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22-6-152
Section 22-6-152 Medicaid regions. The Medicaid Agency shall establish by rule geographic Medicaid
regions in which a regional care organization or alternate care provider may operate, which
together shall cover the entire state. Each Medicaid region, according to an actuary working
for Medicaid, shall be capable of supporting at least two regional care organizations or alternate
care providers. (Act 2013-261, p. 686, §3.)...
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22-6-160
Section 22-6-160 Evaluation and report on long-term care system for Medicaid beneficiaries.
The Medicaid Agency shall decide which groups of Medicaid beneficiaries to include for coverage
by a regional care organization or alternate care provider. The Medicaid Agency, without the
approval of the Governor, shall not make a coverage decision that would affect Medicaid beneficiaries
who are directly served by another state agency. (Act 2013-261, p. 686, §11; Act 2015-322,
§1.)...
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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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22-11B-1
Section 22-11B-1 Health care providers upon request required to give immunization status of
patients. (a) Notwithstanding any of the confidentiality provisions in Chapter 11A of this
title, or any other provisions of law, every public and private health care provider shall,
upon request of the persons or entities herein identified, provide information concerning
the immunization status of any patient in accordance with rules promulgated by the State Board
of Health to the following persons and entities: (1) Other public and private health care
providers. (2) Health care insurers of all descriptions. (3) The Alabama Medicaid Agency.
(4) Individuals and organizations with a need to verify the immunization status of persons
in their care, custody, or enrollment, including but not limited to, the chief executive officer,
or a designee of the officer, of a public or private day care center, school, or postsecondary
educational institution. (b) The authorization granted pursuant to this...
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22-6-226
Section 22-6-226 Review and approval of contracts; rules governing operation of integrated
care networks. (a) All provider contracts of an organization granted final certification as
an integrated care network shall be subject to review and approval of the Medicaid Agency.
(b)(1) If a provider is dissatisfied with any term or provision of the agreement or contract
offered by an integrated care network, the provider shall: a. Seek redress with the integrated
care network. In providing redress, an integrated care network shall afford the provider a
review by a panel composed of a representative of an integrated care network, the same type
of provider, and a representative of the citizens' advisory board appointed by the chair of
the advisory board. b. After seeking redress with an integrated care network, a provider or
an integrated care network who remains dissatisfied may request a review of such disputed
term or provision by the Medicaid Agency. The Medicaid Agency shall have 10 days...
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29-2-105
Section 29-2-105 Coordination council - Composition; meetings; duties. (a) The committee shall
convene a council composed of the chair of the committee or his or her designee and the commissioner
or the commissioner's designee of each department of state government that administers services
to children, youth, and their families, including, but not limited to, the Department of Education,
the Department of Human Resources, the Department of Mental Health, the Department of Public
Health, the Medicaid Agency, the Department of Youth Services, the Department of Rehabilitation
Services, one member from the Alabama Association of County Directors of Human Resources appointed
by that organization, one member from the Alabama Residential Child Care Association appointed
by that organization, two members from the Alabama Foster Parent Association appointed by
that organization, one member from the Juvenile Court Judges Association appointed by that
organization, one guardian ad litem...
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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
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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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34-14C-5
Section 34-14C-5 Exemptions. The licensure requirements of this chapter do not apply to the
following entities or practitioners: (1) Home health agencies certified by the State of Alabama
to participate in the Medicare and Medicaid programs. (2) Hospital based home medical equipment
services, whether or not the services are provided through a separate corporation or other
business entity. (3) Health care practitioners legally eligible to order or prescribe home
medical equipment, or who use home medical equipment to treat patients in locations other
than the patient's residence, including, but not limited to, physicians, nurses, physical
therapists, respiratory therapists, speech therapists, occupational therapists, optometrists,
chiropractors, and podiatrists, except for those practitioners, other than a licensed physician
practicing medicine, who provide home medical equipment services in a patient's residence.
Nothing in this chapter shall be construed as prohibiting or restricting...
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34-23-183
Section 34-23-183 Application. This article shall apply to any audit of the records of a pharmacy
conducted by a managed care company, nonprofit hospital or medical service organization, health
benefit plan, third-party payor, pharmacy benefit manager, a health program administered by
a department of the state, except the Alabama Medicaid Agency, or any entity that represents
those companies, groups, or department. (Act 2012-306, p. 668, §4; Act 2018-457, §1.)...
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