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exclusion of employees of a public agency of a State, in accordance with section 10203 of the Affordable Care Act of 2010.

• Alabama’s eleventh CHIP amendment was submitted on June 8, 2011, and approved on June 15, 2011. This amendment provides temporary adjustments to the State’s enrollment and redetermination policies, and cost sharing requirements for families impacted by disaster events. Through this SPA, the State can provide families with additional time to complete the renewal process, and has the flexibility to waive outstanding premium balances for families living and or working in FEMA or Governor declared disaster counties. This amendment, as it applies to the April 2011 tornadoes that devastated the northern half of Alabama, has a retroactive effective date of April 15, 2011, and a duration of 6 months. In the event of a future natural disaster, this SPA provides Alabama with the authority to implement the aforementioned temporary policy adjustments by notifying CMS of its intent, the effective date and duration of the provision, and a list of the FEMA or Governor declared disaster areas that are applicable. Although the State must provide notice to CMS, this is less administratively burdensome than repeating the SPA process during times of disaster recovery.

Children Covered Under Program

• The State reported that 137,545 children were ever enrolled in CHIP in Federal fiscal year 2010.

Administration

• The Alabama Department of Public Health (ADPH) administers ALL Kids and ALL Kids Plus.

Health Care Delivery System

• Services are provided through self-insured plans that are reimbursed on a fee-for- service basis. Currently, the only ALL Kids vendor for the above services is Blue Cross Blue Shield of Alabama, which provides services statewide.

• The exception to the fee-for-service payment system is the method of reimbursement to federally qualified health centers (FQHCs) and rural health clinics (RHCs) based on a prospective payment system (PPS). ALL Kids has elected to adopt the Medicaid PPS Rates effective October 1, 2009.

• ALL Kids Plus services are authorized through the Alabama Department of Mental Health and Mental Retardation, the Alabama Department of Rehabilitation Services, and the University of Alabama at Birmingham Sparks Center. Services may be provided through public, private, non-profit, individuals and organizations that have contracts with one of the authorizing agencies.