Ala. Admin. Code r. 560-X-62-.07

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-62-.07 - Contract For Case-Management Services With Organization With Probationary Certification

(1) The Medicaid Agency may contract for specific case-management services with an organization that the Medicaid Agency has granted probationary regional care organization certification on such terms and conditions required by the Medicaid Agency.

(2) Probationary certified regional care organizations desiring to contract for specific case management services with the Medicaid Agency must submit a Response to a Medicaid Request for Proposal. The Request for Proposal and/or Contract shall set forth terms and conditions required by the Medicaid Agency to perform case management services. Requests for Proposals and/or Contracts for specific case-management services in each Medicaid region shall be issued and available for inspection on the Medicaid Agency's website. Requests for Proposals and/or Contracts shall set forth the scope of work, pricing, general information, entity qualifications and references, submission requirements, evaluation and selection process, any requirements for establishing an adequate medical service delivery network, any solvency and financial requirements, general terms and conditions, and other provisions for case-management services. Any organization that the Medicaid Agency has granted probationary regional care organization certification by October 1, 2014 shall be eligible to submit a proposal to provide case-management services in the Medicaid region(s) for which it has received probationary certification. The Medicaid Agency may, in its discretion, allow one or more organizations granted probationary regional care organization certification after October 1, 2014 to submit proposals to provide case-management services. The Medicaid Agency may contract for specific case-management services with one or more organizations with probationary certification.

(3) Pursuant to Section 22-6-162 of the Code of Ala. 1975, if any organization that has contracted with the Medicaid Agency for case-management services has failed to gain full regional care organization certification or has had its probationary certification terminated or revoked, then the contract for case-management services shall be terminated and that organization shall refund half the payments, made by the Medicaid Agency to the organization for case-management services, paid over the previous 12 months.

Ala. Admin. Code r. 560-X-62-.07

New Rule: Filed March 28, 2014; Effective May 2, 2014.

Author: Sharon Weaver, Administrator, Administrative Procedures Office

Statutory Authority:Code of Ala. 1975, §§ 22-6-150 et seq.