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27-21A-10
Section 27-21A-10 Complaint system. (a)(1) Every health maintenance organization shall
establish and maintain a complaint system which has been approved by the commissioner, after
consultation with the State Health Officer, to provide reasonable procedures for the resolution
of written complaints initiated by enrollees. (2) Each health maintenance organization shall
submit to the commissioner and the State Health Officer an annual report in a form prescribed
by the commissioner, after consultation with the State Health Officer, which shall include:
a. A description of the procedures of such complaint system; b. The total number of complaints
handled through such complaint system and a compilation of causes underlying the complaints
filed; and c. The number, amount, and disposition of malpractice claims and other claims relating
to the service or care rendered by the health maintenance organization made by enrollees of
the organization that were settled during the year by the health...
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27-21A-17
Section 27-21A-17 Suspension or revocation of certificate of authority. (a) The commissioner
in consultation with and with the approval of the State Health Officer, where necessary, may
suspend or revoke any certificate of authority issued to a health maintenance organization
under this chapter if he finds that any of the following conditions exist: (1) The health
maintenance organization is operating significantly in contravention of its basic organizational
document or in a manner contrary to that described in any other information submitted under
Section 27-21A-2, unless amendments to such submissions have been filed with the commissioner
and the State Health Officer and approved by the commissioner; (2) The health maintenance
organization issues evidence of coverage or uses a schedule of charges for health care services
which do not comply with requirements of Section 27-21A-7; (3) The health maintenance
organization does not provide or arrange for basic health care services; (4)...
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27-21A-2
Section 27-21A-2 Establishment of health maintenance organizations. (a) Notwithstanding
any law of this state to the contrary, any person may apply to the commissioner for and obtain
a certificate of authority to establish and operate a health maintenance organization in compliance
with this chapter. No person shall establish or operate a health maintenance organization
in this state without obtaining a certificate of authority under this chapter. A foreign corporation
may qualify under this chapter, subject to its registration to do business in this state as
a foreign corporation under the provisions of Sections 10-2A-220, et seq. (b) Health maintenance
organizations licensed as of May 29, 1986, shall be issued a certificate of authority in accordance
with Section 27-21A-29. (c) Each application for a certificate of authority shall be
verified by an officer or authorized representative of the applicant, shall be in a form prescribed
by the commissioner, and shall set forth or be...
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41-15B-2.2
Section 41-15B-2.2 Allocation of trust fund revenues. (a) For each fiscal year, beginning
October 1, 1999, contingent upon the Children First Trust Fund receiving tobacco revenues
and upon appropriation by the Legislature, an amount of up to and including two hundred twenty-five
thousand dollars ($225,000), or equivalent percentage of the total fund, shall be designated
for the administration of the fund by the council and the Commissioner of Children's Affairs.
(b) For the each fiscal year, beginning October 1, 1999, contingent upon the Children First
Trust Fund receiving tobacco revenues, the remainder of the Children First Trust Fund, in
the amounts provided for in Section 41-15B-2.1, shall be allocated as follows: (1)
Ten percent of the fund shall be allocated to the Department of Public Health for distribution
to one or more of the following: a. The Children's Health Insurance Program. b. Programs for
tobacco control among children with the purpose being to reduce the consumption...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/41-15B-2.2.htm - 22K - Match Info - Similar pages
27-21A-20
Section 27-21A-20 Administrative procedures. (a) When the commissioner has cause to
believe that grounds for the denial of an application for a certificate of authority exist,
or that grounds for the suspension or revocation of a certificate of authority exist, he shall
notify the health maintenance organization and the State Health Officer in writing specifically
stating the grounds for denial, suspension, or revocation. If so requested in writing by the
health maintenance organization, the commissioner shall set a hearing on the matter within
30 days of the receipt of such request. (b) The State Health Officer, or his designated representative,
shall be in attendance at the hearing and shall participate in the proceedings. The recommendation
and findings of the State Health Officer with respect to matters relating to the quality of
health care services provided in connection with any decision regarding denial, suspension,
or revocation of a certificate of authority, shall be...
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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have
the following meanings, respectively: (1) AGENT. A person who is appointed or employed by
a health maintenance organization and who engages in solicitation of membership in such organization.
This definition does not include a person enrolling members on behalf of an employer, union,
or other organization. (2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital
and physician care, and outpatient medical services. (3) COMMISSIONER. The Commissioner of
Insurance. (4) ENROLLEE. An individual who is enrolled in a health maintenance organization.
(5) EVIDENCE OF COVERAGE. Any certificate, agreement, or contract issued to an enrollee setting
out the coverage to which he is entitled. (6) HEALTH CARE SERVICES. Any services included
in the furnishing to any individual of medical or dental care, or hospitalization or incident
to the furnishing of such care or hospitalization, as well as the...
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22-4-5
Section 22-4-5 Adoption, revision, etc., of rules, regulations, standards, etc., by
State Board of Health; appeals therefrom; State Board of Health not to discriminate among
branches of healing arts in administration of funds. (a) The State Board of Health, with the
advice and consultation of the Statewide Health Coordinating Council, is hereby authorized
and empowered to adopt, revise, abolish, promulgate and publish rules, regulations, standards
and procedures for: (1) The preparation of the preliminary State Health Plan and the State
Medical Facilities Plan; (2) The administration of the State Health Plan and of the State
Medical Facilities Plan after approval by the Statewide Health Coordinating Council; (3) The
construction and operation of health care facilities established under the State Medical Facilities
Plan; and (4) Such other matters as may be necessary to carry out the intent and purpose of
this article. (b) The State Board of Health is also authorized and empowered to...
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22-50-11
Section 22-50-11 Department - Additional and cumulative powers. The Department of Mental
Health is given hereby the following additional and cumulative powers through its commissioner:
(1) It is authorized and directed to set up state plans for the purpose of controlling and
treating any and all forms of mental and emotional illness and any and all forms of mental
retardation and shall divide the state into regions, districts, areas or zones, which need
not be geographic areas, but shall be areas for the purpose of establishing priorities and
programs and for organizational and administrative purposes in accordance with these state
plans. (2) It is designated and authorized to supervise, coordinate, and establish standards
for all operations and activities of the state related to mental health and the providing
of mental health services; and it is authorized to receive and administer any funds available
from any source for the purpose of acquiring building sites for, constructing,...
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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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34-21-2
Section 34-21-2 Board of Nursing generally. (a) There is created the Board of Nursing,
which shall be composed of 13 members to be appointed and have the duties and powers enumerated
in this section. The membership of the board shall be inclusive and reflect the racial,
gender, geographic, urban/rural, and economic diversity of the state. In order to insure continuity
of administration, the nine board members provided for by Section 3 of Act 427, Regular
Session 1975, shall continue to serve to the completion of the term for which they are serving.
The Governor, within 60 days of January 1, 1984, shall appoint a tenth member who shall be
a licensed practical nurse for a term of four years from a list of nominees furnished him
or her by the Alabama Federation of Licensed Practical Nurses, Incorporated, or its successor
organization. As the terms of all board members expire, their successors shall be appointed
for terms of four years each. Vacancies in unexpired terms shall be filled in...
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