Ala. Admin. Code r. 560-X-64-.03

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

Section 560-X-64-.03 - Governing Board Of Directors

(1) An Integrated Care Network (ICN) shall have a governing board of directors composed of the following members:

(a) Sixty percent (60%) of the members shall be persons representing risk-bearing participants in the ICN. A participant bears risk by contributing cash, capital, or other assets to the ICN. At least half of the risk-bearing participants shall be long-term health care or medical providers, or representatives thereof, (herein referred to as "Provider Members") who serve or will serve Medicaid beneficiaries enrolled in the ICN. Provider Members must collectively contribute cash, capital, or other assets approved by the Medicaid Agency to satisfy at least fifty percent (50%) of the minimum financial reserves and capital or surplus requirements established by the Medicaid Agency.

(b) Forty percent (40%) of the members shall be persons who do not represent a risk-bearing participant in the ICN and are not employed by a risk bearing participant. At least four of these members must be Provider Members who serve or will serve Medicaid beneficiaries enrolled in the ICN. The non-risk bearing participants must be comprised as follows:

1. At least twenty (20%) of the members shall be appointed by long-term care and/or disability advocacy groups (including but not limited to Disabilities Leadership Coalition of Alabama, Alabama Arise, AARP, Alabama Disabilities Advocacy Program, Disability Rights and Resources, and Arc of Alabama).

2. Two members shall be appointed by the Medical Association of the State of Alabama, or its successor organization; and

3. One member shall be the chair of the citizens' advisory committee established pursuant to Alabama Medicaid Administrative Code Rule 560-X-64-.04.

(c) The ICN shall adopt policies and procedures, subject to the review and/or approval of the Medicaid Agency, that ensures gender, race, and geographic diversity in the composition of the governing board.

(2) A majority of the members of the board may not represent a single provider. Any provider shall meet licensing requirements set by law, shall have a valid Medicaid provider number, and shall not be otherwise disqualified from participating in Medicare or Medicaid.

(3) Medicaid shall have the power to 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) The governing board may, by resolution adopt by a majority of the directors, appoint an executive committee, which shall consist of two or more directors, who may have such authority and take such action as authorized by the governing board and consistent with state law; provided, however, any at-risk provider type shall be represented on the executive committee. For purposes of this subsection, a legal entity shall be considered the same provider type of the majority owner(s), principal(s) or member(s) of that entity. The governing board shall set policy and direction for the integrated care network and the executive committee shall execute the policies established by the governing board. The governing board may also appoint such other committees as are consistent with Alabama law. All actions of the executive committee and all other committees shall be reported to the governing board. The compositions of the executive committee must ensure gender, race, and geographic diversity. At least one member of an executive committee and any other committee shall be one of the members appointed to the board by the Medical Association of the State of Alabama.

Ala. Admin. Code r. 560-X-64-.03

Adopted by Alabama Administrative Monthly Volume XXXV, Issue No. 03, December 30, 2016, eff. 1/26/2017.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 09, June 29, 2018, eff. 7/26/2018.

Author: Stephanie Lindsay, Administrator, Administrative Procedures Office

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. Part.