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22-6-4
Section 22-6-4 Copayments by persons receiving medical services from physicians under program.
(a) All persons eligible to receive Medicaid shall pay the sum of $1.00 for each visit as
a copayment for medical services provided by a physician under the Medicaid Program. (b) The
$1.00 copayment shall be collected by the attending physician and credited against the Medicaid
payment to the physician for the visit. (c) The provisions of this section shall become effective
only upon the approval of the Department of Health, Education and Welfare of the federal government.
(Acts 1976, No. 626, p. 860; Acts 1977, No. 703, p. 1243.)...
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22-6-4.1
Section 22-6-4.1 Copayments by persons receiving medical services from physicians or other
medical practitioners under program. (a) Medicaid eligible persons shall pay a $2.00 copayment
for medical services provided by a physician or other medical practitioner under the Medicaid
Program. (b) The $2.00 copayment shall be collected by the provider of services and credited
against the Medicaid payment to the provider for the service. (c) Medical services shall include
any services covered by the Medicaid Program and rendered by a physician or other medical
practitioner. (d) The provisions of this section shall not be effective if they are found
by a court of competent jurisdiction to contravene federal laws or federal regulations applicable
to the Medicaid Program. (Acts 1980, No. 80-126, p. 189.)...
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13A-9-150
Section 13A-9-150 Public assistance fraud; penalties. (a) For the purposes of this section,
public assistance means money or property provided directly or indirectly to eligible persons
through programs of the federal government, the state, or any political subdivision thereof,
including any program administered by a public housing authority. (b) It shall be unlawful
for an individual or business entity to knowingly do any of the following: (1) Fail, by false
statement, misrepresentation, impersonation, or other fraudulent means, to disclose a material
fact used in making a determination as to the qualification of the person to receive public
assistance. (2) Fail to disclose a change in circumstances in order to obtain or continue
to receive any public assistance to which he or she is not entitled or in an amount larger
than that to which he or she is entitled. (3) Aid and abet another person in the commission
of the prohibitions enumerated in subdivisions (1) and (2). (4) Use,...
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22-5A-4
Section 22-5A-4 Selection of community ombudsmen; training; certification; duties; area plan
to describe program; notification of department as to prospective ombudsmen; advisory committee
on program. (a) Each area agency on aging funded by the department shall select at least one
community ombudsman in each planning and service area established according to regulations
issued pursuant to the Older Americans Act of 1965, as amended. The community ombudsman shall
be an employee or contractual employee of the area agency on aging and shall certify to having
no association with any health care facility or provider for reward or profit. (b) The duties
of each community ombudsman shall be as follows: (1) To receive, investigate, respond to,
and attempt informally to resolve complaints made by or on behalf of recipients; (2) To report
immediately instances of fraud, abuse, neglect, or exploitation to the department of pensions
and security for investigation and follow-up pursuant to Chapter...
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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
22-6-151
Section 22-6-151 Regional care organizations; governing board of directors; citizen's advisory
committee; solvency and financial requirements; reporting; provider standards committee. (a)
A regional care organization shall serve only Medicaid beneficiaries in providing medical
care and services. (b) Notwithstanding any other provision of law, a regional care organization
shall not be deemed an insurance company under state law. (c)(1) A regional care organization
and an organization with probationary regional care organization certification shall have
a governing board of directors composed of the following members: a. Twelve members shall
be persons representing risk-bearing participants in the regional care organization or organization
with probationary certification. A participant bears risk by contributing cash, capital, or
other assets to the regional care organization. A participant also bears risk by contracting
with the regional care organization to treat Medicaid beneficiaries...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-151.htm - 9K - Match Info - Similar pages
22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, 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. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-153.htm - 10K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-293.htm - 2K - Match Info - Similar pages
27-1-16
Section 27-1-16 Standard health insurance claim form; electronic claims form; various claim
forms. (a)(1) The Commissioner of the Department of Insurance shall prescribe a standard health
insurance claim form to be used by all hospitals. The forms shall be prescribed in a format
which allows for the use of generally accepted diagnosis and treatment coding systems by providers
of health care and payors. The standard form shall be accepted and used by all insurers doing
business in the State of Alabama and by all state agencies which pay providers of health care
for hospital services. (2) The Commissioner of the Department of Insurance shall also prescribe
a format for all health insurance claims transmitted or submitted for payment by electronic
or electro-mechanical means. Such a format shall be used by all insurers doing business in
the State of Alabama and by all state agencies which pay providers of health care for hospital
services. (b) An advisory committee of five persons, two...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-16.htm - 3K - Match Info - Similar pages
40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall have
the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible
hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient.
(2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying
any non-Medicare inpatient stay into groups for the purposes of payment. (3) ALTERNATE CARE
PROVIDER. A contractor, other than a regional care organization, that agrees to provide a
comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of
the state pursuant to a risk contract. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification
in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned
hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated
care provided by publicly owned hospitals and hospitals...
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