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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/40-26B-20.htm - 1K - Match Info - Similar pages
27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or dental plan beneficiary may assign reimbursement for health or dental care services directly to the provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic, optometric, durable medical equipment, and home care services. The company or agency, when authorized by the insured, or health or dental plan beneficiary, shall pay directly to the health care provider the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the contract provider, and any applicable interest. This amount only applies to assigned claims. Any company or agency making a payment to the insured, or health or dental plan beneficiary, after the rights of reimbursement have been assigned to the provider of services, shall be liable to the provider for the payment. If the company or agency fails to reimburse the provider in accordance with the terms...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-19.htm - 2K - Match Info - Similar pages
26-1-4
Section 26-1-4 Alabama State Law Enforcement Agency to provide criminal conviction information on applicants for positions involving child care and treatment; such information to be confidential; applicant to be denied status if has felony conviction; children may be removed from home. (a) Notwithstanding any other provisions of law to the contrary, upon request to the Alabama State Law Enforcement Agency, by the Department of Human Resources, or by any other youth service agency approved by the department, such center shall provide information to the department or an approved agency concerning the felony criminal conviction record in this or another state of an applicant for a paid or voluntary position, including one established by contract, whose primary duty is the care or treatment of children, including applicants for adoption or foster parents. All information, including any criminal conviction record, procured by the department or an approved agency shall be confidential and...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/26-1-4.htm - 2K - Match Info - Similar pages
27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements; discounts. (a) As used in this section, the following words shall have the following meanings: (1) CONTRACTUAL DISCOUNT. A percentage reduction from a provider's usual and customary rate for covered services and materials required under a participating provider agreement. (2) COVERED MATERIALS. Materials for which reimbursement from the insurer or vision care plan is provided to a vision care provider by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual limitations of deductibles, copayments, or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the insurer or vision care plan is provided to a vision care provider by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual plan limitations of deductibles, copayments, or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-10.htm - 4K - Match Info - Similar pages
27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about policy or plan; payment and reimbursement procedures. The provisions of this chapter do not prohibit the following conduct and shall be construed to provide that: (1) A dentist may contract directly with a patient for the furnishing of dental care services to said patient as may be otherwise authorized by law; (2) Any person providing a health insurance policy or employee benefit plan, or an employer, or an employee organization may: a. Make available to its insureds, beneficiaries, participants, employees, or members information relating to dental care services by the distribution of factually accurate information regarding dental care services, rates, fees, location, and hours of service, provided such distribution is made upon the request of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates payment for dental care services by insureds, beneficiaries,...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-7.htm - 1K - Match Info - Similar pages
34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained in this chapter shall be construed to create a requirement that any health benefit plan, group insurance plan, policy, or contract for health care services that covers hospital, medical, or surgical expenses, 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 group health care services to patients, insureds, or beneficiaries in this state, including entities created pursuant to Article 6, commencing with Section 10A-20-6.01, of Chapter 20, Title 10A, provide coverage or reimbursement for the services described or authorized in this chapter. (Act 2017-383, ยง4.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-19-21.htm - 1K - Match Info - Similar pages
22-21-271
Section 22-21-271 Certificates of need - Application fees; appropriation of funds; disposition of fees. (a) Each application for a certificate of need shall be accompanied by a fee of one percent of the estimated cost of the proposed cost of the new Institutional Health Service, or a maximum of twelve thousand dollars ($12,000) (indexed) per application. Provided, that the application fee shall be three-fourths of one percent of the estimated cost of the proposed new Institutional Health Service, or a maximum of eight thousand dollars ($8,000) if the applicant has had an average daily census comprised of 50 percent or more Medicaid patients within the last year prior to the filing of the application and a maximum of six thousand dollars ($6,000) if a rural hospital applicant has had an average daily census comprised of 30 percent or more Medicaid/Medicare patients within the last year prior to the filing of the application. The minimum fee shall be set by the SHPDA. Fees shall be used...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-271.htm - 3K - Match Info - Similar pages
22-6-10
Section 22-6-10 Women's right to health care. (a) This section shall be known and may be cited as the "Women's Right to Health Care Act." (b) Any state program funded under Title XIX of the federal Social Security Act, 42 U.S.C. Section 1396 et seq., and any other publicly funded state health care program which provides coverage for mastectomy surgery shall also provide coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient is eligible for Medicaid and elects reconstruction within two years of the mastectomy surgery and in the manner chosen by the patient and the physician, in accordance with guidelines consistent with Medicare and other third party payers. Reimbursement is allowed only for breast reconstructive surgery following a medically necessary mastectomy when performed for the removal of cancer. As used in this section, the term "reconstruction" shall...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-10.htm - 1K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-12.htm - 2K - Match Info - Similar pages
41-5A-6
Section 41-5A-6 Chief examiner - Recovery audits for overpayments of state funds. (a) For the purposes of this section, the following words have the following meanings: (1) CHIEF EXAMINER. The Chief Examiner of Public Accounts. (2) OVERPAYMENT. Any payment in excess of amounts due and includes failure to meet eligibility requirements, failure to identify third party liability where applicable, any payment for an ineligible good or service, any payment for a good or service not received, duplicate payments, invoice and pricing errors, failure to apply discounts, rebates, or other allowances, failure to comply with contracts or purchasing agreements, or both, failure to provide adequate documentation or necessary signatures, or both, on documents, or any other inadvertent error resulting in overpayment. (3) RECOVERY AUDIT. A financial management technique used to identify overpayments made by a state agency with respect to individuals, vendors, service providers, and other entities in...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/41-5A-6.htm - 8K - Match Info - Similar pages
|