Signed by Governor Robert Bentley

Vote Smart's Synopsis:

Vote to pass a bill that amends the Alabama Medicaid program and establishes regional care organizations and risk contracts.

Highlights:

• Requires the Medicaid Agency to establish geographic Medicaid regions that cover the entire state and may support at least 2 “regional care organizations” or “alternate care providers” (Sec. 3).

• Defines “regional care organization” as an organization of healthcare providers that contracts with the Medicaid Agency to provide certain benefits to Medicaid beneficiaries in a defined region (Sec. 1)

• Defines “alternate care provider” as a contractor, other than a regional care organization, that agrees to provide certain benefits to Medicaid beneficiaries in a defined region (Sec. 1) 

• Requires the Medicaid Agency to enter into a “risk contract” with at least one certified regional care organization in each Medicaid region if in the judgment of the Medicaid Agency the care of the Medicaid beneficiaries would be “better, more efficient, and less costly” than under the existing care delivery system (Sec. 4).

• Defines “risk contract” as an agreement in which the contractor assumes the cost of services covered under the contract and incurs loss if the cost of furnishing the services exceeds the payments under the contract (Sec. 1).

• Requires the Medicaid Agency to set the capitation payments for the risk contracts between the Medicaid Agency and the regional care organizations (Sec. 4). 

• Requires the Medicaid Agency to establish the quality standards and the minimum service delivery network requirements for regional care organizations and alternate care providers that provide care to Medicaid beneficiaries (Sec. 4).

• Requires a regional care organization to contract with a hospital, doctor, or other provider that provides Medicaid services in the regional care organizations region if the provider is willing to accept the payments and terms offered to comparable providers (Sec. 9).

• Authorizes a Medicaid beneficiary to choose the regional care organization to provide his or her care if more than one regional care organization operates in a Medicaid region (Sec. 4). 

• Establishes a timeline for the implementation of this bill including, but not limited to, the following dates (Sec. 10):
• No later than October 1, 2013, the Medicaid Agency must establish Medicaid regions; and
• No later than October 1, 2014, an organization seeking to become a regional care organization must have established a governing board approved by the Medicaid Agency. 

Full Bill Text