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40-26B-2
Section 40-26B-2 Privilege tax upon providers of pharmaceutical services; exceptions. To provide
further for the availability of indigent health care, the operation of the Medicaid Program
and the maintenance and expansion of medical services thereunder, there is hereby levied and
shall be collected as provided in this article a privilege tax on the business activities
of every provider of pharmaceutical services to the citizens of Alabama, except for a pharmacy,
or portion thereof, serving hospital inpatients or pharmacies owned or operated by the State
of Alabama or an agency thereof. The privilege tax imposed by this article is in addition
to all other taxes of any kind now imposed by law, and shall be at the rate of 10 cents for
each prescription filled or refilled for a citizen of Alabama. (Acts 1991, No. 91-124, p.
148, §2; Act 2002-414, p. 1058, §1.)...
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40-26B-20
Section 40-26B-20 Definitions. The following words, terms, and phrases shall have the following
meanings: (1) BED. Any bed that is licensed by the Alabama Department of Health and its successor
agency to provide nursing home care which is in a nursing facility. (2) DEPARTMENT. The Department
of Revenue of the State of Alabama. (3) FISCAL YEAR. An accounting period of 12 months beginning
on the first day of the first month of the state fiscal year. (4) MEDICAID PROGRAM. The medical
assistance program as established in Title XIX of the Social Security Act and as administered
in the State of Alabama by the Alabama Medicaid Agency pursuant to executive order and Title
560 of the Alabama Administrative Code. (5) NURSING FACILITY. An institution which is licensed
under the laws of the State of Alabama as a skilled nursing facility or an intermediate nursing
facility. Nursing facility shall not include any facility owned or operated by, or operating
under an exclusive contract with, the State...
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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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22-6-200
Section 22-6-200 Federal financial participation; contract for services. This article shall
be of no effect if federal financial participation under Title XIX of the Social Security
Act is not available to the Medicaid program for the purposes of this article at the approved
federal medical assistance percentage, established under Section 1905 of the Social Security
Act, for the applicable fiscal year, or in the event a contract for services between the PACE
program and the State of Alabama Medicaid Agency or Regional Care Organization is not executed
by September 30, 2014, and by the end of each subsequent state fiscal year thereafter. (Act
2014-126, p. 236, §11.)...
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27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or dental
plan beneficiary may assign reimbursement for health or dental care services directly to the
provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
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36-1A-3
Section 36-1A-3 Definitions. As used in this chapter the following words have the following
meanings: (1) ALABAMA STATE EMPLOYEE COMBINED CHARITABLE CAMPAIGN (ASECCC). The annual combined
charitable fund-raising program established through this chapter to receive and distribute
voluntary payroll deduction contributions of state employees. (2) CHARITABLE FUND-RAISING
FEDERATION. A legally constituted grouping of at least 10 health and human care agencies that
are bound together to raise and distribute charitable contributions. (3) AFFILIATED CHARITABLE
AGENCY. A charitable agency which is affiliated with a charitable fund-raising federation
for the purpose of directly sharing funds raised by the organization. (4) CHARITABLE AGENCY.
A volunteer, not-for-profit organization under federal regulation 26 CFR 1.501(c)(3) which
provides health or human care services to individuals. (5) CAMPAIGN MANAGER. The participating
federation, selected by the local agency review committee, responsible...
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27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about policy
or plan; payment and reimbursement procedures. The provisions of this chapter do not prohibit
the following conduct and shall be construed to provide that: (1) A dentist may contract directly
with a patient for the furnishing of dental care services to said patient as may be otherwise
authorized by law; (2) Any person providing a health insurance policy or employee benefit
plan, or an employer, or an employee organization may: a. Make available to its insureds,
beneficiaries, participants, employees, or members information relating to dental care services
by the distribution of factually accurate information regarding dental care services, rates,
fees, location, and hours of service, provided such distribution is made upon the request
of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates
payment for dental care services by insureds, beneficiaries,...
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27-21A-15
Section 27-21A-15 Powers of insurers and health care service plans. (a) An insurance company
licensed in this state, or a health care service plan authorized to do business in this state,
may either directly or through a subsidiary or affiliate organize and operate a health maintenance
organization under the provisions of this chapter. Notwithstanding any other law which may
be inconsistent herewith, any two or more such insurance companies, health care service plans,
or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance
organization. The business of insurance is deemed to include the providing of health care
by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any provision of insurance and health care service plan laws, Title 10,
Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may contract with
a health maintenance organization to provide insurance or...
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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...
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27-21A-32
Section 27-21A-32 HMO enrollment requirements. (a) The state government, or any agency, board,
commission, institution, or political subdivision thereof, and any city or county, or board
of education, which offers its employees a health benefits plan may make available to and
inform its employees or members of the option to enroll in at least one health maintenance
organization holding a valid certificate of authority which provides health care services
in the geographic areas in which such employees or members reside. (b) The first time a health
maintenance organization is offered by an employer, either public or private, each covered
employee must make an affirmative written selection among the different alternatives included
in the health benefits plan. Thereafter, those who wish to change from one plan to another
will be allowed to do so annually, provided, that nothing in this section shall prevent any
health maintenance organization or insurer from requiring evidence of...
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