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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow
these procedures: (1) The pharmacy contract shall identify and describe in detail the audit
procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice
at least two weeks before conducting the initial on-site audit for each audit cycle. If the
pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
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34-24-75.1
Section 34-24-75.1 Certificate and limited license under Retired Senior Volunteer Program.
(a) The State Board of Medical Examiners may, at its discretion and subject to the rules and
regulations promulgated by the board, issue a certificate of qualification in behalf of physicians
meeting the requirements for participation in the Retired Senior Volunteer Program. The Retired
Senior Volunteer Program is created for the purpose of permitting doctors of medicine and
doctors of osteopathy who are fully retired from the active practice of medicine to obtain
a limited license without cost which would permit the provision of outpatient health care
services at established free clinics operated pursuant to the Volunteer Medical Professional
Act, Section 6-5-660, et seq. Physicians having certificates issued under this section must
perform no fewer than 100 hours of voluntary service annually and must limit their practice
to the confines of an established free medical clinic, as that term is...
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36-32-3
Section 36-32-3 Officers; powers and duties; compensation; expenditures and revenues; education
and training; facilities. (a) The commission shall elect a chairman and a vice-chairman from
among its members at the first regular quarterly meeting of the calendar year. (b) The commission
may do all of the following: (1) Organize the Alabama Fire College by appointing an executive
director, assistant directors, and such officers as the interest of the Alabama Fire College
may require. (2) Remove the executive director or any assistant or other officer. (3) Fix,
increase, or reduce the compensation of the executive director or any assistant or other officer.
(4) Institute, regulate, alter, or modify the government of the Alabama Fire College as the
commission may deem advisable. (5) Prescribe courses of instruction related to the mission
of the Alabama Fire College. (6) Establish the cost of any prescribed course of study related
to the mission of the Alabama Fire College. (7) Confer...
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38-15-4
Section 38-15-4 Registration of certain youth residential institutions or organizations; staff
training plans; rights of children; licensing and inspection of food preparation areas; access
by law enforcement agencies. (a) Commencing on January 1, 2018, the department shall register
any religious, faith-based, or church nonprofit, other nonprofit, or for profit affiliated
youth residential facility, youth social rehabilitation facility, community treatment facility
for youths, youth transitional care facility, long term youth residential facility, private
alternative boarding school, private alternative outdoor program, and any organization entrusted
with the residential care of children in any organizational form or combination defined by
this section, whenever children are housed at the facility or location of the program for
a period of more than 24 hours. At a minimum, registered youth residential institution or
organization under this section shall do all of the following: (1) Be...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/38-15-4.htm - 13K - Match Info - Similar pages
21-3A-3
Section 21-3A-3 Definitions. The following words and phrases used in this chapter have the
following respective meanings unless the context clearly indicates otherwise: (1) COUNCIL.
The Interagency Coordinating Council as established in Section 21-3A-4. (2) EARLY INTERVENTION
SERVICES. Any developmental services that: a. Are provided under public supervision. b. Are
designed to meet the developmental needs of each eligible child and the needs of the family
related to enhancing the development of the child. c. Are selected in collaboration with the
parents. d. Are provided by qualified personnel as determined by the personnel standards of
the state, the standards of the early intervention program, and the regulations. e. Are provided
in conformity with an individualized family service plan. f. Meet the requirements of Public
Law 99-457 as amended (20 U.S.C. ยงยง1471 to 1485, inclusive), and the early intervention
standards of the State of Alabama. g. Are provided, to the extent...
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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-153.htm - 10K - Match Info - Similar pages
11-91A-7
Section 11-91A-7 Jurisdiction of board; funding; powers of board. The board shall have full,
complete, and exclusive jurisdiction over the program and shall allocate funds from its treasury
for the fulfillment and accomplishment of its duties and responsibilities in a manner as may
be necessary and appropriate to carry out the purposes of this chapter. The board shall have
the general powers and authority granted under the laws of this state for health insurers,
and in addition thereto, the specific authority to do all of the following: (a) Subject to
compliance with Section 11-91A-8 where applicable, execute a contract or contracts to provide
for the administration of the program in accordance with this chapter. The contract or contracts
may be executed with one or more agencies or corporations licensed to transact or administer
group health care business in this state with similar plans of the state for the joint performance
of common administrative functions. (b) Establish, and...
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27-7-4.2
Section 27-7-4.2 Licenses - Applicability to insurance producer. (a) Nothing in this chapter
shall be construed to require an insurer to obtain an insurance producer license. In this
section, the term "insurer" does not include an insurer's officers, directors, employees,
subsidiaries, or affiliates. (b) A license as an insurance producer shall not be required
of any of the following: (1) An officer, director, or employee of an insurer or of an insurance
producer, provided that the officer, director, or employee does not receive any commission
on policies written or sold to insure risks residing, located, or to be performed in this
state and any of the following: a. The officer, director, or employee's activities are executive,
administrative, managerial, clerical, or a combination of these, and are only indirectly related
to the sale, solicitation, or negotiation of insurance. b. The officer, director, or employee's
function relates to underwriting, loss control, inspection, or the...
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27-21A-3
Section 27-21A-3 Issuance of certificate of authority. (a)(1) Upon receipt of an application
for issuance of a certificate of authority, the commissioner shall forthwith transmit copies
of such application and accompanying documents to the State Health Officer. (2) The State
Health Officer shall determine whether the applicant for a certificate of authority, with
respect to health care services to be furnished: a. Has demonstrated the willingness and potential
ability to assure that such health care services will be provided in a manner to assure both
availability and accessibility of adequate personnel and facilities and in a manner enhancing
availability, accessibility, and continuity of service; b. Has arrangements, established in
accordance with the regulations promulgated by the State Health Officer, for an on-going quality
assurance program concerning health care processes and outcomes; and c. Has a procedure, established
in accordance with regulations of the State Health...
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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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