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AL SB459
Bill
AI Summary
SB459 Summary
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Revises regional care organization (RCO) governing board composition to include 12 risk-bearing participant representatives and 8 non-risk-bearing members including 5 medical professionals (3 primary care physicians, 1 optometrist, 1 pharmacist) and 3 community representatives.
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Authorizes RCO boards to establish executive committees and other committees with delegated authority, requiring at-risk provider representation on the executive committee and physician representation on all committees.
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Requires each RCO to create a provider standards committee composed primarily of physicians to review and develop performance standards and quality measures subject to Medicaid Quality Assurance Committee approval.
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Mandates the Medicaid Agency establish minimum provider reimbursement rates by rule, with rates set at prevailing Medicaid fee-for-service payment schedules unless providers and RCOs agree otherwise through contract.
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Establishes three-tier dispute resolution process for dissatisfied providers: internal RCO review, Medicaid Agency review (10 days), and contract dispute committee review (20 days), with final appeal to Montgomery County Circuit Court.
Legislative Description
Medicaid, Regional Care Organizations, membership and eligibility of board of directors revised, appointment of executive committee, creation of provider standards committee, establishment of minimum reimbursement rates by the Medicaid Agency, review of provider contract terms, rulemaking authority of the Medicaid Agency, Secs. 22-6-151, 22-6-153, 22-6-155, 22-6-158, 22-6-163, 22-6-164 am'd.
Medicaid
Last Action
Assigned Act No. 2014-434.
4/2/2014