Overview
Alabama is one of the few states that prohibits most non-compete provisions in employment contracts for professionals, which include physicians. Specifically, the courts held that statutory exemptions allowing non-competes in employment contracts do not apply to professionals and that physicians and other medical providers are professionals under state law.
While the state does not have statutory authority for review or approval of provider mergers, Alabama is the site of a major private antitrust enforcement action against health insurer Blue Shield/Blue Cross. Healthcare providers and individual and small-employer customers separately sued BCBS of Alabama in 2013, alleging horizontal market allocation and conspiracy to divvy up insurance markets all over the country in violation of Section 1 of the Sherman Antitrust Act. The lawsuits were consolidated as MDL in the Northern District of Alabama, which held that the alleged practice of creating exclusive territories is a “per se” violation of the Sherman Antitrust Act and would be subject to the highest legal standard. After the 11th Circuit upheld the decision, BCBS agreed to a settlement agreement with employer subscribers that would pay $2.7 billion to the class plaintiffs, in addition to modification of alleged anticompetitive practices.
See below for an overview of existing Alabama state mandates.
State Action
Latest Legislative Session: 3/7/2023 - 6/6/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 11 – Alabama
Introduced: 2019 Status: Enacted
Relating to hospitals; to amend Sections 35-11-370, 35-11-371, 35-11-372, 35-11-373, 35-11-374, and 35-11-375, Code of Alabama 1975, to require a hospital that provides medical treatment to an injured person to seek compensation solely from that …
HB 126 – Alabama
Introduced: 2022 Status: Inactive / Dead
Under existing law, a health care provider must obtain a certificate of need from the State Health Planning and Development Agency (SHPDA) before the provider may operate a new institutional health service. Under the State …
HB 126 (see companion bill SB 77) – Alabama
Introduced: 2023 Status: Enacted
To create the Medicaid Emergency Reserve Fund and to provide for the withdrawal and use of amounts deposited into the fund. The Legislature finds that it is in the best interest of the State of …
HB 130 – Alabama
Introduced: 2022 Status: Inactive / Dead
Under existing law, health care services and facilities, with some exceptions, are required to apply for and receive a certificate of need before they may construct new health care facilities or offer new or expanded …
HB 176 – Alabama
Introduced: 2019 Status: Enacted
This bill will extend the private hospital assessment and Medicaid funding program for fiscal years 2020, 2021, and 2022.
Ala. Code § 41-16-5. Public contracts with entities engaging in certain boycotting activities: Public Contracts – Alabama
Introduced: Status: Enacted
Statute provide definitions for the sections, including boycott.
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Ala. Code § 6-5-60. By whom and against whom action may be commenced; venue: Trusts, Combines, or Monopolies – Alabama
Introduced: Status: Enacted
Statute provides any damaged or injured person, firm or corporation a cause of action against any entity that has participated in an unlawful trust, combine or monopoly. Statute also defines some procedural requirements in bringing …
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Ala. Code §§ 10A-1-8.01 through 10A-1-8.04: Alabama Business and Nonprofit Entity Code — Conversions and Mergers – Alabama
Introduced: Status: Enacted
Provides the requirements for conversion of business and nonprofit entities and applicability, etc under the Alabama Business and Nonprofit Entities Code.
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Ala. Code §§ 10A-2-11.01 through 10A-2-11.08: Alabama Business Corporation Law — Merger and Share Exchange – Alabama
Introduced: Status: Enacted
Subject to the limitations of the Constitution of Alabama of 1901, as the same may be amended from time to time, one or more corporations may merge into another corporation if the board of directors …
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Ala. Code §§ 10A-3-5.01 through 10A-3-5.07: Alabama Nonprofit Corporation Law — Merger and Consolidation – Alabama
Introduced: Status: Enacted
Provides the procedures and requirements for merger and consolidation of nonprofit corporations.
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In the Matter of Community Health Systems, Inc. and Health Management Associates, Inc. – Alabama, South Carolina
District Court: United States of America Before The Federal Trade Commission Status: Decided
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 …
In Re Blue Cross Blue Shield Antitrust Litigation – Alabama
District Court: N.D. Alabama Status: Decided
On April 5, 2018, U.S. District Court Judge R. David Proctor of the Northern District of Alabama held in a decision that the Blue Shield/Blue …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Alabama’s fiscal year runs from October 1 and ends on September 30 of the following year. To view Alabama’s most recent Budget proposal, click here.
REGULATION & ENFORCEMENT
- 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