Alabama

SUMMARY

In the most recent legislative term, Alabama was inactive in regard to other legislation in regard to healthcare price transparency, cost, or competition.

 

LEGISLATION/REGULATION

Legislative Calendar

Alabama’s legislative session has ended.

 

Legislative Updates

Healthcare Transparency

2015-2016 SB295/HB404

(Bussman/Daniels)

AN ACT PROHIBITING QUALITY RATING SYSTEM USING COST OF SERVICES: would have prohibited health insurance entities from establishing a quality rating system for dentists, using cost of services. SB295 would have required dental quality rating systems to be based solely on data that is “verified for accuracy, made transparent, fair, and accessible to dentists and consumers, and disclosed to the public.” Inactive — Died.

 

Healthcare Cost

  • None identified.

 

Healthcare Markets

  • None identified.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • Code § 27-1-20, the “Patient Right to Know Act,” mandates that insurers must provide enrollees a written plan description in a simple, readable, and easily understandable format and include certain explanation of benefits, exclusions, financial and contact information.

 

  • Code § 27-2-20 authorizes the Commissioner of Insurance to inspect the accounts, records, documents, and transactions pertaining to or affecting the insurance affairs of any broker or agent.

 

  • Code § 22-21-7 within 10 days following discharge, a hospital or nursing home providing services to a patient shall submit to the patient an itemized statement detailing in language comprehensible to an ordinary layman the specific nature of charges or expenses incurred by the patient, enumerating in detail the constituent components of the services received within each department of the hospital or nursing home and including unit-price data on rates charged by the hospital or nursing home.

 

Healthcare Contracting

  • Code § 27-1-19 allows the insured to assign reimbursement for health services directly to the provider, and for the provider to sue in district court for damages if the insurance company or agency fails to reimburse the provider in accordance with the terms of the provider contract.

 

Healthcare Markets

  • Code § 22-21-260 through 22-21-278, implements the state Certificate of Need program, which creates a system of mandatory regulatory reviews before a healthcare facility offers new or expanded services. A Certificate of Need ensures there is a genuine public need for the expanded capacity, but also can be anticompetitive by creating barriers to entry for new market-entrants.

 

  • Code §§ 27-2a-1 through 27-2a-4, the Alabama Disclosure of Material Transactions Act, requires that insurers domiciled in the state of Alabama file a report with the Commissioner of Insurance disclosing all material acquisitions and disposition of assets, defined as one that is nonrecurring and not in the ordinary course of business and involves more than five percent (5%) of the reporting insurer’s total admitted assets as reported in its most recent financial statement filed with the commissioner. This includes any exchanges, mergers, consolidations, succession or other acquisitions.

 

 

  • Code § 27-13-2: the Alabama Department of Insurance (ALDOI) regulates rates with respect to Medicare Supplements, Health Maintenance Organizations (HMO) and Long Term Care rates for forms currently still being marketed. The ALDOI does not regulate commercial health insurance premium rates.

 

  • Code § 27-14-8 requires that life insurance forms that are part of a policy or contract issued for delivery in Alabama are filed by insurance companies and pre-approved by the Alabama Department of Insurance before they are circulated.

 

FY 2018 BUDGET 

Alabama has not enacted its FY 2018 Budget. To view Alabama’s most recent FY 2018 Budget proposal, click here.

 

LITIGATION/ENFORCEMENT

  • Galactic Funk Touring et al. v. Blue Cross Blue Shield of Alabama: Providers and individual and small-employer customers are suing Blue Cross/Blue Shield alleging horizontal market allocation, in two suits that have been consolidated (put into Multi-District Litigation) in federal court in the Northern District of Alabama. The plaintiffs in the putative class actions allege that BC/BS entities conspired to divvy up insurance markets all over the country in violation of Section 1 of the Sherman Antitrust Act. Read the provider complaint and the subscriber complaint. The order denying defendants motion to dismiss from June 2014 is here. As of November 2016, the case is still in discovery.

 

  • FTC Review of Community Health Systems / Health Management Associates Merger: In April 2014, the Federal Trade Commission issued its final order in connection with Community Health Systems, Inc.’s proposed $7.6 billion acquisition of rival health system Health Management Associates, Inc.  The FTC required Community Health Systems, one of the nation’s largest hospital operators, to divest hospitals and related assets, including outpatient facilities, in Alabama and South Carolina as a condition of the acquisition. Prior to issuing the order, in March 2015, the FTC approved CHS’s sale of a Gadsen hospital in accordance with its order. Find the FTC case summary and related documents here.

 

 KEY RESOURCES

Alabama State Legislature

Alabama Office of the Attorney General