The hospital assessment stops, or never takes effect, if certain federal funding, payment-rate, or contracting conditions occur, and any remaining assessment funds must be refunded to hospitals proportionally.
(a) The assessment imposed under this article shall not take effect or shall cease to be imposed and any monies remaining in the Hospital Assessment Account in the Alabama Medicaid Program Trust Fund shall be refunded to hospitals in proportion to the amounts paid by them if any of the following occur: (1) Expenditures for hospital inpatient and outpatient services paid for by the Alabama Medicaid Program for the current fiscal year are less than the amount paid during fiscal year 2017 or reimbursement rates under this article are less than the rates approved by CMS in Sections 40-26B-79 and 40-26B-80. (2) The Alabama Medicaid Agency makes changes in rules that reduce hospital inpatient payment rates, outpatient payment rates, or adjustment payments, including any cost settlement protocol. (3) The inpatient or outpatient hospital access payments required under this article are changed or the assessments imposed or certified public expenditures or intergovernmental transfers recognized under this article are not eligible for federal matching funds under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., or 42 U.S.C. § 1397aa et seq. (4) The Alabama Medicaid Agency contracts with an alternate care provider in a Medicaid region under any terms other than the following: a. The agency may contract with an alternate care provider only if, in the judgment of the agency, care of Medicaid enrollees would be better, more efficient, and less costly than under the then existing care delivery system. The agency may contract with more than one alternate care provider in a Medicaid region. b. If the agency were to contract with an alternate care provider under the terms of this subdivision, that provider would have to pay reimbursements for hospital inpatient or outpatient care at rates at least equal to the most recent published rates pursuant to Sections 40-26B-79 and 40-26B-80. c. If more than a year had elapsed since the agency directly paid reimbursements to hospitals, the minimum reimbursement rates paid by the alternate care provider would have to be changed to reflect any percentage increase in the national medical consumer price index minus 100 basis points. (b)(1) The assessment imposed under this article shall not take effect or shall cease to be imposed if the assessment is determined to be an impermissible tax under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (2) Monies in the Hospital Assessment Account in the Alabama Medicaid Program Trust Fund derived from assessments imposed before the determination described in subdivision (1) shall be disbursed under this article to the extent federal matching is not reduced due to the impermissibility of the assessments, and any remaining monies shall be refunded to hospitals in proportion to the amounts paid by them.