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31-9B-3
Section 31-9B-3 Providing of information; requirements for emergency and disaster planning
provisions; immunity. (a) All appropriate agencies and community-based service providers,
including, but not limited to, home health care providers, hospices, community mental health
centers, and related facilities, but not including health care facilities which provide inpatient
care to include general and specialized hospitals including ancillary services, skilled nursing
facilities, intermediate care facilities, or any assisted living facility, shall provide information
on the number of individuals with medical needs and shall assist the State Health Department
in the establishment of programs to increase the awareness of medical needs shelters, and
in educating clients and sponsors or caregivers about the procedures that may be necessary
for their safety during disasters. (b) State agencies that regulate or contract with providers
of services, or both, for persons with disabilities or...
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27-21A-3
Section 27-21A-3 Issuance of certificate of authority. (a)(1) Upon receipt of an application
for issuance of a certificate of authority, the commissioner shall forthwith transmit copies
of such application and accompanying documents to the State Health Officer. (2) The State
Health Officer shall determine whether the applicant for a certificate of authority, with
respect to health care services to be furnished: a. Has demonstrated the willingness and potential
ability to assure that such health care services will be provided in a manner to assure both
availability and accessibility of adequate personnel and facilities and in a manner enhancing
availability, accessibility, and continuity of service; b. Has arrangements, established in
accordance with the regulations promulgated by the State Health Officer, for an on-going quality
assurance program concerning health care processes and outcomes; and c. Has a procedure, established
in accordance with regulations of the State Health...
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22-21-276
Section 22-21-276 Injunctive relief; issuance of license for inpatient beds or facilities
in violation of article prohibited; facilities in violation of article not to receive reimbursement
for services. (a) Injunctive relief against violations of this article or any reasonable rules
and regulations of the SHPDA may be obtained from the Circuit Court of Montgomery County,
Alabama, at the instance of the SHPDA, any holder of a certificate of need that is adversely
affected in the exercise of privileges thereunder by such violation or any member of the public
directly and adversely affected by such violation. Upon written request by the SHPDA, it shall
be the duty of the Attorney General of the State of Alabama to furnish such legal services
as may be appropriate and to prosecute such action for injunctive relief to an appropriate
conclusion. (b) The State Board of Health shall not issue a license to operate new inpatient
beds or any health care facility constructed, or acquired in...
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27-57-2
Section 27-57-2 Coverage; applicability. (a) All group health benefit plans, policies,
contracts, and certificates executed, delivered, issued for delivery, continued, or renewed
in this state on or after August 1, 2004, shall offer, at the time of proposal, sale, or renewal
of a policy subject to this chapter, to include colorectal cancer examinations within the
coverage. Such offer of coverage shall include colorectal cancer examinations for covered
persons who are 50 years of age or older, or for covered persons who are less than 50 years
of age and at high risk for colorectal cancer according to current American Cancer Society
colorectal cancer screening guidelines. (b) This chapter shall apply to group accident and
sickness insurance policies issued by a fraternal benefit society, a nonprofit hospital service
corporation, a nonprofit medical service corporation, a group health care plan, a health maintenance
organization, or any similar entity. (Act 2004-502, p. 969, §2.)...
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22-4-2
Section 22-4-2 Definitions. When used in this article, the following terms shall have
the following meanings, respectively, unless a different meaning clearly appears from the
context: (1) STATE BOARD OF HEALTH. The statutory agency of the State of Alabama operative
in the field of general health matters and performing the duties and exercising the powers
as set forth in the statutory provisions relating thereto. (2) STATEWIDE HEALTH COORDINATING
COUNCIL. The advisory council established pursuant to this article which shall advise the
State Board of Health on matters relating to health planning and resource development. (3)
HEALTH SYSTEMS AGENCY. An entity which is organized and operated under the provisions of Title
XV of the Public Health Service Act (42 U.S.C. §§ 3001 et seq.) and is responsible for the
health planning and development in a health service area designated by the Governor. (4) HEALTH
SERVICE AREA. A geographical area designated by the Governor as being appropriate...
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27-19-52
Section 27-19-52 Definitions. For purposes of this article, the following terms shall
have the meaning indicated herein: (1) APPLICANT. Includes either of the following: a. In
the case of an individual Medicare supplement policy or subscriber contract, the person who
seeks to contract for insurance benefits. b. In the case of a group Medicare supplement policy
or subscriber contract, the proposed certificate holder. (2) CERTIFICATE. Any certificate
issued under a group Medicare supplement policy, which policy has been delivered or issued
for delivery in this state. (3) CERTIFICATE FORM. The form on which the certificate is delivered
or issued for delivery by the issuer. (4) ISSUER. Insurance companies, fraternal benefit societies,
health care service plans, health maintenance organizations, and any other entity delivering
or issuing for delivery in this state Medicare supplement policies or certificates. (5) MEDICARE.
The "Health Insurance for the Aged Act," Title XVIII of the Social...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this
section, the following terms shall have the following meanings: (1) COVERED PERSON.
Any individual, family, or family member on whose behalf third-party payment or prepayment
of health or medical expenses is provided under an insurance policy, plan, or contract providing
for third-party payment or prepayment of health care or medical expenses. (2) COVERED SERVICES.
Dental care services for which a reimbursement is available under an enrollee's plan contract,
or for which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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27-7-1
Section 27-7-1 Definitions. For the purposes of this chapter, the following terms shall
have the meanings respectively ascribed to them by this section: (1) BUSINESS ENTITY.
A corporation, association, partnership, limited liability company, limited liability partnership,
or other legal entity. (2) COMMISSIONER. The Alabama Commissioner of Insurance. (3) HOME STATE.
The District of Columbia and any state or territory of the United States in which an insurance
producer maintains his or her principal place of residence or principal place of business
and is licensed to act as an insurance producer. (4) INSURANCE. As defined in Section
27-1-2. (5) INSURANCE PRODUCER or PRODUCER. A person required to be licensed under the laws
of this state to sell, solicit, or negotiate insurance. (6) INSURER. As defined in Section
27-1-2. For the purposes of this chapter, insurer shall also mean an insurance company licensed
pursuant to Chapter 3, commencing with Section 27-3-1 of this title; a health...
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22-6-163
Section 22-6-163 Legislative findings; rules; collaboration; approval of agreements
and contracts; state action immunity; confidentiality of records; additional duties. (a) The
Legislature declares that collaboration among public payers, private health carriers, third
party purchasers, and providers to identify appropriate service delivery systems and reimbursement
methods in order to align incentives in support of integrated and coordinated health care
delivery is in the best interest of the public. Collaboration pursuant to this article is
to provide quality health care at the lowest possible cost to Alabama citizens who are Medicaid
eligible. The Legislature, therefore, declares that this health care delivery system affirmatively
contemplates the foreseeable displacement of competition, such that any anti-competitive effect
may be attributed to the state's policy to displace competition in the delivery of a coordinated
system of health care for the public benefit. In furtherance of...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive
denials, adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health
benefit plan that issues or renews any policy of accident or health insurance providing benefits
for medical or hospital expenses for its insured persons shall pay for services rendered by
Alabama health care providers within 45 calendar days upon receipt of a clean written claim
or 30 calendar days upon receipt of a clean electronic claim. If the insurer, health service
corporation, or health benefit plan is denying or pending the claim, the insurer, health service
corporation, or health benefit plan shall, within 45 calendar days for a written claim and
30 calendar days for an electronic claim, notify the health care provider or certificate holder
of the reason for denying or pending the claim and what, if any, additional information is
required to process the claim. Any undisputed portion of the claim...
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