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27-45-20
Section 27-45-20 No agreement for services until written verification of registration
obtained. No insurance company, health maintenance organization (HMO), employer or organization
offering a pharmaceutical prescription program to their employees or members in Alabama, shall
enter into an agreement for services until they have obtained written verification that the
provider pharmacies are registered with the Alabama State Board of Pharmacy. Such verification
must be filed with the Alabama Department of Insurance within 10 days of initiating such agreement.
Said department shall provide a copy of the verification to the Alabama State Board of Pharmacy.
Failure to comply with such verification requirement shall result in a fine to the sponsor
of such prescription program, of $100.00 per day, from the date that such agreement was signed
until such verification requirement is satisfied. (Acts 1991, No. 91-595, p. 1098, §1.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-45-20.htm - 1K - Match Info - Similar pages
27-45-2
Section 27-45-2 Definitions. As used in this article, the following terms shall have
the respective meanings herein set forth, unless the context shall otherwise require: (1)
ALABAMA INSURANCE CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall
have the meaning ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning
ascribed in Section 27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively,
shall have the meanings ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any
obligation under covered policies or employee benefit plans. (6) COVERED POLICY OR PLAN. Any
policy, employee benefit plan, or contract within the scope of this article. (7) HEALTH INSURANCE
POLICY. Any individual, group, blanket, or franchise insurance policy, insurance agreement,
or group hospital service contract providing for pharmaceutical services, including without
limitation, prescription drugs, incurred as a result of accident or sickness, or to prevent
same....
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34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings
as used in this article: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare
benefit plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
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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...
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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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34-23-1
Section 34-23-1 Definitions. For the purpose of this chapter, the following words and
phrases shall have the following meanings: (1) ASSOCIATION. The Alabama Pharmacy Association.
(2) BIOLOGICAL PRODUCT. Has the same meaning as the term as defined in 42 U.S.C. §262. (3)
BOARD or STATE BOARD. The Alabama State Board of Pharmacy. (4) CHEMICAL. Any substance of
a medicinal nature, whether simple or compound, obtained through the process of the science
and art of chemistry, whether of organic or inorganic origin. (5) DISPENSE. To sell, distribute,
administer, leave with, give away, dispose of, deliver, or supply a drug or medicine to the
ultimate user or his or her agent. (6) DRUGS. All medicinal substances, preparations, and
devices recognized by the United States Pharmacopoeia and National Formulary, or any revision
thereof, and all substances and preparations intended for external and internal use in the
cure, diagnosis, mitigation, treatment, or prevention of disease in man or animal...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-1.htm - 10K - Match Info - Similar pages
36-35-2
Section 36-35-2 Definitions. As used in this chapter, the following words and phrases
shall have the following meanings: (1) BOARD. The Alabama Prescription Cost Initiative Board
created by Section 36-35-4 to administer the program. (2) COOPERATIVE. A business entity
functioning on a cooperative basis that distributes its income to a particular member in proportion
with that member's use of the cooperative on a patronage basis. (3) DEPARTMENT. Any department,
agency, office, or program administered by the state for which the board or director has negotiated,
or entered an agreement with a pharmacy benefits manager or cooperative to negotiate, a prescription
drug rebate, or discount. (4) EXECUTIVE DIRECTOR. An executive director employed by the board
to administer this chapter and the program. (5) GOVERNMENTAL ENTITY. Any department of the
State of Alabama; any county government or municipal government; any school system, college,
or university; or any public authority. (6)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-35-2.htm - 2K - Match Info - Similar pages
27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following
meanings: (1) ENROLLEE. A person enrolled in a health benefit plan. (2) HEALTH BENEFIT PLAN.
Any individual or group plan, policy, or contract for health care services issued, delivered,
issued for delivery, renewed in this state by a health care insurer, health maintenance organization,
accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation,
nonprofit medical service corporation, health care service plan, or any other person, firm,
corporation, joint venture, or other similar business entity that pays for, purchases, or
furnishes health care services to patients, insureds, or beneficiaries in this state. The
term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 4
of Title 10. The term shall not include any collective bargaining agreement...
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27-14-11.1
Section 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
27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this
section, the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS.
The design, implementation, and evaluation of environmental modifications, using behavioral
stimuli and consequences, to produce socially significant improvement in human behavior, including
the use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
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