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22-5A-2
Section 22-5A-2 Definitions. For the purposes of this chapter, the following words shall have
the meanings ascribed to them by this section: (1) ADMINISTRATOR. Any person charged with
the general administration or supervision of a health care, domiciliary or residential facility
without regard to whether such person has an ownership interest in such facility or to whether
such person's functions and duties are shared with one or more other persons. (2) COMMUNITY
OMBUDSMAN. A person selected by an area agency on aging who is then trained and certified
as such by the commission pursuant to Section 22-5A-4. (3) DEPARTMENT. Department of Senior
Services. (4) HEALTH CARE FACILITY. Any skilled nursing facility, intermediate care facility,
domiciliary, boarding home facility or hospital now or hereafter subject to regulation or
licensure by the Bureau of Licensure and Certification of the State Department of Health or
a county department of health which provides any generally accepted facet...
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27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or dental
plan beneficiary may assign reimbursement for health or dental care services directly to the
provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
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27-1-21
Section 27-1-21 Uniformity of limits applied to fulfillment of certain drug prescriptions.
(a) For the purposes of this section, the following words shall have the following meanings:
(1) ENROLLEE. A person enrolled in a health benefit plan. (2) HEALTH BENEFIT PLAN. Any individual
or group plan, policy, or contract for health care services issued, delivered, issued for
delivery, renewed in this state by a health care insurer, health maintenance organization,
accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation,
nonprofit medical service corporation, health care service plan, 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. The
term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 4
of Title 10. The term shall not include any collective bargaining agreement...
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27-21A-1
Section 27-21A-1 Definitions. As used in this chapter, the following terms shall have the following
meanings, respectively: (1) AGENT. A person who is appointed or employed by a health maintenance
organization and who engages in solicitation of membership in such organization. This definition
does not include a person enrolling members on behalf of an employer, union, or other organization.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and
outpatient medical services. (3) COMMISSIONER. The Commissioner of Insurance. (4) ENROLLEE.
An individual who is enrolled in a health maintenance organization. (5) EVIDENCE OF COVERAGE.
Any certificate, agreement, or contract issued to an enrollee setting out the coverage to
which he is entitled. (6) HEALTH CARE SERVICES. Any services included in the furnishing to
any individual of medical or dental care, or hospitalization or incident to the furnishing
of such care or hospitalization, as well as the...
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22-11D-8
Section 22-11D-8 Rules and regulations. (a) In accordance with the Alabama Administrative Procedure
Act, the board, with the advice and after approval of the council, shall promulgate rules
to implement and administer this chapter. Rules promulgated by the board may include, but
are not limited to, the following: (1) Criteria to ensure that severely injured or ill people
are promptly transported and treated at designated trauma centers appropriate to the severity
of the injury. Minimum criteria shall address emergency medical service trauma triage and
transportation guidelines as approved under the board's emergency medical services rules,
designation of health care facilities as trauma centers, interhospital transfers, and a trauma
system governance structure. (2) Standards for verification of trauma and health care center
status which assign level designations based on resources available within the facility. Standards
shall be based upon national guidelines, including, but not...
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22-21B-4
Section 22-21B-4 Participation in a health care service that violates the conscience of health
care provider; written objection; liability. (a) A health care provider has the right not
to participate, and no health care provider shall be required to participate, in a health
care service that violates his or her conscience when the health care provider has objected
in writing prior to being asked to provide such health care services. (b) When objecting in
writing in accordance with this chapter, no health care provider shall be civilly, criminally,
or administratively liable for declining to participate in a health care service that violates
his or her conscience except when failure to do so would immediately endanger the life of
a patient. (c) It shall be unlawful for any person, health care provider, health care institution,
public or private institution, public official, or any board which certifies competency in
medical or health care specialties to discriminate against any health...
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6-5-485
Section 6-5-485 Settlement of disputes by arbitration. (a) After a physician, dentist, medical
institution, or other health care provider has rendered services, or failed to render services,
to a patient out of which a claim has arisen, the parties thereto may agree to settle such
dispute by arbitration. Such agreement must be in writing and signed by both parties. Any
such agreement shall be valid, binding, irrevocable, and enforceable, save upon such grounds
as exist in law or in equity for the revocation of any contract. (b) Pursuant to the provisions
of this section, the claimant shall select one competent and disinterested arbitrator, and
the party or parties against whom the claim is made shall select one competent and disinterested
arbitrator. The two arbitrators so named shall select a third arbitrator, or, if unable to
agree thereon within 30 days, then, upon request of any party, such third arbitrator shall
be selected by a judge of a court of record in the county in which...
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22-21-29
Section 22-21-29 Inspections. (a) Every hospital licensed under this article shall be open
to inspection to the extent authorized in this section by employees and agents of the State
Board of Health, under rules as shall be promulgated by the board with the advice and consent
of the advisory board. Employees and agents of the board shall also inspect unlicensed and
suspected unlicensed facilities. Nothing in this section shall authorize the board to inspect
quarters therein occupied by members of any religious group or nurses engaged in work in any
hospital or places of refuge for members of religious orders for whom care is provided, but
any inspection shall be limited and confined to the parts and portions of the hospital as
are used for the care and treatment of the patients and the general facilities for their care
and treatment. No hospital shall, by reason of this section, be relieved from any other types
of inspections authorized by law. (b) All inspections undertaken by the...
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26-1-2
Section 26-1-2 Durable power of attorney; appointment by court of guardian, etc., subsequent
to execution of durable power of attorney; effect of death of principal upon agency relationship;
affidavit by person exercising power of attorney as to lack of knowledge of revocation, etc.;
health care power of attorney. (a) A durable power of attorney is a power of attorney by which
a principal designates another his or her attorney in fact or agent in writing and the writing
contains the words "This power of attorney shall not be affected by disability, incompetency,
or incapacity of the principal" or "This power of attorney shall become effective
upon the disability, incompetency, or incapacity of the principal" or similar words showing
the intent of the principal that the authority conferred shall be exercisable notwithstanding
the principal's subsequent disability, incompetency, or incapacity. (b) All acts done by an
attorney in fact pursuant to a durable power of attorney during any...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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