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22-6-225
Section 22-6-225 Denial of claims; grievances and appeals. (a) The Medicaid Agency shall establish
by rule procedures for safeguarding against wrongful denial of claims and addressing grievances
of enrollees in an integrated care network. (b) If a patient or the provider is dissatisfied
with the decision of an integrated care network, the patient or provider may file a written
notice of appeal to the Medicaid Agency. The Medicaid Agency shall adopt rules governing the
appeal, which shall include a full evidentiary hearing and a finding on the record. The Medicaid
Agency's decision shall be binding upon the integrated care network. However, a patient or
provider may file an appeal in circuit court in the county in which the patient resides, or
the county in which the provider provides services. (c) The Medicaid Agency shall by rule
establish procedures for addressing grievances and appeals of the integrated care network.
The appeal procedure shall include an opportunity for a fair...
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22-6-224
Section 22-6-224 Medicaid Agency to contract for medical care; enrollment; delivery of services;
reimbursement. (a) Subject to approval of the federal Centers for Medicare and Medicaid Services,
the Medicaid Agency shall enter into contracts with one or more integrated care networks to
provide, pursuant to a risk contract under which the Medicaid Agency makes a capitated payment,
medical care to Medicaid beneficiaries assigned to the integrated care network. The Medicaid
Agency may enter into a contract pursuant to this section only if, in the judgment of the
Medicaid Agency, care of Medicaid beneficiaries would be better, more efficient, and less
costly than under the then existing care delivery system. Pursuant to the contract, the Medicaid
Agency shall set capitation payments for the integrated care network. (b) The Medicaid Agency
shall enroll beneficiaries it designates into an integrated care network consistent with guidance
from the Center for Medicare and Medicaid Services. (c)...
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22-6-163
Section 22-6-163 Legislative findings; rules; collaboration; approval of agreements and contracts;
state action immunity; confidentiality of records; additional duties. (a) The Legislature
declares that collaboration among public payers, private health carriers, third party purchasers,
and providers to identify appropriate service delivery systems and reimbursement methods in
order to align incentives in support of integrated and coordinated health care delivery is
in the best interest of the public. Collaboration pursuant to this article is to provide quality
health care at the lowest possible cost to Alabama citizens who are Medicaid eligible. The
Legislature, therefore, declares that this health care delivery system affirmatively contemplates
the foreseeable displacement of competition, such that any anti-competitive effect may be
attributed to the state's policy to displace competition in the delivery of a coordinated
system of health care for the public benefit. In furtherance of...
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22-18-6
Section 22-18-6 Violations; good Samaritan provisions; scope of privilege; control of emergency
scene; penalties. (a) It shall be a Class A misdemeanor for any person, firm, company, corporation,
organization, facility, or agency to do any of the following: (1) Deliberately hinder, obstruct,
or interfere with an officer, inspector, or duly authorized agent of the board while in the
performance of official duties. (2) Deliberately hinder, obstruct, or interfere with any physician,
licensed nurse, licensed EMSP, or emergency personnel exempt from licensure under this article
while that individual is providing emergency care to a third person or while that individual
is assisting at the scene of an emergency, directing traffic at the scene of an emergency,
or managing or helping to manage the scene of an emergency. (3) Violate subsection (c) or
(d). (4) Offer, provide, or perform, without a license or certificate to do so, an emergency
medical service or other function which, under this...
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27-60-2
Section 27-60-2 Interstate Insurance Product Regulation Compact. The State of Alabama hereby
agrees to the following interstate compact known as the Interstate Insurance Product Regulation
Compact: ARTICLE I. PURPOSES. The purposes of this compact are, through means of joint and
cooperative action among the compacting states: 1. To promote and protect the interest of
consumers of individual and group annuity, life insurance, disability income, and long-term
care insurance products; 2. To develop uniform standards for insurance products covered under
the compact; 3. To establish a central clearinghouse to receive and provide prompt review
of insurance products covered under the compact and, in certain cases, advertisements related
thereto, submitted by insurers authorized to do business in one or more compacting states;
4. To give appropriate regulatory approval to those product filings and advertisements satisfying
the applicable uniform standard; 5. To improve coordination of...
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41-16-72
Section 41-16-72 Procurement of professional services. Any other provision of law notwithstanding,
the procurement of professional services by any agency, department, board, bureau, commission,
authority, public corporation, or instrumentality of the State of Alabama shall be conducted
through the following selection process: (1)a. Except as otherwise provided herein, attorneys
retained to represent the state in litigation shall be appointed by the Attorney General in
consultation with the Governor from a listing of attorneys maintained by the Attorney General.
All attorneys interested in representing the State of Alabama may apply and shall be included
on the listing. The selection of the attorney or law firm shall be based upon the level of
skill, experience, and expertise required in the litigation and the fees charged by the attorney
or law firm shall be taken into consideration so that the State of Alabama receives the best
representation for the funds paid. Fees shall be...
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22-18-50
Section 22-18-50 Enactment and text of Emergency Medical Services Personnel Licensure Interstate
Compact. The Emergency Medical Services Personnel Licensure Interstate Compact is hereby enacted
into law and entered into with all other jurisdictions legally joining therein in form substantially
as follows: SECTION 1. PURPOSE In order to protect the public through verification of competency
and ensure accountability for patient care related activities all states license emergency
medical services (EMS) personnel, such as emergency medical technicians (EMTs), advanced EMTs
and paramedics. This Compact is intended to facilitate the day to day movement of EMS personnel
across state boundaries in the performance of their EMS duties as assigned by an appropriate
authority and authorize state EMS offices to afford immediate legal recognition to EMS personnel
licensed in a member state. This Compact recognizes that states have a vested interest in
protecting the public's health and safety...
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30-3-4.2
Section 30-3-4.2 Grandparent visitation. (a) For the purposes of this section, the following
words have the following meanings: (1) GRANDPARENT. The parent of a parent, whether the relationship
is created biologically or by adoption. (2) HARM. A finding by the court, by clear and convincing
evidence, that without court-ordered visitation by the grandparent, the child's emotional,
mental, or physical well-being has been, could reasonably be, or would be jeopardized. (b)
A grandparent may file an original action in a circuit court where his or her grandchild resides
or any other court exercising jurisdiction with respect to the grandchild or file a motion
to intervene in any action when any court in this state has before it any issue concerning
custody of the grandchild, including a domestic relations proceeding involving the parent
or parents of the grandchild, for reasonable visitation rights with respect to the grandchild
if any of the following circumstances exist: (1) An action for...
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22-22A-5
Section 22-22A-5 Powers and functions of department; representation of department by Attorney
General in legal actions. In addition to any other powers and functions which may be conferred
upon it by law, the department is authorized beginning October 1, 1982 to: (1) Administer
appropriate portions of Sections 9-7-10 through 9-7-20, which relate to permitting, regulatory
and enforcement functions; administer and enforce the provisions and execute the functions
of Chapter 28 of this title; Chapter 22 of this title; Article 2 of Chapter 23 of this title;
Chapter 30 of this title; appropriate portions of Article 1 of Chapter 27 of this title; Sections
22-24-1 through 22-24-11; Sections 22-25-1 through 22-25-15; and Sections 22-36-1 through
22-36-10. (2) Acting through the Environmental Management Commission, promulgate rules, regulations,
and standards in order to carry out the provisions and intent of this chapter; provided, however,
that prior to the promulgation of any state primary or...
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22-6-220
Section 22-6-220 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) CAPITATION PAYMENT. A payment the state Medicaid Agency makes
periodically to the integrated care network on behalf of each recipient enrolled under a contract
for the provision of medical services pursuant to this article. (2) COLLABORATOR. A private
health carrier, third party purchaser, provider, health care center, health care facility,
state and local governmental entity, or other public payers, corporations, individuals, and
consumers who are expecting to collectively cooperate, negotiate, or contract with another
collaborator, or integrated care network in the health care system. (3) INTEGRATED CARE NETWORK.
One or more statewide organizations of health care providers, with offices in each regional
care organization region, that contracts with the Medicaid Agency to provide Medicaid benefits
to certain Medicaid beneficiaries as defined in subdivision (4) and...
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