Alabama Medicaid: Changes to the Regional Care Organization Statute


On May 17, 2013, Governor Bentley signed into law Act 2013-261, Ala. Code § 22-6-150 et. seq. As you may recall, the new law changed the Alabama Medicaid program from a fee-for-service program to a managed care program and created Regional Care Organizations ("RCOs") to serve as the conduit for care to Medicaid beneficiaries. In the last legislative session, the Alabama legislature passed amendments to the RCO statute. These changes impacted the way in which RCOs are structured and provide for a grievance procedure for providers who are dissatisfied with the contracts or terms offered by a RCO.

The original RCO statute provided for a RCO board of directors (the "Board") consisting of 12 members representing the risk-bearing participants, 8 non risk-bearing participants and 3 community representatives totaling 23 members. Under the new law, the 3 community representatives are no longer an additional category but are now included as part of the 8 non risk-bearing representatives. Consequently, the 8 non risk-bearing participants consist of 5 medical professionals and 3 community representatives. Of the 5 medical professionals, 2 are primary care physicians appointed by the Medical Association of the State of Alabama ("MASA") as opposed to the caucus of county boards of health. These 2 physicians will serve with 1 physician representing a Federally Qualified Health Care Center, an optometrist and a pharmacist. Therefore, the composition of the Board will be as follows...

Originally Published in the Birmingham Medical News - July 9, 2014.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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