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22-6-160
Section 22-6-160 Evaluation and report on long-term care system for Medicaid beneficiaries.
The Medicaid Agency shall decide which groups of Medicaid beneficiaries to include for coverage
by a regional care organization or alternate care provider. The Medicaid Agency, without the
approval of the Governor, shall not make a coverage decision that would affect Medicaid beneficiaries
who are directly served by another state agency. (Act 2013-261, p. 686, §11; Act 2015-322,
§1.)...
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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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27-56-10
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...
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6-5-548
Section 6-5-548 Burden of proof; reasonable care as similarly situated health care provider;
no evidence admitted of medical liability insurance. (a) In any action for injury or damages
or wrongful death, whether in contract or in tort, against a health care provider for breach
of the standard of care, the plaintiff shall have the burden of proving by substantial evidence
that the health care provider failed to exercise such reasonable care, skill, and diligence
as other similarly situated health care providers in the same general line of practice ordinarily
have and exercise in a like case. (b) Notwithstanding any provision of the Alabama Rules of
Evidence to the contrary, if the health care provider whose breach of the standard of care
is claimed to have created the cause of action is not certified by an appropriate American
board as being a specialist, is not trained and experienced in a medical specialty, or does
not hold himself or herself out as a specialist, a "similarly...
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22-6-192
Section 22-6-192 Definitions. For the purposes of this article, the following words have the
following meanings: (1) DEPARTMENT. The State Department of Revenue. (2) FISCAL YEAR. An accounting
period of 12 months beginning on the first day of the first month of the state fiscal year.
(3) 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 Medicaid Agency pursuant to
executive order and Title 560 of the Alabama Administrative Code. (4) PACE PROVIDER. PACE
means a provider under the federal Program for All Inclusive Care for the Elderly operated
by a public, private, nonprofit, or proprietary entity, as permitted by federal law as defined
at 42 C.F.R. §460.6, as amended and supplemented. (Act 2014-126, p. 236, §3.)...
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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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27-49-3
Section 27-49-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, policy, or contract for health
care services issued, delivered, issued for delivery, renewed in this state by a health care
insurer, health maintenance organization, accident and sickness insurer, fraternal benefit
society, nonprofit hospital service corporation, nonprofit medical service corporation, health
care service plan, or any other person, firm, corporation, joint venture, or other similar
business entity that pays for, purchases, or furnishes health care services to patients, insureds,
or beneficiaries in this state. The term includes, but is not limited to, entities created
pursuant to Article 6 of Chapter 4 of Title 10. For the purposes of this chapter, a health
benefit plan located or domiciled outside of the State of Alabama is deemed to be subject
to the provisions of this chapter if it receives, processes,...
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36-1A-3
Section 36-1A-3 Definitions. As used in this chapter the following words have the following
meanings: (1) ALABAMA STATE EMPLOYEE COMBINED CHARITABLE CAMPAIGN (ASECCC). The annual combined
charitable fund-raising program established through this chapter to receive and distribute
voluntary payroll deduction contributions of state employees. (2) CHARITABLE FUND-RAISING
FEDERATION. A legally constituted grouping of at least 10 health and human care agencies that
are bound together to raise and distribute charitable contributions. (3) AFFILIATED CHARITABLE
AGENCY. A charitable agency which is affiliated with a charitable fund-raising federation
for the purpose of directly sharing funds raised by the organization. (4) CHARITABLE AGENCY.
A volunteer, not-for-profit organization under federal regulation 26 CFR 1.501(c)(3) which
provides health or human care services to individuals. (5) CAMPAIGN MANAGER. The participating
federation, selected by the local agency review committee, responsible...
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22-6-11
Section 22-6-11 Breast and cervical cancer prevention and treatment. (a) This section shall
be known and may be cited as the "2009 Breast and Cervical Cancer Prevention and Treatment
Act." (b)(1) Medicaid eligibility and coverage shall be extended to a woman who has been
determined to be eligible to participate in and has been screened for breast or cervical cancer
by any health care provider or entity, or both, that satisfies any of the following: a. Receives
direct payment for screening services by National Breast and Cervical Cancer Early Detection
Program (NBCCEDP) Title XV funds. b. Is funded at least in part by NBCCEDP grantee Title XV
funds for screening services. c. Is not funded at all by NBCCEDP grantee Title XV funds but
has been identified by the Department of Public Health as part of the Alabama Breast and Cervical
Cancer Early Detection Program and operates consistently within its guidelines. (2) Coverage
under this section shall be limited to any woman screened and...
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27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services provided
under a policy or contract delivered, continued, or renewed in this state on or after August
1, 1997, and to any existing policy or contract, on the policy's or...
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