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22-6-222
Section 22-6-222 Citizens' advisory committee. There shall be a citizens' advisory committee
constituted to advise the integrated care network on ways the integrated care network may
be more efficient in providing quality care to Medicaid beneficiaries. In addition, the advisory
committee shall carry out other functions and duties assigned to it by the integrated care
network and approved by the Medicaid Agency. The committee shall meet all of the following
criteria: (1) Be selected in a method established by the organization seeking to become an
integrated care network, or established by an integrated care network, and approved by the
Medicaid Agency. (2) At least 20 percent of its members shall be Medicaid beneficiaries or
sponsors of Medicaid beneficiaries or, if the organization has been certified as an integrated
care network, at least 20 percent of its members shall be Medicaid beneficiaries enrolled
in the integrated care network, or their sponsor. (3) Include members who are...
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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
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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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27-47-2
Section 27-47-2 Deduction for premiums paid for long-term care insurance contract; treatment
of contract; coverage. (a) The premiums paid for a long-term care insurance contract are deductible
pursuant to Section 40-18-15, if the contract meets the following requirements: (1) Offers
coverage only for qualified long-term care services and benefits incidental to the coverage.
(2) Guaranteed renewal. (3) No cash surrender value. (4) All refunds of premiums and all policyholder
dividends or similar amounts under the contract are to be applied as a reduction in future
premiums or to increase future benefits, except for a refund of premiums on surrender or cancellation
of the policy. (b) For purposes of this chapter, a long-term care insurance contract shall
be treated as an accident or health insurance contract. The amount of coverage under the long-term
care insurance contract shall be equal to or greater than Medicaid coverage for a period of
at least three years. (c) An insurance...
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38-9D-2
Section 38-9D-2 Definitions. The following words are defined for the purposes of this chapter:
(1) COORDINATED SYSTEM OF CARE. The total effort in the state, inclusive of service coordination/case
management, that is directed at meeting the needs of individuals who are at risk of elder
abuse. (2) COUNCIL. The Alabama Interagency Council for the Prevention of Elder Abuse. (3)
ELDER ABUSE. The maltreatment of an older person, age 60 or above, by any person, including
the following: a. Emotional/Psychological Abuse. The intentional infliction of mental or emotional
anguish by threat, humiliation, intimidation, or other verbal or non-verbal abusive conduct.
Examples of psychological abuse include name calling, insulting, ignoring for extended periods
of time, frightening, intimidating, and isolating from friends and family. b. Material Exploitation.
The unauthorized use of funds or any resources of an elderly individual or the misuse of power
of attorney or representative payee status for...
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40-26B-26
Section 40-26B-26 Reduction of revenues; reimbursement computations; quality incentive program.
THIS SECTION WAS AMENDED BY ACT 2020-147 IN THE 2020 REGULAR SESSION, EFFECTIVE MAY 18, 2020.
THIS IS NOT IN THE CURRENT CODE SUPPLEMENT. (a) No revenues resulting from the privilege assessment
established by this article and applied to increases in covered services or reimbursement
levels or other enhancements of the Medicaid program shall be subject to reduction or elimination
while the privilege assessment is in effect. (b) Every nursing facility participating in the
Medicaid program in the State of Alabama shall be reimbursed according to the reimbursement
methodology contained in Chapter 560-X-22 of the Alabama Medicaid Agency Administrative Code
(Supp. 12/31/95) on January 31, 1998, which methodology is incorporated by reference herein,
except that the following shall apply: (1) The ceiling for the operating cost center described
in Title 560-X-22-.06 (2)(a) of the Alabama Medicaid...
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45-39-30.02
Section 45-39-30.02 Definitions. The following words are defined for the purposes of this article:
(1) COORDINATED SYSTEM OF CARE. The total effort in the county, inclusive of service coordination/case
management, that is directed at meeting the needs of individuals who are at risk of elder
abuse. (2) COUNCIL. The Lauderdale County Council for the Prevention of Elder Abuse. (3) ELDER
ABUSE. The maltreatment of an older person, age 60 or above, by any person, including the
following: a. Emotional/Psychological Abuse. The intentional infliction of mental or emotional
anguish by threat, humiliation, intimidation, or other verbal or nonverbal abusive conduct.
Examples of psychological abuse Examples of psychological abuse include name calling, insulting,
ignoring for extended periods of time, frightening, intimidating, and isolating from friends
and family. b. Material Exploitation. The unauthorized use of funds or any resources of an
elderly individual; the misuse of power of attorney or...
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9-9-23
Section 9-9-23 Appointment of district engineer, etc.; preparation, adoption, etc., of report
and water management plan for improvements in district. (a) Within 60 days after the district
is established, it shall be the duty of the board of water management commissioners to appoint
as district engineer a competent civil or agricultural engineer of good standing in his profession
who is familiar with the type of project involved if said engineer is needed or required by
the district. Such services of an engineer may not be required if engineering services are
furnished by a federal, state or local agency. (b) In case an engineer is needed or required,
it shall be the duty of the court of probate to refer the report of the preliminary survey
or other plans to the district engineer, who shall make a survey of the district and shall
prepare a report with plans for improvements for the district. Such report shall include maps,
profiles, specifications, estimates of cost and other data and...
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22-13A-8
Section 22-13A-8 Department authorized to replicate programs and enter into contracts with
organizations with expertise. (a) The department may replicate and use successful osteoporosis
programs and enter into contracts and purchase materials or services, or both, from organizations
with appropriate expertise and knowledge of osteoporosis for services and materials which
may include any of the following: (1) Educational information and materials on the causes,
prevention, detection, treatment, and management of osteoporosis. (2) Training of staff. (3)
Physician and health care professional education and training, and clinical conferences. (4)
Conference organization and staffing. (5) Regional office development and staffing. (6) Nominations
for advisory panels. (7) Support group development. (8) Consultation. (9) Resource library
facilities. (10) Training home health aides and nursing home personnel. (11) Training teachers.
(b) The department may enter into an agreement to work with a...
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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
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