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 

 

2023
Date Filed Rule Number & Name
3/20/23 560-X-43-.15 Cost for Services
3/20/23 560-X-43-.13 Service Providers
3/20/23 560-X-43-.12 Records
3/20/23 560-X-43-.08 Payment Methodology for Covered Services
3/20/23 560-X-35-.16 Cost for Services
3/20/23 560-X-35-.14 Service Providers
3/20/23 560-X-35-.13 Records
3/20/23 560-X-35-.09 Payment Methodology for Covered Services
3/20/23 560-X-25-.03 Coverage Groups
3/20/23 560-X-4-.05 Fraud, Waste, and/or Abuse by Recipients or Sponsors of Recipients
2/17/23 560-X-36-.04 Covered Services
2/17/23 560-X-36-.01 Authority and Purpose
1/20/23 560-X-15-.01 Dental Program - General
1/20/23 560-X-15-.03 Limitations
1/20/23 560-X-35-.01 Authority and Purpose
1/20/23 560-X-35-.17 Fair Hearings
1/20/23 560-X-43-.01 Authority and Purpose
1/20/23 560-X-43-.16 Fair Hearings
1/20/23 560-X-52-.01 Authority and Purpose
1/20/23 560-X-52-.15 HCBS Waiver Appeal Process
1/20/23 560-X-54-.01 Authority and Purpose
1/20/23 560-X-57-.01 Authority and Purpose
2/17/23 560-X-36-.01 Authority and Purpose
2/17/23 560-X-36-.04 Covered Services
2022
Date Filed Rule Number & Name
6/22/22 560-X-16-.31 Hemophilia Management Standards of Care
3/18/22 560-X-18-.25 NET Provider and Driver Requirements-Exclusions
3/18/22 560-X-18-.25ER NET Provider and Driver Requirements-Exclusions  Emergency Rule
1/20/22 560-X-35-.17 Fair Hearings
1/20/22 560-X-52-.15 Waiver Appeal Process
1/13/22 560-X-43 Home and Community-Based Services Community Waiver Program (CWP) for Persons with Intellectual Disabilities
2021
Date Filed Rule Number & Name
10/1/21 560-X-7-.17ER Outpatient Hospital Services
9/20/21 560-X-7-.17 Outpatient Hospital Services
7/20/21 560-X-37-.10 Payments to Primary Care Physicians and Delivering Healthcare Professionals Participating with the Alabama Coordinated Health Network
6/21/21 560-X-52-.01 Authority and Purpose
6/21/21 560-X-52-.02 Description of Services
6/21/21 560-X-35-.01 Authority and Purpose
6/21/21 560-X-35-.02 Description of Services
6/21/21 560-X-7-.17 Outpatient Hospital Services
5/19/21 560-X-51-.03 Provider Eligibility and Certification of Terminal Illness Requirements
5/19/21 560-X-51-.04 Recipient Eligibility
4/20/21 560-X-17-.03 Optometrist Services
4/20/21 560-X-17-.04 Eyeglasses
2020
Date Filed Rule Number & Name
11/18/20 560-X-1-.29 Electronic Records and Signatures
11/18/20 560-X-41-.01 General
11/18/20 560-X-41-.02 Conditions of Participation
11/18/20 560-X-41-.03 Inpatient Psychiatric Benefits
11/18/20 560-X-41-.08 Payment
11/18/20 560-X-41-.13 Certification of Need for Residential Treatment Services
11/18/20 560-X-41-.14 Residential Continued Stay Reviews
11/18/20 560-X-41-.16 Reporting of Deaths and Serious Occurences
9/21/20 560-X-14-.01 Family Planning - General
9/21/20 560-X-37-.02 Primary Care Case Management
9/21/20 560-X-37-.08 Sanctions
8/20/20 560-X-57-.10 Payment Methodology for Covered Services
8/20/20 560-X-57-.07 Financial Accountability of Operating Agency
8/20/20 560-X-57-.06 Application Process
8/20/20 560-X-57-.04 Covered Services
8/20/20 560-X-57-.02 Eligibility
8/20/20 560-X-57-.01 Authority and Purpose
8/20/20 560-X-16-.27 Preferred Drug List
8/20/20 560-X-16-.06 Reimbursement for Covered Drugs and Services
8/20/20 560-X-13-.01 Durable Medical Equipment, Supplies, Appliances, Prosthetics, Orthotics, & Pedorthics - General
8/20/20 560-X-12-.05 Covered Services
8/20/20 560-X-12-.09 Visits
8/20/20 560-X-12-.08 Physician Certification and Recertification
8/4/20 560-X-01-.22ER Declaration of Emergency Plan of Action to Protect Public Health and Welfare
6/19/20  560-X-1-.22 Declaration of Emergency Plan of Action to Protect Public Health and Welfare
5/8/20 560-X-11-.10 ER Reimbursement
4/14/20 560-X-37-.10 ER Payments to Primary Care Physicians and Delivering Healthcare Professionals Participating w/ ACHN
4/6/20 560-X-1-.29 ER Emergency Rule NEW RULE
4/1/20 560-X-18-.04 ER Scope of Ambulance Transportation Service Operations
4/1/20 560-X-18-.03 ER Prior Authorization
3/25/20 560-X-11-.15 ER Temporary Rule Pursuant to COVID-19 Emergency
3/24/20 560-X-13-.04 ER Temporary Rules Pursuant to COVID-19 Emergency
3/20/20 560-X-1-.18 ER Provider and Recipient Signature Requirements
3/20/20 560-X-40-.01 Definitions
3/20/20 560-X-10-.07 Review of Medicaid Recipients
3/18/20 560-X-6-.14 ER Limitations on Services
3/18/20 560-X-06-.13 ER Covered Services Details on Covered Services
2/19/20 560-X-41-.02 Conditions of Participation
2/19/20 560-X-37-.09 Attribution under the Alabama Coordinated Health Network Program
2/19/20 560-X-5-.02. Participation
2019 
Date Filed Rule Number & Name
12/18/19 560-X-37-.10 Payments to Primary Care Physicians and Delivering Healthcare Professionals Participating with the Alabama Coordinated Health Network - NEW RULE
11/18/19 560-X-48-.03 Reimbursement
11/18/19 560-X-35-.01 Authority and Purpose
11/18/19 560-X-35-.17 Fair Hearings
11/18/19 560-X-8-.03 Reimbursement
11/18/19 560-X-35-.03 Eligibity
11/18/19 560-X-35-.02 Description of Services
10/21/19 560-X-6-.01 Physician Program (General)
10/21/19 560-X-6-.13 Covered Services: Details on Selected Services
10/21/19 560-X-7-.17 Outpatient Hospital Services
10/21/19 560-X-14-.06 Plan First Waiver
10/21/19 560-X-37-.09 Attribution under the Alabama Coordinated Health Network Program
10/21/19 560-X-41-.01 General
10/21/19 Chapter 45 Maternity Care Program (Repealed)
9/19/19 560-X-37-.09 ER Attribution under the Alabama Coordinated Health Network Program
9/19/19 560-X-11-.14 EPSDT Referred Service Providers
8/20/19 560-X-40-.03 Description of Covered Services, Limitations, Exclusions (General)
8/20/19 560-X-40-.02 Eligibility
8/20/19 560-X-40-.01 Definitions
7/22/19 560-X-47-.03 Service Providers
7/22/19 560-X-47-.04 Minimum Qualifications for Mental Health, Substance Abuse, and Child & Adolescent Services/Adult Protective Services Professional Staff
6/19/19 560-X-37-.09 Managed Care
6/19/19 560-X-49-.01 Certified Nurse Practitioner Program
5/20/19 560-X-37-.07 Alabama Coordinated Health Network Program
5/20/19 560-X-37-.08 Sanctions Under the Alabama Coordinated Health Network Program
1/22/19 560-X-62 Regional Care Organizations

2018

Date Filed Rule Number & Name
3/21/18 560-X-14-.06 Plan First Waiver
3/21/18 560-X-44-.01 Authority and Purpose
3/21/18 560-X-44-.02 Eligibility
3/21/18 560-X-44-.03 Operating Agencies
3/21/18 560-X-44-.04 Covered Services
3/21/18 560-X-44-.06 Application Process
3/21/18 560-X-44-.08 Payment Methodology for Covered Services
3/21/18 560-X-44-.10 Records
3/21/18 560-X-44-.11 Service Providers
3/21/18 560-X-44-.12 Enrollment
4/20/18 560-X-1-.21 Provider Medicaid Records Inspection-Audit
4/20/18 560-X-1-.22 Authorship of Regulations
4/20/18 560-X-3-.03. Fair Hearing Procedures for Recipients and Providers
4/20/18 560-X-28-.01 Forms (Repealed)
4/20/18 560-X-28-.01 Forms (New Rule)
4/20/18 560-X-28-.02 Summary of State Law Regarding Advanced Directives
4/20/18 560-X-54-.02 Eligibility
4/20/18 560-X-54-.05 Application Process
4/20/18 560-X-54-.07 Payment Methodology for Covered Services
4/20/18 560-X-54-.09 Records
4/20/18 560-X-64-.01 Certificate in Order to Collaborate with other Entities, Individuals, or Integrated Care Network
4/20/18 560-X-64-.02 Active Supervision of Collaborations
4/20/18 560-X-64-.03 Governing Board of Directors
4/20/18 560-X-64-.07 Service Delivery Network Requirements for Integrated Care Networks (Repealed)
4/20/18 560-X-64-.07 Service Delivery Network Requirements for Integrated Care Network (New Rule)
4/20/18 560-X-64-.09 Information and Marketing Requirements for Enrollees and Potential Enrollees
4/20/18 560-X-64-.09 Qualification Criteria for Participation in the Mandated Competitive Procurement for Integrated Care Networks
4/20/18 560-X-64-.16 ICN Covered Population
4/20/18 560-X-64-.17 ICN Covered Services
5/22/18 560-X-6-.13 Covered Services: Details on Selected Services
5/22/18 560-X-7-.02 Participation
5/22/18 560-X-7-.16 Utilization Review for Inpatient Hospital Admissions and Concurrent Stays
5/22/18 560-X-7-.27 Split Billing (Inpatient Claims)
5/22/18 560-X-17-.01 Eye Care Services - General
5/22/18 560-X-40-.01 Definitions
5/22/18 560-X-43 Prenatal Services
5/22/18 560-X-45-.01 Authority and Purpose
5/22/18 560-X-45-.03 Primary Contractor Standards
5/22/18 560-X-45-.06 Covered Services
5/22/18 560-X-45-.07 Complaints and Grievances
5/22/18 560-X-45-.08 District Designation and Selection of Primary Contractors
5/22/18 560-X-45-.10 High Risk Protocols
5/22/18 560-X-45-.12 Health Care Professional Panel
5/22/18 560-X-45-.13 Recipient Choice
5/22/18 560-X-48-.02 Participation
5/22/18 560-X-58 Home and Community-Based Services for Individuals Diagnosed with HIV-AIDS and Related Illness
5/22/18 560-X-64-.06 Solvency and Financial Requirements for Integrated Care Networks
5/22/18 560-X-64-.08 Active Supervision of Organizations with Probationary Certification
5/22/18 560-X-64-.10 Financial Reporting and Audit Requirements
5/22/18 560-X-64-.12 Probationary Certification of Organizations Seeking to Become Integrated Care Networks
5/22/18 560-X-64-.14 Right to Terminate Certificates of Probationary and Fully Certified Integrated Care Networks
5/22/18 560-X-64-.19 Readiness Assessment Requirements
6/20/18 560-X-2-.01 Methods for Assuring High Quality Care
6/20/18 560-X-6-.01 Physician Program - General
6/20/18 560-X-12-.08 Physician Certification and Recertification
6/20/18 560-X-13-.01 Durable Medical Equipment, Supplies, Appliances, Prosthetics, Orthotics and Pedorthics - General
6/20/18 560-X-64-.04 Citizens' Advisory Committee
6/20/18 560-X-64-.05 ICN Quality Assurance Committee
6/20/18 560-X-64-.11 Hazardous Financial Condition and Insolvency
6/20/18 560-X-64-.13 Conflict of Interest Policy for Directors and Officers of Integrated Care Networks
6/20/18 560-X-64-.15 Grievances and Fair Hearings of Integrated Care Networks
6/20/18 560-X-64-.18 Sanctions
7/17/18 560-X-1-.29 Managed Care
7/17/18 560-X-4-.01 General
7/17/18 560-X-4-.02 Purpose
7/17/18 560-X-4-.03 Method
7/17/18 560-X-4-.04 Fraud and Abuse by Providers
7/17/18 560-X-4-.05 Abuse, Fraud, and or Deliberate Misuse by Recipients or Sponsors of Recipients
7/17/18 560-X-4-.06 Medicaid Eligibility Quality Control
7/17/18 560-X-10-.05 Reservation of Beds
7/17/18 560-X-10-.11 Establishment of Medical Need
7/17/18 560-X-10-.23 Resident Assessment
7/17/18 560-X-15-.06 Participation Requirements
7/17/18 560-X-29-.01 Definitions (Repealed)
7/17/18 560-X-29-.01 Definitions (New Rule)
7/17/18 560-X-35-.01 Definitions Authority and Purpose
7/17/18 560-X-35-.02 Description of Services
7/17/18 560-X-35-.03 Eligibility
7/17/18 560-X-42-.03 Definitions
7/17/18 560-X-51-.04 Recipient Eligibility
7/17/18 560-X-63-.06 Nursuing Facility Participation Requirement
7/18/18 560-X-25-.02 Adminstrative Responsibilities
7/18/18 560-X-25-.03 Coverage Groups
7/18/18 560-X-25-.04 Application Initial Determination or Denial of Eligibility and Redetermination of Eligibility
7/18/18 560-X-25-.05 General Categorical Eligibility Criteria
7/18/18 560-X-25-.06 Financial Eligibility Criteria- Resources
7/18/18 560-X-25-.09 Transfer of Assets Affecting Eligibility
7/18/18 560-X-25-.10 Income Criteria for SSI-Related Individuals
7/18/18 560-X-25-.12 Periods of Entitlement
7/18/18 560-X-25-.14 Pregnant Women Children Age 0-18 with Income Equal to or Below 141%
7/18/18 560-X-25-.15 Parents and Other Caretakers Relatives, Extended Medicaid Benefits due to Spousal Support and Transitional Medicaid Benefits
7/18/18 560-X-25-.16 Income and Resources of a Married Couple for Insitutional Care
8/21/18 560-X-40-.03 Description of Covered Services, Limitations, and Exclusions (General)
8/21/18 560-X-40-.02 Eligibility
8/21/18 560-X-40-.01 Definitions
8/21/18 560-X-16-.06 Reimbursement for Covered Drugs and Services
8/21/18 560-X-16-.01 Pharmacy Services-General
9/20/18 560-X-52-.01 Authority and Purpose
9/20/18 560-X-52-.02 Description of Services
9/20/18 560-X-52-.03 Eligibility
11/19/18 560-X- 47-.05 Requirements for Client Intake, Treatment Planning, and Service Documentation
11/19/18 560-X-47-.06 Covered Services
11/19/18 560-X-47-.07 Payment Methodology
11/19/18 560-X-47-.11 Records
11/19/18 560-X-47-.04 Minimum Qualifications for Mental Health, Substance Abuse, and Child & Adolescent Services/Adult Protective Services Professional Staff
11/19/18 560-X-47-.02 Eligibility
12/18/18 560-X-11-.14 EPSDT Referred Service Providers

2017

Date Filed Rule Number & Name
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-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
6/20/17 560-X-10-.26 Transfer and Discharge Rights
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
11/17/17 560-X-37-.02 Primary Care Case Management
12/19/17 560-X-37-.01  General

2016
Date Filed Rule Number & Name
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

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