Dear Healthcare Provider, I am pleased to

Dear Healthcare Provider,
I am pleased to announce that Alabama Community Care has been approved as a Regional Care Organization in
Alabama. The Alabama Medicaid Agency has taken several positive steps to transition Medicaid from traditional feefor-service to a Regional Care Organization approach of managed care. Alabama Community Care conducted provider
meetings across North Alabama in December and more in the coming months to share our vision to make this
transition a reality including ways to make your life easier. We will eliminate unnecessary work for you, educate
members about their benefits and the appropriate use of services, enhance patient alignment with health homes,
improve cash flow for you, and introduce quality and efficiency incentives. We can promise these things because we
have the proven success in making this happen through our partners.
As a provider-sponsored not-for-profit managed care organization, Alabama Community Care is a partnership between
Huntsville Hospital Health System and Sentara Healthcare of Virginia. Huntsville brings 120 years of experience
serving the residents of North Alabama and includes 11 hospitals and organizations: Athens-Limestone Hospital,
Decatur Morgan Hospital (3 campuses), Heart Center, Inc., Helen Keller Hospital, Huntsville Hospital, Huntsville
Hospital for Women & Children, Lawrence Medical Center, Madison Hospital, and Red Bay Hospital. Sentara has
made not-for-profit Medicaid managed care successful in Virginia for over 20 years and no one else comes close to this
many years of experience. Alabama Community Care is also the exclusive partner with North Alabama Community
Care and the Best Start Maternity Care Program, building on existing relationships with providers and easing the
transition to this new care model. We are building on experience, collaborating with existing organizations and
maximizing the best of each to help improve the health outcomes of Medicaid recipients while making your life easier.
You are central to this transition and we need you to help make this vision a reality. Attached you will find a Medicaid
prescribed Letter of Intent for Regional Care Organization (RCO) and/or Health Home Services1 contract that was
drafted in conjunction with the Alabama Medicaid Agency. We invite you to join the Alabama Community Care
provider network by completing the enclosed Letter of Intent.
Please follow these steps to complete the enclosed Medicaid Letter of Intent:
1.
Completely fill out sections 1 through 8. Primary Care Providers are encouraged to check both the RCO and Health Home programs
on line 8.
2.
Sign the Letter of Intent. Signing with Alabama Community Care does not obligate you to sign a contract with us, neither does it
preclude you from connecting with other Regional Care Organizations. This simply allows us to be transparent in our reporting to
Medicaid around the quantity and types of providers we anticipate will be in our network.
3.
Complete the Supplemental Provider Information Sheet. This information will help us understand your practice and will enable us
to better describe your services and capabilities to the Alabama Medicaid Agency.
4.
Return the signed Letter of Intent and the supplemental information sheet to us in one of three ways:
a.
b.
c.
Fax to (256) 265-0998.
Email to Kyle Buchanan, Alabama Community Care Executive Director, at [email protected].
In the enclosed prepaid postage envelope to Alabama Community Care P.O. Box 18888 Huntsville, AL 35804.
We ask that you complete and return the Letter of Intent by January 20, 2015. If you have any questions, please do not
hesitate to contact us at (844) 840-2522. Finally, for more information, Frequently Asked Questions, printable versions
of the enclosed documents and updates, please visit us at www.AlabamaCommunityCare.org. We appreciate your
support and look forward to working with you to make this transformation successful.
Sincerely,
David S. Spillers
Chairman, Governing Body,
Alabama Community Care
1
The Patient 1st Health Home Program provides comprehensive care coordination services to eligible chronically ill/high risk patients and data support and other resources to Primary
Medical Providers. If you currently participate in this program and wish to continue services or would like to enroll into the Health Home Program, we must receive your signed Letter of
Intent by January 20, 2015.
Letter of Intent to Contract
By signing below, the provider is expressing his or her interest in contracting with Alabama Community
Care- Region A, Inc. as a subcontractor for the provision of covered services to Medicaid eligible enrollees for
the following programs:


Health Home Services, if Alabama Community Care- Region A, Inc. is awarded a Health Home
contract and/or;
Regional Care Organizations, if Alabama Community Care- Region A, Inc. is awarded full
certification as a Regional Care Organization and enters into a full-risk contract with the Alabama
Medicaid Agency
All subcontractors shall comply with Title VI of the Civil Rights Act of 1964 (42 USC §2000d, et. seq.), Section
504 of the Rehabilitation Act of 1973 (29 USC §6101, et seq.), the Americans with Disabilities Act of 1990 (42
USC §2101, et seq.), and the regulations issued thereunder by the Department of Health and Human Services
(45 CFR Parts 80, 84 and 90). No individual shall, on the ground of race, sex, color, creed, national origin, age
or disability be excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program of services.
In accordance with Section 22-6-153 (c) of the Alabama Code and Medicaid Administrative Rule No. 560-X-62.10, the minimum fee- for--service reimbursement rates that a Regional Care Organization shall pay providers
for applicable Medicaid services provided to a Medicaid beneficiary shall be the prevailing Medicaid fee-forservice schedule, unless otherwise jointly agreed to by a provider and a Regional Care Organization through
a contract or mandated by federal law.
By signing below, the provider is not obligated to sign a contract with Alabama Community Care- Region A,
Inc. upon review of the terms of any proposed contract.
The following information is furnished by the provider:
1. Printed Name: ________
2. NPI:
MAID:
3. Provider Type or Specialty:
4. Are you planning to be a PMP or a Core Specialist?
5. Counties from which the provider will take patients:____________________________________
6. Address:
City: ______
(where services will be provided)
State: _
Zip: _
Letter of Intent to Contract
7. Telephone:
Fax:
8. Program Intent (check all that apply):
Email:
☐ Health Home
Provider Signature
Date Signed
Printed Name/Title
Office Contact
☐ RCO Program
Attachment A: Group Attestation if submitting a Letter Of Intent on behalf of multiple providers
Name
NPI
MAID
Type or Specialty
PMP or Specialist