The Alabama Medicaid Agency today released a draft map of
five geographical regions where Regional Care Organizations will provide essential
Medicaid services through providers. The preliminary map could change after
public hearings and Medicaid rule-making.
The Business Council of Alabama supports Medicaid reform in
order to control costs and ensure long-term sustainability by improving
efficiency, addressing fraud and abuse, and ensuring access to quality health
care for Alabamians.
The legislature passed and Governor Robert Bentley in May signed
legislation requiring Medicaid to divide the state into regions where community-based
Regional Care Organizations will contract to manage health care for patients
assigned to one of five regions based on their residence.
Bentley has said that the current fee-based system is
The Medicaid Agency will have to draw final region lines by
Oct. 1. Provider payments will be negotiated on a per-patient basis, Medicaid
said. Providers potentially will make money by keeping patients healthy and
with their cooperation preventing or controlling future conditions.
Networks that coordinate health care in each region
ultimately will bear the risk of contracting with the state to provide care.
The timeline is RCOs must be established by Oct. 1; RCO
governing boards will have to be approved by Medicaid by Oct. 1, 2014; RCO
provider networks will have to be in place by April 1, 2015, and RCOs must meet
solvency requirements by Oct. 1, 2015. Finally, RCOs will have to accept
capitation payments from Medicaid by Oct. 1, 2016. Capitation is a set payment to
a provider for each enrolled Medicaid recipient assigned to them.
Regions have a combination of rural and large urban centers.
According to the preliminary map, the southwest region
including Mobile and Baldwin counties will have eight counties; the
central-southeast region will have 21 counties including Montgomery; the
central-east region including Jefferson and Shelby counties will have 15
counties; the west region including Tuscaloosa County will have 13 counties and
the north region that includes Madison will have 10 counties.
The legislature appropriated $615 million in state dollars
to Medicaid for Fiscal 2013-14 that begins Oct. 1.
Medicaid recipients in nursing homes and those receiving
dental care will not be included in an RCO, initially.