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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow
these procedures: (1) The pharmacy contract shall identify and describe in detail the audit
procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice
at least two weeks before conducting the initial on-site audit for each audit cycle. If the
pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-184.htm - 9K - Match Info - Similar pages
16-44B-1
Commission may deem appropriate. The executive director shall serve as secretary to the Interstate
Commission, but shall not be a Member of the Interstate Commission. The executive director
shall hire and supervise such other persons as may be authorized by the Interstate Commission.
D. The Interstate Commission's executive director and its employees shall be immune from suit
and liability, either personally or in their official capacity, for a claim for damage to
or loss of property or personal injury or other civil liability caused or arising
out of or relating to an actual or alleged act, error, or omission that occurred, or that
such person had a reasonable basis for believing occurred, within the scope of Interstate
Commission employment, duties, or responsibilities; provided, that such person shall not be
protected from suit or liability for damage, loss, injury, or liability caused by the
intentional or willful and wanton misconduct of such person. 1. The liability of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-44B-1.htm - 46K - Match Info - Similar pages
35-11-371
persons, firms, or corporations claimed by the injured person, or the legal representative
of the person, to be liable for damages arising from the injuries. The claimant shall also
within one day after the filing of the claim or lien, mail a copy thereof by registered or
certified mail, postage prepaid, for each person, firm, or corporation so claimed to be liable
on account of the injuries, at the addresses so given in the statement, and to the patient,
his or her guardian, or his or her personal representative at the address given at
the time of admission. (d) The filing of a claim or lien shall be notice thereof to all persons,
firms, or corporations liable for damages, whether or not they are named in the claim or lien.
Nothing shall be deemed to preclude the hospital from perfecting its lien outside of the time
limits stated in this section through providing actual notice to persons, firms, or corporations.
(e) The judge of probate shall endorse thereon the date and hour of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/35-11-371.htm - 5K - Match Info - Similar pages
27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-3A-3.htm - 3K - Match Info - Similar pages
31-9B-3
Section 31-9B-3 Providing of information; requirements for emergency and disaster planning
provisions; immunity. (a) All appropriate agencies and community-based service providers,
including, but not limited to, home health care providers, hospices, community mental health
centers, and related facilities, but not including health care facilities which provide inpatient
care to include general and specialized hospitals including ancillary services, skilled nursing
facilities, intermediate care facilities, or any assisted living facility, shall provide information
on the number of individuals with medical needs and shall assist the State Health Department
in the establishment of programs to increase the awareness of medical needs shelters, and
in educating clients and sponsors or caregivers about the procedures that may be necessary
for their safety during disasters. (b) State agencies that regulate or contract with providers
of services, or both, for persons with disabilities or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/31-9B-3.htm - 3K - Match Info - Similar pages
22-21-263
Section 22-21-263 New institutional health services subject to review. (a) All new institutional
health services which are subject to this article and which are proposed to be offered or
developed within the state shall be subject to review under this article. No institutional
health services which are subject to this article shall be permitted which are inconsistent
with the State Health Plan. For the purposes of this article, new institutional health services
shall include any of the following: (1) The construction, development, acquisition through
lease or purchase, or other establishment of a new health care facility or health maintenance
organization. A transaction involving the sale, lease, or other transfer or change of control
of an existing health care facility, existing health maintenance organization, or existing
institutional health service is not subject to certificate of need review or approval under
this article unless the transaction also involves implementing one or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-263.htm - 6K - Match Info - Similar pages
22-21-264
Section 22-21-264 Criteria for state agency review. The SHPDA, pursuant to the provisions of
Section 22-21-274, shall prescribe by rules and regulations the criteria and clarifying definitions
for reviews covered by this article. These criteria shall include at least the following:
(1) Consistency with the appropriate State Health Facility and services plans effective at
the time the application was received by the State Agency, which shall include the latest
approved revisions of the following plans: a. The most recent Alabama State Health Plan which
shall include updated inventories and separate bed need methodologies for inpatient rehabilitation
beds, inpatient psychiatric beds and inpatient/residential alcohol and drug abuse beds. b.
Alabama State Health Plan for services to the mentally ill. c. Alabama State Plan for rehabilitation
facilities. d. Alabama developmental disabilities plan. e. Alabama State alcoholism plan.
f. Such other State Plans as may from time to time be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-264.htm - 4K - Match Info - Similar pages
27-14-11.1
27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid eligibility
void. (a) For purposes of this section, "private insurer" is defined as any of the
following: (1) Any commercial insurance company offering health or casualty insurance to individuals
or groups, including both experience-rated contracts and indemnity contracts. (2) Any profit
or nonprofit prepaid plan offering either medical services or full or partial payment for
the diagnosis or treatment of an injury, disease, or disability. (3) Any organization
administering health or casualty insurance plans for professional associations, unions, fraternal
groups, employer-employee benefit plans, and any similar organization offering these payments
or services, including self-insured and self-funded plans. (4) Any health insurer, including
group health plans, as defined in Section 607(1) of the Employee Retirement Income Security
Act of 1974, self-insured plans, service benefit plans, managed care...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-14-11.1.htm - 3K - Match Info - Similar pages
11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration of
program. (a) The Local Government Health Insurance Board shall govern and administer the Local
Government Health Insurance Program currently governed and administered by the State Employees'
Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the governance
and administration to the board shall take effect at 12:01 a.m. on January 1, 2015, and thereafter
the board shall take all control and responsibility for the program under procedures and authority
set out in this chapter. (b) The program governed and administered by the board shall provide
a reasonable relationship between the health care benefits to be included and the expected
health care expenses to be incurred by affected employees, retirees, and their dependents.
The board may establish a fully insured or self-insured health care plan for employees and
retirees as defined in this chapter and may adopt rules for the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/11-91A-2.htm - 5K - Match Info - Similar pages
36-29-1
Section 36-29-1 Definitions. When used in this chapter, the following terms shall have the
following meanings, respectively, unless the context clearly indicates otherwise: (1) BOARD.
The State Employees' Insurance Board. (2) CLASS. An employee or retiree shall be included
in one of the following classes: (i) active employee single, (ii) active employee family,
(iii) non-Medicare retiree single, (iv) non-Medicare retiree family, (v) Medicare retiree
single, (vi) Medicare retiree family, (vii) non-Medicare retiree with Medicare eligible dependent(s),
or (viii) Medicare retiree with non-Medicare dependent(s). (3) EMPLOYEE. A person who works
full time for the State of Alabama or for a county health department and who receives his
or her full compensation on a monthly basis through means of a state warrant drawn upon the
State Treasury or by check drawn by the Treasurer of the Alabama State Port Authority or by
check drawn by the treasurer of the Alabama state agency for surplus property...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-29-1.htm - 11K - Match Info - Similar pages
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