(a) An integrated care network shall serve only Medicaid beneficiaries in providing medical care and services. For the purposes of this article, a beneficiary cannot be a member of both an integrated care network and a regional care organization.
(b) An integrated care network shall provide required medical care and services to Medicaid beneficiaries and may coordinate care provided by or through an affiliation of other health care providers or other programs as the Medicaid Agency shall determine.
(c) Notwithstanding any other provision of law, the integrated care network shall not be deemed an insurance company under state law.
(d)(1) An integrated care network shall have a governing board of directors composed of the following members:
a. Twelve members shall be persons representing risk bearing participants. A participant bears risk by contributing cash, capital, or other assets to the integrated care network.
b. Eight members shall be persons who do not represent a risk bearing participant in the integrated care network and are not employed by a risk bearing participant.
c. A majority of the board may not represent a single provider. The Medicaid Agency may promulgate rules providing for the criteria and selection of risk bearing and non-risk bearing participants on the board of directors.
(2) Any provider represented on the governing board shall meet licensing requirements set by law, shall have a valid Medicaid provider number, and shall not otherwise be disqualified from participating in Medicare or Medicaid.
(3) The Medicaid Agency shall approve the members of the governing board and the board's structure, powers, bylaws, or other rules of procedure. No organization shall be granted integrated care network certification without approval.
(4) Any vacancy on the governing board of directors in connection with non-risk bearing directors shall be filled in accordance with rules promulgated by the Medicaid Agency. A vacancy in a board of directors' seat held by a representative of a risk bearing participant as defined herein, shall be filled by a majority vote of the remaining directors of the integrated care network. Notwithstanding other provisions of this subsection, the Medicaid Commissioner shall fill a board seat left vacant for more than three months.
(5) All appointing authorities for the governing board shall coordinate their appointments so that diversity of gender, race, and geographical areas is reflective of the makeup of the population served.
Structure Code of Alabama
Title 22 - Health, Mental Health, and Environmental Control.
Title 1 - Health and Environmental Control Generally.
Section 22-6-220 - Definitions.
Section 22-6-221 - Service by Integrated Care Network; Board of Directors.
Section 22-6-222 - Citizens' Advisory Committee.
Section 22-6-223 - Solvency and Financial Requirements.
Section 22-6-225 - Denial of Claims; Grievances and Appeals.
Section 22-6-227 - Quality Assurance Committee; Reporting Requirements.
Section 22-6-228 - Risk Contracts.
Section 22-6-229 - Termination of Certification.
Section 22-6-230 - Rates for Contracting Services; Provider Requirements.
Section 22-6-231 - Implementation of Article.
Section 22-6-232 - Coverage of Medicaid Beneficiaries by Integrated Care Networks.
Section 22-6-234 - Advance Directive for Health Care Options.
Section 22-6-235 - Rulemaking Authority.
Section 22-6-236 - Construction and Application of &Sect;ยง22-6-220 Through 22-6-234.