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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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27-50-5
Section 27-50-5 Penalties for compliance with article - Prohibited. (a) No health benefit plan
subject to the provisions of this chapter shall terminate the services, reduce capitation
payment, or otherwise penalize an attending physician or other health care provider who orders
medical care consistent with this chapter. (b) Nothing in this chapter is intended to expand
the list or designation of covered providers as specified in any health benefit plan. (Acts
1997, No. 97-414, p. 685, §5.)...
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27-48-1
Section 27-48-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. A health insurance policy 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 health care services to patients, insureds, or beneficiaries in this state. For
the purpose of this chapter, a health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to the provisions of this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted by or on behalf of
the State of Alabama or who receive health care services in the State of Alabama. The term
includes, but is not limited to, entities created pursuant to Article 6 of...
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27-58-4
Section 27-58-4 Benefits subject to annual deductible, coinsurance, exclusions, reductions,
etc. (a) The benefits provided in this chapter shall be subject to the same annual deductible
or coinsurance established for all covered benefits within a given policy. Private third party
payors may not reduce or eliminate coverage due to the requirements of this chapter. (b) A
health benefit plan subject to this chapter shall not terminate services, reduce capitation
payment, or otherwise penalize an attending physician or health care provider who orders medical
care consistent with this chapter. (c) Nothing in this chapter is intended to expand the list
of designations of covered providers as specified in any health benefit plan. (Act 2007-389,
p. 778, §4.)...
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27-59-3
Section 27-59-3 Implementation of coverage. (a) The benefits provided in this chapter shall
be subject to the same annual deductible or co-insurance established for all covered benefits
within a given policy. Private third party payors may not reduce or eliminate coverage due
to the requirements of this chapter. (b) A health benefit plan subject to this chapter may
not terminate services, reduce capitation payment, or otherwise penalize an attending physician
or health care provider who orders medical care consistent with this chapter. (c) Nothing
in this chapter is intended to expand the list of designations of covered providers as specified
in any health benefit plan. (Act 2008-502, p. 1106, §3.)...
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14-14-4
Section 14-14-4 Establishment of furlough program. (a) The department shall establish a medical
furlough program. The commissioner shall adopt the rules and regulations for implementation
of the medical furlough program. For each person considered for medical furlough, the commissioner
shall determine whether the person is a geriatric inmate, permanently incapacitated inmate,
or terminally ill inmate. (b) Notwithstanding any other law to the contrary, an inmate who
has not served his or her minimum sentence shall be considered eligible for consideration
for furlough under this chapter. (c) This chapter shall not apply to inmates convicted of
capital murder or a sexual offense. (d) Medical furlough consideration shall be in addition
to any other release for which an inmate may be eligible. (e) The commissioner shall determine
the conditions of release of any inmate pursuant to this chapter, including the appropriate
level of supervision of the inmate, and shall develop a discharge plan...
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27-48-2
Section 27-48-2 Coverage for medically necessary inpatient care for mother and newly born child.
(a) Every health benefit plan that provides maternity coverage shall provide coverage for
the following: (1) All medically necessary inpatient care for a mother and her newly born
child as determined by the woman's prenatal care physician, obstetrician-gynecologist, certified
nurse midwife, or the child's attending pediatrician and when consistent with the most recent
version of the "Guidelines for Perinatal Care" prepared by the American Academy
of Pediatrics and the American College of Obstetricians and Gynecologists, including the administration
of medical tests recommended by the American Academy of Pediatrics or the American College
of Obstetricians and Gynecologists or both on the admission and discharge of a mother and
the newborn child to determine whether additional medical care is needed for the mother or
newborn child or both. Included in medically necessary inpatient care is the...
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34-19-16
Section 34-19-16 Where care may be performed; required forms an duties of licensed midwife.
(a) A licensed midwife may provide midwifery care in the setting of the client's choice, except
a hospital. (b) A licensed midwife shall ensure that the client has signed a midwife disclosure
form provided by the board indicating receipt of a written statement that includes all of
the following information: (1) A description of the licensed midwife's education, training,
and experience in midwifery. (2) Antepartum, intrapartum, and postpartum conditions requiring
medical referral, transfer of care, and transport to a hospital. (3) A plan for medical referral,
transfer of care, and transport of the client or newborn or both when indicated by specific
antepartum, intrapartum, or postpartum conditions. (4) Instructions for filing a complaint
against a licensed midwife. (5) A statement that the licensed midwife must comply with the
federal Health Insurance Portability and Accountability Act. (6) The...
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40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall have
the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible
hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient.
(2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying
any non-Medicare inpatient stay into groups for the purposes of payment. (3) ALTERNATE CARE
PROVIDER. A contractor, other than a regional care organization, that agrees to provide a
comprehensive package of Medicaid benefits to Medicaid beneficiaries in a defined region of
the state pursuant to a risk contract. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification
in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned
hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated
care provided by publicly owned hospitals and hospitals...
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27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
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