|
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, ยง4.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-19-21.htm - 1K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-153.htm - 10K - Match Info - Similar pages
27-21A-7
Section 27-21A-7 Evidence of coverage and charges for health care services. (a)(1) Every enrollee
residing in this state is entitled to an evidence of coverage. If the enrollee obtains such
coverage through an insurance policy or a contract issued by a health care service plan, the
insurer or the health care service plan shall issue the evidence of coverage. Otherwise, the
health maintenance organization shall issue the evidence of coverage. (2) No evidence of coverage,
or amendment thereto, shall be issued or delivered to any person in this state until a copy
of the basic form of the evidence of coverage, or amendment thereto, has been filed with the
commissioner and the State Health Officer, and approved by the commissioner. (3) An evidence
of coverage shall contain: a. No provisions or statements which encourage misrepresentation,
or which are untrue, misleading, or deceptive as defined in subsection (a) of Section 27-21A-13;
and b. A clear and concise statement, if a contract, or a...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-7.htm - 3K - Match Info - Similar pages
27-56-2
Section 27-56-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) COVERED PERSON. Any individual, family, or family member on whose behalf third-party
payment or prepayment of health or medical expenses is provided under an insurance policy,
plan, or contract providing for third-party payment or prepayment of health care or medical
expenses. (2) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist. (3)
INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF HEALTH
OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health insurance,
an individual or group hospital or health care service contract, an individual or group health
maintenance organization contract, an organized delivery system contract, or a preferred provider
organization contract, and any other similar policy, plan, or contract. This term shall not
include any employee welfare benefit plan, as defined...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-2.htm - 1K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-54-2.htm - 3K - Match Info - Similar pages
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,...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21B-3.htm - 3K - Match Info - Similar pages
34-25A-4
Section 34-25A-4 Referral and consultation limits. (a) A licensed prosthetist, licensed orthotist,
or licensed prosthetist/orthotist may provide services utilizing new prostheses or orthoses
for which he or she is licensed and only under a written order from an authorized health care
practitioner. A consultation with and periodic review by an authorized health care practitioner
is not required for the evaluation, repair, adjusting, or servicing of a prosthesis by a licensed
prosthetist, or licensed prosthetist/orthotist and for the evaluation, repair, adjusting,
or servicing of an orthosis by a licensed orthotist, or licensed prosthetist/orthotist; nor
is an order from an authorized health care practitioner required for maintenance or replacement
of an orthosis or prosthesis to the level of its original prescription for an indefinite period
of time if the original order remains appropriate for the patient's medical needs. (b) Prosthetists
and orthotists must refer persons receiving...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-25A-4.htm - 2K - Match Info - Similar pages
26-16-2
Section 26-16-2 Definitions. As used in this article, the following words and phrases shall
have the meanings herein ascribed to them: (1) CHILD. A person under 18 years of age. (2)
CHILD ABUSE. Harm or threatened harm to a child's health or welfare by a person responsible
for the child's health or welfare, which harm occurs or is threatened through nonaccidental
physical or mental injury; sexual abuse, which includes a violation of any provision of Article
4, Chapter 6, Title 13A. (3) CULTURAL COMPETENCY. The ability of an individual or organization
to understand and act respectfully toward, in a cultural text, the beliefs, interpersonal
styles, attitudes, and behaviors of persons and families of various cultures, including persons
and families of various cultures who participate in services from the individual or organization
and persons of various cultures who provide services for the individual or organization. (4)
DEPARTMENT. The Department of Child Abuse and Neglect Prevention....
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/26-16-2.htm - 2K - Match Info - Similar pages
22-52-91
Section 22-52-91 Duty of law enforcement officer, community mental health officer to take into
custody alleged mentally ill persons; detention; admission; hearing. (a) When a law enforcement
officer is confronted by circumstances and has reasonable cause for believing that a person
within the county is mentally ill and also believes that the person is likely to be of immediate
danger to self or others, the law enforcement officer shall contact a community mental health
officer. The community mental health officer shall join the law enforcement officer at the
scene and location of the person to assess conditions and determine if the person needs the
attention, specialized care, and services of a designated mental health facility. If the community
mental health officer determines from the conditions, symptoms, and behavior that the person
appears to be mentally ill and poses an immediate danger to self or others, the law enforcement
officer shall take the person into custody and,...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-52-91.htm - 7K - Match Info - Similar pages
27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every health
benefit plan that provides coverage for prescription drugs or devices, or administers a plan,
including, but not limited to, third party administrators for self-insured plans and state
administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds a
card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-22.htm - 3K - Match Info - Similar pages
|