Ala. Admin. Code r. 410-1-2-.11

Current through Register Vol. 42, No. 12, September 30, 2024

Section 410-1-2-.11 - Health Maintenance Organization (HMO)

(1) A public or private organization, organized under the law of the state which

(a) provides or otherwise makes available to enrolled participants, health care services, including at least the following basic health care services: usual physician services, hospitalization, laboratory, x-ray, emergency and preventive services, and out-of-area coverage; and

(b) is compensated (except for co-payments) for the provision of the basic health care services listed in paragraph (1)(a) of this definition to enrolled participants by a payment which is paid on a periodic basis without regard to the date the health care services are provided and which is fixed without regard to frequency, extent, or kind of health service actually provided; and

(c) provides physicians' services primarily directly through physicians who are either employees or partners of the organization or through arrangements with individual physicians or one or more groups of physicians (organized on a group practice or individual practice basis); and

(d) owns or operates a facility wherein clinical services are provided to enrolled participants.

Author: State Health Planning and Development Agency

Ala. Admin. Code r. 410-1-2-.11

Amended: Filed February 26, 1991; effective April 2, 1991.

Statutory Authority:Code of Ala. 1975, §§ 22-21-263, 264.