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34-23-183
Section 34-23-183 Application. This article shall apply to any audit of the records of a pharmacy
conducted by a managed care company, nonprofit hospital or medical service organization, health
benefit plan, third-party payor, pharmacy benefit manager, a health program administered by
a department of the state, except the Alabama Medicaid Agency, or any entity that represents
those companies, groups, or department. (Act 2012-306, p. 668, §4; Act 2018-457, §1.)...
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27-54-6
Section 27-54-6 Cost report. Every issuer of a group health benefit plan subject to this chapter
shall provide a cost report for each calendar year to the Commissioner of Insurance no later
than April 30th of the following year. The report shall be in a form prescribed by the commissioner
and shall include certification of parity in mental health benefits and total annual costs
of mental health services relative to total health costs. The commissioner shall compile this
data for all health benefit plans in an annual report solely for the purpose of demonstrating
the health cost impact of the requirements of this chapter. (Act 2000-386, p. 605, §7.)...
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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the following terms
shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer, health maintenance
organization, or health care service plan organized under Article 6, Chapter 20, Title 10A,
authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM. Receipt by
the hospital of either of the following: a. Full payment for services as billed. b. If the
hospital has a contract with the injured person's health care payor, payment together with
all credits, discounts, and contractual adjustments that the patient's bill would be entitled
under the contract, including recoupments, between the hospital and the patient's health care
payor which extinguish the patient's obligation for the services rendered. (b) Unless specifically
contrary to any contractual agreement between the hospital and the injured person's health
care payor or unless contrary to any statute or governmental...
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27-1-18
Section 27-1-18 Contract providing for mental health services to entitle insured to reimbursement
for outpatient and inpatient services by qualified psychiatrist or psychologist. (a) Whenever
any group, or blanket hospital or medical expense insurance policy or hospital or medical
service contract issued for delivery in this state provides for the reimbursement of health
or health related services which includes mental health services, and such services are within
the lawful scope of practice of a duly qualified psychiatrist or psychologist, the insured
or other person entitled to benefits under such policy or contract shall be entitled to reimbursement
for outpatient services, and inpatient services if requested by the attending physician, performed
by a duly qualified psychiatrist or psychologist notwithstanding any provisions of the policy
or contract to the contrary. (b) For purposes of this section, a duly qualified psychologist
means, one who is duly licensed or certified at the...
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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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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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16-25A-8
Section 16-25A-8 Funding of health insurance plan; participation; Public Education Employees'
Health Insurance Fund. (a) The Public Education Employees' Health Insurance Board is hereby
authorized to provide under the contract or contracts entered into under the provisions of
this article an insurance benefit plan for each covered employee and, under certain conditions,
retired employees; the cost of such plan may be funded in part or in full through monthly
premiums per active employee from the same source of funds as those used for the payment of
salaries of active members and in part from other funds. (b) On or before January 1 next preceding
each regular meeting of the Legislature, the board shall certify to the Governor and to the
Legislature the amount or amounts necessary to fund coverage for benefits authorized by this
article for the following fiscal year for employees and for retired employees as a monthly
premium per active member per month. The Legislature shall set the...
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31-9B-3
Section 31-9B-3 Providing of information; requirements for emergency and disaster planning
provisions; immunity. (a) All appropriate agencies and community-based service providers,
including, but not limited to, home health care providers, hospices, community mental health
centers, and related facilities, but not including health care facilities which provide inpatient
care to include general and specialized hospitals including ancillary services, skilled nursing
facilities, intermediate care facilities, or any assisted living facility, shall provide information
on the number of individuals with medical needs and shall assist the State Health Department
in the establishment of programs to increase the awareness of medical needs shelters, and
in educating clients and sponsors or caregivers about the procedures that may be necessary
for their safety during disasters. (b) State agencies that regulate or contract with providers
of services, or both, for persons with disabilities or...
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22-8A-9
Section 22-8A-9 Withholding or withdrawal of treatment, etc., not suicide; execution of advance
directive not to affect sale, etc., of life or health insurance nor be condition for receipt
of treatment, etc.; provisions of chapter cumulative. (a) The withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration from a patient
in accordance with the provisions of this chapter shall not, for any purpose, constitute a
suicide and shall not constitute assisting suicide. (b) The making of an advance directive
for health care pursuant to this chapter shall not affect in any manner the sale, procurement,
or issuance of any policy of life or health insurance, nor shall it be deemed to modify the
terms of an existing policy of life or health insurance. No policy of life or health insurance
shall be legally impaired or invalidated in any manner by the withholding or withdrawal of
life-sustaining treatment or artificially provided nutrition and hydration...
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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,...
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