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22-5A-6
Section 22-5A-6 Procedures for resolving complaints. (a) A community ombudsman's access
to any health care facility shall be limited to standard operating hours unless prior arrangements
with the operator of the facility has been made. If the complaint involves more than one provider
or alleges to involve more than one provider, the ombudsman shall investigate all providers.
(b) Any complaint requiring remedial action and deemed valid by the ombudsman shall be identified
and brought to the attention of the administrator or provider involved and followed up in
writing within a reasonable time. Upon receipt of such document, the administrator or provider,
in coordination with the ombudsman, shall establish a course of appropriate remedial action.
If the remedial action is not forthcoming within a reasonable time, the ombudsman must refer
the case to the State Ombudsman who may take any one or more of the following actions: (1)
Allow more time if the State Ombudsman has reason to believe...
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26-22-3
Section 26-22-3 Prohibition, exceptions, and regulations. (a) Prohibition. Except as
provided in subsection (b), no person shall intentionally, knowingly, or recklessly perform
or induce an abortion when the unborn child is viable. (b) Exceptions. (1) It shall not be
a violation of subsection (a) if an abortion is performed by a physician and that physician
reasonably believes that it is necessary to prevent either the death of the pregnant woman
or the substantial and irreversible impairment of a major bodily function of the woman. No
abortion shall be deemed authorized under this paragraph if performed on the basis of a claim
or a diagnosis that the woman will engage in conduct which would result in her death or in
substantial and irreversible impairment of a major bodily function. (2) It shall not be a
violation of subsection (a) if the abortion is performed by a physician and that physician
reasonably believes, after making a determination of the viability of the unborn child in...
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27-15-53
Section 27-15-53 Requirements for death master file comparisons. (a) An insurer shall
perform a comparison of its insureds' in-force life insurance policies, annuity contracts,
and retained asset accounts against a death master file, to identify potential death master
file matches of its insureds. Such comparison shall be completed by January 1, 2019. Thereafter,
an insurer shall maintain a program designed to compare each such policy, contract, or account
with a death master file no less frequently than every three years, it being the intent that
insurers fashion a program that best fits their business systems while at the same time protecting
consumers by assuring reasonable checks are being performed to identify unreported deaths.
For those potential death master file matches identified as a result of a death master file
comparison, the insurer shall do all of the following: (1) Within 90 days of a death master
file match: a. Complete a commercially reasonable effort, which shall be...
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27-3A-5
Section 27-3A-5 Standards for utilization review agents. (a) Except as provided in subsection
(b), all utilization review agents shall meet the following minimum standards: (1) Notification
of a determination by the utilization review agent shall be mailed or otherwise communicated
to the provider of record or the enrollee or other appropriate individual within two business
days of the receipt of the request for determination and the receipt of all information necessary
to complete the review. (2) Any determination by a utilization review agent as to the necessity
or appropriateness of an admission, service, or procedure shall be reviewed by a physician
or determined in accordance with standards or guidelines approved by a physician. (3) Any
notification of determination not to certify an admission, service, or procedure shall include
the principal reason for the determination and the procedures to initiate an appeal of the
determination. (4) Utilization review agents shall maintain...
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34-24-360
Section 34-24-360 Restrictions, etc., on license; grounds. The Medical Licensure Commission
shall have the power and duty to suspend, revoke, or restrict any license to practice medicine
or osteopathy in the State of Alabama or place on probation or fine any licensee whenever
the licensee shall be found guilty on the basis of substantial evidence of any of the following
acts or offenses: (1) Fraud in applying for or procuring a certificate of qualification to
practice medicine or osteopathy or a license to practice medicine or osteopathy in the State
of Alabama. (2) Unprofessional conduct as defined herein or in the rules and regulations promulgated
by the commission. (3) Practicing medicine or osteopathy in such a manner as to endanger the
health of the patients of the practitioner. (4) Conviction of a felony; a copy of the record
of conviction, certified to by the clerk of the court entering the conviction, shall be conclusive
evidence. (5) Conviction of any crime or offense which...
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41-9-351
Section 41-9-351 Commission may provide for insurance for properties and employees.
(a) The commission may provide insurance covering loss or damage to its properties or any
properties of others in its custody, care, or control or any properties as to which it has
any insurable interest caused by fire or other casualty and may likewise provide insurance
for the payment of damages on account of the injury or death of persons and the loss or destruction
of properties of others, and may pay the premiums out of the revenues of the commission. Nothing
in this section shall be construed to authorize or permit the institution of any civil
action or proceeding in any court against the commission for or on account of any matter referred
to in this section. Any contracts of insurance authorized by this section may,
in the discretion of the chair of the commission, provide for a direct right of action against
the insurance carrier for the enforcement of any claims or causes of action. (b) The...
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22-8A-3
Section 22-8A-3 Definitions. As used in this chapter, the following terms shall have
the following meanings, respectively, unless the context clearly indicates otherwise: (1)
ADULT. Any person 19 years of age or over. (2) ARTIFICIALLY PROVIDED NUTRITION AND HYDRATION.
A medical treatment consisting of the administration of food and water through a tube or intravenous
line, where the recipient is not required to chew or swallow voluntarily. Artificially provided
nutrition and hydration does not include assisted feeding, such as spoon or bottle feeding.
(3) ADVANCE DIRECTIVE FOR HEALTH CARE. A writing executed in accordance with Section
22-8A-4 which may include a living will, the appointment of a health care proxy, or both such
living will and appointment of a health care proxy. (4) ATTENDING PHYSICIAN. The physician
selected by, or assigned to, the patient who has primary responsibility for the treatment
and care of the patient. (5) CARDIOPULMONARY CESSATION. A lack of pulse or...
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12-15-102
Section 12-15-102 Definitions. When used in this chapter, the following words and phrases
have the following meanings: (1) ADULT. An individual 19 years of age or older. (2) AFTERCARE.
Conditions and supervision as the juvenile court orders after release from the Department
of Youth Services. (3) CHILD. An individual under the age of 18 years, or under 21 years of
age and before the juvenile court for a delinquency matter arising before that individual's
18th birthday, or under 19 years of age and before the juvenile court for a child in need
of supervision matter or commitment to the State Department of Mental Health or under 19 years
of age and before the juvenile court for a proceeding initiated under Section 12-15-115(b)(2).
Where a delinquency petition alleges that an individual, prior to the individual's 18th birthday,
has committed an offense for which there is no statute of limitation pursuant to Section
15-3-5, the term child also shall include the individual subject to the...
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27-36A-16
Section 27-36A-16 Requirements of a principle-based valuation. (a) A company must establish
reserves using a principle-based valuation that meets the following conditions for policies
or contracts as specified in the valuation manual: (1) Quantify the benefits and guarantees,
and the funding, associated with the contracts and their risks at a level of conservatism
that reflects conditions that include unfavorable events that have a reasonable probability
of occurring during the lifetime of the contracts. For polices or contracts with significant
tail risk, reflects conditions appropriately adverse to quantify the tail risk. (2) Incorporate
assumptions, risk analysis methods and financial models, and management techniques that are
consistent with, but not necessarily identical to, those utilized within the company's overall
risk assessment process, while recognizing potential differences in financial reporting structures
and any prescribed assumptions or methods. (3) Incorporate...
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27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance
policy or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services
provided under a policy or contract delivered, continued, or renewed in this state on or after
August 1, 1997, and to any existing policy or contract, on the policy's or...
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