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40-26B-20
Section 40-26B-20 Definitions. The following words, terms, and phrases shall have the
following meanings: (1) BED. Any bed that is licensed by the Alabama Department of Health
and its successor agency to provide nursing home care which is in a nursing facility. (2)
DEPARTMENT. The Department of Revenue of the State of Alabama. (3) FISCAL YEAR. An accounting
period of 12 months beginning on the first day of the first month of the state fiscal year.
(4) MEDICAID PROGRAM. The medical assistance program as established in Title XIX of the Social
Security Act and as administered in the State of Alabama by the Alabama Medicaid Agency pursuant
to executive order and Title 560 of the Alabama Administrative Code. (5) NURSING FACILITY.
An institution which is licensed under the laws of the State of Alabama as a skilled nursing
facility or an intermediate nursing facility. Nursing facility shall not include any facility
owned or operated by, or operating under an exclusive contract with, the State...
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22-12B-2
Section 22-12B-2 Board established; composition; meetings; powers. There is hereby established
the Alabama Mothers and Babies Indigent Care Trust Board to administer said fund. The board
shall consist of the Governor, who shall serve as ex officio chairman, the commissioner of
the Alabama Medicaid Agency, the Finance Director and the State Health Officer. The board
shall meet as necessary to carry out its duties, upon three days' notice to all board members.
The board shall have the power to transfer moneys from the trust fund to the Alabama Medicaid
Agency to carry out the purposes, intent and provisions of this chapter. The Medicaid Agency
may accept unconditional and unrestricted transfers of such moneys. The existence or availability
of this trust fund shall not reduce appropriations from the State General Fund. (Acts 1987,
No. 87-707, p. 1245, ยง2.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-12B-2.htm - 1K - Match Info - Similar pages
22-6-223
Section 22-6-223 Solvency and financial requirements. (a) An integrated care network
shall meet minimum solvency and financial requirements as provided by the Medicaid Agency.
The Medicaid Agency shall require the integrated care network, as a condition of certification
or continued certification, to maintain minimum solvency and financial reserves. The Medicaid
Agency shall hereafter promulgate rules setting forth requirements for minimum solvency, financial
reserves, and other financial requirements of an integrated care network based on the number
of integrated care networks that may be certified and based on actuarial soundness as determined
by the Medicaid Agency. The Medicaid Agency shall allow for the requirements to be met through
the submission of an irrevocable letter of credit in an amount equal to the financial reserves
that would otherwise be required of the integrated care network, to guarantee the performance
of the provisions of the risk contract. If an irrevocable...
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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have
the following meanings, respectively: (1) AGENT. A person who is appointed or employed by
a health maintenance organization and who engages in solicitation of membership in such organization.
This definition does not include a person enrolling members on behalf of an employer, union,
or other organization. (2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital
and physician care, and outpatient medical services. (3) COMMISSIONER. The Commissioner of
Insurance. (4) ENROLLEE. An individual who is enrolled in a health maintenance organization.
(5) EVIDENCE OF COVERAGE. Any certificate, agreement, or contract issued to an enrollee setting
out the coverage to which he is entitled. (6) HEALTH CARE SERVICES. Any services included
in the furnishing to any individual of medical or dental care, or hospitalization or incident
to the furnishing of such care or hospitalization, as well as the...
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27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every
health benefit plan that provides coverage for prescription drugs or devices, or administers
a plan, including, but not limited to, third party administrators for self-insured plans and
state administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds
a card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-22.htm - 3K - Match Info - Similar pages
27-21A-16
Section 27-21A-16 Examination. (a) The commissioner may make an examination of the affairs
of any health maintenance organization and providers with whom such organization has contracts
or agreements as often as is reasonably necessary for the protection of the interests of the
people of this state, but not less frequently than once every three years. (b) The State Health
Officer may make an examination concerning health care service of any health maintenance organization
and providers with whom such organization has contracts, agreements, or other arrangements
as often as is reasonably necessary for the protection of the interests of the people of this
state, but not less frequently than once every three years. (c) Every health maintenance organization
shall submit its relevant books and records for such examinations and in every way facilitate
these examinations. For the purpose of examinations, the commissioner and the State Health
Officer may administer oaths to, and examine the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-16.htm - 2K - Match Info - Similar pages
22-4-31
Section 22-4-31 Legislative findings. The Legislature does hereby set out the following
findings and reasons for passage of this article. Alabama has adopted a system of health planning
and development administered by the State Health Planning and Development Agency (SHPDA).
In addition, the Statewide Health Coordinating Council (SHCC) is charged with reviewing Alabama's
health planning needs and writing the State Health Plan to assist the Certificate of Need
Review Board. The Certificate of Need Review Board is responsible for reviewing and approving
certificate of need applications in Alabama. There is no current systematic way for the SHPDA,
SHCC, or the Certificate of Need Review Board to collect all the health care services information
necessary for proper health care planning in Alabama, because reporting to SHPDA is voluntary.
The Legislature hereby finds and determines that collection of additional health care information
is necessary for informed statewide health planning. The...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-4-31.htm - 1K - Match Info - Similar pages
27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses.
(a) The Legislature finds and declares the following: (1) The citizens of this state rely
upon health insurance to cover the cost of obtaining health care and it is essential that
the citizens' expectation that their health care costs will be paid by their insurance policies
is not disappointed and that they obtain the coverage necessary and appropriate for their
care within the terms of their insurance policies. (2) Some insurers deny payment for drugs
that have been approved by the Federal Food and Drug Administration, hereafter referred to
as FDA, when the drugs are used for indications other than those stated in the labelling approved
by the FDA, off-label use, while other insurers with similar coverage terms do pay for off-label
use. (3) Denial of payment for off-label use can interrupt or effectively deny access to necessary
and appropriate treatment for a person being treated for a...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-10.1.htm - 6K - Match Info - Similar pages
27-21A-2
Section 27-21A-2 Establishment of health maintenance organizations. (a) Notwithstanding
any law of this state to the contrary, any person may apply to the commissioner for and obtain
a certificate of authority to establish and operate a health maintenance organization in compliance
with this chapter. No person shall establish or operate a health maintenance organization
in this state without obtaining a certificate of authority under this chapter. A foreign corporation
may qualify under this chapter, subject to its registration to do business in this state as
a foreign corporation under the provisions of Sections 10-2A-220, et seq. (b) Health maintenance
organizations licensed as of May 29, 1986, shall be issued a certificate of authority in accordance
with Section 27-21A-29. (c) Each application for a certificate of authority shall be
verified by an officer or authorized representative of the applicant, shall be in a form prescribed
by the commissioner, and shall set forth or be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-2.htm - 6K - Match Info - Similar pages
36-1A-5
Section 36-1A-5 Participation limited to voluntary, charitable, health and human care
federations and agencies with a substantial local presence. (a) Participation in the Alabama
State Employee Combined Charitable Campaign shall be limited to voluntary, charitable, health
and human care federations and agencies with a substantial local presence that provide or
support direct health and welfare services to individuals or their families and meet the criteria
set forth in this section. "Substantial local presence" is defined as a facility,
staffed by professionals or volunteers, available to provide its services and open at least
15 hours a week. Such services must be available to state employees in the local campaign
community, unless they are rendered to needy persons overseas. Such services must directly
benefit human beings, whether children, youth, adults, the aged, the ill and infirm, or the
mentally or physically handicapped. Such services must consist of care, research, or...
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