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6-5-333
Section 6-5-333 Dentists, chiropractors, and physicians serving on utilization and quality
control committees, peer review committees, or professional standards review committees; consultants
thereto and employees thereof; dental, chiropractic and medical societies and associations;
appeal to Alabama Dental Association; confidentiality. (a) Any dentist, chiropractor, or physician
licensed to practice medicine in Alabama who serves on a peer review or a utilization and
quality control committee or professional standards review committee or a similar committee
or a committee of similar purpose or any dentist, physician, chiropractor, or individual who
serves as a consultant or employee to one of said committees established either by a dental
society or dental association or by a chiropractic society or chiropractic association or
by a state medical association or county medical society to review any aspect of dental care,
chiropractic care, or medical care at the request of a government...
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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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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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6-5-549.1
Section 6-5-549.1 Limits of liability insurance coverage in legal action against health care
providers; testimony of health care providers as specialists. (a) This section and Sections
6-5-548 and 6-5-549 shall be known and may be cited as "The Alabama Medical Liability
Act of 1996." (b) The Legislature of the State of Alabama finds and declares that a crisis
continues to threaten the delivery and availability of medical services to the people of Alabama
and the health and safety of the citizens of this state are in jeopardy as a result of this
crisis. In accordance with the previous declarations of the Legislature of Alabama in Sections
6-5-480 to 6-5-488, inclusive, 27-26-1 to 27-26-4, inclusive, and 27-26-20 to 27-26-43, inclusive,
and Sections 6-5-540 to 6-5-552, inclusive, it is the declared intent of this Legislature
to ensure that quality medical services continue to be available at reasonable costs to the
citizens of the State of Alabama. The continuing and ever increasing...
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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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20-2-250
Section 20-2-250 Definitions. As used in this article, the following words shall have the following
meanings: (1) ADMINISTER. The direct application of a controlled substance whether by injection,
inhalation, ingestion, or any other means, to the body of a patient by any of the following:
a. A collaborating physician or, in his or her presence, his or her authorized agent. b. A
certified registered nurse practitioner or certified nurse midwife. c. The patient at the
direction and in the presence of the collaborating physician, certified registered nurse practitioner,
or certified nurse midwife. (2) BOARD. The Board of Medical Examiners of the State of Alabama.
(3) CERTIFIED NURSE MIDWIFE or CNM. An advanced practice nurse who is subject to a collaborative
practice agreement with a collaborating physician pursuant to Title 34, Chapter 21, Article
5, and who has advanced knowledge and skills relative to the management of women's health
care focusing on pregnancy, childbirth, the...
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34-24-210.1
Section 34-24-210.1 Evaluation and treatment by physical therapist. (a) Without prescription
or referral, a licensed physical therapist may perform an initial evaluation or consultation
of a screening nature to determine the need for physical therapy and may perform the physical
therapy and other services provided in subdivisions (1) to (5), inclusive, of subsection (b).
Implementation of physical therapy shall otherwise be based on the referral of a person licensed
to practice medicine, surgery, dentistry, chiropractic, licensed assistant to a physician
acting pursuant to a valid supervising agreement, or a licensed certified registered nurse
practitioner in a valid collaborative practice agreement with a licensed physician. (b) The
physical therapy and other services referred to in subsection (a), which may be performed
without prescription or referral, include and are limited to the following: (1) To a child
with a diagnosed developmental disability pursuant to the plan of care for...
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27-14-11.1
Section 27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid eligibility
void. (a) For purposes of this section, "private insurer" is defined as any of the
following: (1) Any commercial insurance company offering health or casualty insurance to individuals
or groups, including both experience-rated contracts and indemnity contracts. (2) Any profit
or nonprofit prepaid plan offering either medical services or full or partial payment for
the diagnosis or treatment of an injury, disease, or disability. (3) Any organization administering
health or casualty insurance plans for professional associations, unions, fraternal groups,
employer-employee benefit plans, and any similar organization offering these payments or services,
including self-insured and self-funded plans. (4) Any health insurer, including group health
plans, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974,
self-insured plans, service benefit plans, managed care...
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22-21-265
Section 22-21-265 Certificates of need - Required for new institutional health service. (a)
On or after July 30, 1979, no person to which this article applies shall acquire, construct,
or operate a new institutional health service, as defined in this article, or furnish or offer,
or purport to furnish a new institutional health service, as defined in this article, or make
an arrangement or commitment for financing the offering of a new institutional health service,
unless the person shall first obtain from the SHPDA a certificate of need therefor. Notwithstanding
any provisions of this article to the contrary, those facilities and distinct units operated
by the Department of Mental Health, and those facilities and distinct units operating under
contract or subcontract with the Department of Mental Health where the contract constitutes
the primary source of income to the facility, shall not be required to obtain a certificate
of need under this article. (b) Notwithstanding all other...
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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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