Proposed Agency Rules

Amendments to the Administrative Code are required when changes to amount, duration or scope of services, or eligibility requirements are proposed. 

Inquiries regarding proposed rules should be directed to:
Alabama Medicaid Agency
Administrative Procedures Office
501 Dexter Avenue
Montgomery, AL  36130
(334) 242-5833

2017

Date Filed Proposed Rule
1/20/17 560-X-40-.01 Definitions
2/24/17 560-X-62-.12 Service Delivery Network Requirements - Emergency Rule
3/21/17 560-X-42-.01 ICF MR Reimbursement
3/21/17 560-X-42-.02 Introduction
3/21/17 560-X-42-.03 Definitions
3/21/17 560-X-42-.04 Medicaid Per Diem Rate Computation Methodology
3/21/17 560-X-42-.06 Resident Days
3/21/17 560-X-42-.07 Management and Administrative Costs
3/21/17 560-X-42-.08 Interest Expense
3/21/17 560-X-42-.09 Laundry Expense
3/21/17 560-X-42-.10 Travel Expense
3/21/17 560-X-42-.11 Property Costs
3/21/17 560-X-42-.17 Chain Operations
3/21/17 560-X-42-.19 Unallowable Expenses
3/21/17 560-X-42-.20 Cost Reports
3/21/17 560-X-42-.21 Accounting Records
3/21/17 560-X-62-.12 Service Delivery Network Requirements
3/31/17 560-X-64-.06 Solvency and Financial Requirements for Integrated Care Networks – NEW RULE
3/31/17 560-X-64-.07 Service Delivery Network Requirements for Integrated Care Networks – NEW RULE
3/31/17 560-X-64-.08 Active Supervision of Organizations with Probationary Certification – NEW RULE
4/20/17 560-X-13-.17 Wheelchairs
5/22/17 560-X-5-.02 Participation
5/22/17 560-X-35-.01 Authority and Purpose
5/22/17 560-X-35-.02 Description of Services
5/22/17 560-X-35-.03 Eligibility
5/22/17 560-X-35-.04 Characteristics of Persons Requiring ICF-MR Care
5/22/17 560-X-35-.05 Qualifications of Staff Who Will Serve as Review Team for Medical Assistance
5/22/17 560-X-35-.07 Individual Assessments
5/22/17 560-X-35-.08 Informing Beneficiaries of Choice
5/22/17 560-X-35-.15 Application Process
5/22/17 560-X-52-.01 Authority of Purpose
5/22/17 560-X-52-.02 Description of Services
5/22/17 560-X-52-.03 Eligibility
5/22/17 560-X-52-.05 Qualifications of Staff Who Will Serve as Review Team for Medical Assistance
6/20/17 560-X-10-.26 Transfer and Discharge Rights
6/20/17 560-X-64-.09 Qualification Criteria for Participation in the Mandated Competitive Procurement for Integrated Care Networks – NEW RULE
6/20/17 560-X-64-.10 Financial Reporting and Audit Requirements – NEW RULE
6/20/17 560-X-64-.11 Hazardous Financial Condition and Insolvency – NEW RULE
7/20/17 560-X-11-.14 EPSDT Referred Service Providers
8/21/17 560-X-64-.13 Conflict of Interest Policy for Directors and Officers of Integrated Care Networks – NEW RULE
8/21/17 560-X-64-.14 Right to Terminate Certificates of Probationary and Fully Certified Integrated Care Networks – NEW RULE
8/21/17 560-X-64-.15 Grievances and Fair Hearings of Integrated Care Networks – NEW RULE
8/21/17 560-X-64-.16 ICN Covered Population – NEW RULE

2016
Date Filed Proposed Rule
1/20/16 560-X-62-.03 Governing Board of Directors
2/12/16 560-X-62-.19 Requirements for Full Certification of Regional Care Organizations
4/20/16 560-X-62-.12 Service Delivery Network Requirements
4/20/16 560-X-62-.26 Active Supervision of Regional Care Organizations
4/20/16 560-X-64-.01 Certificate to Collaborate with other Entities
4/20/16 560-X-64-.02 Active Supervision of Collaborations
6/21/16 560-X-1-.02 Laws and Publications Applicable to Medicaid
6/21/16 560-X-62-.01 Certificate in Order to Collaborate with other Entities, Individuals, or Regional Care Organizations
7/20/16 560-X-1-.18 Provider and Recipient Signature Requirements
10/20/16 560-X-64-.03 Governing Board of Directors
10/20/16 560-X-64-.04 Citizens' Advisory Committee
10/20/16 560-X-64-.05 ICN Quality Assurance Committee
10/20/16 560-X-62-.12 Service Delivery Network Requirements
10/27/16 560-X-40-.02 Eligibility
11/17/16 560-X-10-.01 Definitions
11/17/16 560-X-10-.07 Review of Medicaid Residents
11/17/16 560-X-10-.06 Therapeutic Leave
11/17/16 560-X-10-.05 Reservation of Beds
11/17/16 560-X-10-.10 Admission Criteria
11/17/16 560-X-10-.11 Establishment of Medical Need
11/17/16 560-X-10-.12 Utilization Review for ICF-MR
11/17/16 560-X-10-.13 Resident Medical Evaluation
11/17/16 560-X-10-.16 Preadmission Screening and Resident Review
11/17/16 560-X-10-.21 Admission of Mentally Ill Residents to Nursing Facilities
11/17/16 560-X-10-.20 Conditions Under Which Nursing Facilities are Not Classified as Mental Disease Facility Under Title XIX
12/19/16 560-X-12-08 Physician Certification and Recertification
12/19/16 560-X-13-.01 Durable Medical Equipment, Supplies, Appliances, Prosthetics, Orthotics & Pedorthics - General
12/19/16 560-X-62-.27 Contracts with Additional Regional Care Organizations– NEW RULE
2015
Date Filed Proposed Rule
1/22/15 560-X-01-.17 Providers' Claims
1/22/15 560-X-26-.01 Rules of Practice Before Agency
1/22/15 560-X-26-.02 Authority of Representative
1/22/15 560-X-51-.04 Recipient Eligibility
1/22/15 560-X-62-.16 Solvency and Financial Requirements for Regional Care Organizations
1/22/15 560-X-62-.17 Financial Reporting and Audit Requirements
1/22/15 560-X-62-.18 Hazardous Financial Condition and Involvency
1/22/15 560-X-62-.19 Requirements for Full Certification of Regional Care Organizations
1/22/15 560-X-62-.20 Grievances and Fair Hearings of Regional Care Organizations
1/22/15 560-X-62-.21 Information Requirements for Enrollees and Potential Enrollees
1/22/15 560-X-62-.22 Readiness Assessment Requirements
2/19/15 560-X-16-.27 Preferred Drug List
2/19/15 560-X-45-.03 Primary Contractor Standards
2/19/15 560-X-45-.04 Primary Contractor Functions/Responsibilities
2/19/15  560-X-45-.05 Payment to Primary Contractors
2/19/15 560-X-45-.10 High Risk Protocol
2/19/15  560-X-62-.23 Grievance and Appeals of Medicaid Enrollees in Regional Care Organizations and Alternate Care Providers
4/20/15 560-X-1-.14 Medicaid payments for Medicare/Medicaid and/or Qualified Medicare Beneficiaries (QMB) Eligible Recipients
4/20/15 560-X-5-.01 Psychiatric Facilities for Individuals 65 or Over - General
4/23/15 560-X-7-.01 Hospital Program – General
4/23/15 560-X-7-.12 Physical Therapy
4/23/15 560-X-7-.17 Outpatient Hospital Services
4/23/15 560-X-7-.25 Prior Authorization
4/23/15 560-X-25-.15 Parents and Other Caretaker Relatives, Extended Medicaid Benefits due to Spousal Support, and Transitional Medicaid Benefits
4/23/15 560-X-41-.01 Psychiatric Facilities for Individuals under age 21 - General
5/20/15 560-X-47-.02 Eligibility
5/20/15 560-X-47-.03 Service Providers
5/20/15 560-X-47-.04 Minimum Qualifications for Mental Health, Substance Abuse, and Child & Adolescent Services/Adult Protective Services Professional Staff
5/20/15 560-X-62-.19 Requirements for Full Certification of Regional Care Organizations
6/22/15 560-X-7-.03 Inpatient Benefits
6/22/15 560-X-23-.11 Other Matters
6/22/15 560-X-38-.07 Submission of Claims
6/22/15 560-X-41-.05 Medical, Psychiatric & Social Evaluations
6/22/15 560-X-41-.10 Inpatient Utilization Review
6/22/15 560-X-62-.24 Sanctions
7/20/15 560-X-1-.07 Provider Rights and Responsibilities
7/20/15 Rule No. 560-X-16-.27 Preferred Drug List
9/21/15 560-X-47-.04 Minimum Qualifications for Mental Health, Substance Abuse, and Child & Adolescent Services/Adult Protective Services
10/21/15 560-X-.33 Recoupments, Estate Recovery and Liens
10/21/15 560-X-62-.25 Surplus Notes
11/18/15 560-X-1-.18 Provider and Recipient Signature Requirements
11/18/15 560-X-6-.01 Physician Program - General
11/18/15 560-X-6-.02 Submission of Claims - General
11/18/15 560-X-6-.09 Consent Forms Required Before Payments Can be Made
11/18/15 560-X-6-.12 Covered Services: General
11/18/15 560-X-6-.13 Covered Services: Details on Selected Services
11/18/15 560-X-13 Durable Medical Equipment, Supplies, Appliances, Prosthetics, Orthotics and Pedorthics
12/18/15 560-X-7-.17 Outpatient Hospital Services
12/18/15 560-X-23-.08 Outpatient Services
2014
Date Filed Proposed Rule
1/21/14 560-X-16-.31 – Hemophilia Management Standards of Care
2/21/14 560-X-13-.01 - Supplies, Appliances, and Durable Medical Equipment - General
2/21/14 560-X-13-.16 - External Breast Prostheses
2/21/14 560-X-25-.16 - Income and Resources of a Married Couple for Institutional Care
2/21/14 560-X-55-.01 - Perinatal Coordinators - Authority and Purpose
2/21/14 560-X-55-.02 - Qualifications of a Perinatal Coordinator
2/21/14 560-X-55-.03 - Functions of Perinatal Coordinator
2/21/14 560-X-55-.04 - Auditing Procedures
2/21/14 560-X-55-.05 - Payment for Services
3/20/14 560-X-14-.06 - Plan First Waiver
4/22/14 560-X-52-.01 - Authority and Purpose
4/22/14 560-X-52-.02 - Description of Services
4/22/14 560-X-52-.03 - Eligibility
4/22/14 560-X-52-.04 - Characteristics of Persons Requiring ICF/MR Care
4/22/14 560-X-52-.05 - Qualifications of Staff Who Will Serve as Review Team for Medical Assistance
4/22/14 560-X-52-.07 - Individual Assessments
4/22/14 560-X-52-.08 - Informing Beneficiaries of Choice
4/22/14 560-X-52-.09 - Payment Methodology for Covered Services
4/22/14 560-X-52-.12 - Records
4/22/14 560-X-52-.15 - Fair Hearings
4/22/14 560-X-52-.16 - Application Process
4/22/14 560-X-54-.02 - Eligibility
4/22/14 560-X-54-.03 - Covered Services
4/22/14 560-X-54-.05 - Application Process
4/22/14 560-X-54-.06 - Fair Hearing
4/22/14 560-X-54-.07 - Payment Methodology for Covered Services
5/30/14 560-X_62-03 Governing Board of Directors
5/30/14 560-X-62-.05 - Probationary Certification of Organizations Seeking to Become Regional Care Organizations
5/30/14 560-X-62-.08 Conflict of Interest Policy for Directors and Officers of Regional Care Organizations
5/30/14 560-X-62-.09 Provider Standards Committee
5/30/14 560-X-62-.10 Minimum Fee-For-Service Reimbursement Rates
5/30/14 560-X-62-.11 Provider Contract Disputes
5/30/14 560-X-62-.12 Service Delivery Network Requirements
6/30/14 560-X-62-.13 Quality Assurance Committee - NEW RULE
6/30/14 560-X-62-.14 Quality Assurance Process - NEW RULE
6/30/14 560-X-62-.15 Right to Terminate Certificates of Probationary and Fully Certified Regional Care Organizations - NEW RULE
8/20/14 560-X-7-.25 Prior Authorization
9/22/14 560-X-10-.02 Long Term Care Program – General
9/22/14 560-X-38-.06 Surgical Procedures Group
9/22/14 560-X-62-.03 Governing Board of Directors
9/22/14 560-X-62-.12 Service Delivery Network Requirements
10/20/14 560-X-1-.09 Recipient Identification Number
10/20/14 560-X-63-.06 Nursing Facility Participation Requirements
11/18/14 560-X-20-.01 Third Party Program
11/18/14 560-X-20-.02 Third Party Recovery
11/18/14 560-X-20-.03 Third Party Resources Identification
11/18/14 560-X-20-.04 Third Party Payments/Denials
11/18/14 560-X-20-.05 Release of Information – All Providers
11/18/14 560-X-20-.06 Fiscal Agent Responsibility
11/18/14 560-X-20-.07 Recipient Responsibility
11/18/14 560-X-10-.14 Resident Rights
2013
Date Filed Proposed Rule
7/22/13 Chapter One - General
7/22/13 Rule No. 560-X-23-.02 Definitions and Basic Concepts
7/22/13 Rule No. 560-X-23-.03 Inpatient Medicaid Base Payment
7/22/13 Rule No. 560-X-23-.04 Inpatient Hospital Access Payments
7/22/13 Rule No. 560-X-23-.05 Psychiatric Hospitals
7/22/13 Rule No. 560-X-23-.06 Disproportionate Share Hospital (DSH) Payments
7/22/13 Rule No. 560-X-23-.07 Calculation of Medicaid Prospective Payment Inpatient Rate for Out-of-State Hospitals
7/22/13 Rule No. 560-X-23-.08 Outpatient Service
7/22/13 Rule No. 560-X-23-.10 The CMS 2552-96 Cost Report
9/20/13 Rule No. 560-X-1-.27 Organ Transplants
9/20/13 Rule No. 560-X-5-.10 Inpatient Utilization Review
9/20/13  Rule No. 560-X-14-.06 Plan First Waiver
9/20/13 Rule No. 560-X-37-.06 Plan First Waiver
9/20/13 Rule No. 560-X-46-.08 Admission and Periodic Review
9/20/13 Rule No. 560-X-46-.09 Inspection of Care/Utilization Review
10/21/13 Rule 560-X-11-.14 EPSDT Referred Service Providers
10/21/13 Rule 560-X-16-.01 Pharmacy Services - General
10/21/13 Rule No. 560-X-62-.01 Certificate in Order to Collaborate with Other Entities, Individuals, or Regional Care Organizations
10/21/13 Rule No. 560-X-62-.02 Active Supervision of Collaborations
12/17/13 Rule No. 560-X-25-.02 Administrative Responsibilities
12/17/13 Rule No. 560-X-25-.03 Coverage Groups 
12/17/13 Rule No. 560-X-25-.12 Periods of Entitlement
12/17/13 Rule No. 560-X-25-.14 Pregnant Women and Young Children with Income Equal to or Below 133% of the Federal Poverty Level and Children with Income Equal to or Below 100% of the Federal Poverty Level
12/17/13  Rule No.  560-X-25-.15 Medicaid for Low Income Families, Extended Medicaid Benefits due to State Collected Child Support, and Transitional Medicaid Benefits
12/17/13 Rule No. 560-X-62-.03 Regional Care Organizations - Governing Board of Directors
12/17/13 Rule No. 560-X-62-.04 Citizen's Advisory Committee
12/17/13 Rule No. 560-X-62-.05 Probationary Certification of Organizations Seeking to Become RCOs
12/17/13 Rule No. 560-X-62-.06 - Active Supervision of Organizations with Probationary Certification
12/17/13 Rule No. 560-X-62-.07 - Contract for Case-Management Services with Organization with Probationary Certification