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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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40-26B-83
Section 40-26B-83 State plan amendment. (a) There is established the Hospital Services and
Reimbursement Panel to advise in the development of and approve any state plan amendment which
involves hospital services or reimbursement to be submitted to the Centers for Medicare and
Medicaid Services. (1) The panel shall consist of six members and be constituted in the following
manner: a. The Commissioner of the Alabama Medicaid Agency. b. Three members to be appointed
by the Governor from a list of 10 names submitted by the Alabama Hospital Association. The
hospital members appointed shall represent the diverse ownership type of hospitals in the
state. c. Two members to be appointed by the Governor. (2) All panel members shall be residents
of Alabama and the composition of the board shall reflect the racial, gender, geographic,
urban/rural, and economic diversity of the state. The panel shall meet within 30 days subsequent
to May 15, 2009, to elect a chair and establish procedures...
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27-48-3
Section 27-48-3 Prohibition against plan termination of services, reduction of capitation payment,
or other penalty for health care provider in compliance with chapter; prohibition against
financial encouragement of early discharge from postpartum care. No health benefit plan subject
to the provisions of this chapter shall terminate the services, reduce capitation payment,
or otherwise penalize an attending physician, certified nurse midwife, or other health care
provider who orders medical care consistent with this chapter. No health benefit plan shall
provide, directly or indirectly, any financial incentive or disincentive or grant or deny
any special favor or advantage of any kind or nature to any person to encourage or cause early
discharge of a hospital patient from postpartum care, excluding capitation or global fee arrangements.
Provided nothing contained in this chapter is intended to expand the list or designation of
covered providers as specified in any health benefit plan or...
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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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27-56-6
Section 27-56-6 When provisions applicable. This chapter shall apply to services provided under
a policy, plan, or contract providing for third-party payment or prepayment of health or medical
expenses delivered, continued, or renewed in this state on or after August 1, 2001, and to
any such existing policy, plan, or contract, on its anniversary or renewal date, or upon the
expiration of the applicable collective bargaining contract, if any, whichever is later. (Act
2001-477, p. 640, §6.)...
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27-17A-10
Section 27-17A-10 Certificate required. (a) No person may sell a preneed contract without first
having a valid certificate of authority. (b)(1) No person may receive any funds for payment
on a preneed contract who does not hold a valid certificate of authority. (2) Any preneed
transaction in which a buyer pays to the seller before need, in whole or in part, a purchase
price for funeral or cemetery merchandise and services, and in which the seller is not obligated
to deliver the contracted for merchandise or to perform the services until need, in whole
or in part, shall be evidenced by a written preneed contract satisfying the requirements of
this chapter and signed by the seller and the purchaser. No person may receive or accept any
form of consideration in such a transaction without a fully signed written preneed contract.
A transaction not evidenced by a signed written preneed contract shall be voidable at the
election of the buyer and, if such election is made, the seller shall...
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34-21-81
Section 34-21-81 Definitions. As used in this article, the following terms shall have the following
meanings: (1) BOARD OF MEDICAL EXAMINERS. The State Board of Medical Examiners established
pursuant to Section 34-24-53. (2) BOARD OF NURSING. The Board of Nursing established under
Section 34-21-2. (3) ADVANCED PRACTICE NURSE. A registered nurse that has gained additional
knowledge and skills through successful completion of an organized program of nursing education
that prepares nurses for advanced practice roles and has been certified by the Board of Nursing
to engage in the practice of advanced practice nursing. There shall be four categories of
advanced practice nurses: Certified registered nurse practitioners (CRNP), certified nurse
midwives (CNM), certified registered nurse anesthetists (CRNA), and clinical nurse specialists
(CNS). Certified registered nurse practitioners and certified nurse midwives are subject to
collaborative practice agreements with an Alabama physician....
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22-21-366
Section 22-21-366 Subscriber rates subject to approval of department; provisions in contract
between corporation and dentist. (a) The rates charged by a dental service plan corporation
to the subscribers for dental services shall at all times be subject to the approval of the
department. (b) Every contract between a dental service plan corporation and a dentist, whereby
the plan provides for payment of a fee or fees to the dentist for dental services rendered
by the dentist to subscribers, shall contain a clause stating that the dental service plan
corporation shall be liable for such fee or fees rather than the subscribers receiving said
dental services. Such contract shall also contain a clause whereby, upon termination of the
contract by either party or upon expiration thereof, a dentist is obligated to complete any
procedure which he has undertaken upon any subscriber. (Acts 1982, No. 82-463, p. 741, §7.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-366.htm - 1K - 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...
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16-25A-45
Section 16-25A-45 Rules and regulations; contracts for services. The board shall promulgate
rules and regulations to implement the flexible benefits program, including, but not limited
to, setting policies and requirements concerning the administration of employee payments,
amounts deducted pursuant to salary reduction agreements, and advances from the Public Employees'
Health Insurance Plan and appropriations, if any. The board may contract for services with
the Flexible Employees' Benefit Board for the first year of operation of the plan regarding
pretax deductions for the payment of employee health insurance premium payments authorized
by the board and may contract for services with the Flexible Employees' Benefit Board or other
entities in subsequent years. The board may contract for necessary services to implement the
flexible benefits program including, but not limited to, the administration of salary reduction
agreements and non-health insurance premium components of the...
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