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22-6-13
Section 22-6-13 Medicaid benefits for county inmates and certain juveniles. (a) For the purposes
of this section, the following words have the following meanings: (1) COUNTY INMATE. Any person
being held in a public institution under the administrative control and responsibility of
the county sheriff and for whom the county is responsible for the provision of medical care.
The term includes a person in custody while awaiting arraignment or bond, a pretrial detainee,
a convicted person who is awaiting transfer to but has not otherwise become the responsibility
of the Department of Corrections, or a person serving his or her sentence in the county jail.
(2) INPATIENT. This term as defined in 42 C.F.R. ยง 435.1010, as may be amended. (3) JUVENILE.
Any child under the jurisdiction of the juvenile court who is detained in a public institution
and for whom the county is responsible for the provision of medical care pursuant to Section
12-15-108. (4) MEDICAL INSTITUTION. This term as defined...
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, 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 health
care services to patients, insureds, or...
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22-6-122
Section 22-6-122 Medicaid Pharmacy and Therapeutics Committee - Classification and recommendation
of drugs; assurance of quality patient care; review of pharmaceutical products. (a) The Medicaid
Pharmacy and Therapeutics Committee shall review and recommend classes of drugs to the Medicaid
Commissioner for inclusion in the Medicaid Preferred Drug Plan. Class means a therapeutic
group of pharmaceutical agents approved by the FDA as defined by the American Hospital Formulary
Service. The classes of anti-retroviral and anti-psychotic drugs shall not be included in
the Medicaid Preferred Drug Plan. (b) The Medicaid Pharmacy and Therapeutics Committee shall
develop its preferred drug list recommendations by considering the clinical efficacy, safety,
and cost effectiveness of a product. Within each covered class, the committee shall review
and recommend drugs to the Medicaid Commissioner for inclusion on a preferred drug list. Generics
and over the counter drugs covered by Medicaid may be...
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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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38-9A-1
Section 38-9A-1 Definitions. As used in this chapter, the following definitions shall have
the following meanings, respectively, unless the context clearly indicates otherwise: (a)
ADULT. An individual 18 years of age or older with a developmental disability. (b) AGENCY.
Any public state agency, including, but not limited to, the Department of Mental Health, Department
of Public Health, and Department of Education. (c) CHILD. An individual under the age of 18
who has a developmental disability or who is at risk for a developmental disability. A child
under the age of six is considered at risk for a developmental disability if the child has
substantial developmental delay or specific congenital or acquired condition that has a high
probability of resulting in a developmental disability if services are not provided. (d) COMMUNITY
COUNCIL. A local council composed of people with a developmental disability and their family
members who supervise the implementation of the program in its...
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41-10-757
Section 41-10-757 Disposition of proceeds of bonds. (a) The authority is authorized and empowered
to apply the proceeds of any bonds and any other funds belonging to the authority for any
of the following purposes or uses: (1) For the purposes for which the bonds were authorized
to be issued, in the following order: a. To repay the General Fund Rainy Day Account for the
$161,565,874 transferred to the State General Fund in fiscal year 2010 pursuant to Amendment
803 to the Constitution of Alabama of 1901. b. To repay a total of $238,434,126 to the Alabama
Trust Fund for amounts transferred to the State General Fund in fiscal years 2013, 2014, and
2015 pursuant to Section 4 of Amendment 856 to the Constitution of Alabama of 1901. c. To
provide one hundred twenty million dollars ($120,000,000) to the Alabama Medicaid Agency to
be distributed fifteen million dollars ($15,000,000) in fiscal year 2017 and one hundred five
million dollars ($105,000,000) in fiscal year 2018. The Alabama...
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41-5A-6
Section 41-5A-6 Chief examiner - Recovery audits for overpayments of state funds. (a) For the
purposes of this section, the following words have the following meanings: (1) CHIEF EXAMINER.
The Chief Examiner of Public Accounts. (2) OVERPAYMENT. Any payment in excess of amounts due
and includes failure to meet eligibility requirements, failure to identify third party liability
where applicable, any payment for an ineligible good or service, any payment for a good or
service not received, duplicate payments, invoice and pricing errors, failure to apply discounts,
rebates, or other allowances, failure to comply with contracts or purchasing agreements, or
both, failure to provide adequate documentation or necessary signatures, or both, on documents,
or any other inadvertent error resulting in overpayment. (3) RECOVERY AUDIT. A financial management
technique used to identify overpayments made by a state agency with respect to individuals,
vendors, service providers, and other entities in...
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7-9A-408
Section 7-9A-408 Restrictions on assignment of promissory notes, health-care-insurance receivables,
and certain general intangibles ineffective. (a) Term restricting assignment generally ineffective.
Except as otherwise provided in subsection (b), a term in a promissory note or in an agreement
between an account debtor and a debtor which relates to a health-care-insurance receivable
or a general intangible, including a contract, permit, license, or franchise, and which term
prohibits, restricts, or requires the consent of the person obligated on the promissory note
or the account debtor to, the assignment or transfer of, or creation, attachment, or perfection
of a security interest in, the promissory note, health-care-insurance receivable, or general
intangible, is ineffective to the extent that the term: (1) would impair the creation, attachment,
or perfection of a security interest; or (2) provides that the assignment or transfer or the
creation, attachment, or perfection of the...
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21-3A-4
Section 21-3A-4 Composition; appointment and duties of members. (a) For the purposes of implementing
this chapter, the Governor shall appoint the Interagency Coordinating Council. The council
shall consist of not less than 15 members nor more than the number allowed by regulation.
(b) The Governor shall designate a member of the council to serve as the chair, or shall require
the council to designate a member to serve as the chair. (c) The council shall be composed
as follows: (1) At least 20 percent of the members shall be parents, including minority parents,
of infants and toddlers with disabilities or children with disabilities aged 12 or younger.
At least one member shall be a parent of an infant or toddler with a disability or a child
with a disability aged 6 or younger. (2) At least 20 percent of the members shall be public
or private providers of early intervention services. (3) One representative from the Alabama
Legislature. (4) One person involved in personnel preparation....
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