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34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained in
this chapter shall be construed to create a requirement that any health benefit plan, group
insurance plan, policy, or contract for health care services that covers hospital, medical,
or surgical expenses, health maintenance organizations, preferred provider organizations,
medical service organizations, physician-hospital organizations, or any other person, firm,
corporation, joint venture, or other similar business entity that pays for, purchases, or
furnishes group health care services to patients, insureds, or beneficiaries in this state,
including entities created pursuant to Article 6, commencing with Section 10A-20-6.01, of
Chapter 20, Title 10A, provide coverage or reimbursement for the services described or authorized
in this chapter. (Act 2017-383, §4.)...
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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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22-6-159
Section 22-6-159 Implementation of article. (a) The following is the timeline for implementation
of this article: (1) Not later than October 1, 2013, the Medicaid Agency shall establish Medicaid
regions. (2) Not later than October 1, 2014, an organization seeking to become a regional
care organization shall have established a governing board and structure as approved by the
Medicaid Agency. An organization may receive probationary certification as a regional care
organization upon submission of an application for, and demonstration of, a governing board
acceptable to the Medicaid Agency. Probationary certification shall expire on October 1, 2016,
or a later date established by the Medicaid Agency. (3) Not later than April 1, 2015, an organization
with probationary regional care organization certification shall have demonstrated to Medicaid's
approval the ability to establish an adequate medical service delivery network. (4) Not later
than October 1, 2015, an organization with...
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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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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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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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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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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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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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22-21B-3
Section 22-21B-3 Definitions. The following words and terms shall have the meanings ascribed
to them in this section, unless otherwise required by their respective context: (1) CONSCIENCE.
The religious, moral, or ethical principles held by a health care provider. (2) DISCRIMINATION.
Discrimination includes, but is not limited to: Hiring, termination, refusal of staff privileges,
refusal of board certification, demotion, loss of career specialty, reduction of wages or
benefits, adverse treatment in the terms and conditions of employment, refusal to award any
grant, contract, or other program, or refusal to provide residency training opportunities.
(3) HEALTH CARE PROVIDER. Any individual who may be asked to participate in any way in a health
care service, including, but not limited to: A physician, physician's assistant, nurse, nurse's
aide, medical assistant, hospital employee, clinic employee, nursing home employee, pharmacist,
researcher, medical or nursing school faculty, student,...
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