27-21A-3
Section 27-21A-3 Issuance of certificate of authority. (a)(1) Upon receipt of an application
for issuance of a certificate of authority, the commissioner shall forthwith transmit copies
of such application and accompanying documents to the State Health Officer. (2) The State
Health Officer shall determine whether the applicant for a certificate of authority, with
respect to health care services to be furnished: a. Has demonstrated the willingness and potential
ability to assure that such health care services will be provided in a manner to assure both
availability and accessibility of adequate personnel and facilities and in a manner enhancing
availability, accessibility, and continuity of service; b. Has arrangements, established in
accordance with the regulations promulgated by the State Health Officer, for an on-going quality
assurance program concerning health care processes and outcomes; and c. Has a procedure, established
in accordance with regulations of the State Health...
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27-60-2
Section 27-60-2 Interstate Insurance Product Regulation Compact. The State of Alabama hereby
agrees to the following interstate compact known as the Interstate Insurance Product Regulation
Compact: ARTICLE I. PURPOSES. The purposes of this compact are, through means of joint and
cooperative action among the compacting states: 1. To promote and protect the interest of
consumers of individual and group annuity, life insurance, disability income, and long-term
care insurance products; 2. To develop uniform standards for insurance products covered under
the compact; 3. To establish a central clearinghouse to receive and provide prompt review
of insurance products covered under the compact and, in certain cases, advertisements related
thereto, submitted by insurers authorized to do business in one or more compacting states;
4. To give appropriate regulatory approval to those product filings and advertisements satisfying
the applicable uniform standard; 5. To improve coordination of...
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22-21-270
Section 22-21-270 Certificates of need - Period for which valid; extension of time; termination;
transferability. (a) A certificate of need issued under subsection (a) of Section 22-21-265
and Section 22-21-268 shall be valid for a period not to exceed 12 months and may be subject
to one extension not to exceed 12 months, provided the criteria for extension as set forth
in the rules and regulations of the SHPDA are met. Applications for an extension filed under
this section shall be accompanied by a filing fee to be established by rule, not to exceed
25 percent of the original CON application fee. If no obligation has occurred within such
period, the certificate of need shall be considered terminated and shall be null and void.
Should the obligation be incurred within such valid period, the certificate of need shall
be continued in effect for a period not to exceed one year or the completion of the construction
project, whichever shall be later, or the inauguration of the service or...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
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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...
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22-6-155
Section 22-6-155 Terms of contracts; cost evaluations. An initial contract between the Medicaid
Agency and a regional care organization shall be for three years, with the option for the
Medicaid Agency to renew the contract for not more than two additional one-year periods. The
Medicaid Agency shall obtain provider input and an independent evaluation of the cost savings,
patient outcomes, and quality of care provided by each regional care organization, and obtain
the results of each regional care organization's evaluation in time to use the findings to
decide whether to enter into another multi-year contract with the regional care organization
or change the Medicaid region's care-delivery system. (Act 2013-261, p. 686, §6; Act 2014-434,
p. 1598, §1.)...
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22-6-157
Section 22-6-157 Termination of regional care organization certification. (a) The Medicaid
Agency shall establish by rule the procedure for the termination of a regional care organization
certification or probationary regional care organization certification for non-performance
of contractual duty or for failure to meet or maintain benchmarks, standards, or requirements
provided by this article or established by the Medicaid Agency as required by this article.
(b) Termination of a regional care organization certification or probationary certification
shall follow the standard administrative process, with the right to a hearing before a hearing
officer appointed by the Medicaid Agency. (Act 2013-261, p. 686, §8.)...
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22-6-162
Section 22-6-162 Case-management services. The Medicaid Agency may contract for case-management
services with an organization that has been granted by the Medicaid Agency a probationary
regional care organization certification. If the agency has contracted with such an organization,
and that organization on or before October 1, 2016, or a later date established by the Medicaid
Agency, has failed to gain full regional care organization certification or has had its probationary
certification terminated, then that organization shall refund half the payments, made by the
Medicaid Agency to the organization for case-management services, paid over the previous 12
months. (Act 2013-261, p. 686, §13; Act 2016-377, §1.)...
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22-6-224
Section 22-6-224 Medicaid Agency to contract for medical care; enrollment; delivery of services;
reimbursement. (a) Subject to approval of the federal Centers for Medicare and Medicaid Services,
the Medicaid Agency shall enter into contracts with one or more integrated care networks to
provide, pursuant to a risk contract under which the Medicaid Agency makes a capitated payment,
medical care to Medicaid beneficiaries assigned to the integrated care network. 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. Pursuant to the contract, the Medicaid
Agency shall set capitation payments for the integrated care network. (b) The Medicaid Agency
shall enroll beneficiaries it designates into an integrated care network consistent with guidance
from the Center for Medicare and Medicaid Services. (c)...
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22-6-158
Section 22-6-158 Contracts with service providers. A regional care organization shall contract
with any willing hospital, doctor, or other provider to provide services in a Medicaid region
if the provider is willing to accept the payments and terms offered comparable providers.
Any provider shall meet licensing requirements set by law, shall have a Medicaid provider
number, and shall not otherwise be disqualified from participating in Medicare or Medicaid.
(Act 2013-261, p. 686, §9.)...
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