HB454 Summary

• Establishes a managed care system for Alabama Medicaid through regional care organizations (RCOs) and alternate care providers operating under risk-based capitated payment contracts.

• Requires RCOs to have governing boards composed of 12 risk-bearing participants, 5 medical professionals (primary care physicians, dentist, optometrist, pharmacist), and 3 community representatives including Medicaid beneficiaries.

• Mandates minimum financial reserves of $250,000 or 25% of monthly expenditures and $2.5 million in capital/surplus, with alternative bonding provisions available.

• Creates a quality assurance committee led by the Medicaid Commissioner to establish outcome and quality measures, with financial audits required at least every three years.

• Establishes implementation timeline from October 2013 through October 2016 for regional certification and provides exemptions from state and federal antitrust laws for collaborative health care delivery efforts.