Title 22 — Title 22

(a) All provider contracts of an organization granted final certification as an integrated care network shall be subject to review and approval of the Medicaid Agency. (b)(1) If a provider is dissatisfied with any term or provision of the agreement or contract offered by an integ…

(a) The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid Commissioner to review the care rendered through the integrated care networks. The members of the committee shall serve two-year terms. The Medicaid Agency shall promulgate a rule establi…

A risk contract between the Medicaid Agency and an integrated care network shall be for two years, with the option for Medicaid to renew the contract for not more than three additional one-year periods. The Medicaid Agency shall obtain provider input and an independent evaluation…

(a) The Medicaid Agency shall establish by rule the procedure for the termination of an integrated care network certification for non- performance of contractual duty or for failure to meet or maintain standards or requirements provided by this article or established by the Medic…

Where referred to in this article, facility shall mean intermediate care facility and skilled nursing facility licensed by the State Board of Health. More specific definitions shall be established by the department pursuant to the Alabama Administrative Procedures Act in order to…

An integrated care network shall contract with any willing nursing home, doctor, home and community waiver program, or other provider to provide services through an integrated care network if the provider is willing to accept the payments and terms offered comparable providers, w…

(a) The following timeline applies to implementation of this article: (1) Not later than April 1, 2017, the Medicaid Agency shall establish integrated care network rules setting forth solvency, governing board, network, and active supervision requirements, as well as other requir…

(a) The Medicaid Agency shall determine by rule which groups of Medicaid beneficiaries to include for coverage by an integrated care network. The Medicaid Agency, without the approval of the Governor, shall not make a coverage decision that would affect Medicaid beneficiaries who…

(a) The Legislature declares that collaboration among public payers, private health carriers, third party purchasers, and providers to identify appropriate service delivery systems and reimbursement methods in order to align incentives in support of integrated and coordinated hea…

Any participant in the integrated care network system receiving long term care services shall be offered information regarding advance directive for health care options consistent with applicable Alabama state law. History: (Act 2015-322, §16.)

The Medicaid Agency shall adopt rules necessary to implement this article and to administer the Medicaid Program as provided in this article in a manner consistent with state and federal law, as well as any State Plan or State Plan Waiver approved by the Centers for Medicare and …

All laws or parts of laws which conflict with this act are repealed. Notwithstanding the above, it is expressly declared that the provisions of Sections 22-6-220 to 22-6-234, inclusive, apply only to long-term care and integrated care networks as provided for in those sections. T…

Any other provision of law to the contrary notwithstanding, integrated care networks as defined in this article 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 …

Medicaid is designated as the agency responsible to ensure compliance with the facility reform enforcement process provisions of OBRA. All funds received pursuant to this article shall be deposited with the treasury to credit of Medicaid and are hereby continually appropriated fo…

Medicaid shall have such specific civil remedies of enforcement as is required by OBRA as a minimum state enforcement remedy. In order to ensure compliance with this article, Medicaid rules and regulations and OBRA, Medicaid shall also specify criteria, as to when and how each of…

This article shall be known as the Medicaid Emergency Reserve Fund Act. History: (Act 2023-359, §1.)

The Legislature finds that it is in the best interest of the State of Alabama that the Alabama Medicaid Agency is not forced to reduce payments to medical providers or eliminate optional but essential medical benefits to Medicaid recipients when the fiscal year appropriation is i…

There is created in the State Treasury a fund to be known as the Medicaid Emergency Reserve Fund. The fund shall be administered in accordance with the provisions of this article. The fund shall be budgeted and allotted in accordance with Sections 41-4-80 through 41-4-96 and Sect…

(a) The Medicaid Emergency Reserve Fund shall only be used for the following reasons: (1) To cover expenditure variances due to cost increases. (2) To cover expenditure variances due to unforeseen cost. (3) To prevent overdraft or deficit if the Alabama Medicaid Agency is expecte…

(a) The Commissioner of the Alabama Medicaid Agency shall notify the Governor when he or she foresees that the Alabama Medicaid Agency will exhaust its State General Fund appropriation within 180 days or less due to any of the reasons stated in Section 22-6- 253(a). The notificat…

The Governor shall notify the Commissioner of the Alabama Medicaid Agency, the Director of Finance, and all individuals listed in Section 22-6-254(b) of his or her decision to release funds in the Medicaid Emergency Reserve Fund. The Governor shall include the maximum amount of f…

At the end of fiscal year 2024, and at the end of every fiscal year thereafter, the unencumbered balance of both the Medicaid State General Fund Account, Account No. 0106, and the Medicaid State General Fund Carryforward Account, Account No. 0110, which was not appropriated in a …

(a) In addition to all other appropriations, there is appropriated eighty-eight million dollars ($88,000,000) from the Medicaid State General Fund Carryforward Account to the Medicaid Emergency Reserve Fund for the state fiscal year ending September 30, 2024. (b) In addition to a…

The balance in the Medicaid Emergency Reserve Fund shall not exceed one hundred million dollars ($100,000,000). No transfers may be made to the Medicaid Emergency Reserve Fund if the balance exceeds one hundred million dollars ($100,000,000). History: (Act 2023-359, §9.)

The State Treasurer shall invest the funds in the Medicaid Emergency Reserve Fund in investments that are eligible investments for the State Treasurer, as authorized by subsections (b), (c), and (d) of Section 41-14-30. All interest earned on the investment of money in the reserv…

This article shall in no way supersede, replace or affect the licensing and certification responsibilities or other regulatory functions of the Health Department. All health care facilities licensing authority shall remain the responsibility of the Department of Public Health upo…

All revenue collected pursuant to assessing civil penalties shall be deposited in the State Treasury to the credit of Medicaid in a trust fund known as The Resident Protection Trust Fund. This fund is hereby appropriated to Medicaid to be expended for the purpose of protecting th…

(a) All balances of revenue, income and receipts remaining in the Medicaid Fund at the end of a fiscal year shall carry over to the next fiscal year and shall not revert to the State General Fund under the provisions of Section 41-4-93. (b) All balances carried forward to the nex…

There is hereby established the Alabama Health Care Trust Fund in the State Treasury for the purpose of further providing for the operation of the Medicaid Program and the maintenance and expansion of medical services available thereunder. This fund shall consist of revenues rece…

All moneys deposited in said fund shall be available solely for appropriation by the Legislature to the Alabama Medicaid Agency. Said moneys shall be used and expended under the supervision of the Commissioner of the Alabama Medicaid Agency in order to accomplish the purposes of …

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…

(a) All persons eligible to receive Medicaid shall pay the sum of $1.00 for each visit as a copayment for medical services provided by a physician under the Medicaid Program. (b) The $1.00 copayment shall be collected by the attending physician and credited against the Medicaid p…

(a) Medicaid eligible persons shall pay a $2.00 copayment for medical services provided by a physician or other medical practitioner under the Medicaid Program. (b) The $2.00 copayment shall be collected by the provider of services and credited against the Medicaid payment to the…

(a) Medicaid eligible persons shall pay the maximum allowable copayment under federal law or administrative regulation for each prescription drug received under the Medicaid Program, except for designated exemptions. (b) Said maximum allowable copayment shall be collected by the …

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 Leg…

This financing shall be available to physicians in family practice, pediatrics and obstetrics who provide obstetrical services in rural and underserved areas. History: (Acts 1991, No. 91-596, p. 1099, §2.)

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 r…

Repealed by Act 2015-70 effective April 21, 2015. History: (Acts 1980, No. 80-113, p. 164.)

Etc., Thereto; Manner of Enforcement of Rights of State; Effect of Action by State or Recipient Against Person, Etc., Causing Injury, Etc., Upon Rights of Other; Provision of Written Notice, Etc., by Recipients Instituting Civil Actions for Damages. (a) If medical assistance is p…

(a) Every recipient of medical assistance under the Alabama Medicaid Program shall be deemed to have made assignment to the State of Alabama of any and all rights of his to medical support or payments for medical care from any person, firm or corporation, together with the rights…

Claims. (a) The Medicaid Agency of the State of Alabama, the single state agency charged with responsibility for administering the Alabama Medicaid Program, is hereby authorized to contract, for periods not to exceed seven years, with one or more fiscal intermediaries for the pur…

Contracts for the procurement of prescription eyewear for recipients of the Alabama Medicaid Program which are competitively bid may be awarded to the bidder whose proposal is the most advantageous to the state for periods not to exceed three years taking into consideration cost …

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 sha…

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 Ta…

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…

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 Treasur…

Restored; Award of Restricted Status to Pregnant Recipient Whose Eligibility Has Been Revoked. (a) Upon determination by a utilization review committee of the designated State Medicaid Agency that a Medicaid recipient has abused, defrauded, or misused the benefits of the program …

(a) The Department of Human Resources shall issue to all eligible recipients a special color picture medicaid identification card, which shall be separate from and entirely distinct from the valid color picture driver license or non-driver identification card. The Medicaid identi…

This article shall be known as the “Medicaid Revenue Use Act.” History: (Act 2002-410, p. 1031, §1.)

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 …