the commissioner of mental health and mental retardation
			 shall be the secretary. The board shall meet quarterly at a place to be
			 designated by the chairman and may meet more frequently upon the call of the
			 chairman, or a majority of the members.
(c) The governor shall appoint, as the
			 initial board of trustees, four (4) members for a term of one (1) year; four
			 (4) members for a term of two (2) years; four (4) members for a term of three
			 (3) years; all trustees shall take office effective upon appointment. No
			 trustee shall serve more than three consecutive three year terms; provided,
			 however, that trustees shall continue to serve until their successors have been
			 appointed. Subsequent appointments shall be made for a period of three (3)
			 years except that vacancies shall be filled by the governor for the unexpired
			 term only.
(d) The trustees shall
			 receive $100.00 per day and mileage expenses while attending meetings of the
			 board of trustees or while engaged in other official duties at the request of
			 the governor or board of trustees.
Author:
Division of Mental Retardation,
				DMH/MR
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.05 - Department Of Mental Health And Mental Retardation

Current through Register Vol. 42, No. 9, June 28, 2024
The governor and the commissioner of mental health and mental
				retardation are constituted by law as a public corporation to be known as the
				Department of Mental Health and Mental Retardation.
Author:
Division of Mental Retardation,
				DMH/MR
Statutory Authority:
Code of Ala.
				  1975
, §
										22-50-4.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.06 - Authority Of Commissioner

Current through Register Vol. 42, No. 9, June 28, 2024
The authority of the department, and its commissioner, is set
				forth in
Code of Ala. 1975
, §
								22-50-9 and §
								22-50-11 and includes but is not limited to the following:
(1) The Department of Mental Health and
			 Mental Retardation through its commissioner is hereby authorized to act in any
			 prudent way to provide mental health, substance abuse services and mental
			 retardation services for the people of Alabama.
(2) To authorize and set up state plans to
			 control and treat any and all forms of mental and emotional illness and any and
			 all forms of mental retardation.
(3) To supervise, coordinate, and establish
			 standards for all operations and activities of the state related to mental
			 health and mental retardation and the providing of mental health services and
			 mental retardation services; and it is authorized to receive and administer any
			 funds available from any source for the purpose of acquiring building sites
			 for, constructing, equipping, maintaining or operating mental health centers,
			 and community retardation programs or facilities or institutions for the
			 purpose of providing mental health services and mental retardation
			 services.
(4) The single state
			 agency of the state to receive and administer, through its commissioner, any
			 and all funds available from any source for purposes of training, research and
			 education in regard to all forms of mental and emotional illness and all forms
			 of mental retardation through its commissioner.
(5) To enter into contracts.
(6) To develop programs for the
			 aged.
(7) To appoint advisory
			 councils.
(8) The Mental Health and
			 Mental Retardation Department is authorized to establish and promulgate
			 reasonable rules, policies, orders and regulations providing details of
			 carrying out its duties and responsibilities, including bylaws for its own
			 organization, government and procedures.
(9) To purchase or lease land or
			 property.
(10) To determine
			 reasonable fees for services rendered to the public.
(11) To establish and promulgate reasonable
			 minimum standards for the construction and operation of its
			 facilities.
(12) To inspect any
			 institution or facility providing any kind of treatment or care for those
			 suffering from mental or emotional illness or mental retardation, and to
			 certify any such institution or facility which meets its minimum
			 standards.
(13) To establish and
			 collect reasonable fees for necessary inspection services.
(14) To provide hearings for those claiming
			 to be damaged by decisions of its employees.
(15) To file and prosecute suits.
(16) To accept gifts, trusts, bequests,
			 etc.
(17) To receive moneys by way
			 of fees for its services.
Author:
Division of Mental Retardation,
				DMH/MR
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-50-9,
				  22-50-11.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.07 - Statutory Authority

Current through Register Vol. 42, No. 9, June 28, 2024
The State Department of Mental Health and Mental Retardation
				operates under the provisions set forth in the
Code of Ala.
				1975
, Title 22, Chapter 50.
Author:
Division of Mental Retardation,
				DMH/MR
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-50-9,
				  22-50-11.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.09 - Location Of Offices

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 The central office of the Alabama Department of Mental Health and Mental
			 Retardation is located at 100 N. Union Street, Montgomery, AL 36130-1410.
Author:
Division of Mental Retardation,
				DMR/MR
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-50-9,
				  22-50-11.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.10 - Availability Of Forms And Records

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Any form or publication used by the
			 Department of Mental Health and Mental Retardation during the course of its
			 operation and dealings with the public may be obtained by contacting the office
			 of the Commissioner of Mental Health, 100 N. Union Street, Montgomery, AL
			 36130-1410.
(2) Availability of
			 Records. No employee of any of the facilities under the management, control,
			 supervision or affiliated with the Alabama Mental Health and Mental Retardation
			 Department shall be required to disclose any record, report, case history,
			 memorandum or other information, oral or written, which may have been acquired,
			 made or compiled in attending or treating any patient of said facilities in a
			 professional character, when such information was necessary in order to
			 evaluate or treat said patient or to do any act for him in a professional
			 capacity, unless a court of competent jurisdiction shall order disclosure for
			 the promotion of justice; provided, that where a person is a defendant in a
			 criminal case and a mental examination of such defendant has been ordered by
			 the court, the results or the report of such mental examination shall be
			 forwarded to the clerk of said court and to the district attorney and to the
			 attorney of record for the defendant.
(3) Applicable federal regulations limit
			 disclosure of treatment records.
(4) Other records not subject to disclosure
			 include:
(a) pending criminal
			 investigations
(b) sensitive
			 personnel records
(c) recorded
			 information received in confidence by a public official or any
			 individual
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.11 - Public Information

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Public information within the State Mental Health and Mental Retardation
			 Department is designed to provide information for the general public and
			 designed to work closely with advocacy and consumer groups and other concerned
			 citizens where support is vital in fostering mental health and mental
			 retardation services in the state. The Public Information function includes;
			 annual reports, news releases, newsletters, speakers, magazines, brochures,
			 coordination of special events, tours, photography and graphic assistance. An
			 additional function is the recruitment, orientation and utilization of
			 volunteers and sponsors.
(2) The
			 public may obtain information or make submissions or requests by writing the
			 Director, Office of Public Information and Community Relations who is located
			 in the Commissioner's Office, 100 N. Union Street, Montgomery, AL 36130-1410.
Author:
Division of Mental Retardation
				DMR/MR
Statutory Authority:
Code of Ala.
				  1975
, §
										22-50-62.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.12 - Rulemaking Proceedings

Current through Register Vol. 42, No. 9, June 28, 2024
The rulemaking proceedings of the Department of Mental Health
				and Mental Retardation shall be carried out in the manner prescribed by law in
				the
Code of Ala. 1975
, §
								22-50-11(8) which states that "The mental health and mental retardation department is
				hereby authorized and directed to establish and promulgate reasonable rules,
				policies, orders and regulations providing details of carrying out its duties
				and responsibilities." (Acts 1984, No. 346 §ll.) The rulemaking
				proceedings of the Department will also comply with the rules published in the
Alabama Administrative Code
.
Author:
Division of Mental Retardation,
				DMR/MR
Statutory Authority:
Code Of Ala.
				  1975
, §
										22-50-11.
Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-1-1 - ORGANIZATION AND METHOD OF OPERATION › Section 580-1-1-.13 - Declaratory Rulings

Current through Register Vol. 42, No. 9, June 28, 2024
The Department of Mental Health and Mental Retardation shall
				follow the rules of procedure for filing, consideration, and disposition of
				declaratory rulings under the provisions of the
Code of Ala.
				1975
, Title 4, Chapter 22, in accordance with the rules published
				in the Alabama Administrative Code.
Author:
Division of Mental Retardation
				DMR/MR
Statutory Authority:
Code of Ala.
				  1975
, §
										22-50-11.