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27-54-5
Section 27-54-5 Implementation of coverage. (a) A group health benefit plan, policy, or contract
that provides coverage for the services to be offered pursuant to this chapter may contain
provisions for maximum benefits and coinsurance and limitations, deductibles, exclusions,
and utilization review protocols to the extent that these provisions are not inconsistent
with the requirements of this chapter. (b) The issuer of a group health benefit plan, policy,
or contract may either disclose the additional premium for such additional mental health benefits
to the prospective contract holder and allow the contract holder to elect such additional
benefits on an optional basis; or conform its policies, contracts, or certificates issued
on and after January 1, 2001, and adjust its premium costs to reflect the additional benefit
costs. (Act 2000-386, p. 605, ยง6.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-54-5.htm - 1K - Match Info - Similar pages
22-6-221
Section 22-6-221 Service by integrated care network; board of directors. (a) An integrated
care network shall serve only Medicaid beneficiaries in providing medical care and services.
For the purposes of this article, a beneficiary cannot be a member of both an integrated care
network and a regional care organization. (b) An integrated care network shall provide required
medical care and services to Medicaid beneficiaries and may coordinate care provided by or
through an affiliation of other health care providers or other programs as the Medicaid Agency
shall determine. (c) Notwithstanding any other provision of law, the integrated care network
shall not be deemed an insurance company under state law. (d)(1) An integrated care network
shall have a governing board of directors composed of the following members: a. Twelve members
shall be persons representing risk bearing participants. A participant bears risk by contributing
cash, capital, or other assets to the integrated care network....
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-6-221.htm - 2K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration of
program. (a) The Local Government Health Insurance Board shall govern and administer the Local
Government Health Insurance Program currently governed and administered by the State Employees'
Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the governance
and administration to the board shall take effect at 12:01 a.m. on January 1, 2015, and thereafter
the board shall take all control and responsibility for the program under procedures and authority
set out in this chapter. (b) The program governed and administered by the board shall provide
a reasonable relationship between the health care benefits to be included and the expected
health care expenses to be incurred by affected employees, retirees, and their dependents.
The board may establish a fully insured or self-insured health care plan for employees and
retirees as defined in this chapter and may adopt rules for the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/11-91A-2.htm - 5K - Match Info - Similar pages
27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this section,
the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS. The design,
implementation, and evaluation of environmental modifications, using behavioral stimuli and
consequences, to produce socially significant improvement in human behavior, including the
use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
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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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22-57-3
Section 22-57-3 Definitions. For purposes of this article, the following terms shall have the
following meanings: (1) AUTISM SERVICES. Any developmental services that include all of the
following: a. Are designed to meet developmental needs of an individual with ASD across the
lifespan, including transitions from early intervention to preschool, childhood to adolescence,
and adolescence to adulthood. b. Are selected in collaboration with the parents or guardians
of children with ASD or adults with ASD. c. Are delivered in inclusive environments, to the
extent practical. d. Are part of a coordinated system of care. (2) AUTISM SPECTRUM DISORDER
(ASD). ASD is a developmental disability that causes substantial impairments in social interaction
and communication and the presence of unusual behaviors and interests. Many people with ASD
have unusual ways of learning, paying attention, and reacting to different sensations. The
thinking and learning abilities of people with ASD can vary from...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-57-3.htm - 4K - Match Info - Similar pages
27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements; discounts.
(a) As used in this section, the following words shall have the following meanings: (1) CONTRACTUAL
DISCOUNT. A percentage reduction from a provider's usual and customary rate for covered services
and materials required under a participating provider agreement. (2) COVERED MATERIALS. Materials
for which reimbursement from the insurer or vision care plan is provided to a vision care
provider by an enrollee's plan contract, or for which a reimbursement would be available but
for the application of the enrollee's contractual limitations of deductibles, copayments,
or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the insurer or
vision care plan is provided to a vision care provider by an enrollee's plan contract, or
for which a reimbursement would be available but for the application of the enrollee's contractual
plan limitations of deductibles, copayments, or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-10.htm - 4K - Match Info - Similar pages
41-15B-2.2
Section 41-15B-2.2 Allocation of trust fund revenues. (a) For each fiscal year, beginning October
1, 1999, contingent upon the Children First Trust Fund receiving tobacco revenues and upon
appropriation by the Legislature, an amount of up to and including two hundred twenty-five
thousand dollars ($225,000), or equivalent percentage of the total fund, shall be designated
for the administration of the fund by the council and the Commissioner of Children's Affairs.
(b) For the each fiscal year, beginning October 1, 1999, contingent upon the Children First
Trust Fund receiving tobacco revenues, the remainder of the Children First Trust Fund, in
the amounts provided for in Section 41-15B-2.1, shall be allocated as follows: (1) Ten percent
of the fund shall be allocated to the Department of Public Health for distribution to one
or more of the following: a. The Children's Health Insurance Program. b. Programs for tobacco
control among children with the purpose being to reduce the consumption...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/41-15B-2.2.htm - 22K - Match Info - Similar pages
22-21-275
Section 22-21-275 Procedures for review of applications for certificates of need. The SHPDA,
pursuant to the provisions of Section 22-21-274, shall prescribe by rules and regulations
the procedures for review of applications for certificates of need and for issuance of certificates
of need. Rules and regulations governing review procedures shall include, but not necessarily
be limited to, the following: (1) Agreement with other review agencies for review procedures
consistent with this article and federal regulations. (2) Application procedures and forms
of the application necessary to elicit and provide all necessary information as required by
the review criteria. (3) Establishment of a project review period of 90 days from the date
the state agency determines that the application is complete and notification thereof is made
to the applicant. The rules and regulations may provide for a period of not more than 15 days
for determination of the completeness of the application,...
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