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27-50-5
Section 27-50-5 Penalties for compliance with article - Prohibited. (a) No health benefit plan
subject to the provisions of this chapter shall terminate the services, reduce capitation
payment, or otherwise penalize an attending physician or other health care provider who orders
medical care consistent with this chapter. (b) Nothing in this chapter is intended to expand
the list or designation of covered providers as specified in any health benefit plan. (Acts
1997, No. 97-414, p. 685, ยง5.)...
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22-11A-38
Section 22-11A-38 Notification of third parties of disease; rules; who may be notified; liability;
confidentiality; disclosure of information for certain criminal proceedings; penalty. (a)
The State Committee of Public Health is hereby authorized to establish the rules by which
exceptions may be made to the confidentiality provisions of this article and establish rules
for notification of third parties of such disease when exposure is indicated or a threat to
the health and welfare of others. All notifications authorized by this section shall be within
the rules established pursuant to this subsection. (b) Physicians and hospital administrators
or their designee may notify pre-hospital transport agencies and emergency medical personnel
of a patient's contagious condition. In case of a death in which there was a known contagious
disease, the physician or hospital administrator or their designee may notify the funeral
home director. (c) The attending physician or the State Health Officer...
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22-21-7
Section 22-21-7 Itemized statement of services rendered to be furnished patient upon request;
provisions of statement; itemization of services and expenses; action by Attorney General;
payment of claims by insurance companies. (a) For the purposes of this section, the term "hospital"
shall mean any hospital in which human patients are given medical care. It shall include all
emergency rooms or outpatient facilities connected thereto. (b) Within 10 days following discharge
or release from confinement in a hospital or nursing home, or within 10 days after the earliest
date at which the expense from the confinement or service may be determined, which in the
case of long-term confinement may be the monthly charge, the hospital or nursing home providing
the service shall submit to the patient, or to his survivor or legal guardian as may be appropriate,
upon written request, an itemized statement detailing in language comprehensible to an ordinary
layman the specific nature of charges or...
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22-6-4
Section 22-6-4 Copayments by persons receiving medical services from physicians under program.
(a) All persons eligible to receive Medicaid shall pay the sum of $1.00 for each visit as
a copayment for medical services provided by a physician under the Medicaid Program. (b) The
$1.00 copayment shall be collected by the attending physician and credited against the Medicaid
payment to the physician for the visit. (c) The provisions of this section shall become effective
only upon the approval of the Department of Health, Education and Welfare of the federal government.
(Acts 1976, No. 626, p. 860; Acts 1977, No. 703, p. 1243.)...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, health maintenance organizations, preferred provider organizations, medical
service organizations, physician-hospital organizations, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for, purchases, or furnishes health
care services to patients, insureds, or...
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22-21B-3
Section 22-21B-3 Definitions. The following words and terms shall have the meanings ascribed
to them in this section, unless otherwise required by their respective context: (1) CONSCIENCE.
The religious, moral, or ethical principles held by a health care provider. (2) DISCRIMINATION.
Discrimination includes, but is not limited to: Hiring, termination, refusal of staff privileges,
refusal of board certification, demotion, loss of career specialty, reduction of wages or
benefits, adverse treatment in the terms and conditions of employment, refusal to award any
grant, contract, or other program, or refusal to provide residency training opportunities.
(3) HEALTH CARE PROVIDER. Any individual who may be asked to participate in any way in a health
care service, including, but not limited to: A physician, physician's assistant, nurse, nurse's
aide, medical assistant, hospital employee, clinic employee, nursing home employee, pharmacist,
researcher, medical or nursing school faculty, student,...
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27-19-39
Section 27-19-39 Policies, etc., providing for reimbursement for visual service. Whenever any
policy of insurance or any medical service plan or hospital service contract or hospital and
medical service contract provides for reimbursement for any visual service in Alabama which
is within the lawful scope of practice of a duly licensed optometrist, as defined in Section
34-22-1, the insured or other person entitled to benefits under such policy shall be entitled
to reimbursement for such services, whether such services are performed by a duly licensed
physician or by a duly licensed optometrist, whichever the insured selects, notwithstanding
any provision to the contrary in any statute or in such policy, plan, or contract. Duly licensed
optometrists shall be entitled to participate in such policies, plans, or contracts providing
for visual services to the same extent as fully licensed physicians. (Acts 1967, No. 508,
p. 1224.)...
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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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13A-9-150
Section 13A-9-150 Public assistance fraud; penalties. (a) For the purposes of this section,
public assistance means money or property provided directly or indirectly to eligible persons
through programs of the federal government, the state, or any political subdivision thereof,
including any program administered by a public housing authority. (b) It shall be unlawful
for an individual or business entity to knowingly do any of the following: (1) Fail, by false
statement, misrepresentation, impersonation, or other fraudulent means, to disclose a material
fact used in making a determination as to the qualification of the person to receive public
assistance. (2) Fail to disclose a change in circumstances in order to obtain or continue
to receive any public assistance to which he or she is not entitled or in an amount larger
than that to which he or she is entitled. (3) Aid and abet another person in the commission
of the prohibitions enumerated in subdivisions (1) and (2). (4) Use,...
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22-21-293
Section 22-21-293 Financial responsibility for out-of-county indigent patients treated at a
regional referral hospital. Ultimate financial responsibility for treatment received at a
regional referral hospital by a certified indigent patient, who is a resident of the State
of Alabama but is not a resident of the county in which the regional referral hospital is
located, shall be the obligation of the county of which the certified indigent patient is
a resident. A county's annual financial responsibility for each of its resident certified
indigent patients receiving treatment at a regional referral hospital shall be limited to
payment for 30 days or the number of days of services allowed per annum for the care of Medicaid
patients through the State Medicaid Program at the time of the patient's hospitalization,
whichever shall be less, at the per diem reimbursement rate currently in effect for the regional
referral hospital under the medical assistance program for the needy under Title...
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