27-21A-4
Section 27-21A-4 Powers of health maintenance organizations. (a) The powers of a health maintenance organization include, but are not limited to the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment; (2) The making of loans other than in the ordinary course of business, to providers under contract with it in furtherance of its program or the making of loans to a corporation or corporations in which it owns a majority interest for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees. (3) The furnishing of health care services through providers which are under contract with or employed by the health maintenance organization. (4) The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment, and administration. (5) The purchase,...
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34-19-16
Section 34-19-16 Where care may be performed; required forms an duties of licensed midwife. (a) A licensed midwife may provide midwifery care in the setting of the client's choice, except a hospital. (b) A licensed midwife shall ensure that the client has signed a midwife disclosure form provided by the board indicating receipt of a written statement that includes all of the following information: (1) A description of the licensed midwife's education, training, and experience in midwifery. (2) Antepartum, intrapartum, and postpartum conditions requiring medical referral, transfer of care, and transport to a hospital. (3) A plan for medical referral, transfer of care, and transport of the client or newborn or both when indicated by specific antepartum, intrapartum, or postpartum conditions. (4) Instructions for filing a complaint against a licensed midwife. (5) A statement that the licensed midwife must comply with the federal Health Insurance Portability and Accountability Act. (6) The...
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27-45A-5
Section 27-45A-5 Disclosure of cost share information; discussion and sale of prescription drug alternatives; prohibited payment practices. (a) A pharmacy or pharmacist may provide a covered person with information regarding the amount of the covered person's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy benefits manager from discussing any such information or for selling a more affordable alternative to the covered person if such an alternative is available. (b) A health benefit plan that covers prescription drugs may not include a provision that requires an enrollee to make a payment for a prescription drug at the point of sale in an amount that exceeds the lessor of: (1) the contracted co-payment amount; or (2) the amount an individual would pay for a prescription if that individual were paying with cash. (c) For purposes of this section, the following words have the following meanings: (1) COVERED PERSON. Any individual,...
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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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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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22-6-233
Section 22-6-233 Legislative findings; certification of collaborators; powers of Medicaid Agency; state action immunity. (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 this goal, the Legislature declares its intent...
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27-52-2
Section 27-52-2 Authority. The plan shall have the general powers and authority granted under the laws of this state to health insurers and in addition thereto, the specific authority to do all of the following: (1) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this article, including the authority, with the approval of the commissioner, to enter into contracts with similar plans of other states for the joint performance of common administrative functions, or with persons or other organizations for the performance of administrative functions. (2) Sue or be sued, including taking any legal actions necessary or proper to recover or collect assessments due the plan. (3) Take legal action as necessary to do any of the following: a. To avoid the payment of improper claims against the plan or the coverage provided by or through the plan. b. To recover any amounts erroneously or improperly paid by the plan. c. To recover any amounts paid by the...
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27-54-4
Section 27-54-4 Illnesses covered; requirements of benefit plans, etc. (a) All group health benefit plans shall offer to provide, at a minimum, additional benefits according to this chapter for a person receiving medical treatment for any of the following mental illnesses diagnosed by an appropriately licensed provider. (1) Schizophrenia, schizophrenia form disorder, schizo affective disorder. (2) Bipolar disorder. (3) Panic disorder. (4) Obsessive-compulsive disorder. (5) Major depressive disorder. (6) Anxiety disorders. (7) Mood disorders. (8) Any condition or disorder involving mental illness, excluding alcohol and substance abuse, that falls under any of the diagnostic categories listed in the mental disorders section of the International Classification of Disease, as periodically revised. (b) All group health benefit plans, policies, contracts, and certificates executed, delivered, issued for delivery, continue, or renewed in this state on or after January 1, 2001, shall offer, at...
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45-39-30.04
Section 45-39-30.04 Powers and duties. The council shall have the following duties and authority: (1) To define the roles and responsibilities of all participating departments. (2) To adopt rules for the internal operation of the council. (3) To recommend to the lead agency the appointment of additional members to serve on the council as deemed necessary and appropriate. (4) To develop a long-range plan, reviewed semiannually, for a comprehensive countywide system of care, which, to the extent practical, is derived from scientific based research and nationally recognized best practices. The council shall provide a copy of the plan and a detailed summary of any progress toward implementation of the plan to the lead agency annually. The plan should include, but not be limited to, all of the following: a. The elimination of barriers to identifying and reporting elder abuse, such as duplicative or fragmented policies which may require modification. b. The development of a coordinated...
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11-91A-7
care plan under Chapter 29 of Title 36, and in the State Employees' Retirement System under Chapter 27 of Title 36. (j) Acquire property by purchase or lease. (k) Provide for reinsurance of risks incurred by the program. (l)(1) Provide additional types of optional health care coverages or services including, but not limited to, providing for the administration of the payment of health care services on behalf of employer participants whose eligible employees or officials suffer on-the-job injury, under such terms and conditions as the board shall determine. (2) Participation in any service established for the administration of the payment of health care services on behalf of an employer participant relating to on-the-job injury shall be at the sole option of the employer participant. Refusal to participate by an employer participant shall not affect eligibility for the program or factor into the establishment of rates as authorized in subsection (b). (m) Adopt bylaws, policies, and...
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