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22-21-263
Section 22-21-263 New institutional health services subject to review. (a) All new institutional
health services which are subject to this article and which are proposed to be offered or
developed within the state shall be subject to review under this article. No institutional
health services which are subject to this article shall be permitted which are inconsistent
with the State Health Plan. For the purposes of this article, new institutional health services
shall include any of the following: (1) The construction, development, acquisition through
lease or purchase, or other establishment of a new health care facility or health maintenance
organization. A transaction involving the sale, lease, or other transfer or change of control
of an existing health care facility, existing health maintenance organization, or existing
institutional health service is not subject to certificate of need review or approval under
this article unless the transaction also involves implementing one or...
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26-25-4
Section 26-25-4 Emergency medical services provider. For the purposes of this chapter, an emergency
medical services provider shall mean a licensed hospital, as defined in Section 22-21-20,
which operates an emergency department. An emergency medical services provider does not include
the offices, clinics, surgeries, or treatment facilities of private physicians or dentists.
No individual licensed health care provider, including physicians, dentists, nurses, physician
assistants, or other health professionals shall be deemed to be an emergency medical services
provider under this chapter unless such individual voluntarily assumes responsibility for
the custody of the child. (Act 2000-760, p. 1740, §4.)...
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27-36A-2
Section 27-36A-2 Definitions. For purposes of this chapter, the following definitions shall
apply on or after the operative date of the valuation manual as defined by Section 27-36A-15:
(1) ACCIDENT AND HEALTH INSURANCE. Contracts that incorporate morbidity risk and provide protection
against economic loss resulting from accident, sickness, or medical conditions and as may
be specified in the valuation manual. (2) APPOINTED ACTUARY. A qualified actuary who is appointed
in accordance with the valuation manual to prepare the actuarial opinion required in subsection
(b) of Section 27-36A-4. (3) COMPANY. An entity, which (i) has written, issued, or reinsured
life insurance contracts, accident and health insurance contracts, or deposit-type contracts
in this state and has at least one such policy in force or on claim or (ii) has written, issued,
or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type
contracts in any state and is required to hold a...
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36-1A-5
Section 36-1A-5 Participation limited to voluntary, charitable, health and human care federations
and agencies with a substantial local presence. (a) Participation in the Alabama State Employee
Combined Charitable Campaign shall be limited to voluntary, charitable, health and human care
federations and agencies with a substantial local presence that provide or support direct
health and welfare services to individuals or their families and meet the criteria set forth
in this section. "Substantial local presence" is defined as a facility, staffed
by professionals or volunteers, available to provide its services and open at least 15 hours
a week. Such services must be available to state employees in the local campaign community,
unless they are rendered to needy persons overseas. Such services must directly benefit human
beings, whether children, youth, adults, the aged, the ill and infirm, or the mentally or
physically handicapped. Such services must consist of care, research, or...
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16-25A-18
Section 16-25A-18 Generic equivalent medications. As a condition of participation in the Public
Education Employees Health Insurance Programs (PEEHIP), a pharmacist shall dispense a generic
equivalent medication to fill a prescription for a patient covered by PEEHIP when one is available
unless the physician indicates in longhand writing on the prescription, indicates by mark
or signature in the appropriate place on the prescription, or indicates in an electronic prescription,
the following: "medically necessary" or "dispense as written" or "do
not substitute". The generic equivalent drug product dispensed shall be pharmaceutically
and therapeutically equivalent and contain the same active ingredient or ingredients, and
shall be of the same dosage, form, and strength. (Act 2002-266, p. 549, §1; Act 2016-304,
§1.)...
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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, 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. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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25-5-314
Section 25-5-314 Contracts for medical services at mutually agreed rates. Notwithstanding any
other provisions of this article to the contrary, any employer, workers' compensation insurance
carrier, self-insured employer, or group fund, may contract with physicians, hospitals, and
any other health care provider for the provision of medical services to injured workers at
any rates, fees, or levels of reimbursement which shall be mutually agreed upon between the
physician, hospitals, and any other health care provider and the employer, workers' compensation
insurance carrier, self-insured employer, or group fund. (Acts 1992, No. 92-537, p. 1082,
§46.)...
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27-21A-4
Section 27-21A-4 Powers of health maintenance organizations. (a) The powers of a health maintenance
organization include, but are not limited to the following: (1) The purchase, lease, construction,
renovation, operation, or maintenance of hospitals, medical facilities, or both, and their
ancillary equipment; (2) The making of loans other than in the ordinary course of business,
to providers under contract with it in furtherance of its program or the making of loans to
a corporation or corporations in which it owns a majority interest for the purpose of acquiring
or constructing medical facilities and hospitals or in furtherance of a program providing
health care services to enrollees. (3) The furnishing of health care services through providers
which are under contract with or employed by the health maintenance organization. (4) The
contracting with any person for the performance on its behalf of certain functions such as
marketing, enrollment, and administration. (5) The purchase,...
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27-26-5
Section 27-26-5 Reports of judgments and settlements; confidentiality; penalty. (a) Any insurance
company which sells medical liability insurance to Alabama physicians or their professional
corporations or professional associations, or to hospitals or other health care providers
shall be required to report to the state licensing agency which issues the license of the
physician, hospital, or other health care provider any final judgment or any settlement in
or out of court resulting from a claim or action for damages for personal injuries caused
by an error, omission, or negligence in the performance of professional services with or without
consent rendered by its policyholder within 30 days after entry of a judgment in court or
agreement to settle a claim in or out of court. (b) The report rendered to the appropriate
state agency shall consist of the name of the policyholder, or if the policyholder is a professional
corporation or professional association, the name of the physician or...
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27-56-7
Section 27-56-7 Applicability to certain providers. (a) This chapter does not require and shall
not be construed to require any insurance policy, plan, or contract to provide health care
coverage for eye care. The provisions of this chapter are applicable only to those insurance
policies, plans, or contracts which provide coverage for eye care. (b) Insurers or other issuers
of any insurance policy, plan, or contract which provides coverage for eye care shall continue
to be able to establish and apply selection criteria and utilization protocols for health
care providers as well as credentialing criteria used in the selection of providers. (c) This
chapter does not require and shall not be construed to require the coverage of eye care services
by providers who are not designated as covered providers, or who are not selected as participating
providers, by an insurance policy, plan, or contract, or the issuer thereof having a participating
network of service providers. Provided, however,...
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