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27-57-5
Section 27-57-5 Coverage by participating providers; selection criteria and utilization protocols;
maximum benefits, exclusions, etc. (a) This chapter does not require and shall not be construed
to require the coverage of services of providers who are not designated as covered providers,
or who are not selected as a participating provider, by a group health benefit plan or insurer
having a participating network of service providers. Nothing in this chapter is intended to
expand the list or designation of participating providers as specified in any health benefit
plan. (b) Insurers or other issuers of any health benefit plan covered by this chapter shall
continue to be able to establish and apply selection criteria and utilization protocols for
health care providers including the designation of types of providers for which coverage is
provided as well as credentialing criteria used in the selection of providers. (c) A group
health benefit plan, policy, or contract that provides coverage...
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34-24-210.1
Section 34-24-210.1 Evaluation and treatment by physical therapist. (a) Without prescription
or referral, a licensed physical therapist may perform an initial evaluation or consultation
of a screening nature to determine the need for physical therapy and may perform the physical
therapy and other services provided in subdivisions (1) to (5), inclusive, of subsection (b).
Implementation of physical therapy shall otherwise be based on the referral of a person licensed
to practice medicine, surgery, dentistry, chiropractic, licensed assistant to a physician
acting pursuant to a valid supervising agreement, or a licensed certified registered nurse
practitioner in a valid collaborative practice agreement with a licensed physician. (b) The
physical therapy and other services referred to in subsection (a), which may be performed
without prescription or referral, include and are limited to the following: (1) To a child
with a diagnosed developmental disability pursuant to the plan of care for...
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38-9B-3
Section 38-9B-3 Contributors allowed to supplement care of impaired persons; assets of trustees.
THIS SECTION WAS AMENDED BY ACT 2018-36 IN THE 2018 REGULAR SESSION, EFFECTIVE JANUARY 31,
2018. THIS IS NOT IN THE CURRENT CODE SUPPLEMENT. (a) Contributors may supplement the care,
support, habilitation, and treatment of impaired persons pursuant to this chapter. Neither
the contribution to the AFT Trust for the benefit of a life beneficiary nor the use of AFT
Trust assets to provide benefits shall in any way reduce, impair, or diminish the benefits
to which a person is otherwise entitled by law. The establishment and administration of the
AFT Trust shall not be taken into consideration in appropriations for the department or the
Alabama Medicaid Agency to render services required by law. (b) The assets held by the trustee
and assets held in the AFT Trust and the AFT Charitable Trust pursuant to this chapter shall
not be considered state money, assets of the state, or revenue for any...
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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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22-5B-2
Section 22-5B-2 Legislative findings. (a) The legislative findings, purpose, and intent of
this chapter are to develop the infrastructure for a statewide network of lifespan respite
programs in Alabama and for Alabama Respite to be the statewide entity to address issues relating
to respite care in our state. (b) The Alabama Legislature makes the following findings: (1)
Respite is short term temporary relief that can make a world of difference for family caregivers
of both children and adults with disabilities and other health care needs. (2) Respite is
one of the home and community-based services most requested by family caregivers, yet remains
in short supply. (3) As of 2012, over 818,000 adults in Alabama are caregivers for a family
member. (4) Respite helps preserve families by reducing stress, supporting stability, preventing
situations that can lead to abuse and neglect, and reducing the incidence of divorce and out-of-home
placement. (5) Respite is a simple, cost-effective...
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22-6-122
Section 22-6-122 Medicaid Pharmacy and Therapeutics Committee - Classification and recommendation
of drugs; assurance of quality patient care; review of pharmaceutical products. (a) The Medicaid
Pharmacy and Therapeutics Committee shall review and recommend classes of drugs to the Medicaid
Commissioner for inclusion in the Medicaid Preferred Drug Plan. Class means a therapeutic
group of pharmaceutical agents approved by the FDA as defined by the American Hospital Formulary
Service. The classes of anti-retroviral and anti-psychotic drugs shall not be included in
the Medicaid Preferred Drug Plan. (b) The Medicaid Pharmacy and Therapeutics Committee shall
develop its preferred drug list recommendations by considering the clinical efficacy, safety,
and cost effectiveness of a product. Within each covered class, the committee shall review
and recommend drugs to the Medicaid Commissioner for inclusion on a preferred drug list. Generics
and over the counter drugs covered by Medicaid may be...
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25-5-312
Section 25-5-312 Powers and duties of the board. The board shall exercise general supervision
in all matters related to the provision of medical services provided by physicians, as defined
in Section 25-5-310, rendered to workers under this article. The duties of the board shall
include, but are not limited to, the following: (1) Study, develop, and implement any necessary
and reasonable guidelines for medical services and physician care provided by physicians.
In addition, with respect to services provided by physicians, the board shall study, develop,
and recommend to the secretary uniform medical criteria and policies for the conduct of utilization
review, bill screenings, and medical necessity determinations for use by insurance carriers,
self-insurers, and claims administrators. (2) Study, design, and implement standardized uniform
claims processing forms and forms for the reporting of medical information to employers and
insurance companies by physicians. (3) Address and give...
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41-10-351
Section 41-10-351 Definitions. The following terms hereafter used in this article shall have
the following respective meanings: (1) AUTHORITY. The public corporation organized pursuant
to the provisions of this article. (2) BONDS. The bonds issued under the provisions of this
article. (3) COMMISSIONER. The Commissioner of Mental Health. (4) DEPARTMENT. The Department
of Mental Health provided for in Chapter 50 of Subtitle 2 of Title 22. (5) DIRECTORS. The
board of directors of the authority. (6) MENTAL HEALTH FACILITIES. Any one or more of the
following: hospitals and other facilities of any kind for treatment and care of the mentally
ill and individuals with an intellectual disability; regional or community-based mental health
centers; regional or community-based facilities for treatment and care of the mentally ill
or individuals with an intellectual disability; regional or community-based centers for the
treatment of alcoholism or drug addiction; and improvements to existing state...
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11-91A-7
Section 11-91A-7 Jurisdiction of board; funding; powers of board. The board shall have full,
complete, and exclusive jurisdiction over the program and shall allocate funds from its treasury
for the fulfillment and accomplishment of its duties and responsibilities in a manner as may
be necessary and appropriate to carry out the purposes of this chapter. The board shall have
the general powers and authority granted under the laws of this state for health insurers,
and in addition thereto, the specific authority to do all of the following: (a) Subject to
compliance with Section 11-91A-8 where applicable, execute a contract or contracts to provide
for the administration of the program in accordance with this chapter. The contract or contracts
may be executed with one or more agencies or corporations licensed to transact or administer
group health care business in this state with similar plans of the state for the joint performance
of common administrative functions. (b) Establish, and...
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22-52-17
Section 22-52-17 Public facilities other than Department of Mental Health not required to perform
mental evaluations; exceptions. Notwithstanding any other language in this article, the following
limitations shall apply. No public facility other than the Department of Mental Health may
be required (as distinguished from authorized) by the probate court to perform any mental
evaluation of a person sought to be committed for use in any final commitment hearing except:
(1) In an emergency case wherein no other source or agency which is funded or mandated by
federal law, state law or both to provide such services is objectively capable of performing
such evaluation within the time limit imposed by law; or (2) In an emergency case wherein
no other source or agency operates to perform such evaluation in such emergency case, a public
hospital may be required to accept a person sought to be committed for the provision of hospital
care, if such person is admitted to the public hospital or other...
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