“Senate Bill 340 as introduced provides for the Alabama Medicaid Agency to establish not more than eight regional care organizations (RCO) throughout the State to provide medical services to Medicaid recipients. The bill provides that subject to approval by the Centers for Medicare and Medicaid Services, the Medicaid Agency shall do the following:
(1) enter into a contract in each Medicaid region for at least one fully certified RCO to provide Medicaid services;
(2) enroll beneficiaries into a RCO and if there is more than one RCO that operates in a region, a Medicaid beneficiary may choose the organization to provide his or her care;
(3) establish by rule procedures to address the provisions of this bill to include procedures for termination of certification or probationary certification of a RCO for non-performance of contractual duty or failure to meet or maintain benchmarks; and
(4) conduct an evaluation of the existing long-term care system and integrate long-term care for Medicaid beneficiaries into the care-delivery system of each region by October 1, 2017.
The bill also provides that each RCO shall do the following:
(1) establish a board to act as the governing body of the RCO, which shall consist of at least 60 percent of the seats on the Board being held by a participant in the organization and no single type of provider shall hold a majority of the seats on the Board;
(2) establish a citizen’s advisory committee;
(3) meet minimum solvency and financial requirements as a condition of certification by the Alabama Medicaid Agency;
(4) contract with any willing hospital, doctor, or other providers to provide services in a Medicaid region that is willing to accept the payments and terms offered to comparable providers; and
(5) provide Medicaid services to Medicaid enrollees directly or by contract with other providers.
The actual increase in obligations or savings to the Agency as a result of the implementation of the provisions of this bill are undetermined at this time and are dependent upon the date of full implementation, the number of Medicaid recipients enrolled, and any unfunded mandates which may be levied by the Federal Government.
As substituted, amended and reported by the Committee on Health, provides that the Alabama Medicaid Agency shall
(1) establish geographic regions in which a regional care organization (RCO) or alternate care provider may operate and removes the requirements for eight regional care organizations;
(2) establish procedures for safeguarding against wrongful denial of claims;
(3) creates a quality assurance committee to identify objective outcomes and quality measures to hold RCOs accountable for the performance and customer satisfaction requirements;
(4) conduct an evaluation of the existing long-term care services provided to Medicaid beneficiaries and report evaluation findings to the Legislature and the Governor on October 1, 2015. This bill as substituted also removes the provision that the long-term care system shall be integrated into the care delivery system of each region by October 1, 2017 and provides that the current long-term care delivery system shall remain in place until the end of fiscal year 2016 when the evaluation is reported to the Legislature and the Governor. The bill also provides that the Medicaid Agency may contract for case-management services with an organization that has been granted probationary regional care certification prior to October 1, 2016 and establishes the terms under which the Medicaid Agency may enter into a contract with an alternate care provider.
The bill also provides that each RCO’s governing body which shall consist of twelve members representing risk-bearing participants in the RCO, eight members who do not represent risk-bearing participants in the RCO and three members who are community representatives. The bill further provides that Medicaid will contract with providers who are not otherwise disqualified from participating in Medicare or Medicaid.”