Ala. Admin. Code r. 560-X-64-.13

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

Section 560-X-64-.13 - Conflict Of Interest Policy For Directors And Officers Of Integrated Care Networks

(1) The Integrated Care Network (ICN) shall adopt a conflict of interest policy for directors and officers. The conflict of interest policy shall require all directors and officers to conduct their activities as directors or officers so that they do not advance or protect their own interests, or the interests of others with whom they have a private or professional relationship, in a way that is detrimental to the interests of, or to, the ICN, and the conflict of interest policy shall provide for the removal of any director or officer whose conduct violates such policy, unless a remedial action shall be sufficient to bring the director or officer into compliance with the policy. The conflict of interest policy shall require each director and officer to disclose in a written statement all employments, associations, commitments and financial interests that may currently exist or may have previously existed within the preceding two (2) years or that they reasonably expect to arise in the future, on the part of the director or officer, or his or her immediate family member, including spouse, dependents, adult children and their spouses, parents, spouse's parents, siblings and their spouses, that could reasonably be perceived, directly or indirectly, as a conflict of interest with the ICN or organization with probationary ICN certification. The statement shall also disclose whether the director or officer or his or her immediate family member as described in the preceding sentence is a current or former employee of, consultant with, or lobbyist for the Medicaid Agency or with any individual or entity (including subcontractors) providing enrollment broker or choice counseling services on behalf of the Medicaid Agency. Each director and officer shall file such disclosure statement with the ICN's or organization's board of directors and the Medicaid Agency on an annual basis.

(2) The conflict of interest policy must also:

(a) Require each director or officer to disclose relevant financial interests and potential conflicts of interest

(b) Provide a procedure satisfactory to the Medicaid Agency to determine whether an actual or potential conflict of interest exists and set forth a process satisfactory to the Medicaid Agency to address any potential conflicts of interest that arise;

(c) Address remedial action for directors or officers that fail to comply with the policy; and

(d) Require that the board of directors of the organization be responsible for enforcement of the conflict of interest policy and maintain minutes, disclosures of potential conflicts and other related documents, which will be subject to review by the Medicaid Agency, describing potential conflicts of interests and the action taken by the directors.

(3) An ICN and each of its directors and officers must complete and submit to the Medicaid Agency the Disclosure Statement required by Act 2001-955 prior to the ICN entering into a contract with the Medicaid Agency.

(4) All current and former employees and agents of the Medicaid Agency who have responsibilities relating to contracts with an ICN must comply with applicable provisions of the state ethics laws including, but not limited to, Sections 36-25-5, -7, -8, -11, -12, and -13 of the Code of Ala. 1975.

(5) An ICN and each of its directors and officers must observe the independence and freedom from conflict of interest requirements of 42 C.F.R. § 438.810(b)(1) and (2) in connection with any enrollment broker services that may be provided.

(6) No individual or entity of any kind shall have a direct or indirect ownership interest in more than one ICN. No individual or entity of any kind that has a direct or indirect ownership interest in an ICN may enter into an administrative and/or managerial contract or subcontract relating to another ICN.

(7) The Medicaid Agency may require an ICN and each of its directors and officers to comply with additional conflict of interest requirements and policies the Medicaid Agency determines to be necessary to satisfy State and Federal requirements or necessary to address issues of noncompliance with the requirements of this Conflict of Interest Rule.

Ala. Admin. Code r. 560-X-64-.13

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 01, October 31, 2017, eff. 11/28/2017.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 11, August 31, 2018, eff. 9/24/2018.

Author: Stephanie Lindsay, Administrator, Administrative Procedures Office

Statutory Authority:Code of Ala. 1975, §§ 22-6-220 et seq.