HB475 Summary

• Repeals Article 9 (Sections 22-6-150 to 22-6-165) of Alabama Code authorizing regional care organizations to provide Medicaid services on a managed care basis statewide, as the program was never implemented and has zero beneficiary enrollment.

• Amends multiple Medicaid statutes to replace references to regional care organizations with integrated care networks, which serve only Medicaid beneficiaries and must meet specific governance and certification requirements.

• Establishes integrated care network governing boards with 12 risk-bearing and 8 non-risk-bearing members, subject to Medicaid Agency approval of board composition and bylaws.

• Modifies hospital payment provisions to establish baseline payment amounts for inpatient and outpatient services if Medicaid begins payments under the new system by September 30, 2018, with contingencies for alternative payment calculations if implementation is delayed.

• Becomes effective on the first day of the third month following passage and Governor approval.