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22-6-154
Section 22-6-154 Quality assurance committee; collection and publication of information.
(a) The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid
Commissioner. The members of the committee shall serve two-year terms. At least 60 percent
of the members shall be physicians who provide care to Medicaid beneficiaries served by a
regional care organization. In making appointments to the committee, the Medicaid Commissioner
shall seek input from the appropriate professional associations. (b) The committee shall identify
objective outcome and quality measures, including measures of outcome and quality for ambulatory
care, inpatient care, chemical dependency and mental health treatment, oral health care, and
all other health services provided by coordinated care organizations. Quality measures adopted
by the committee shall be consistent with existing state and national quality measures. The
Medicaid Commissioner shall incorporate these measures into...
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22-6-221
Section 22-6-221 Service by integrated care network; board of directors. (a) An integrated
care network shall serve only Medicaid beneficiaries in providing medical care and services.
For the purposes of this article, a beneficiary cannot be a member of both an integrated care
network and a regional care organization. (b) An integrated care network shall provide required
medical care and services to Medicaid beneficiaries and may coordinate care provided by or
through an affiliation of other health care providers or other programs as the Medicaid Agency
shall determine. (c) Notwithstanding any other provision of law, the integrated care network
shall not be deemed an insurance company under state law. (d)(1) An integrated care network
shall have a governing board of directors composed of the following members: a. Twelve members
shall be persons representing risk bearing participants. A participant bears risk by contributing
cash, capital, or other assets to the integrated care network....
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22-7A-1
Section 22-7A-1 Physician agreements; dentist agreements. (a) For the purposes of this
chapter, the following words shall have the following meanings: (1) DENTIST. A person licensed
to practice dentistry in this state. (2) DENTIST AGREEMENT or AGREEMENT. A contract between
a dentist and a patient or his or her legal representative in which the dentist or the dentist's
medical practice agrees to provide dental services to the patient for an agreed upon fee and
period of time. (3) DENTIST PRACTICE. A dentist or a dental practice of a dentist that charges
a periodic fee for dental services and which does not bill a third party any additional fee
for services for patients covered under a dental agreement. The per visit charge of the practice
shall be less than the monthly equivalent of the periodic fee. (4) PHYSICIAN. A person licensed
to practice medicine in this state. (5) PHYSICIAN AGREEMENT or AGREEMENT. A contract between
a physician and a patient or his or her legal representative in...
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26-10-26
Section 26-10-26 Subsidies - Report; modification of subsidy; review; duration of subsidy.
(a)(1) The department may require the adoptive parent or parents to submit a report, annually
or at a time or times specified in the agreement or when the department is investigating an
allegation of improperly received benefits. The parent shall state in the report that the
child remains under their care and any change in the conditions or circumstances of the adopting
parent or the needs of the child. The subsidy agreement shall continue according to its terms,
except as provided by this article. The department may confirm the accuracy and veracity of
the report from any reliable sources of information concerning the adoptive family and child,
including any governmental or private agency that serves the area in which the child resides.
If the report or information received by the department indicates a substantial change in
the conditions that existed when the adoption subsidy agreement was...
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27-19-103
Section 27-19-103 Definitions. Unless the context requires otherwise, the definitions
in this section apply throughout this article. (1) APPLICANT. In the case of: a. An
individual long-term care insurance policy, the person who seeks to contract for benefits.
b. A group long-term care insurance policy, the proposed certificate holder. (2) CERTIFICATE.
Any certificate issued under a group long-term care insurance policy, which policy has been
delivered or issued for delivery in this state. (3) COMMISSIONER. The Alabama Commissioner
of Insurance. (4) GROUP LONG-TERM CARE INSURANCE. A long-term care insurance policy which
is delivered or issued for delivery in this state and issued to any of the following: a. One
or more employers or labor organizations, or to a trust or to the trustees of a fund established
by one or more employers or labor organizations, or a combination thereof, for employees or
former employees or a combination thereof, or for members or former members or a...
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27-21A-4
Section 27-21A-4 Powers of health maintenance organizations. (a) The powers of a health
maintenance organization include, but are not limited to the following: (1) The purchase,
lease, construction, renovation, operation, or maintenance of hospitals, medical facilities,
or both, and their ancillary equipment; (2) The making of loans other than in the ordinary
course of business, to providers under contract with it in furtherance of its program or the
making of loans to a corporation or corporations in which it owns a majority interest for
the purpose of acquiring or constructing medical facilities and hospitals or in furtherance
of a program providing health care services to enrollees. (3) The furnishing of health care
services through providers which are under contract with or employed by the health maintenance
organization. (4) The contracting with any person for the performance on its behalf of certain
functions such as marketing, enrollment, and administration. (5) The purchase,...
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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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34-21-81
Section 34-21-81 Definitions. As used in this article, the following terms shall have
the following meanings: (1) BOARD OF MEDICAL EXAMINERS. The State Board of Medical Examiners
established pursuant to Section 34-24-53. (2) BOARD OF NURSING. The Board of Nursing
established under Section 34-21-2. (3) ADVANCED PRACTICE NURSE. A registered nurse
that has gained additional knowledge and skills through successful completion of an organized
program of nursing education that prepares nurses for advanced practice roles and has been
certified by the Board of Nursing to engage in the practice of advanced practice nursing.
There shall be four categories of advanced practice nurses: Certified registered nurse practitioners
(CRNP), certified nurse midwives (CNM), certified registered nurse anesthetists (CRNA), and
clinical nurse specialists (CNS). Certified registered nurse practitioners and certified nurse
midwives are subject to collaborative practice agreements with an Alabama physician....
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34-21A-21
Section 34-21A-21 Revocation and suspension of license. (a) The board shall establish
criteria for circumstances warranting the suspension or revocation of a license and establish
the procedures for suspension or revocation of licenses. These circumstances shall include,
but not be limited to, the following: (1) Obtaining a license under false pretense. (2) Obtaining
a license by having another person take the examination. (3) Allowing another person to use
the license in violation of the regulations of the board. (4) Selling or conveying the license
to another person. (5) Failure to timely renew a license. (6) Failure to follow the rules
and regulations of the State of Alabama Department of Public Health or the appropriate local
health department or authorities. (7) Committing a dishonest or illegal act in the performance
of work covered under the license. (b) The board shall take appropriate action to enforce
the rules adopted with regard to license suspension or revocation. (c)...
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10A-20-6.07
Section 10A-20-6.07 Certificates of authority; contracts with public. Every corporation
organized under this article shall procure from the Commissioner of Insurance a certificate
of authority to do business, for which the corporation shall pay the sum of two hundred dollars
($200), and the certificates of authority shall be renewed thereafter on or before the first
day of March of each year. The corporation may then enter into contracts with the public,
subject to the restrictions contained in this article, for benefits under its health service
plan. It shall be the duty of the corporation to enter into contracts with and issue certificates
to those of the public who may desire to avail themselves of the benefits of the health service
plan and who, under its rules and regulations, make application and are eligible therefor.
The contracts may provide for more than one class of services or benefits, may designate the
person or persons, or the class of persons, entitled thereto, may...
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