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25-5-293
and insurers operating in Alabama shall, at the secretary's request, provide the secretary
such data as he or she deems necessary to evaluate costs and quality. The data shall be provided
in the form and content to the secretary's specifications and in a manner deemed timely by
the secretary. The secretary may gather from health care claims intermediaries that operate
in Alabama any claims data related to diagnoses and procedures encountered in the treatment
of workers'-compensation-type injury and illness in Alabama. Results from all data
gathered shall be made available to employers or their representatives for use in decisions
regarding the direction of care or to determine appropriateness of reimbursement. (i) Beginning
immediately after May 19, 1992, and to be completed within six months thereafter, the secretary
may engage an independent firm to identify the initial costs for the program. These initial
expenses shall include, but not be limited to, the establishment of a data...
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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...
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22-11A-118
Section 22-11A-118 Health Care Data Advisory Council. (a) There is established the Health Care
Data Advisory Council to assist in developing regulations and standards necessary to implement
the provisions of this article, to review and serve as consultants to the board on matters
related to any reports or publications prior to a report or publication release and to serve
as consultants to the board on matters relating to the protection, collection, and dissemination
of health care facility acquired infection data. (b) The council shall consist of 18 members
and be constituted in the following manner: (1) Six hospital members to be appointed by the
Alabama Hospital Association, two of which shall be infection control professionals. (2) Three
members to be appointed by the Medical Association of the State of Alabama. (3) Two members
to be appointed by the Business Council of Alabama, at least one of whom represents a small
business, all of whom are purchasers of health care, and none of...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
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16-1-18.1
Director of the Alabama School of Fine Arts; the Executive Director of the Alabama High School
of Mathematics and Science; the Secretary of the Senate, the Clerk of the House of Representatives,
the Lieutenant Governor; the Speaker of the House of Representatives; the chief executive
officer of any other employer as provided in this section. (4) SICK LEAVE. The absence from
duty by an employee as a result of any of the following: a. Personal illness or doctor's
quarantine. b. Incapacitating personal injury. c. Attendance upon an ill member
of the employee's immediate family (parent, spouse, child, foster child currently in the care
and custody of the employee, sibling); or an individual with a close personal tie.
d. Death in the family of the employee (parent, spouse, child, sibling, parent-in-law, son-in-law,
daughter-in-law, brother-in-law, sister-in-law, nephew, niece, grandchild, grandparent, uncle,
or aunt). e. Death, injury, or sickness of another person who has unusually...
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27-61-1
functions. 5. CORPORATE RECORDS OF THE COMMISSION The Commission shall maintain its corporate
books and records in accordance with the Bylaws. 6. QUALIFIED IMMUNITY, DEFENSE, AND INDEMNIFICATION
a. The Members, officers, executive director, employees, and representatives of the Commission,
the Executive Committee, and any other Committee of the Commission shall be immune from suit
and liability, either personally or in their official capacity, for any claim for damage to
or loss of property or personal injury or other civil liability caused by or
arising out of any actual or alleged act, error, or omission that occurred, or that the person
against whom the claim is made had a reasonable basis for believing occurred within the scope
of Commission employment, duties, or responsibilities; provided that nothing in this paragraph
shall be construed to protect any such person from suit and/or liability for any damage, loss,
injury, or liability caused by the intentional or willful or wanton...
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27-60-2
committees as its bylaws may provide for the carrying out of its functions. 4. Corporate records
of the commission. The commission shall maintain its corporate books and records in accordance
with the bylaws. 5. Qualified immunity, defense, and indemnification. a. The members, officers,
executive director, employees, and representatives of the commission shall be immune from
suit and liability, either personally or in their official capacity, for any claim for damage
to or loss of property or personal injury or other civil liability caused by
or arising out of any actual or alleged act, error, or omission that occurred, or that the
person against whom the claim is made had a reasonable basis for believing occurred within
the scope of commission employment, duties, or responsibilities. Nothing in this paragraph
shall be construed to protect any such person from suit or liability, or both, for any damage,
loss, injury, or liability caused by the intentional or willful and wanton...
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40-27-1
a tax measured in any way by the capital of a corporation considered in its entirety. 6. "Gross
receipts tax" means a tax, other than a sales tax, which is imposed on or measured by
the gross volume of business, in terms of gross receipts or in other terms, and in the determination
of which no deduction is allowed which would constitute the tax an income tax. 7. "Sales
tax" means a tax imposed with respect to the transfer for a consideration of ownership,
possession or custody of tangible personal property or the rendering of services measured
by the price of the tangible personal property transferred or services rendered and
which is required by state or local law to be separately stated from the sales price by the
seller, or which is customarily separately stated from the sales price, but does not include
a tax imposed exclusively on the sale of a specifically identified commodity or article or
class of commodities or articles. 8. "Use tax" means a nonrecurring tax, other than
a...
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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...
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25-5-311
Section 25-5-311 Workers' Compensation Medical Services Board; creation, members, functions.
There is established a Workers' Compensation Medical Services Board composed of five physicians
licensed to practice medicine in the State of Alabama who shall be appointed by the Secretary
of the Department of Labor. The initial board shall be selected from a list of 15 physicians
who are members of the Medical Association of the State of Alabama, submitted by the association.
Members of the board shall serve terms of five years. In order that the appointments be staggered,
one member shall serve an initial term of six years, one member shall serve an initial term
of two years, one member shall serve an initial term of three years, one member shall serve
an initial term of four years, and the remaining member shall serve an initial term of five
years. Thereafter, successors shall be appointed by the secretary from among a list of three
nominees submitted by the Medical Association of the State...
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