Sponsor(s): Representatives McClendon and Davis

Summary/Synopsis: Under existing law, the Court of Civil Appeals has ruled that a certificate of need (CON) issued to a business entity not specified in the law for a health care facility or health maintenance organization, or issued for an institutional health service, is generally not transferable by sale, lease, or other transaction.

This bill would specify that the transfer of a certificate of need by lease issued to a limited liability company or other legal entity by lease, sale, or other transaction involving an existing health care facility, health maintenance organization, or institutional health service does not require a new or additional CON.

The bill would apply retroactively when an amendment to the CON law was enacted which had previously been interpreted as authorizing the transfers without a new CON.



League Action and Justification: LWVAL is monitoring HB174.
The LWVAL position on CON does not bear directly on the legislation, but the membership’s high level of interest in Alabama health care issues, the bill will be monitored in order to keep the membership informed.

Bill Progress in Legislature:
02/06/2013 – First Reading and referred to the
02/14/2013: 2nd Reading and placed on the calendar; pending 3rd reading and Favorable from Health.

02/26/2013: 3rd Reading Passed; Motion to Read a 3rd Time and Pass adopted (90-0-0); Gaston intended to vote “Yea”

02/26/2013: Read for the 1st time in the Senate and referred to the
04/04/2013: 2nd Reading and placed on the calendar; pending 3rd Reading and Favorable from Judiciary.

HB178
Sponsor(s): Representative Ball

SB246
Sponsor(s): Senators Bussman, Holtzclaw, Sanford, McGill, Irons and Sanders

Summary/Synopsis: This bill would establish a State Board of Midwifery to grant licensure to practice midwifery; would provide for the composition of the board members; would provide for a licensing fee; would provide for the functions of the board; would specify requirements for rules for licensed midwives, particularly requiring that clients be provided an informed consent form prior to having services performed; would provide for midwives to file certificates of birth; and would provide for penalties for violating this bill.

The legislation defines midwifery as: “The provision of primary maternity care that is consistent with a licensed midwife's training, education, and experience to women and their newborn children throughout the childbearing cycle, in circumstances under which a licensed midwife has determined that the client is at a low risk of developing complications. Midwifery is not the practice of medicine.” The Board membership is mainly composed of licensed midwives but also includes a doctor. Licensure requirements are discussed. Provisions are made for certain exemptions from liability for doctors, hospitals, etc.

League Action and Justification: LWVAL is monitoring HB178 and SB246.
The League has no position that applies but will follow the legislation’s progress in order to inform the membership and public. This is the most comprehensive version of such legislation introduced over the past several years.

Bill Progress in the Legislature:

HB178

02/06/2013 - First Reading and referred to the


SB246

02/26/2013: First Reading and referred to the

HB307
Sponsor(s): Representatives R. Johnson and Wren

SB229
Sponsor(s): Senators Reed, Marsh, and Waggoner

Summary/Synopsis: The bill would:
1 allow for the prescribing of certain schedules of controlled substances by certified registered nurse practitioners and certified nurse midwives.
2 authorize the Board of Medical Examiners to create a Limited Purpose Schedule II Permit for certain persons who hold a Qualified Alabama Controlled Substances Registration Certificate (QACSC); and
3 amend existing law to conform to the provisions of this act.

League Action and Justification: LWVAL is monitoring HB307/SB229.
The League has no position that applies but will follow the legislation’s progress in order to inform the membership and public.

Bill Progress in Legislature:

HB 307:

02/19/2013 – First Reading and referred to the Acted on by Health as Favorable

03/202013: 2nd Reading and placed on the calendar; pending 3rd reading and Favorable from Health.

04/11/2013: 3rd Reading Passed; R Johnson Amendment (151890-1) Offered; Motion to Adopt adopted (92-0-2); Motion to Read a 3rd Time and Pass adopted (96-0-2); Engrossed

04/18/2013: Read for the First time in the Senate and referred to the
04/24/2013: Read for the 2nd time and placed on the calendar; pending 3rd reading and Favorable from Health.

SB229:

02/19/2013 – First Reading and referred to the
02/19/2013: Reported from Health as Favorable with 1 Amendment (149620-2); 1st Health Amendment offered.

03/05/2013: 2nd Reading and placed on the Calendar with 1 Amendment (149620-2); Health 1st Amendment Offered; pending 2rd reading and Favorable from Health with 1 Amendment.

04/16/2013: 3rd Reading Passed; Health Amendment (149620-2) Offered; Reed Motion to Adopt adopted (28-0-0); Motion to Read a 3rd Time and Pass adopted (27-1-0); Engrossed

4/16/2013: Read for the First Time in the House and referred to the
04/24/2013: Read for the 2nd time and placed on the calendar; pending 3rd reading and Favorable from Health.

05/07/2013: Motion for 3rd Reading and Passed in House; Adopted in House; Enrolled; Delivered to Governor for signature

NOTE: The Health Committee bill calls for Board of Medical Examiners supervision. As in other states, the Alabama Board of Nursing would prefer to supervise controlled substantive prescriptive authority for all advanced practice nurses. See LWVAL’s Health Care in Alabama 2013: Facts and Issues for a discussion of the issues involved.

Sponsor(s): Senator Reed

Summary/Synopsis: The bill provides for the delivery of medical services to Medicaid beneficiaries on a managed care basis through regional care organizations or alternate care providers.

The 04/17/2013 Fiscal Note summaries the bill’s major content but is unable to determine what the costs savings or increases will be. The Note states:

“Senate Bill 340 as introduced provides for the Alabama Medicaid Agency to establish not more than eight regional care organizations (RCO) throughout the State to provide medical services to Medicaid recipients. The bill provides that subject to approval by the Centers for Medicare and Medicaid Services, the Medicaid Agency shall do the following:

(1) enter into a contract in each Medicaid region for at least one fully certified RCO to provide Medicaid services;
(2) enroll beneficiaries into a RCO and if there is more than one RCO that operates in a region, a Medicaid beneficiary may choose the organization to provide his or her care;
(3) establish by rule procedures to address the provisions of this bill to include procedures for termination of certification or probationary certification of a RCO for non-performance of contractual duty or failure to meet or maintain benchmarks; and
(4) conduct an evaluation of the existing long-term care system and integrate long-term care for Medicaid beneficiaries into the care-delivery system of each region by October 1, 2017.

The bill also provides that each RCO shall do the following:

(1) establish a board to act as the governing body of the RCO, which shall consist of at least 60 percent of the seats on the Board being held by a participant in the organization and no single type of provider shall hold a majority of the seats on the Board;
(2) establish a citizen’s advisory committee;
(3) meet minimum solvency and financial requirements as a condition of certification by the Alabama Medicaid Agency;
(4) contract with any willing hospital, doctor, or other providers to provide services in a Medicaid region that is willing to accept the payments and terms offered to comparable providers; and
(5) provide Medicaid services to Medicaid enrollees directly or by contract with other providers.

The actual increase in obligations or savings to the Agency as a result of the implementation of the provisions of this bill are undetermined at this time and are dependent upon the date of full implementation, the number of Medicaid recipients enrolled, and any unfunded mandates which may be levied by the Federal Government.

As substituted, amended and reported by the Committee on Health, provides that the Alabama Medicaid Agency shall

(1) establish geographic regions in which a regional care organization (RCO) or alternate care provider may operate and removes the requirements for eight regional care organizations;
(2) establish procedures for safeguarding against wrongful denial of claims;
(3) creates a quality assurance committee to identify objective outcomes and quality measures to hold RCOs accountable for the performance and customer satisfaction requirements;
(4) conduct an evaluation of the existing long-term care services provided to Medicaid beneficiaries and report evaluation findings to the Legislature and the Governor on October 1, 2015. This bill as substituted also removes the provision that the long-term care system shall be integrated into the care delivery system of each region by October 1, 2017 and provides that the current long-term care delivery system shall remain in place until the end of fiscal year 2016 when the evaluation is reported to the Legislature and the Governor. The bill also provides that the Medicaid Agency may contract for case-management services with an organization that has been granted probationary regional care certification prior to October 1, 2016 and establishes the terms under which the Medicaid Agency may enter into a contract with an alternate care provider.

The bill also provides that each RCO’s governing body which shall consist of twelve members representing risk-bearing participants in the RCO, eight members who do not represent risk-bearing participants in the RCO and three members who are community representatives. The bill further provides that Medicaid will contract with providers who are not otherwise disqualified from participating in Medicare or Medicaid.”

League Action and Justification: LWVAL is monitoring SB340 to keep members informed.

Bill Progress in Legislature:
03/14/2013: Read for the First Time and referred to the
04/18/2013: 2nd Reading and placed on the calendar with 1 Substitute and 3 Amendments;
04/25/2013: 3rd Reading Passed; Health Amended (151942-2) Offered; Health Amendment (152014-2) Offered; Health Amendment (152087-4) Offered; Health 1st Substitute (151489-4) Offered; Read Motion to Adopt adopted (27-0-0); Reed Motion to Adopt adopted (25-0-0); Reed Motion to Adopt adopted (22-0-0); Read Motion to Adopt adopted (20-0-0); Reed Amendment (152675-1) Offered; Coleman Amendment(152868-1) Offered; Reed Motion to Adopt adopted (19-0-0); Coleman Motion to Adopt adopted (29-0-0); Rules Committee Petition to Cease Debate Adopted (23-9-0); Motion to Read a 3rd Time and Pass adopted (27-3-0); Engrossed;
04/25/2013: Read for the First Time in the House and referred to the
04/30/2013: Read for the 3rd time and placed on the calendar; pending 3rd reading and favorable from Health.

05/07/2013: Motion for 3rd Reading and Passed in House; Adopted in House; Passed second house; Enrolled; Delivered to Governor for signature.

Sponsor(s): Representatives Wren, Clouse and Barton

Summary/Synopsis: This bill would place a 10-year funding cap on the amount of State General Fund dollars which shall be appropriated annually to the Alabama Medicaid Agency. It would also place a spending cap on the per member per month rate for services provided to Medicaid recipients.

Implementation of the funding cap is contingent on the passage of legislation, which if enacted during the 2013 Regular Legislative Session, would established a network of Patient Care Case Management (PCCM) Networks across the state. The funding cap shall be effective beginning in the fiscal year ending September 30, 2017 or the first fiscal year following the full implementation of PCCM Networks across the state. The initial cap shall be a negative 1.0% growth in the amount appropriated to the Alabama Medicaid Agency in fiscal year 2016 and .05% on the amount appropriated for each fiscal year thereafter.

The Medicaid funding cap does not include increases in the program due to unfunded mandates from the federal government or the growth in Medicaid recipients.

In addition to the State General Fund Funding cap, there is hereby levied a cap on the per member per year rate for services provided to Medicaid recipients. The Alabama Medicaid Agency shall devise a formula to ensure that at least 45% of the savings that are achieved in reaching the State General Fund funding cap are from programmatic enhancements implemented through the establishment of PCCMs throughout the state. This formula shall not include savings that may be achieved through any possible long term care restructuring that may be implemented from recommendations of the Long Term Care Task Force established by legislation enacted during the 2013 Regular Legislative Session. In addition, any programmatic changes implemented to achieve the 10 year funding cap must be approved by the Permanent Joint Medicaid Committee established during the 2013 Regular Legislative Session.

League Action and Justification: LWVAL is monitoring HB370.
Implementation of this bill if passed is contingent upon adoption of legislation to reorganize the Legislature and legislation establishing Patient Care Case Management Networks across the state. It appears to be an attempt to control costs and improve service delivery. There has been little, if any, discussion of the bill in the public domain. See also HB372.

Bill Progress in Legislature:

02/28/2013: First reading and referred to the Acted upon by W&MGF as Favorable with 1 Substitute (149878-3)

03/20/2013: 2nd Reading and placed on the calendar with 1 Substitute from W&MGF; pending 3rd reading and Favorable from W&MFG with 1 Substitute.

04/23/2013: 3rd Reading Passed; W&M-GF 1st Substitute (149878-3) Offered; Motion to Adopt adopted (70-23-0); Motion to Read a 3rd Time and Pass adopted (71-28-0); Engrossed.

05/20/2013: Senate
Died in Senate basket.

Sponsor(s): Representatives Wren, Clouse and Barton

Summary/Synopsis: This bill would require the Alabama Medicaid Agency to request a waiver from the Centers for Medicare and Medicaid Services to increase Medicaid recipient co-payments for health care services. The request for the increase in co-payments shall be accomplished in a manner and time frame to insure that new co-payments take effect no later than January 1, 2014 or immediately upon approval from the Centers for Medicare and Medicaid. The new co-payment amount is not specified.

League Action and Justification: LWVAL is monitoring HB371 for information purposes due to lack of a League position on the co-payments.

Bill Progress in Legislature:

02/28/2012: First Reading and referred to the Acted upon by W&MGF as Favorable

03/20/2013: 3nd Reading and placed on the calendar; pending 3rd reading and Favorable from W&MGF.

04/23/2013: 3rd Reading Passed; Motion to Read a 3rd Time and Pass adopted (83-13-2).

05/20/2013: Senate
Died in Senate basket.

Sponsor(s): Representatives Wren, Clouse and Barton

Summary/Synopsis: The bill would abolish the Medicaid Joint Interim Committee and the Permanent Joint Legislative Committees on Medicaid Policy and create the Permanent Joint Medicaid Committee, would provide for the membership of the committee, and would provide the duties and responsibilities of the committee, would create the Medicaid Advisory Commission and provide for the membership.
League Action and Justification: LWVAL is monitoring HB372.
The new committee has a role in the actions instituted in HB370.

Bill Progress in Legislature:

02/28/2013: First Reading and referred to the Acted upon by W&MGF with 1 Substitute (148268-4) and 1 Amendment (150406-2)

03/20/2013: 2nd Reading and placed on the calendar with 1 W&MGF Substitute (148268-4) and 1 W&MGF Amendment (150406-2); pending 3rd Reading and Favorable from W&MGF with 1 Substitute and 1 Amendment.

04/23/2013: 3rd Reading Passed; W&M—GF 1st Substitute (148268-4) Offered; Motion to Adopt adopted (99-0-0); W&M Amendment (150406-2) Offered; Motion to Adopt adopted (101-0-0); Wren Amendment Offered (152487-1); Motion to Adopt adopted (101-0-1); Motion to Read a 3rd Time and Pass adopted (99-0-0); Engrossed.

05/20/2013: Senate
Died in Senate basket.

Sponsor(s): Representative Weaver

Summary/Synopsis: Under existing law, a state income tax credit is given to rural physicians who practice and reside in rural communities. This bill would increase the amount of the tax credit and extend the years for its allowance.

League Action and Justification: LWVAL is monitoring HB380 and SB73 for information purposes. No League position applies.

Bill Progress in Legislature:

HB380

02/28/2013: First Reading and referred to the
SB73

02/05/2013: Read for the first time and referred to the 03/05/2013: 2nd Reading and placed on the calendar with 1 Amendment (149742-2); F&TE 1st Amendment offered; pending 3rd reading and Favorable from F&TE with 1 amendment.

05/07/2013: Indefinitely postponed in House of Origin

Sponsor(s): Representative Wren

Summary/Synopsis: This bill would provide for the establishment, operations and funding of the Health Center Access and Quality Improvement Program, would provide for an assessment on qualified health centers in Alabama to be administered by the Department of Revenue; would create a Health Center Assessment Account and require health center assessments be deposited in that account for use by the Alabama Medicaid Agency to obtain matching federal funds; would provide that the program shall terminate on September 30, 2016; would provide that the Centers for Medicare and Medicaid Services CMS) must approve changes to the Medicaid State Plan associated with the creation, operation, and funding of the Health Center Access and Quality Improvement Program before the assessment program is put into place; would establish and set out responsibilities of the Health Center Services and Reimbursement Panel.

League Action and Justification: LWVAL is monitoring HB499 for movement. This act attempts to better fund and increase access to Medicaid services.

Bill Progress in Legislature:
04/02/2013: First Reading and referred to the
04/25/2013: Read for the 2nd Time and placed on the calendar; pending 3rd Reading and Favorable from Health.

05/07/2013: Indefinitely Postponed in House of Origin

Sponsor(s): Senators Smith, Irons, Coleman, Dunn and Figures

Summary/Synopsis: This bill would require all health benefit plans executed or renewed in this state to include coverage for breast reconstruction surgery after a mastectomy.

League Action and Justification: LWVAL is monitoring SB474 to keep membership informed.

Bill Progress in Legislature:
04/25/2013: Read for the first tie and referred to the Smitherman Motion to Rerefer; Whatley Motion to table Smitherman Motion to Rerefer adopted.